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Diarrhoea and constipation in the critically ill 

Diarrhoea and constipation in the critically ill
Chapter:
Diarrhoea and constipation in the critically ill
Author(s):

Geoffrey J. Dobb

DOI:
10.1093/med/9780199600830.003.0183
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date: 24 September 2021

The diagnosis of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS ) relies on accurate IAP measurement. The current gold standard for measurement is intermittently every 4–6 hours via the bladder. IAP monitoring should be performed in all critically-ill or injured patients exhibiting ≥1 risk factors for the development of IAH, and continued until risk factors are resolved and intra-abdominal pressure (IAP) has remained normal for 24–48 hours. IAH and ACS cause organ dysfunction through direct compression of the heart, compression of both arterial and venous perfusion of the abdominal organs, and abdomino-thoracic pressure transmission. All organ systems are affected by IAH-induced injury. Standard surgical treatment of established ACS not responding to non-invasive management consists of decompressive laparotomy via midline or transverse incision. Promising alternative surgical strategies are being developed to avoid the complications of the open abdomen.

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