Abdominal compartment syndrome: Difference between revisions
(15 intermediate revisions by 6 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Organ dysfunction caused by intrabdominal hypertension | |||
*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]] | *Acute [[Pancreatitis]] | ||
*[[Ascites]] | *[[Ascites]] | ||
*Diffuse [[peritonitis]] | |||
*Large volume [[IVF|fluid resuscitation]] | |||
* | *Reperfusion of [[ischemic bowel]] | ||
* | *[[Retroperitoneal hemorrhage]] | ||
*[[Small bowel obstruction]] | |||
*[[Trauma]] | |||
* | |||
* | |||
* | |||
==Clinical Features== | ==Clinical Features== | ||
*Decreased central venous return | *Most patients are critically ill and unable to communicate | ||
*Decreased [[hypotension|central venous return]] | |||
**Increased JVP | **Increased JVP | ||
**Increased ICP | **[[Increased ICP]] | ||
**Decreased cardiac preload | **Decreased cardiac preload | ||
**Increased cardiac afterload | |||
*Increased intrathoracic pressure | *Increased intrathoracic pressure | ||
**Decreased lung compliance | **Decreased lung compliance (will cause high peak pressures in vented patients) | ||
**Decreased functional residual capacity | **Decreased functional residual capacity | ||
**Worsened V/Q mismatch | **Worsened [[hypoxia|V/Q mismatch]] | ||
*Oliguria, renal failure | *Oliguria, [[renal failure]] | ||
*Bowel ischemia | *[[ischemic bowel|Bowel ischemia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Line 38: | Line 38: | ||
==Evaluation== | ==Evaluation== | ||
[[File:PMC3267056 jkss-81-S1-g002.png|thumb|Abdominal compartment syndrome caused by bulimia post vomiting. CT shows dilated stomach with food and air pressed other visceral organs and major abdominal vessels.]] | |||
* | [[File:PMC4972924 gr2.png|thumb|A case of abdominal compartment syndrome derived from simple elongated sigmoid colon in an elderly man.. Abdominal CT scan of the patient pre-decompression (a) and post-decompression (b). The arrow shows the inferior vena cava, which was collapsed pre-decompression.]] | ||
**> | ''Physical exam is neither sensitive nor specific'' | ||
* | *Obtain bladder pressure | ||
**Normal < 12 mmHg | |||
**Intra-abdominal hypertension 12 - 20 mmHg | |||
**Abdominal compartment syndrome > 20 mmHg PLUS end-organ damage | |||
*Abdominal perfusion pressure < 60 mmHg suggests abdominal hypoperfusion<ref>Al-Dorzi HM et al. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care. 2012; 2(Suppl 1): S4.</ref> | |||
*Note that IVC scanning for volume status is especially unreliable as collapse may not represent volume depletion in the context of high intra-abdominal pressures<ref>Bauman Z et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015 Dec; 18(4): 343–348.</ref> | |||
==Management== | ==Management== | ||
Line 47: | Line 52: | ||
''Often first line approach when no abdominal injury present<ref>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).</ref>'' | ''Often first line approach when no abdominal injury present<ref>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).</ref>'' | ||
*Limit fluid resuscitation | *Limit fluid resuscitation | ||
*Nasogastric and bladder decompression | *[[Nasogastric tube|Nasogastric]] and bladder decompression | ||
*[[ | *[[Electrolyte repletion]] | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
*[[Pressors]] | *[[Pressors]] | ||
Line 64: | Line 69: | ||
==See Also== | ==See Also== | ||
*"Traditional" [[compartment syndrome]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] [[Category:Surgery]] [[Category:Critical Care]] | [[Category:GI]] | ||
[[Category:Surgery]] | |||
[[Category:Critical Care]] |
Revision as of 20:05, 30 July 2020
Background
- Organ dysfunction caused by intrabdominal hypertension
- 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
- Most patients are critically ill and unable to communicate
- Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
- Increased cardiac afterload
- Increased intrathoracic pressure
- Decreased lung compliance (will cause high peak pressures in vented patients)
- 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
Physical exam is neither sensitive nor specific
- Obtain bladder pressure
- Normal < 12 mmHg
- Intra-abdominal hypertension 12 - 20 mmHg
- Abdominal compartment syndrome > 20 mmHg PLUS end-organ damage
- Abdominal perfusion pressure < 60 mmHg suggests abdominal hypoperfusion[1]
- Note that IVC scanning for volume status is especially unreliable as collapse may not represent volume depletion in the context of high intra-abdominal pressures[2]
Management
Nonoperative
Often first line approach when no abdominal injury present[3]
- 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
- "Traditional" compartment syndrome
References
- ↑ Al-Dorzi HM et al. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care. 2012; 2(Suppl 1): S4.
- ↑ Bauman Z et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015 Dec; 18(4): 343–348.
- ↑ 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).