Abdominal exam in ACS

Q: 44 years old male is admitted to the ICU with severe acute pancreatitis after a bout of binge drinking at a Saturday night party. Patient required massive fluid resuscitation. 24 hours after admission, patient complains of worsening abdominal pain. Nurse raised the concern for acute abdominal compartment syndrome (ACS). A good abdominal exam is a better indicator of developing acute ACS than other parameters.

A) True

B) False

Answer: B

This question has two objectives. First, in acute pancreatitis or in any other critical situation where a patient requires a large amount of intravenous resuscitation, the development of ACS is always an unintended consequence. Second, unfortunately, physical examination of the abdomen remained a poor predictor of ACS. Measurement of bladder pressure is the gold standard. 

Other clinical signs should also be considered, such as worsening oliguria, increased ventilatory requirement if intubated, worsening pulmonary insufficiency otherwise, hypotension, tachycardia, an elevated jugular venous pressure (JVP), jugular venous distension, peripheral edema, abdominal tenderness, evidence of hypoperfusion (cool skin), and mental status change. Rising lactic acidosis is usually a norm.

#GI

#surgical-critical-care

References:

1. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006; 32:1722.

2. Kirkpatrick AW, Brenneman FD, McLean RF, et al. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 2000; 43:207.

3. Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 2002; 26:1428.