SUN-PP061: Gut Dysfunction in Abdominal Compartment Syndrome during Severe Acute Pancreatitis and Dilemmas in Nutritional Support

Bezmarević, Mihailo; Panisic-Sekeljic, Marina; Popadić, Ana; Mirković, Darko; Soldatović, Ivan

doi:10.1016/s0261-5614(15)30212-0

Cited by 2 publications

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“…In fact, it seems that the critical point of this sequence of events is reduced venous outflow in abdominal organs to the extent that affects arterial perfusion 76 . Venous stasis and the development of interstitial edema reduce arterial blood perfusion in the abdominal organs, especially gut, with ischemia and additional inflammation 77,78 . This may be the beginning of the second insult for the induction of severe organ dysfunction in two-hit model of the multiple organ dysfunction syndrome (MODS) 9,79 .…”

Section: Abdominal Perfusion Pressure and Additional Ischemia Of The mentioning

confidence: 99%

Pathophysiology of the abdominal compartment syndrome in acute pancreatitis: Dilemmas and critical points

Bezmarević

2018

VOJNOSANIT PREGL

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Section: Abdominal Perfusion Pressure and Additional Ischemia Of The mentioning

confidence: 99%

Pathophysiology of the abdominal compartment syndrome in acute pancreatitis: Dilemmas and critical points

Bezmarević

2018

VOJNOSANIT PREGL

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“…This fact point to the favorable effects of EN on gut functioning in patients with SAP, but without effects, even deterioration in gut functioning, in patients suffering from ACS during course of the SAP. 41 It is certain that EN should be the first line of nutritional support in almost all patients with AP, but in those with IAH/ ACS this route of feeding should be carefully monitored. The occurrence of further abdominal distension, elevation of IAP and high nasogastric output should result in immediate discontinuation of tube feeding rather than repeated attempts to alter the formula.…”

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confidence: 99%

Nutritional Support of Patients with the Abdominal Compartment Syndrome during Severe Acute Pancreatitis

Bezmarević¹,

Panisic-Sekeljic²

2016

Pancreas Open J

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Short CommunicationThere is growing evidence in the literature that development of Abdominal Compartment Syndrome (ACS) in patients with Severe Acute Pancreatitis (SAP) has a strong impact on the course of disease. Incidence of ACS in patients with SAP is around 20%. The mortality rate in patients who developed ACS during SAP is 49%, while it is 11% in patients without this complication. The development of organ failure in SAP is in correlation with the presence of intra-abdominal hypertension which can deteriorate already compromised pancreatic perfusion and perfusion of gut in early stages of SAP. The latter leads to the alteration of gut functioning with consequent reduced possibility for enteral feeding. Enteral Nutrition (EN) facilitates gut motility and alleviates bacterial translocation, but in patients suffering from ACS during course of SAP could aggravate bowel ischemia. Parenteral nutrition is required as nutritional support in ACS, but it may increase bacterial translocation and deteriorate gut functioning. Since in the literature data there still have not had recommendations regarding nutritional support of patients with ACS during course of SAP, including optimal time for initiation, duration and amount of specific nutritional regiment, in this short review we have tried to give insight into problems in nutritional support in those patients. This should fortify the interest of physicians to make additional research in order to support further strategies for the more optimal nutritional support of patients with this lethal complication.The abdominal compartment syndrome (ACS) is well described entity which importance in various clinical conditions has been recognized in the last two decades. It is defined as a state of serious organ dysfunction resulting from sustained increase in Intra-Abdominal Pressure (IAP).1 There is growing evidence in the literature data that the development of ACS in patients with severe form of acute pancreatitis (SAP) has strong influence on the course of disease.2-5 The incidence of Intra-Abdominal Hypertension (IAH) in patients suffering from SAP is approximately 70%, while ACS can be found in up to 27% of patients with this form of AP.3,4,6,7 When we add to this a mortality rate of 49% in patients with SAP and ACS, 5 it is clear that IAH and ACS have become an issue of concern in patients with AP. In addition, it was recently mentioned that the number of patients with AP and this complication has increased, but still there have not had standard recommendations for interventional treatment of patients who develop ACS during SAP.8 The step-up approach for conservative treatment of ACS was proposed several years ago.9 However, the appropriate interventional procedure, including surgical technique, and optimal time for reacting in the treatment of AP patients suffering from this serious condition is still debated.From a metabolic point of view, SAP is characterized by nitrogen waste and protein catabolism with negative nitrogen balance and secondary malnutrition.10 Similarl...

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SUN-PP061: Gut Dysfunction in Abdominal Compartment Syndrome during Severe Acute Pancreatitis and Dilemmas in Nutritional Support

Cited by 2 publications

References 1 publication

Pathophysiology of the abdominal compartment syndrome in acute pancreatitis: Dilemmas and critical points

Pathophysiology of the abdominal compartment syndrome in acute pancreatitis: Dilemmas and critical points

Nutritional Support of Patients with the Abdominal Compartment Syndrome during Severe Acute Pancreatitis

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