1

DIGESTIVE SYSTEM











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DEFINISI
Basic Science & Clinical Evidence (2001)Terjadinya TIA akibat edem masif
usus & jaringan sekitar dalam ruang kompartemen abdomen
Ivatury , et al 2000Sindroma klinik yang ditandai TIA > 2025 cmH20, airway
pressure, hipoksia, kesulitan ventilasi, oliguria atau anuria, keadaan membaik
setelah dekompresi.
Morris et al 1993Abdomen distensi & tegang, peak inspiratory pressure
dengan ventilasi mekanik > 85 cmH
2
O atau ada oligouria.
Eddy et al , The Nashville experience 1997Abdomen yang distensi & tegang,
elevated peak airway pressure dan hiperkarbia. Oliguria tidak selalu ditemukan




HIA/IAP (Hipertensi Intra Abdominal/Intra Abdominal Pressure) :
Peningkatan tekanan intra abdomen menjadi 20 25 cmH2O.
ACS (Abdominal Compartemen Syndrome) : HIA yang tidak terkontrol disertai
dengan gejala klinis seperti gangguan ginjal, hati, kardiovaskuler & splanknikus.
FAKTOR PREDISPOSISI ACS.
Trauma Abdomen dan Pelvis yang extensive.
Damage control surgery
Abdominal packing : Selama maupun setelah packing
Continuing bleeding
Kontaminasi cavum peritoneal
Transfusions Massive dan crystaloid infusions
Inadequate resuscitation.
Munculnya Trias of Deathhypothermia-coagulopathy-acidosis
Penutupan fascia terlalu ketat.
Hemorrhagic pancreatitis
Ileus and intestinal obstruction
Ruptured abdominal aortic aneurysm
Abdominal sepsis especially when associated with septic shock
Intraabdominal disease processes : massive ascites, tension
pneumoperitoneum, ovarian masses, etc.
Loss of abdominal wall compliance : abdominal wall burns, repair of large
hernias

MANIFESTASI KLINIS
Distended Abdomen ( Stone-Hard )
Peak inspiratory pressures > 85 cm H
2
O, & CVP
Hypoxia, Hypercarbia, Oliguria or anuria
HIA/IAP 25mmHg or 30cmH
2
0/urine
ABDOMINAL COMPARTEMEN SYNDROME

Multiple organ dysfunction syndrome (MODS) attributable to increased
intraabdominal pressures (IAPs), that improves clinically by
decompressive laparotomy



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Abdomen
Dinding abdomen aliran darah
Traktus Gastrointestinal aliran darah mukosa, pH intramukosa,
Translokasi bakteri, >15mmHg blood flow a. Mesenterica Superior.
Hepar aliran darah portal, fungsi mitokondria hepatosit.
Ginjal tekanan vena ginjal, plasma renin dan aldosteron, aliran darah
ginjal, filtrasi glomerulus, produksi urin.
Paru tekanan intratorakal, peak airway pressure, peak inspiratory pressure
dan intrapulmonary shunt, compliance paru
Kardiovaskulervenous return dan cardiac output, False increased of central
venous pressure and pulmonary artery wedge pressure, resistensi vaskuler
sistemik dan pulmoner
Sistem Saraf Pusat tekanan intrakranial sekunder venous return,
tekanan perfusi serebral
Splanchnic Blood Flow Promotes gut mucosal acidosis, bowel edema and
production of oxygen free radicals
CARA MENGUKUR TIA/IAP
DIREKMenempatkan kateter/transducer di dalam rongga peritoneum lalu
hubungkan dengan manometer air.
INDIREK ( Gaster via NGT, Buli-buli via Kateter, Tek.v.Cava Inferior)
Alat pengukur (kateter/transducer) ditempatkan di dalam suatu organ dalam
rongga abdomen misalnya gaster atau buli-buli







Grade IAP (mmHg/ cmH2O) Clinical
I 7.3 11.0 (10-15) None
II
a
11.7 18.3 (16-25) Oliguria, splancnic hypoperfusion
Grade Tekanan Buli Anjuran
I 10 15 mmHg Maintenan normovolemik
II 16 25 mmHg Resusitasi hipervolemik
III 26 35 mmHg Dekompresi
IV >35 mmHg Dekompresi dan reeksplorasi
2
SINDROMA KOMPARTEMEN ABDOMINAL
Hipoperfusi splanknikus
Iskemia Hepatik
Asidosis mukosa usus
Edema usus
Koagulopati, hipotermi,
dan Asidosis
Perdarahan intra abdominal
Tidak terkontrol
Hipertensi
Intra Abdominal
Oksigen Radikal Bebas
Kerusakan organ
Sindroma Kompartemen Abdominal


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III
b
19.1 25.7 (26-35) Anuria, ventilation pressure
IV
b
>25.7 (>35) As above & pO
2

GRADING SYSTEM ACS
( Abdominal Compartment Syndrome )
GRADE (1 mmHg = 1,26 cmH
2
O ) Bladder Presure
I 10 - 15
II 16 25
III 26 35
IV >35
Abdominal Perfusion Pressure (APP)
APP = MAP IAP (mmHg)
MAP = SP + (DPx2) (mmHg)
3
APP = Abdominal Perfusion Pressure
MAP = Mean Arterial Pressure
SP = Systolic Pressure
DP = Diastolic Pressure



Percentage of Patients with Respective Organ Dysfunction per Grade of Abdominal
Compartment Syndrome


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PENANGANAN DAN PENCEGAHAN.
Penutupan Fascia Sementara bila dicurigai resiko tinggi IAH.
Rawat ICU Monitoring pH mukosa gaster variable keberhasilan resusitasi.
Pengukuran IAP minimal tiap 4-6 jam.
Peningkatan IAP persisten > 20-25 mmHg indikasi Re-explorasi.