Acute Abdomen in the ICU Patient

Posted by e-Medical PPT
Acute abdominal pathology that if left untreated will increase patient MORBIDITY & MORTALITY

Physiology
Visceral and parietal peritoneum
Peritoneal fluid normally <50ml
Absorbed via lymphatics in omentum and diaphragmatic peritoneum (30%)
Omentum acts as physiologic “patch” for perforation or infection
Pain – somatic and visceral
Somatic from direct irritation of parietal peritoneum, visceral follows embryologic origin or major splanchnic vessels
Refered pain – ex. Shoulder and phrenic nerve
Pathophysiology
Similar incidence of common diseases as general population plus more unique processes
Post-surgical state
Hypotension and low flow states
Antibiotic therapy (Overgrowth ex. C. diff)
Narcotics
Poor nutrition
Co-morbidities
Trauma

Postoperative Considerations
Bleeding
Anastamotic leak
Fascial Dehiscence
Bowel obstruction
Abscess
Abdominal Compartment Syndrome

Bowel obstruction
Diagnosis often confounded by normal post-op adynamic illeus
Patients on narcotic pain meds
Management per standard protocol
Complete obstruction or nonresolving/ worsening PSBO requires reoperation..

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