Metabolic and biochemical changes in acute abdominal compartment syndrome
Authors:
Angela Molčányiová 1; Theodoz Molčányi 2; Miroslav Kitka 2
Authors‘ workplace:
Laboratóriá Labmed a. s., Košice, 2Klinika úrazovej chirurgie, Univerzitná nemocnica L. Pasteura, Košice
1
Published in:
Úraz chir. 21., 2013, č.4
Overview
INTRODUCTION:
Acute compartment syndrome is caused by rapid pressure increase within an anatomically defined space encased by considerably a more ore less non-elastic mantle. Augmentation of the inner content of abdominal cavity wrapped by structures with low elasticity leads to an intra-abdominal hypertension accompanied by decrease in perfusion pressure.
METHODS, RESULTS:
Hypoperfusion and ischemia of the bowels and other intra/retroperitoneal structures causes a metabolic malfunction associated with low energy production, free oxygen radicals and release of cytokines initiating the development of an inflammatory reaction. Ischemic and oedematous wall of the intestine looses its barrier function, which in turn leads to a translocation of endotoxines and fecal bacteria into the lymphatic system, followed by generalized inflammatory reaction. In the reperfusion phase, ischemically damaged tissues become a source of proinflammatory mediators, amplifying the systemic inflammatory reaction. Increased intra-abdominal pressure influences the functioning of organs and tissues of the abdominal cavity (solid organs – liver, spleen; hollow organs – stomach, intestine and vessels) and transmits its effects on other body compartments, as well. Typical changes being observed are hemodynamic and respiratory disorders, acute renal insufficiency etc. These are mediated by mechanical (high position of the diaphragm), humoral (vascular, immune, endocrine system) and nervesystem associated pathways.
CONCLUSIONS:
Acute abdominal compartment syndrome is a serious complication in critically ill patients because of both direct intra-abdominal effect and also its impact on remote body systems. It is not considered as an isolated illness, but rather as a syndrome created by symptoms of various origins. If not diagnosed/treated early, it leads to MODS (multiple organ dysfunction syndrome), MOFS (multiple organ failure syndrome) or even to a death.
Keywords:
abdominal compartment syndrome, intraabdominal hypertension, intra-abdominal pressure.
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