Abdominal Emergencies in the ICU

We were fortunate enough to have Dr. Jose Diaz from the R Adams Cowley Shock Trauma Center give a talk for our Core Content Lecture Series on what the Intensivist MUST keep in mind when evaluating the acute abdomen.  What’s the differential diagnosis for the undifferentiated, critically-ill patient who initially presented with pneumonia and sepsis, but now has a rigid abdomen?  Well, there are a number of things you must consider, but what if your resuscitative efforts are actually KILLING your patient?

Diaz – Abdominal Emergencies in the ICU.mp3

Pearls

• Consider acute gastric outlet obstruction, acalculous cholecystitis, non-occlusive mesenteric ischemia, Ogilvie’s syndrome, toxic megacolon, and most importantly abdominal compartment syndrome in the critically-ill patient who develops a rigid abdomen in the ICU.
• Consider abdominal compartment syndrome in patients receiving large volume resuscitation who’s UOP is decreasing, pressor-requirement is increasing, and plateau pressures are rising.  If the bladder pressure is > 20 with new clinical symptoms, consider the diagnosis.  Check a Bladder Pressure!
• Ogilvie’s syndrome is a generalized dilation of the colon that on XR has preserved haustral markings and smooth inner contour (UNLIKE colitis), does not have fluid levels (UNLIKE obstruction), sand mall bowel dilation is typically absent (UNLIKE ileus).  Treat with neostigmine or mechanical decompression.