Abdominal compartment syndrome: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 22: | Line 22: | ||
==Clinical Features== | ==Clinical Features== | ||
*Most patients are critically ill and unable to communicate | *Most patients are critically ill and unable to communicate | ||
*Decreased central venous return | *Decreased [[hypotension|central venous return]] | ||
**Increased JVP | **Increased JVP | ||
**Increased ICP | **[[Increased ICP]] | ||
**Decreased cardiac preload | **Decreased cardiac preload | ||
*Increased intrathoracic pressure | *Increased intrathoracic pressure | ||
**Decreased lung compliance | **Decreased lung compliance | ||
**Decreased functional residual capacity | **Decreased functional residual capacity | ||
**Worsened V/Q mismatch | **Worsened [[hypoxia|V/Q mismatch]] | ||
*Oliguria, [[renal failure]] | *Oliguria, [[renal failure]] | ||
*[[ischemic bowel|Bowel ischemia]] | *[[ischemic bowel|Bowel ischemia]] | ||
Revision as of 16:10, 25 October 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).