Abdominal compartment syndrome: Difference between revisions
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*Acute [[Pancreatitis]] | *Acute [[Pancreatitis]] | ||
*[[Ascites]] | *[[Ascites]] | ||
*Diffuse peritonitis | *Diffuse [[peritonitis]] | ||
*Large volume fluid resuscitation | *Large volume [[IVF|fluid resuscitation]] | ||
*Reperfusion of ischemic bowel | *Reperfusion of ischemic bowel | ||
*[[Retroperitoneal hemorrhage]] | *[[Retroperitoneal hemorrhage]] | ||
*[[Small bowel obstruction]] | *[[Small bowel obstruction]] | ||
*Trauma | *[[Trauma]] | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 30: | Line 30: | ||
**Decreased functional residual capacity | **Decreased functional residual capacity | ||
**Worsened V/Q mismatch | **Worsened V/Q mismatch | ||
*Oliguria, renal failure | *Oliguria, [[renal failure]] | ||
*Bowel ischemia | *Bowel ischemia | ||
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''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]] | *[[Electrolyte repletion]] | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
Revision as of 19:12, 26 September 2019
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 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
Physical exam is neither sensitive nor specific
- Obtain bladder pressure
- Measurement >20mmHg WITH new organ dysfunction is indicative of compartment syndrome
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
- "Traditional" compartment syndrome
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).