Intraabdominal pressure

In dogs, it has been shown that increasing the intra-abdominal pressure by instillation of saline into the peritoneal cavity leads to acute renal failure and anuria. An intra-abdominal pressure of 15 mmHg may decrease urinary output, and 30 mmHg induces anuria. The same mechanism has been described in patients suffering from serious hemoperitoneum. The mechanism of this phenomenon remains unclear. Arterial renal flow has been reported to be normal in some patients, with normal renograms. It has been suggested that renal cortical pressure is elevated in association with increased intra-abdominal pressure, and as a result acute tubular necrosis may develop (Harman,.efal 1983).

It has been shown experimentally that, with increased intra-abdominal pressure, the serum level of ADH is increased, leading to oliguria and anuria. There may also be increased pressure in the renal vein and the inferior vena cava (Richards et al. 1984). Increased external and internal abdominal pressure in human volunteers with a measured inferior vena cava pressure of 20 mmHg resulted in decreased renal plasma flow, glomerular filtration rate, and tubular glucose reabsorption. This suggests intrarenal shunting.

Apart from effects on renal function, increased intra-abdominal pressure may lead to occlusion of the inferior vena cava. It can also lead to difficulties in ventilation due to diaphragmatic excursion. High intra-abdominal pressure may also decrease normal splanchnic blood flow, creating an 'abdominal compartment syndrome' with a low flow state to the bowels, leading to ischemia and necrosis, or possible reperfusion syndrome after reduction of intra-abdominal pressure.

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