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 known as intrabdominal hypertension (IAH)
 
===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===
*Trauma
*Acute [[Pancreatitis]]
*[[Ascites]]
*Diffuse peritonitis
*Diffuse peritonitis
*[[Small bowel obstruction]]
*Large volume fluid resuscitation
*Large volume fluid resuscitation
*Reperfusion of ischemic bowel
*[[Retroperitoneal hemorrhage]]
*[[Retroperitoneal hemorrhage]]
*Reperfusion of ischemic bowel
*[[Small bowel obstruction]]
*Acute [[Pancreatitis]]
*Trauma
*[[Ascites]]
 
===Pathophysiology===
*Build up of fluid or blood within the peritoneum or retroperitoneum
**And/or decrease in abdominal wall compliance
*Causes increased pressure within cavity of fixed volume
**Abdominal perfusion pressure = MAP - intrabdominal pressure
*Hypoperfusion of abdominal organs
*Restriction of diaphragmatic excursion
*Impaired central venous return


==Clinical Features==
==Clinical Features==
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==Evaluation==
==Evaluation==
*Suspect ACS/IAH
*Obtain bladder pressure
*Transduce 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]]
*[[Electrolyte repletion]]
*[[Antibiotics]]
*[[Antibiotics]]
*[[Pressors]]
*[[Pressors]]
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<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

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

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]

Operative

Definitive treatment

  • Laparotomy provides decompression
    • High complication rate
    • No guidelines for timing of closure

Disposition

  • Admit

See Also

References

  1. 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).