Increased intra-abdominal pressure symptoms causes. Abdominal compartment syndrome and intra-abdominal hypertension

Summary

Normally, intra-abdominal pressure is slightly higher than atmospheric pressure. However, even small increases in intra-abdominal pressure can adversely affect renal function, cardiac output, hepatic blood flow, respiratory mechanisms, organ perfusion, and intracranial pressure. A significant increase in intra-abdominal pressure is observed in many conditions; this phenomenon is often encountered in intensive care units, in particular, with perforation of an arterial aneurysm, trauma abdominal cavity and acute pancreatitis. Abdominal compartment syndrome is a combination of increased intra-abdominal pressure and organ dysfunction. At this syndrome noted high level mortality, mainly due to sepsis or multiple organ failure.

Often, when examining a patient, we find a swollen abdomen, but, unfortunately, we do not often think about the fact that a swollen abdomen is also an increased intra-abdominal pressure (IAP), which can cause Negative influence on the activities of various organs and systems. The effects of increased IAP on the functions of internal organs were described back in the 19th century. Thus, in 1876, E. Wendt reported in his publication about undesirable changes occurring in the body due to increased pressure in the abdominal cavity. Subsequently, individual publications by scientists described disturbances in hemodynamics, respiration and renal function associated with increased IAP. However, only relatively recently were its negative effects recognized, namely the development of abdominal compartment syndrome (ABS, in the English literature - abdominal compartment syndrome) with a mortality rate of up to 42-68%, and in the absence of appropriate treatment reaching up to 100%. Underestimation or ignorance of the clinical significance of IAP and intra-abdominal hypertension (IAH) are circumstances that increase the number of adverse outcomes in the intensive care unit.

The occurrence of such conditions is based on an increase in pressure in a limited space, which leads to impaired circulation, hypoxia and ischemia of organs and tissues located in this space, contributing to a pronounced decrease in their functional activity until its complete cessation. Classic examples include conditions arising from intracranial hypertension, intraocular hypertension (glaucoma), or intrapericardial cardiac tamponade.

Regarding the abdominal cavity, it should be noted that its entire contents are considered as a relatively incompressible space, subject to hydrostatic laws. The formation of pressure is influenced by the condition of the diaphragm, abdominal muscles, as well as the intestines, which can be empty or overcrowded. Abdominal tension plays a significant role in pain and agitation of the patient. Basic etiological factors, which lead to an increase in IAP, can be combined into three groups: 1) postoperative (peritonitis or abscess of the abdominal cavity, bleeding, laparotomy with tightening of the abdominal wall during suturing, postoperative swelling of the internal organs, pneumoperitoneum during laparoscopy, postoperative ileus, acute dilatation of the stomach ); 2) post-traumatic (post-traumatic intra-abdominal or retroperitoneal bleeding, swelling of internal organs after massive infusion therapy, burns and polytrauma); 3) as a complication of internal diseases (acute pancreatitis, acute intestinal obstruction, decompensated ascites in cirrhosis, rupture of an abdominal aortic aneurysm).

When studying the effects of VBH, it was revealed that its increase most often can cause hemodynamic and respiratory disorders. However, as practice shows, pronounced changes not only in hemodynamics, but also in other vital systems do not always occur, but only under certain conditions. Obviously, that's why J.M. Burch in his works identified 4 degrees of intra-abdominal hypertension (Table 1).

Recently passed World Congress according to the AKS (December 6-8, 2004) proposed for discussion another option for grading VBH (Table 2).

Considering that normally the pressure in the abdominal cavity is about zero or negative, its increase to the indicated figures is naturally accompanied by changes in various organs and systems. Moreover, the higher the IAP, on the one hand, and the weaker the body, on the other, the more likely the development of unwanted complications. The exact level of IAP considered IAP remains a matter of debate, but it should be noted that the incidence of SAH is proportional to the increase in IAP. Recent experimental data in animals have shown that a moderate increase in IAP of ~10 mmHg. (13.6 cm water column) has a significant systemic impact on the function of various organs. And with IAP above 35 mm Hg. SAH is observed in all patients and without surgical treatment(decompression) can be fatal.

Thus, an increase in pressure in a closed space has a uniform effect in all directions, of which the most significant is the pressure on back wall the abdominal cavity, where the inferior vena cava and aorta are located, as well as pressure in the cranial direction on the diaphragm, which causes compression of the thoracic cavity.

Numerous authors have proven that increased pressure in the abdominal cavity slows down blood flow through the inferior vena cava and reduces venous return. Moreover, high IAP pushes the diaphragm upward and increases the average intrathoracic pressure, which is transmitted to the heart and blood vessels. Increased intrathoracic pressure reduces the pressure gradient across the myocardium and limits ventricular diastolic filling. The pressure in the pulmonary capillaries increases. Venous return is further affected and stroke volume is reduced. Cardiac output (CO) decreases, despite compensatory tachycardia, although at first it may not change or even increase due to the “squeezing out” of blood from the venous plexuses of the internal organs of the abdominal cavity by high IAP. Total peripheral vascular resistance increases as IAP increases. This is facilitated, as indicated above, by a decrease in venous return and cardiac output, as well as activation of vasoactive substances - catecholamines and the renin-angiotensin system, changes in the latter are determined by a decrease in renal blood flow.

Some argue that a moderate increase in IAP may be accompanied by an increase effective pressure filling and, as a result, an increase in cardiac output. Kitano showed no changes in CO when IAP was less than 16 mmHg. . However, when the intraperitoneal pressure is above 30 cm H2O, the blood flow in the inferior vena cava and CO are significantly reduced.

Experimentally, C. Caldweli et al. it has been shown that an increase in IAP of more than 15 mmHg. causes a reduction in organ blood flow for all organs located both intra- and retroperitoneally, with the exception of the cortex of the kidneys and adrenal glands. The decrease in organ blood flow is not proportional to the decrease in CO and develops earlier. Studies have shown that blood circulation in the abdominal cavity begins to depend on the difference between mean arterial and intra-abdominal pressure. This difference is called abdominal perfusion pressure and it is believed that it is its magnitude that ultimately determines visceral ischemia. It manifests itself most clearly in the deterioration of the condition gastrointestinal tract- due to a decrease in mesenteric blood flow in conditions of respiratory acidosis, ischemia occurs and progresses, the peristaltic activity of the gastrointestinal tract and the tone of the sphincter apparatus decrease. This is a risk factor for the occurrence of passive regurgitation of acidic gastric contents into the tracheobronchial tree with the development of acid aspiration syndrome. Moreover, changes in the state of the gastrointestinal tract, disturbances in central and peripheral hemodynamics are the cause of postoperative nausea and vomiting. Acidosis and swelling of the intestinal mucosa due to IAH occurs before clinically detectable SAH appears. IAH causes deterioration of blood circulation in abdominal wall and slows down the healing of postoperative wounds.

Some studies indicate the possibility of additional local regulatory mechanisms. IAP, while increasing arginine vasopressin levels, likely reduces hepatic and intestinal oxygenation and reduces portal blood flow. Hepatic arterial blood flow decreases when IAP is greater than 10 mm Hg, and portal blood flow decreases only when it reaches 20 mm Hg. . A similar decrease occurs in renal blood flow.

A number of authors have shown that an increase in intra-abdominal pressure can cause a reduction in renal blood flow and glomerular filtration rate. It has been noted that oliguria begins at an IAP of 10-15 mm Hg, and anuria begins at an IAP of 30 mm Hg. . Possible mechanisms for the development of renal failure are increased renal vascular resistance, compression of the renal veins, increased levels of antidiuretic hormone, renin and aldosterone, and a decrease in CO.

Increases in intra-abdominal volume and pressure limit the movement of the diaphragm with increased resistance to ventilation and reduce lung compliance. Thus, compression of the lungs leads to a decrease in functional residual capacity, collapse of the capillary network of the pulmonary circulation, increased pulmonary vascular resistance, increased pressure in the pulmonary artery and capillaries, and increased afterload on the right side of the heart. There is a change in ventilation-perfusion relationships with increased shunting of blood into the lungs. A pronounced respiratory failure, hypoxemia and respiratory acidosis, and the patient is transferred to artificial ventilation.

Important with IAH has respiratory support by selecting modes of artificial ventilation. It is known that FiO 2 is greater than 0.6 and/or P peak is above 30 cm water column. damage healthy lung tissue. Therefore, modern tactics of mechanical ventilation in these patients require not only normalization of the blood gas composition, but also the choice of the most gentle support regimen. P media, for example, is preferable to increase by increasing positive end-expiratory pressure (PEEP) rather than tidal volume (TI), which, on the contrary, should be reduced. The specified parameters are selected according to the pressure-volume (distensibility) graph of the lungs. It must be remembered that if in the primary syndrome of acute lung injury the compliance of the lung tissue primarily decreases, then in SAH the compliance of the chest wall decreases. There are studies showing that in patients with SAH, high PEEP involves collapsed but viable alveoli in ventilation and leads to improved compliance and gas exchange. Therefore, timely and adequate selection of ventilation modes for IAH reduces the risk of developing iatrogenic baro- and volutrauma.

Interesting works on the influence of VBG on intracranial pressure(ICP). The authors indicate that acute IAH contributes to an increase in ICP. Possible mechanisms are a violation of the outflow of blood through the jugular veins due to increased intrathoracic pressure and the effect of IAH on the cerebrospinal fluid through the epidural venous plexus. Obviously, therefore, in patients with severe combined trauma of the skull and abdomen, the mortality rate is two times higher than with these injuries separately.

Thus, IAH is one of the main factors in the disorder of vital systems of the body and a pathology with a high risk of adverse outcomes, requiring timely diagnosis and immediate treatment. The symptom complex in SAH is nonspecific; its manifestation can occur in a wide variety of surgical and non-surgical pathologies. Thus, oliguria or anuria, a high level of central venous pressure (CVP), pronounced tachypnea and decreased saturation, profound impairment of consciousness, and a drop in cardiac activity can be interpreted as manifestations of multiple organ failure due to a traumatic disease, heart failure, or a severe infectious process. Ignorance of the pathophysiology of IAH and the principles of treatment of SAH, for example the prescription of diuretics in the presence of oliguria and high central venous pressure, can adversely affect the patient's condition. Therefore, timely diagnosis of IAH will prevent misinterpretation of clinical data. To diagnose IAP, you need to know and remember about it, however, even examination and palpation of a swollen abdomen will not give the doctor accurate information about the size of IAP. IAP can be measured in any part of the abdomen - in the cavity itself, the uterus, the inferior vena cava, the rectum, the stomach or the bladder. However, the most popular and simplest method is measuring pressure in the bladder. The method is simple, does not require special, complex equipment, and allows monitoring this indicator over a long period of patient treatment. Measurement of bladder pressure is not performed if there is damage to the bladder or compression of it by a pelvic hematoma.

In conclusion, IAH is another real factor that must be taken into account when managing patients in the intensive care unit. Underestimating it can lead to disruption of almost all vital important functions organism, IAH is a fatal pathology that requires timely diagnosis and immediate treatment. Clinicians have realized the need to measure abdominal pressure following intracranial and intrathoracic pressure. As numerous researchers point out, adequate monitoring of intra-abdominal hypertension makes it possible to promptly recognize the level of IAP that threatens the patient and promptly implement the necessary measures to prevent the occurrence and progression of organ disorders.

Measuring intra-abdominal pressure is becoming a mandatory international standard for patients with abdominal accidents. That is why, in the Department of Surgical Reanimation of the Russian Research Center for Emergency Medicine, which is the base of the Department of Anesthesiology and Reanimatology of the Tashkent Institute of Ultrasound, research is currently being carried out aimed at studying the problems associated with the effects of VBG. In a comparative aspect, various modes of mechanical ventilation and methods for correcting disorders that occur in various organs and systems of the body are studied.

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Many of us do not attach importance to symptoms such as bloating, aching pain in the abdominal region, and discomfort when eating.

But these manifestations can mean a complex process - intra-abdominal pressure. It is almost impossible to immediately determine the disease, internal pressure differs from the external one, and if the body’s systems are disrupted, they begin to work defectively.

In literary terms, intra-abdominal pressure is a condition accompanied by an increase in pressure that comes from organs and fluid.

Measuring intra-abdominal pressure

To find out IAP, you need to place a special sensor in the abdominal cavity or in the liquid medium of the large intestine. This procedure is performed by a surgeon, usually during surgery.

Devices for measuring IAP

There is another way to check pressure, but it is considered minimally invasive and less informative; this is measuring IAP using a catheter in the bladder.

Reasons for the increase in indicators

Intra-abdominal pressure can be caused by many negative processes in the body, one of which is bloating.

Abundant accumulation of gases usually develops due to stagnant processes as a result of individual characteristics or surgical pathologies.

If we look at specific cases, common causes include irritable bowel syndrome, obesity and constipation. Even eating food that includes gas-forming foods can trigger IBD. People who suffer from irritable bowel syndrome most often experience a decrease in the tone of the autonomic region of the nervous system ( nervous system).

There are often cases when the cause is diseases such as hemorrhoids and. Normal intestinal microflora is represented by a variety of microelements that are found throughout the gastrointestinal tract. Their absence provokes the development of many diseases, which may result in intra-abdominal hypertension.

Causes of IAP may include the following surgical pathologies: peritonitis, closed injuries in the abdominal area, pancreatic necrosis.

Symptoms and treatment

The symptoms accompanying increased intra-abdominal pressure are as follows:

• abdominal pain;
• bloating;
• dull pain in the kidneys;
• nausea;
• dizziness;
• jerking sensations in the peritoneum.

As you can see, this list cannot clearly and accurately diagnose IAP, since other diseases may have such alarming factors. In any case, you should consult your doctor and conduct a proper examination.

The first thing you need to pay attention to during VBD is the degree of its development and the reasons for its occurrence. Patients suffering from increased IAP are given a rectal probe. This procedure does not cause pain. In particular, it is impossible to achieve a reduction in indicators with the help of such an intervention; it is used only for measurements.

In the case of surgical intervention, the likelihood of developing abdominal compression syndrome may increase, then it is necessary to begin therapeutic measures.

The earlier the treatment process is started, the greater the chances of stopping the disease at initial stage and prevent multiple organ failure from developing.

For abdominal hypertension to reduce painful spasm and tension, it is customary to resort to abdominal surgery. In order to normalize blood pressure, analgesics and sedatives are prescribed.

It is mandatory forbidden to wear tight clothing or lie in a lying position above 20 degrees on the bed. In some cases, the patient is prescribed drugs to relax muscles - muscle relaxants for parenteral use.

Some precautions:

• avoid infusion loading.
• Do not remove fluid by stimulating diuresis.

When the pressure crosses the 25 mm limit. rt. Art., the decision to perform surgical abdominal decompression in most cases is not subject to discussion.

Timely intervention in more percentage allows you to normalize the functioning of organs and systems of the body, namely to stabilize hemodynamics, diuresis, and eliminate respiratory failure.

However surgical intervention There is also a “reverse side of the coin”. In particular, this method can contribute to the development of reperfusion, as well as the entry into the bloodstream of under-oxidized nutrient medium for microorganisms. This moment can cause the heart to stop beating.

If IAP serves to develop abdominal compression, the patient may be prescribed artificial ventilation procedures, with parallel normalization of the body’s water and electrolyte balance infusion using crystalloid solutions.

It is especially worth noting patients who experience IAP due to obesity. A significant increase in the load on the tissue contributes to this process. As a result, the muscles atrophy and become unstable to physical activity. The consequence of the complication may be chronic cardiopulmonary failure.

In turn, this moment leads to disruption of the blood supply to blood vessels and tissues. A way to eliminate IAP in obese people is to sew in mesh implants. But the operation itself does not exclude the leading cause of high blood pressure - obesity.

With excess body weight, there is a tendency to cholecystitis, fatty liver degeneration, organ prolapse, cholelithiasis, which are the result of IAP. Doctors strongly recommend reviewing the diet of obese people and contacting a specialist to create proper nutrition.

Exercises that increase intra-abdominal pressure

A complex of physical natural factors that increase IAP occurs naturally.

For example, frequent sneezing, coughing during bronchitis, screaming, defecation, urination - a number of processes that lead to an increase in IAP.

Especially often, men may suffer from gastroesophageal reflux disease, which can also be caused by increased IAP. This partly occurs in those who frequently exercise in gyms.

Measuring IAP in a medical facility

No matter how much patients would like to measure IAP on their own, nothing will work.

Currently, there are three methods for measuring IAP:

1. Foley catheter;
2. laparoscopy;
3. water-perfusion principle.

The first method is often used. It is available but is not used for bladder trauma or pelvic hematoma. The second method is quite complicated and expensive, but will give the most correct result. The third is carried out by a special device and a pressure sensor.

IAP levels

To understand which value is high, you should know the levels from normal condition to critical.

Intra-abdominal pressure: normal and critical level:

• normal value It has<10 см вод.ст.;
• average value 10-25 cm water column;
• moderate 25-40 cm water column;
• high>40 cm water column

What is the specialists' diagnosis based on?

Increased intra-abdominal pressure can be determined by the following signs:

• increased IAP - more than 25 cm of water. Art.;
• carbon dioxide value equal to >45 ml. rt. Art. in arterial blood;
• features of the clinical conclusion (pelvic hematoma or liver tamponade);
• decreased diuresis;
• high pressure in the lungs.

If at least three symptoms are identified, the doctor diagnoses intra-abdominal pressure.

Venous pressure is an important indicator necessary for the most accurate diagnosis cardiovascular pathologies. Measurement of BP is necessary to monitor patients with heart or lung disease.

Blood pressure levels change several times during the day. You can find out how you can track this indicator and how daily changes in blood pressure occur here.

Video on the topic

Device for functional monitoring of IAP:

The problem of UBI has not previously been such a discussed topic, but medicine does not stand still, making discoveries and research for the benefit of human health. You should not treat this topic with cold blood. The factors considered are directly proportional to the occurrence of many serious life-threatening diseases.

Do not self-medicate and be sure to contact a medical facility if similar symptoms begin to bother you. Take into account all the recommendations and you will no longer be bothered by the question of how to reduce intra-abdominal pressure.

What is Blood Pressure - a short educational program on the site

Blood pressure is the process of compression of the walls of capillaries, arteries and veins under the influence of blood circulation. Types of blood pressure:

• upper, or systolic;
• lower, or diastolic.

Both of these values ​​should be taken into account when determining your blood pressure level. The very first units of its measurement remain - millimeters of mercury. This is because older machines used mercury to determine blood pressure levels. Therefore, the blood pressure indicator looks like this: upper blood pressure (for example, 130) / lower blood pressure (for example, 70) mm Hg. Art.

Circumstances that directly affect blood pressure range include:

• the level of force of contractions performed by the heart;
• the proportion of blood ejected by the heart during each contraction;
• resistance of the walls of blood vessels, which is the flow of blood; the amount of blood circulating in the body;
• fluctuations in pressure in the chest that are caused by the respiratory process.

Blood pressure levels can change throughout the day and as you age. But for most healthy people characterized by a stable blood pressure.

Determination of types of blood pressure

Systolic (upper) blood pressure is a characteristic of the general condition of the veins, capillaries, arteries, as well as their tone, which is caused by contraction of the heart muscle. It is responsible for the work of the heart, namely with what force the latter is able to push out blood.

Thus the level upper pressure depends on the strength and speed with which heart contractions occur. It is unreasonable to assert that arterial and cardiac pressure are the same concept, since the aorta also participates in its formation.

Lower (diastolic) pressure characterizes the activity of blood vessels. In other words, this is the blood pressure level at the moment when the heart is most relaxed. Lower pressure is formed as a result of contraction of the peripheral arteries, through which blood enters the organs and tissues of the body. Therefore, the state of blood vessels – their tone and elasticity – is responsible for the level of blood pressure.

Every person has individual norm Blood pressure, which may not be associated with any diseases. Blood pressure levels are determined by a number of factors that are of particular importance:

• age and gender of the person;
• personal characteristics;
• life style;
• features of lifestyle (work activity, preferred type of recreation, and so on).

Blood pressure also tends to increase when performing unusual activities. physical activity and emotional stress. And if a person constantly performs physical activity (for example, an athlete), then the blood pressure level may also change both for time and for a long period. For example, when a person is stressed, his blood pressure can rise to thirty mm Hg. Art. from the norm.

However, there are still certain limits for normal blood pressure. And every ten points of deviation from the norm indicates a disruption in the functioning of the body.

You can also calculate your individual blood pressure using the following formulas:

1. For men:

• upper blood pressure = 109 + (0.5 * number of completed years) + (0.1 * weight in kg);
• lower blood pressure = 74 + (0.1 * number of completed years) + (0.15 * weight in kg).

2. For women:

• upper blood pressure = 102 + (0.7 * number of completed years) + 0.15 * weight in kg);
• lower blood pressure = 74 + (0.2 * number of completed years) + (0.1 * weight in kg).

Round the resulting value to a whole number according to the rules of arithmetic. That is, if the result is 120.5, then when rounded it will be 121.

What to do to normalize blood pressure?

These tips will help you feel energetic all day if you are hypotensive.

1. Don't rush to get out of bed. When you wake up, do a short warm-up while lying down. Move your arms and legs. Then sit down and stand up slowly. Perform actions without sudden movements. they can cause fainting.
2. Take a contrast shower in the morning for 5 minutes. Alternate the water – one minute warm, one minute cool. This will help you cheer up and is good for blood vessels.
3. A cup of coffee is good for you! But only natural tart drink will raise the pressure. Drink no more than 1-2 cups a day. If you have heart problems, drink green tea instead of coffee. It invigorates no worse than coffee, and does not harm the heart.
4. Sign up for the pool. Go at least once a week. Swimming improves vascular tone.
5. Buy ginseng tincture. This natural “energetic energy” gives tone to the body. Dissolve 20 drops of tincture in ¼ glass of water. Drink half an hour before meals.
6. Eat sweets. As soon as you feel weak, eat ½ teaspoon of honey or a little dark chocolate. Sweets will drive away fatigue and drowsiness.
7. Drink clean water. Every day, 2 liters of pure and non-carbonated. This will help keep your blood pressure at a normal level. If you have diseased heart and kidneys, drinking regime must be prescribed by a doctor.
8. Get enough sleep. A rested body will work as it should. Sleep at least 7-8 hours a day.
9. Get a massage. According to oriental medicine specialists, there are special points on the body. By influencing them, you can improve your well-being. The pressure is controlled by the point located between the nose and upper lip. Gently massage it with your finger for 2 minutes clockwise. Do this when you feel weak.

First aid for hypotension and hypertension

If you feel dizzy, very weak, or have tinnitus, call an ambulance. While the doctors are on their way, take action:

1. Unbutton the collar of your clothing. The neck and chest should be free.
2. Lie down. Lower your head. Place a small pillow under your feet.
3. Smell the ammonia. If you don't have it, use table vinegar.
4. Have some tea. Definitely strong and sweet.

If you feel it coming hypertensive crisis, then you also need to call doctors. In general, this disease should always be supported by preventive treatment. As first aid measures, you can resort to the following actions:

1. Organize a foot bath with hot water, to which mustard has been previously added. An alternative may be to apply mustard compresses to the heart area, back of the head and calves.
2. Lightly wrap your right and then your left arm and leg for half an hour on each side. When the tourniquet is applied, the pulse should be palpable.
3. Have a drink from chokeberry. It could be wine, compote, juice. Or eat jam from this berry.

To reduce the risk of occurrence and development of hypotension and hypertension, you should adhere to the regimen healthy eating, prevent the appearance excess weight, exclude harmful foods from the list, move more.

Blood pressure should be measured from time to time. If you observe a trend of high or low blood pressure, it is recommended to consult a doctor to determine the causes and prescribe treatment. Prescribed therapy may include methods to normalize blood pressure, such as taking special medications and herbal infusions, dieting, doing a set of exercises, and so on.

Intra-abdominal pressure: symptoms and treatment of deviations from the norm - tips and recommendations on the site

The information on the site is for reference and general information, collected from publicly available sources and in no case can be the basis for making a decision on use in the course of treatment. If in any doubt, consult your doctor.

During normal functioning, the body maintains unchanged some indicators that form its internal environment. These indicators include not only temperature, arterial, intracranial, intraocular, but also intra-abdominal pressure (IAP).

The abdominal cavity looks like a sealed sac. It is filled with organs, fluids, and gases that put pressure on the bottom and walls of the abdominal cavity. This pressure is not the same in all areas. At vertical position body, pressure readings will increase from top to bottom.

Measuring intra-abdominal pressure

Measuring IAP: direct and indirect methods

Direct have the greatest efficiency. They are based on direct measurement of pressure in the abdominal cavity using a special sensor, most often the measurement is carried out during laparoscopy and perinatal dialysis. Their disadvantages include complexity and high price.

Indirect ones are an alternative to direct ones. The measurement is made in hollow organs, the wall of which either borders the abdominal cavity or is located in it ( bladder, uterus, rectum).

Of the indirect methods, measurement through the bladder is most often used. Due to its elasticity, its wall acts as a passive membrane, which quite accurately transmits intra-abdominal pressure. To measure, you will need a Foley catheter, a tee, a ruler, a transparent tube, and saline solution.

This method makes it possible to carry out measurements during long-term treatment. Such measurements are impossible with bladder injuries and pelvic hematomas.

Norm and levels of increased IAP

Normally, in adults, intra-abdominal pressure is 5–7 mmHg. Art. Its slight increase to 12 mm Hg. Art. may be caused postoperative period, obesity, pregnancy.

There is a classification of increased IAP, which includes several degrees (mmHg):

1. 13–15.
2. 16–20.
3. 21–25.
4. A pressure of 26 or higher leads to respiratory depression (displacement of the dome of the diaphragm in chest), cardiovascular (impaired blood flow) and renal (decreased rate of urine formation) failure.

Causes of high blood pressure

Increased IAP is often caused by flatulence. The accumulation of gases in the gastrointestinal tract develops as a result of stagnant processes in the body.

They arise as a result:

• regular problems with bowel movements;
• disorders of intestinal motility and digestion of food (IBS), in which there is a decrease in the tone of the autonomic zone of the nervous system;
• inflammatory processes occurring in the gastrointestinal tract (hemorrhoids, colitis);
• intestinal obstruction caused by surgery, various diseases(peritonitis, pancreatic necrosis);
• gastrointestinal microflora disorders;
• excess weight;
• varicose veins;

• the presence in the diet of products that stimulate gas formation (cabbage, radish, dairy products, etc.);
• overeating, sneezing, coughing, laughing and physical activity - a short-term increase in IAP is possible.

Exercises that increase abdominal pressure

1. Raising the legs (the body or both the body and legs) from a lying position.
2. Power crunches in a lying position.
3. Deep side bends.
4. Strength balances on the arms.
5. Push ups.
6. Performing deflections.
7. Squats and powerlifts with heavy weights (over 10 kg).

When performing exercises, you should avoid using heavy weights, breathe correctly during the exercise, do not sulk or suck in your stomach, but strain it.

Intra-abdominal pressure: symptoms

Increased pressure in the abdominal area is not accompanied by special symptoms, so a person may not attach importance to them.

As pressure increases, it may occur:

• bloating;
• pain in the abdominal area, which can change location;
• kidney pain.

Such symptoms do not make it possible to accurately diagnose increased intra-abdominal pressure. Therefore, when they appear, you should not self-medicate, but rather consult a doctor. If a doctor has diagnosed “increased IAP,” the patient should be observed by a doctor and regularly monitor changes in this indicator.

What is the diagnosis based on?

Confirmation of the diagnosis of increased intra-abdominal pressure is carried out when two or more of these signs are detected:

1. increase in IAP (over 20 mm Hg);
2. pelvic hematoma;
3. decreased volume of urine excreted;
4. hanging pulmonary pressure:
5. an increase in the partial pressure of CO2 in arterial blood above 45 mm Hg. Art.

Treatment of high blood pressure

Timely initiation of treatment will help stop the development of the disease at the initial stage and allow the functioning of internal organs to normalize.

The doctor may prescribe:

Different treatment methods are used for different degrees of the disease:

• Observation by a doctor and infusion therapy;
• Observation and therapy; if clinical manifestations of abdominal compartment syndrome are detected, decompression laparotomy is prescribed;
• Continuation of medical therapy;
• Carrying out resuscitation measures (dissection of the anterior abdominal wall).

Surgery also has another side. It can lead to reperfusion or the release of a breeding ground for microorganisms into the blood.

Prevention

Preventing a disease is much easier than treating it later. Complex preventive measures is aimed at preventing gastrointestinal diseases, gas accumulation, as well as maintaining the general condition of the body normal. It includes:

• establishing water balance in the body;
• healthy lifestyle;
• proper nutrition;
• getting rid of excess weight;
• reducing the amount of foods that increase gas formation in the diet;
• rejection of bad habits;
• ensuring emotional stability;
• carrying out routine examinations with a doctor;

Any “internal” pressure in the human body plays a very important role. In addition to the most common problems with increased blood pressure, about increased intraocular pressure, increased intracranial pressure. In addition, recently the concept of increased intra-abdominal pressure has often been included. Increased intra-abdominal pressure as a risk factor is very dangerous, as it results in dangerous complication as: compartment syndrome, which leads to difficulty in the functioning of all organs and systems of the body, also intra-abdominal hypertension leads to sustained bacterial translocation from the large intestine to the circulatory system.

How can intra-abdominal pressure increase?

Increased intra-abdominal pressure most often occurs as a result of the accumulation of gases in the intestines. A persistent increase in gases occurs as a result of stagnation, both with various hereditary and severe surgical pathologies, and with more banal diseases such as constipation, irritable bowel syndrome, or eating foods that cause active selection gases: cabbage, radish, radish. All of the above plays as a risk factor for possible complications.

Diagnostics using invasive methods

Diagnosis involves several methods of measuring intra-abdominal pressure. Basically, the methods are surgical, or quite invasive, which implies instrumental intervention in the human body. The surgeon places a sensor either in the large intestine or in the abdominal cavity, which detects any changes. This method is used in patients undergoing third-party surgery on the abdominal organs, that is, measuring intra-abdominal pressure is not the main purpose of these operations, but is only additional method diagnosis of complications.

The second less invasive method is to place a sensor in the bladder. The method is simpler to implement, but no less informative.

In newborns and children of the first year of life, increased intra-abdominal pressure is measured through the placement of a gastric tube. Abdominal hypertension in newborns, as a risk factor, is very dangerous, as it causes bacterial translocation and can trigger pathological mechanisms associated with disruption of the main organs and systems.

Increased intra-abdominal pressure outside the hospital

Intra-abdominal hypertension is not a particularly pleasant fact, even in healthy people. When it occurs, a person usually feels pain in the abdomen of a bursting nature, and rapid changes in the location of the pain are possible. To clarify, such symptoms are caused by the accumulation of excess gases in the intestines. In addition, it may appear unpleasant consequences in the form of gas release. All these symptoms actually indicate the presence of a problem. Increased intra-abdominal pressure almost always accompanies diseases such as: irritable bowel syndrome with a predominance of decreased tone of the autonomic nervous system, inflammatory diseases intestines, such as: Crohn's disease, various colitis, even hemorrhoids can be accompanied by this symptom. In addition to the above, it is worth adding such surgical pathology as intestinal obstruction. There is even a specific symptom of intestinal overbloating, which occurs due to intra-abdominal hypertension, the so-called “Obukhov Hospital” symptom.

Increased intra-abdominal pressure in children

Very often, the above symptoms of the disease can appear in preschool children. The child will be swollen and worried about abdominal pain, in addition, this problem can be diagnosed by placing your hand on the stomach, determining the degree of tension in the abdominal muscles, and the rumbling and tension of the intestines, the latter can rumble quite loudly under your fingers. In general, you need to be extremely careful with abdominal pain in children; it can act as a risk factor for serious surgical complications.

Alcohol as a risk factor for complications in intra-abdominal hypertension

Based on the results of studies, it has been proven that drinking alcoholic beverages, especially those made by fermentation, sharply increases intra-abdominal pressure in people with already elevated levels. So if you feel the above symptoms, the urgent advice is to refrain from drinking alcoholic beverages, it will not improve your health.

Treatment methods for intra-abdominal hypertension

At inpatient treatment The control method is aimed at removing excess accumulation of gases from the intestines; this can be achieved with special therapeutic enemas or by installing a gas outlet tube. In home treatment, the easiest way is to use decoctions of carminative herbs; you should also adhere to a diet and not eat foods that cause particularly large gas formation. Be sure to eat light soups several times a week. Physical stress on the body should be treated with caution, since any type of intense work triggers mechanisms for the formation of increased metabolism and catabolism.

Conclusion

Measuring intra-abdominal pressure is a relatively new direction in medicine. Its pros and cons are still not well defined, however, both persistent and non-persistent hypertension is quite an aggravating risk factor for abdominal diseases, which, of course, should be paid attention to by both doctors and patients. Paying attention to your health is the key to a good standard of living.

Intra-abdominal pressure (IA) is the pressure caused by organs and fluids located in the abdominal cavity (AP). A low or high reading is often a symptom of some disease occurring in the patient’s body. From our article you will learn why intra-abdominal pressure increases, symptoms and treatment of this disease, as well as ways to measure its indicators.

Increased VD

Norms and deviations

The normal VD is below 10 centimeters units. If a person decides to measure his BP and the result deviates more from the standard value, this can be regarded as a sign of the presence of some pathological process in the body.

In modern medicine, the following classification of indicators is used (measured in mmHg):

• first degree – 12-15;
• second degree – 16-20;
• third degree – 21-25;
• fourth degree – more than 25.

Important! It is impossible to determine the indicator or “guess” it based on the symptoms that appear. To find out the correct value of VD, special measures should be taken.

Etiology

An increase in BP in a patient may occur due to:

• chronic constipation;
• increased gas formation in the gastrointestinal tract;
• genetic disorders of the gastrointestinal tract;
• intestinal obstruction;
• inflammation of PD organs;
• varicose veins;
• pancreatic necrosis (death of pancreatic tissue as a result of advanced pancreatitis);
• microflora disorders in the intestines;
• obesity;
• improper nutrition.

The last point requires special attention. Inflated BP indicators often arise due to the patient’s abuse of products that provoke increased gas formation. These include:

• milk;
• all varieties of cabbage and dishes prepared using it;
• radishes, legumes, nuts;
• sparkling water and drinks;
• fatty foods;
• canned and pickled foods.

Also, high BP often occurs due to severe coughing or excessive physical exertion. In such cases, the disease has no symptoms and does not need to be treated.

Note! It is strictly forbidden to independently determine the cause of the increase in VD - this should only be done by a qualified specialist.

To do this, he must carry out the required diagnostic measures.

Symptoms

A slight excess of the VD norm generally does not manifest itself with any symptoms and is not a sign of a serious illness.

But if the VD indicators are greatly increased, the patient may suffer from:

• feelings of a full and heavy stomach;
• bloating;
• dull aching pain;
• jerky sensations in the PD;
• increase in blood pressure;
• vertigo;
• attacks of nausea and vomiting;
• bowel disorders;
• rumbling in the stomach.

The clinical manifestation of the disease is not specific, so its etiology can only be established through a thorough examination of the patient.

In addition to general symptoms, the patient may exhibit specific signs of the disease, due to which the VD began to increase. In such cases, you need to urgently seek qualified help, since ignoring the problem or trying to solve it on your own can negatively affect the patient’s health and provoke his death.

Diagnostics

To determine the reasons that can reduce or increase VD indicators, a specialist uses a two-stage examination. Let's look at each of them in detail.

First stage

Involves conducting a physical examination of the patient. This procedure allows the doctor to find out the following information:

• when the patient’s first symptoms of the disease appeared, how long the exacerbation lasted, the frequency of occurrence, what could provoke their development;
• whether the patient suffered from a chronic gastroenterological disease or underwent surgery for PD;
• the patient's diet and food intake;
• whether the patient uses any medications as self-medication to improve well-being.

Second phase

After communicating with the patient, the doctor carries out diagnostic measures. Most often they resort to:

• standard analyzes ( general research blood and urine);
• blood biochemistry;
• examining feces for occult blood;
• endoscopy;
• ultrasound diagnostics of PD;
• X-ray of the gastrointestinal tract;
• CT or MRI of PD.

To measure VD, the doctor may use a surgical or minimally invasive method. In total, modern medicine has developed several methods to perform this study:

• using a Foley catheter. Measuring in this way involves inserting a device into the bladder. The data obtained is the most accurate;
• using laparoscopy;
• using water-perfusion technique.

The last two are considered surgical procedures and involve the use of sensors.

Having received the diagnostic results, the specialist can tell what exactly the phenomenon was able to change the VD and what therapeutic methods will help reduce it to normal levels.

Treatment of intra-abdominal hypertension (IAH)

The peculiarity of therapeutic measures is closely related to the factor that began to increase VD. Treatment can be conservative (the sick person uses special pharmaceuticals, follows dietary restrictions, carries out physiotherapeutic procedures) or radical (surgery).

Important! In case the ID exceeds 25 mm. rt. Art., the patient urgently undergoes surgical intervention using the abdominal technique.

If medication therapy is enough for the patient to reduce VD, the specialist resorts to using:

• analgesic;
• sedative;
• muscle relaxant;
• drugs that stabilize the functionality of the gastrointestinal tract;
• vitamins and minerals.

Physiotherapy allows you to:

• normalize the water-electrolyte ratio;
• stimulate diuresis and urination.

The patient may also have an enema or a drainage tube installed.

The patient is prohibited from wearing tight clothes and tightening the belt on his trousers; it is not recommended to recline on a bed or sofa.

You should definitely adjust your sports activities and completely remove from your workout exercises that increase intra-abdominal pressure:

• You cannot lift a load of more than 10 kilograms;
• you need to reduce physical activity;
• reduce BP muscle tension.

The patient should strictly adhere to the following dietary recommendations:

• exclude from daily menu or at least reduce the consumption of foods that increase gas formation;
• practice the principle of fractional meals;
• drink at least one and a half liters of clean water;
• Try to eat foods in liquid or puree form.

Often IAH is a consequence of the patient's obesity. In this case, the doctor prescribes a therapeutic diet for the patient and selects a complex correct exercises, capable of reducing VD indicators and describes in detail how the pressure from their implementation is reduced.

Why should IBH be treated?

Intra-abdominal hypertension (IAH) prevents many organs located in and adjacent to the peritoneum from functioning normally (in this case, the risk of developing multiple organ failure (MOF) increases). As a result, a person develops IAH syndrome - a complex of symptoms that are formed under the influence of high BP and are accompanied by the development of MODS.

In parallel with this, increased pressure negatively affects:

• inferior genital vein and provokes a decrease in venous return;
• diaphragm - it moves towards the chest. As a result, a person experiences mechanical compression of the heart. This violation provokes pressure pressure in the small circle. Also, violation of the position of the diaphragm increases the value of intrathoracic pressure. This negatively affects tidal volume and lung capacity, and respiratory biomechanics. The patient's risk of developing acute respiratory failure increases;
• compression of the parenchyma and renal vessels, as well as hormonal background. As a result, a person develops acute renal failure, glomerular filtration and anuria decrease (with an AHI above 30 mmHg);
• intestinal compression. As a result, it disrupts microcirculation and provokes thrombosis of small vessels, ischemic lesion intestinal wall, its swelling, complicated by intracellular acidosis. These pathological conditions provoke transudation and exudation of fluid, and an increase in AHI;
• intracranial pressure (an increase is observed) and brain perfusion pressure (it decreases).

Ignoring AHI provokes the death of the patient.