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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم.  (( وقل رب زدني علما )) . Abdominal Compartment Syndrome.  Dr.Saad AL-Qahtani Department of Surgery College of medicine, King Saud University. Abdominal Compartment Syndrome. When IAP > 20 mmHg this is called “intra-abdominal hypertension”

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم  (( وقل رب زدني علما )) 

  2. Abdominal Compartment Syndrome  Dr.Saad AL-Qahtani Department of Surgery College of medicine, King Saud University

  3. Abdominal Compartment Syndrome • When IAP > 20 mmHg this is called “intra-abdominal hypertension” • But if IAP >25-30 with at least one of the followings : compromised respiratory mechanisms & ventilation, oliguria or anuria or increase in ICP ,this is “Abdominal Compartment Syndrome”

  4. Abdominal Compartment Syndrome • Normal IAP < 10 mmHg • Grade: I 10 – 15 mmHg II 16 – 25 mmHg III 26 – 35 mmHg IV > 35 mmHg

  5. Abdominal Compartment Syndrome Eitiology Surgical 1-Trauma 2-post liver transplantation. 3-tight surgical closures or burn scars. 4-others ; ruptured AAA, pancreatic &intestinal injury will increase risk of development of IAH &ACS Non-surgical bowel obstruction ,pancreatitis , massive ascites, peritonitis ,….

  6. Abdominal Compartment Syndrome Progressive abd distetion Increased peak airway ventilator pressure Oliguria &anuria Intracranial hypertension

  7. Abdominal Compartment Syndrome CNS • Intra thoracic pressure + central venous pressure ICP • An elevated CVP &ICP with hypotension cerebral flow&ischemia. CVS • Reduction of CO ,Venous return. • Hypovolemia. • Increase in PCWP , CVP. • DVT.

  8. Abdominal Compartment Syndrome Pulmonary • Increase in ITP, airway pressure, shunt fracion. • Hypoxia , hypercarbia. • Compression of chest lead to : atelectasis, edema ,infection. Renal Reduction in UO, GFR, ,….. Renal failure

  9. Abdominal Compartment Syndrome • ABDOMEN • CELIAC &SMA flow. • Compressionn of veins , venous HTN, intestinal edema , ….. Hypoperfusion , bowel ischemia & Lactic acidosis.

  10. ACS : Bowel Edema Endothelial Permeability Capillary Hydrostatic Pressure Plasma Oncotic Pressure Transcapillary Fluid Flux Mesenteric Lymphatic Resistance Shock 2003

  11. Abdominal Compartment Syndrome

  12. Postinjury Damage Control : ACS MOF MOF MORTALITY Raeburn et al Am J Surg 2001

  13. Abdominal Compartment Syndrome Management -Relase of abdominal fascia & keep it open. -Temporary abd closure techniques. ( vaccum assisted or vaccum pack) -If untreated , multiple system end-organ dysfunction or failure & high mortality.

  14. Abdominal Compartment Syndrome

  15. Abdominal Compartment Syndrome • I 10 – 15 mmH maintain normovolemia • II 16 – 25 mmHg hypervolemic resuscitation • III 26 – 35 mmHg Decompression • IV > 35 mmHg Decompression &re- exploration

  16. Summary • Primary vs. Secondary Mechanisms • Sx : Pulmonary and Renal • Dx : Bladder Pressure Monitoring • Rx : Prompt Decompression • Prevention : ???

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