Abdominal compartment syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Also known as intrabdominal hypertension (IAH) | |||
*Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics | *Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics | ||
*Also | |||
===Pathophysiology=== | |||
*Abdominal perfusion pressure = MAP - intrabdominal pressure | |||
*Build up of fluid or blood within the peritoneum or retroperitoneum | |||
**And/or decrease in abdominal wall compliance | |||
*Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs | |||
**Also causes restriction of diaphragmatic excursion and impaired central venous return | |||
===Causes=== | ===Causes=== | ||
* | *Acute [[Pancreatitis]] | ||
*[[Ascites]] | |||
*Diffuse peritonitis | *Diffuse peritonitis | ||
*Large volume fluid resuscitation | *Large volume fluid resuscitation | ||
*Reperfusion of ischemic bowel | |||
*[[Retroperitoneal hemorrhage]] | *[[Retroperitoneal hemorrhage]] | ||
* | *[[Small bowel obstruction]] | ||
*Trauma | |||
* | |||
==Clinical Features== | ==Clinical Features== | ||
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==Evaluation== | ==Evaluation== | ||
* | *Obtain bladder pressure | ||
**Measurement >20mmHg WITH new organ dysfunction is indicative of compartment syndrome | |||
**>20mmHg WITH new organ dysfunction | *''Physical exam is neither sensitive nor specific'' | ||
*Physical exam is neither sensitive nor specific | |||
==Management== | ==Management== | ||
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*Limit fluid resuscitation | *Limit fluid resuscitation | ||
*Nasogastric and bladder decompression | *Nasogastric and bladder decompression | ||
*[[ | *[[Electrolyte repletion]] | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
*[[Pressors]] | *[[Pressors]] | ||
| Line 68: | Line 65: | ||
<references/> | <references/> | ||
[[Category:GI]] [[Category:Surgery]] [[Category:Critical Care]] | [[Category:GI]] | ||
[[Category:Surgery]] | |||
[[Category:Critical Care]] | |||
Revision as of 05:46, 7 July 2017
Background
- Also known as intrabdominal hypertension (IAH)
- Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
Pathophysiology
- Abdominal perfusion pressure = MAP - intrabdominal pressure
- Build up of fluid or blood within the peritoneum or retroperitoneum
- And/or decrease in abdominal wall compliance
- Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs
- Also causes restriction of diaphragmatic excursion and impaired central venous return
Causes
- Acute Pancreatitis
- Ascites
- Diffuse peritonitis
- Large volume fluid resuscitation
- Reperfusion of ischemic bowel
- Retroperitoneal hemorrhage
- Small bowel obstruction
- Trauma
Clinical Features
- Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
- Increased intrathoracic pressure
- Decreased lung compliance
- Decreased functional residual capacity
- Worsened V/Q mismatch
- Oliguria, renal failure
- Bowel ischemia
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
- Obtain bladder pressure
- Measurement >20mmHg WITH new organ dysfunction is indicative of compartment syndrome
- Physical exam is neither sensitive nor specific
Management
Nonoperative
Often first line approach when no abdominal injury present[1]
- Limit fluid resuscitation
- Nasogastric and bladder decompression
- Electrolyte repletion
- Antibiotics
- Pressors
- CRRT
- Percutaneous fluid drainage
Operative
Definitive treatment
- Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure
Disposition
- Admit
See Also
References
- ↑ Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).
