Intra-abdominal hypertension and acute pancreatitis

Abstract

Intra-abdominal hypertension (IAH) contributes to organ dysfunction and leads to the development of the abdominal compartment syndrome (ACS). IAH and ACS are relatively frequent fi ndings in patiens with severe acute pancreatitis (SAP) and are associated with deterioration in organ functions. The most affected are cardiovascular, respiratory and renal functions. The incidence of IAH in patients with SAP is approximately 60-80%. There is an accumulating evidence in human and animal studies that changes of perfusion, particularly to the microvasculature, are crucial events in the progression of acute pancreatitis (AP). The perfusion of the small and large intestine is impaired due to reduced arterial pressure, increased vascular resistence and diminished portal blood fl ow. Bacterial translocation has been described in patients with ACS, and this may apply to patients with SAP. Approximately 30-40% of SAP patients develop ACS because of pancreatic (retroperitoneal) infl ammation, peripancreatic tissue edema, formation of fl uid collections or abdominal distension. Surgical debridement was the preferred treatment to control necrotizing pancreatitis in the past. However, the management of necrotizing pancreatitis has changed over the last decade. The main objective of this article is to describe the association between IAH and AP and to emphasize this situation in clinical praxis as well (Fig. 1

Cardiac depression in severe acute pancreatitis: development mechanisms and possible treatment approaches. Review

“…Она способна вызывать снижение сердечного выброса, артериального давления и органной перфузии. Эти эффекты опосредованы через снижение венозного возврата и увеличение постнагрузки на левый желудочек [65,66]. Существует ряд методов контроля внутрибрюшного давления.…”

“…Кроме того, снижения внутрибрюшного давления можно добиться чрескожным дренированием жидкостных образований, нередко осложняющих тяжелый ОП. Миорелаксация и хирургическая декомпрессия рассматриваются как способ снижения внутрибрюшного давления в случае неэффективности других методов [2,66].…”

Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Acute Pancreatitis

“…Mortality related to IAH in AP has been reported 30-40% and 50-75% for ACS [15,16]. Hospital stay is longer in patients affected by IAH and the risk of infection of pancreatic necrosis is also greater in this patients may be due to increased bacterial translocation [17].…”

Mortality predictors of patients suffering of acute pancreatitis and development of intraabdominal hypertension

“…The maximum IAP; the Acute Physiological, Age, and Chronic Health Evaluation II (APACHE II) score; the maximum sequential organ failure assessment score; age; maximum lactate and creatinine; and base deficiency were previously found to be significantly increased in deceased patients with acute pancreatitis (8,9). The aim of this study is to determine the predictive factors for development of IAH, which influences the evolution of acute pancreatitis.…”