Title: Abdominal Compartment Syndrome – Key Points for Surgery MCQs
What is Abdominal Compartment Syndrome?
Abdominal Compartment Syndrome (ACS) is a life-threatening condition caused by increased intra-abdominal pressure (IAP) leading to organ dysfunction.
Key Definitions
- Normal IAP: 5–7 mmHg in critically ill adults
- Intra-abdominal hypertension (IAH): IAP >12 mmHg
- ACS: IAP >20 mmHg with new-onset organ dysfunction
Common Causes of ACS
- Massive fluid resuscitation
- Trauma or abdominal injury
- Bowel obstruction or edema
- Hemoperitoneum
- Pancreatitis
- Abdominal packing or tight surgical closures
Pathophysiology Highlights
- ↓ Venous return → ↓ Cardiac output
- ↑ Intrathoracic pressure → Respiratory compromise
- ↓ Renal perfusion → Acute kidney injury
- ↓ Splanchnic perfusion → Bowel ischemia
Clinical Features
- Abdominal distension, tense abdomen
- Hypotension, tachycardia
- Oliguria or anuria
- Increased peak airway pressures (in ventilated patients)
- Metabolic acidosis, elevated lactate
Diagnosis
- Gold Standard: Bladder pressure measurement via Foley catheter
- Thresholds:
- IAP >20 mmHg + Organ dysfunction = ACS
Management Principles
- Initial Steps:
- Sedation and neuromuscular blockade
- Nasogastric and rectal decompression
- Diuretics or fluid restriction (if appropriate)
- Definitive Treatment:
- Decompressive laparotomy is the gold standard
- Temporary abdominal closure (e.g., Bogota bag, vacuum-assisted closure)
High-Yield MCQ Points
- IAP is best measured via the bladder
- ACS can occur without visible abdominal trauma
- Decompressive laparotomy is lifesaving in refractory cases
- Early detection of IAH prevents progression to ACS
Leave a Reply