Abdominal compartment syndrome: Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
{{Abdominal trauma DDX}}


==Diagnosis==
==Diagnosis==

Revision as of 04:26, 18 June 2015

Background

  • Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
  • Also known as intrabdominal hypertension (IAH)

Causes

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

  • 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

Diagnosis

  • Suspect ACS/IAH
  • Transduce bladder pressure
    • >20mmHg WITH new organ dysfunction
  • 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).