Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS)

Posted by e-Medical PPT Monday, October 4, 2010
Causes of Intra-abdominal Pressure (IAP) Elevation
  1. Retroperitoneal: pancreatitis, retroperitoneal or pelvic bleeding, contained abdominal aortic aneurism(AAA) rupture, aortic surgery, abscess, visceral oedema
  2. Intraperitoneal: intraperitoneal bleeding, AAA rupture, acute gastric dilatation, bowel obstruction, ileus, mesenteric venous obstruction, pneumoperitoneum, abdominal packing, abscess, visceral oedema secondary to resuscitation (SIRS)
  3. Abdominal Wall: burn eschar, repair of gastroschisis or omphalocele, reduction of large hernias, pneumatic anti-shock garments, lap closure under tension, abdominal binders
  4. Chronic: central obesity, ascites, large abdominal tumors, PD, pregnancy
Abdominal compartment syndrome(ACS) is a potentially lethal condition caused by any event that produces intra-abdominal hypertension; the most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome(MODS). The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Hemodynamic, respiratory, renal, and neurological abnormalities are hallmarks of abdominal compartment syndrome. Medical management consists of urgent decompressive laparotomy.

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