Intra-abdominal hypertension refers to high pressure within the abdominal cavity. It can reduce the blood supply and oxygen to the area, which may lead to abdominal compartment syndrome (ACS), a condition that causes multiple organ dysfunction.
Both conditions commonly occur in people who are seriously ill. Of those in intensive care units (ICUs),
Once the pressure is high enough to cause ACS, symptoms may include wheezing, a tense abdomen, and trouble breathing.
Early nonsurgical treatment may prevent the high pressure from resulting in ACS. However, when this is not effective, the main treatment is a surgical procedure called a decompressive laparotomy.
This article discusses intra-abdominal hypertension, including the causes, symptoms, and how it may progress to ACS. It also examines the risk factors of both conditions, as well as their diagnosis, treatment, complications, and outlook.
Intra-abdominal hypertension (IAH) refers to sustained pressure within the abdomen of
The different grades of intra-abdominal hypertension are as follows:
- Grade I: Intra-abdominal pressure (IAP) is 12–15 mm Hg.
- Grade II: IAP is 16–20 mm Hg.
- Grade III: IAP is 21–25 mm Hg.
- Grade IV: IAP is greater than 25 mm Hg.
Why is intra-abdominal pressure important?
IAH reduces the blood supply containing oxygen to an array of organs. A lack of oxygen can cause organ dysfunction. The more prolonged the higher pressure in the abdomen, the more harm can occur in the organs, resulting in ACS.
ACS is a life threatening condition. Doctors define it as an elevation of pressure within the abdomen
When IAH progresses, it can lead to ACS. The causes are likely the same.
- abdominal trauma
- intestinal obstruction
- abdominal aortic aneurysm rupture, which is the bursting of an enlarged area in the main artery in the abdomen
- peritoneal hematoma, which is a pool of mostly clotted blood that forms in the tissue lining the abdominal wall and pelvic cavity
Secondary causes include:
- intra-abdominal sepsis, an extreme response to an infection within the abdomen
- ileus, a temporary deficit in normal intestinal movements
- ascites, the accumulation of fluid in the abdomen
- large-volume fluid replacement
Chronic, or long-term, causes include:
An older 2011 study reports that more severe intra-abdominal hypertension links to a higher incidence of gastrointestinal symptoms, such as:
- absence of bowel sounds
When IAH is severe enough to cause ACS, symptoms may
- a tense abdomen
- increased abdominal girth
- cyanosis, a bluish or grayish discoloration of the skin
- difficulty breathing
Examples of conditions that may increase intra-abdominal volume include:
- severe constipation
- abdominal sepsis
- pancreatitis, which is inflammation of the pancreas
Examples of conditions that may decrease abdominal compliance include:
- tight sutures
- capillary leaks from trauma, which is bleeding from tiny blood vessels
A diagnosis starts with a physical exam, when a doctor may note symptoms, such as a tense abdomen and trouble breathing. Imaging — such as CT scans — can help determine the cause, such as trauma or an obstruction.
Learn more about how a doctor takes a physical exam here.
A type of surgery, called a decompressive laparotomy, is the
Some complications that can occur
- kidney failure
- difficulty breathing
- low heart output and shock
- higher cranial pressure, which is elevated pressure within the skull
- reduced blood flow to the intestines
If a person does not receive treatment, ACS can be fatal. Delayed treatment also links to
Intra-abdominal hypertension is a pressure of
The condition has an array of causes that may include cirrhosis, obesity, or cancer. If it is mild, it may result in no symptoms, but once it progresses to ACS, symptoms may include a tense abdomen, cyanosis, and trouble breathing.
A physical exam may lead a doctor to suspect ACS, and an abdominal pressure measurement can confirm the diagnosis. The ultimate treatment is decompressive laparotomy once the higher pressure results in ACS.
ACS can lead to complications, such as kidney failure and low heart output. Without treatment, ACS is fatal.