Compartment syndrome occurs when there is additional pressure that builds up in a fixed area, which in turn decreases blood flow and compresses other organs and tissues within that space, such as the bladder. When blood flow is decreased, organs and tissues do not receive the necessary amount of oxygen-carrying blood. The additional pressure can cause the collapse of hollow organs, like the bladder.
Abdominal Compartment Syndrome
Abdominal compartment syndrome is a potentially lethal condition. The condition can develop because of trauma, surgery or a medical condition. Trauma or surgery can cause massive bleeding into the confined space of the abdomen, causing the increased pressure. Intestinal obstruction, cancer or severe infection are medical conditions that can contribute to abdominal compartment syndrome. Patients who have significant burns to the abdomen may also develop compartment syndrome.
Significance
The abdominal area houses a number of major organs within the body. The spleen, which helps the body fight infections, and the liver, which stores vitamins, minerals and detoxifies toxic substances, are both in the abdomen. The pancreas, whose function is to produce hormones and insulin, is found in the abdominal cavity. In the rear of the abdominal cavity, kidneys help to rid waste products from the body. If these organs are deprived of blood flow or compressed, the effect will be a constellation of complex signs and symptoms. The bladder is a hollow organ that sits on the pelvic floor. As pressure within the abdomen increases, pressure is placed on the bladder. Because the bladder walls are flexible and will absorb pressure, obtaining readings of bladder pressure will help gauge increasing pressures within the abdomen.
Signs and Symptoms
As noted in "Nursing 2007," when the abdominal compartment pressures increase the patient will have an increased heart rate and changes in the blood pressure as the cardiac system is impacted. The pressure buildup will impinge on the diaphragm, which will cause difficulty breathing and shortness of breath. The impact on the kidneys will cause a decrease in urine output. Patients who are at risk for abdominal compartment syndrome need to be assessed frequently. Monitoring bladder pressures frequently will indicate subtle changes that, when recognized, can prevent untoward complications. Normal pressure within the bladder is 0 to 5 mmHg. When pressures exceed 25 mmHg the potential for severe organ damage increases significantly because organs are being compressed and their functioning is being reduced.
Measuring Pressure
Monitoring the amount of pressure in the abdomen is important in the treatment and management of abdominal compartment syndrome. A reliable method of measuring the pressure is by determining bladder pressure. According to the "American Journal of Critical Care," the bladder has a compliant wall, and when partially filled the pressure within the bladder accurately reflects the abdominal pressure. To measure the bladder pressure an indwelling urinary catheter is placed in the patient's bladder. A measuring device is attached to the catheter, which will display the pressure reading.
Treatment
The definitive treatment for abdominal compartment syndrome requires surgical decompression, wherein the abdominal wall is opened to relieve pressure on the bladder and other organs.
References
- "American Journal of Critical Care"; Pathophysiology and Management of Abdominal Compartment Syndrome; Walker & Criddle; 2003
- "Nursing 2007"; The Pressure Is On; Brush; 2007
- AACN: Intra-Abdominal Hypertension: Pittfalls, Prevalence, and Treatment Options
