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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The acute and persistent increase of the intra-abdominal pressure (IAP) above 25 cm H2O represents a pathologic entity called the abdominal compartment syndrome (ACS). This intra-abdominal high pressure is responsible of dysfunctions in cardiovascular, respiratory and renal systems and also dysfunctions in brain and abdomen. In polytrauma patients with combined head and abdominal lesions, increases of IAP are transmitted via thorax and superior venous caval system to brain generating intracranial hypertension, reducing cerebral blood flow (CBF) and cerebral perfusion pressure (CPP) thus worsening neurological status and increasing mortality. A better prognosis for this polytrauma patients is possible only by elucidating the mechanisms which produces the dysfunctions in ACS and by promoting an aggressive therapeutical surgical approach.
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PMID:[Abdominal compartment syndrome in multiple trauma patients with concomitant abdominal and head lesions --mechanisms and therapeutical aspects]. 1637 80

A 70-year-old man with clinically localised prostate carcinoma underwent extraperitoneal endoscopic radical prostatectomy. His medical history revealed hypertension, renal colic, hypogonadotropic hypogonadism and recurrent deep venous thrombosis in the legs. The operation was uneventful with 500 ml blood loss and no periods ofhypotension. The patient developed oliguria within 12 h after surgery. A hypovolemic state was initially suggested to explain the oliguria and increasing amounts of intravenous fluids were administered. The oliguria persisted, however, and the patient did not respond to a diuretic. There was no fluid loss in the drain. Blood pressure, pulse and temperature were normal. Peritonitis and bowel perforation were excluded. Ultrasound examination of the bladder and kidneys revealed an empty bladder and no dilatation of the upper urinary tract, which excluded a post-renal obstruction. The clinical situation deteriorated within hours as the patient developed anuria, bowel distension, metabolic acidosis with progressive renal failure and signs of respiratory distress for which mechanical ventilation was needed. A chest X-ray prior to intubation did not show pneumonia or signs indicating pulmonary embolism. CT of the abdomen was performed to evaluate urinary leakage but revealed no fluid collection or urinoma. Thus pre- and post-renal causes of oliguria were excluded. In view of the systemic symptoms, intra-abdominal pressure was measured using a bladder catheter; it varied between 25 and 35 cm water. Together with the clinical situation, a diagnosis of abdominal compartment syndrome was made and coeliotomy was performed immediately. Within 10 min after decompression of the peritoneal cavity, diuresis started spontaneously. Renal function was restored to preoperative levels in 3 weeks. Abdominal compartment syndrome is a potentially life-threatening cause of anuria. The syndrome should be part of the differential diagnosis for patients with postoperative anuria, including those who underwent extraperitoneal minimally invasive procedures.
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PMID:[Clinical reasoning and decision-making in practice. A patient with oliguria following prostatectomy]. 1637 15

Multitrauma patients commonly develop abdominal compartment syndrome, which is defined as the end result of sustained, uncorrected, intra-abdominal hypertension. We aimed to assess the effects of increased intra-abdominal pressure (IAP) upon intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in the presence or absence of lipopolysacharide (LPS)-induced endotoxemia using an experimental porcine model of pneumoperitoneum. Experimental procedures were approved by the Animal Care Review Committee of the National Veterinary Institute. Sixteen female pigs weighing 20 to 25 kg, aged 3 to 4 months were used. The animal model of increased IAP employed in our studies was produced with intraperitoneal administration of helium at 25 mm Hg under general anesthesia. After induction of pneumoperitoneum, 16 animals were randomly divided into 2 groups of 8 pigs each. One group received LPS intravenously (endotoxin group) and the second group received saline (control group). ICP, CPP, and hemodynamic variables were continuously monitored and recorded. A significant reduction of the cardiac output and concurrent increases in systemic vascular resistance and central venous pressure were observed in both groups after induction of pneumoperitoneum. ICP increased whereas CPP decreased significantly compared with baseline values in both groups after elevation of IAP. After LPS administration (endotoxin group), the cardiac output and mean arterial pressure decreased significantly. The CPP decreased further in the endotoxin group after LPS administration, whereas ICP remained unchanged. IAP increases produce significant increases in the ICP and decreases in the CPP in this animal model. LPS-induced endotoxemia further decreased CPP.
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PMID:Effects of pneumoperitoneum and LPS-induced endotoxemia on cerebral perfusion pressure in pigs. 1679 47

Abdominal compartment syndrome (ACS) involves progressive uncontrolled increase in intra-abdominal pressure which eventually leads to multi organ failure. Therefore the ability to diagnose and adequately treat ACS is so important in hospital practice. The aim of this paper was to review current data on intra-abdominal hypertension and ACS, with emphasis on practical aspects. The article presents main concepts, symptoms, causes, pathophysiology and diagnosis of abdominal hypertension and abdominal compartment syndrome (ACS). The article also describes the key elements of contemporary strategy of treatment and prevention of the condition.
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PMID:[Intra-abdominal hypertension and abdominal compartment syndrome--therapeutic implications]. 1688 82

The abdominal compartment syndrome is a state of serious organ dysfunction. The syndrome results from sustained intra-abdominal hypertension, which is indirectly identified by measuring intra-bladder pressures (IBPs) using various priming volumes. This technique is poorly standardized across published data. Malbrain and Deeren have identified the risk of falsely elevated IBPs with instillation priming volumes greater than 50 ml. This overestimation appears to increase with larger priming aliquots. As a result, erroneous IBP measurements may incorrectly label a patient with the abdominal compartment syndrome, and therefore subject them to the potential complications of surgical and/or medical decompression techniques. The utility and benefit of using continuous IBP monitoring is discussed. These data require confirmation in other patient subgroups with younger ages, altered body mass indices and varied diagnoses.
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PMID:'Progression towards the minimum': the importance of standardizing the priming volume during the indirect measurement of intra-abdominal pressures. 1688 4

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) may result from several clinic situations and carries high morbidity and mortality risk, particularly in intensive care unit patients. The clinical spectrum changes from splanchnic hypoperfusion and intestinal ischemia to multiple organ failure. Previous studies demonstrated that serum D-lactate levels may be an early indicator in intestinal ischemia. This study aimed to investigate the relationship between intestinal ischemia and serum D-lactate levels during experimental IAH. Thirty-two male Wistar Albino rats weighing 250+/-50 g were divided into four groups. Three different intra-abdominal pressure (IAP) levels supplied by placement of an intraperitoneal Peritofix catheter and iso-osmotic polyethylene glycol infusion. Each of the IAP levels (15, 20, and 25 mm Hg groups) was checked with the monitor system and fixed for an hour. Control-group animals were not subjected to increased IAP. One hour later, 5-ml blood samples were taken for measurement of serum D-lactate levels and 2-cm intestinal tissue samples were taken 5 cm proximal to the ileocecal valve for histopathologic examination. Elevated serum D-lactate levels were recorded in animals with higher IAP levels. There was a positive correlation between serum D-lactate levels and IAP levels. Histological examinations of the intestinal tissue samples showed no significant pathologic changes in concordance with intestinal ischemia. Serum D-lactate levels may be an early indicator for increased IAP pressure before intestinal ischemic changes occur.
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PMID:The relationship between intestinal hypoperfusion and serum d-lactate levels during experimental intra-abdominal hypertension. 1708 Feb 44

CSF is thought to flow continuously from the site of production in the ventricles into interconnected spaces; i.e. cisterns and subarachnoid spaces (SASs). Since the SAS of the optic nerve is defined by a cul-de-sac anatomy, it is not evident how local CSF might recycle from that region to the general SAS. The concept of free communication of CSF has recently been challenged by the description of a concentration gradient of beta-trace protein, a lipocalin-like prostaglandin d-synthase (L-PGDS), between the spinal CSF and that in the SAS of the optic nerve, indicating diminished local clearance or local overproduction of L-PGDS here. In fact, computed cisternography with a contrast agent in three patients with idiopathic intracranial hypertension and asymmetric papilloedema demonstrate a lack of contrast-loaded CSF in the SAS of the optic nerve despite it being present in the intracranial SAS, thus suggesting compartmentation of the SAS of the optic nerve. The concept of an optic nerve compartment syndrome is further supported by a concentration gradient of brain-derived L-PGDS between the spinal CSF and the CSF from the optic nerve SAS in the same patients.
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PMID:Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? 1711 96

The abdominal compartment syndrome (ACS) occurs most commonly in the setting of major trauma and complex abdominal surgical procedures. The syndrome reflects the adverse physiological consequences of an acute increase in intra-abdominal pressure (generally >18 mm Hg). The effects of increased abdominal pressures on the kidney were initially described in 1876 and include impairment of renal blood flow and glomerular filtration resulting in oliguria or anuria and acute kidney dysfunction. These effects are magnified by the concomitant effects of increased intra-abdominal pressure to impair venous return and cardiac output. Patients with intra-abdominal hypertension (IAH) can be easily detected using simple methodology. If employed early, abdominal decompression to lower IAH is associated with restoration of organ function and avoidance of the ACS. However, the overall mortality associated with this syndrome remains high. In postsurgical, trauma patients, or those at risk, ACS should be considered as a potential etiology for acute kidney dysfunction and intra-abdominal pressures should be measured, monitored and when necessary intervened upon in order to attempt to improve organ dysfunction.
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PMID:Acute kidney dysfunction secondary to the abdominal compartment syndrome. 1713 82

Correct monitoring of medicosurgical critically-ill patients aids the early diagnosis and appropriate treatment of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The abdominal cavity and the retroperitoneum act sealed compartments and any change in the volume of their contents can increase intraabdominal pressure (IAP). IAH is only one measure of elevated IAP, and ACS represents the end result of sustained IAH with the appearance of organ dysfunction. To diagnose IAH and ACS, measurement of IAP, abdominal perfusion pressure and intramucous gastric pH must be performed and the results correlated with signs of clinical deterioration in the patient. Medical therapeutic measures in ACS are limited and abdominal decompression is the established symptomatic treatment of this entity.
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PMID:[Intra-abdominal hypertension and abdominal compartment syndrome. What should surgeons know and how should they manage these entities?]. 1726 51

Intraabdominal hypertension and the abdominal compartment syndrome are known to deleteriously affect a wide array of organ systems. We retrospectively reviewed 62 women who underwent either laparoscopic gastric bypass surgery or adjustable gastric banding. Their age, body mass index (BMI), and race were known. Their opening abdominal pressure was recorded by connecting a Verress needle to a pressure monitor. Linear regression was used to assess the contribution of age, race, and BMI to the observed variation in opening abdominal pressure. Neither variation in age or race explained the variation in opening pressure (P > .05). By contrast, variation in BMI explained 8% of the observed variation in opening pressure (P < .05). For every 1 kg/mm(2) increase in BMI, there was on average a 0.07 mm Hg increase in opening pressure. Increases in BMI are associated with increases in intraabdominal pressure.
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PMID:Morbid obesity causes chronic increase of intraabdominal pressure. 1734 1


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