Describe the effects of the Intra-abdominal Compartment Syndrome. Outline your method for measuring intra-abdominal pressure and explain the pitfalls of this method.
Discussion on the effects of the ICS should include:
• renal effects – capillary compression, decreased GFR/UO, ATN,
• bowel – decreased SMA/coeliac flow, decreased pHi, bowel ischaemia
• hepatic – decreased portal blood flow, lactate clearance
• cardiac –decreased venous return/cardiac output, elevated PAOP/CVP/afterload
• respiratory –increased PIP, shunt, Paw,
• cerebral – increased ICP, decreased CPP
Description of a simple, sterile and practical technique for measurement of intra-vesical pressure was expected.
• using the wrong zero point
• allowing a leak in the system to produce a falsely low reading
• chronic cystitis, radiation cystitis producing a small contracted bladder with low compliance which gives a falsely high reading
• pelvic haematoma producing a tight pelvic compartment with falsely elevated IAP.
The majority of this question is answered by the discussion of Question 8 from the first paper of 2013. A slightly less formal discussion of abdominal compartment syndrome takes place in Question 21 from the second paper of 2006: "Outline the causes, consequences and the management of abdominal compartment syndrome. "
The "pitfalls" section is not addressed anywhere else.
Briefly, the following are reasons as to why one's intrabdominal measurements may be wrong:
- Failure of technique
- Improper setup of the measuring set
- Improperly calibrated transducer
- Inappropriate zero point
- Leaking transducer system
- Confounding factors
- Increased pelvic pressure
- High detrusor tone
- Detrusor fibrosis
- Incompletely paralysed patient