Increased intra-abdominal pressure causes. Intra-abdominal hypertension syndrome

Intra-abdominal pressure (IP) is the pressure exerted by organs and fluids located in the abdominal cavity(BP). Reduced or increased rate often a symptom of some disease that occurs in the body of the patient. From our article you will learn why intra-abdominal pressure rises, the symptoms and treatment of this ailment, as well as ways to measure its performance.

Increased VD

Norms and deviations

The norm of VD is an indicator below 10 centimeters units. If a person decides to measure his VD and the result deviates from the standard value by a large side, this can be regarded as a sign of the presence of some kind of pathological process in the body.

IN modern medicine the following classification of indicators is used (measured in mm Hg):

first degree - 12-15;
second degree - 16-20;
third degree - 21-25;
fourth degree - more than 25.

Important! It is impossible to determine the indicator or “guess” it by the symptoms that appear. To find out correct value VD, special arrangements should be made.

Etiology

An increase in blood pressure in a patient may occur due to:

chronic constipation;
increased gas formation in the gastrointestinal tract;
genetic disorders of the gastrointestinal tract;
intestinal obstruction;
inflammation of the organs of BP;
varicose veins;
pancreatic necrosis (death of pancreatic tissue as a result of advanced pancreatitis);
violations of the microflora in the intestine;
obesity;
improper nutrition.

Obesity

The last point requires special attention. Elevated VP values often occur due to the patient's abuse of products that provoke increased gas formation. These include:

milk;
all varieties of cabbage and dishes prepared with its use;
radishes, legumes, nuts;
carbonated water and drinks;
fatty food;
canned and pickled foods.

Carbonated drinks

Also, high TD is often due to severe cough or excessive physical activity. In such cases, the disease has no symptoms and does not need to be treated.

Note! It is strictly forbidden to independently establish the cause of the increase in VD - this should only be done by a qualified specialist.

For this, he without fail undertakes the required diagnostic measures.

Symptoms

A slight excess of the VD norm is generally not manifested by any symptoms and is not a sign of a serious illness.

But if the VD values are greatly elevated, the patient may suffer from:

feelings of a full and heavy stomach;
swelling;
dull aching pain;
jerky sensations in the BP;
increase in blood pressure;
vertigo;
bouts of nausea and vomiting;
stool disorders;
rumbling in the stomach.

The clinical manifestation of the disease does not differ in a specific character, therefore, it is possible to establish its etiology only during thorough examination patient.

In addition to the general symptoms, the patient may show specific signs of the disease, due to which the VD began to increase. In such cases, an urgent need to apply for qualified help, since ignoring the problem or trying to solve it on your own can adversely affect the patient's health and provoke his death.

Diagnostics

To determine the reasons that can reduce or increase VD indicators, the specialist uses a two-stage examination. Let's consider each of them in detail.

First stage

Involves a physical examination of the patient. This procedure allows the doctor to find out the following information:

when the patient had the first symptoms of the disease, how long the exacerbation lasts, the frequency of occurrence, which could provoke their development;
whether the patient suffered from a chronic gastroenterological disease or experienced surgical intervention on BP;
the patient's diet and eating pattern;
whether the patient uses any drugs as self-medication to improve well-being.

Second phase

After communicating with the patient, the doctor conducts diagnostic measures. Most often resort to:

standard analyzes ( general study blood and urine)
blood biochemistry;
examining faeces for occult blood;
endoscopy;
ultrasound diagnostics of PD;
x-ray of the gastrointestinal tract;
CT or MRI of BP.

ultrasound

To measure VD, a doctor may use a surgical or minimally invasive method. In total, in modern medicine, several methods have been developed to perform this study:

using a Foley catheter. Measurement in this way involves the introduction of a device into the bladder. The data obtained is the most accurate;
using laparoscopy;
using the water perfusion technique.

The last two are considered surgical procedures and involve the use of sensors.

Having received the diagnostic results, the specialist can say which phenomenon could change the VD and which therapeutic methods help bring it down to normal levels.

Treatment of intra-abdominal hypertension (IAH)

Peculiarity therapeutic measures is closely related to the factor that began to increase the VD. Treatment can be conservative (use of special pharmaceuticals by a sick person, compliance with dietary restrictions, physiotherapy) or radical (surgery).

Important! In the case when the VD exceeds 25 mm. rt. Art., the patient is urgently performed surgical intervention by abdominal technique.

If drug therapy is sufficient for the patient to reduce VD, the specialist resorts to the use of:

analgesics;
sedative drug;
muscle relaxant;
drugs that stabilize the functionality of the gastrointestinal tract;
vitamins and minerals.

The appointment of physiotherapy allows you to:

normalize the water-electrolyte ratio;
stimulate diuresis and urination.

The patient may also be given an enema or a bypass tube.

The patient is forbidden to wear tight clothes and tightly tighten the belt on his trousers, it is not recommended to reclining on a bed or sofa.

It is imperative to correct sports activities and completely remove exercises that increase intra-abdominal pressure from training:

you can not lift a load of more than 10 kilograms;
need to reduce physical activity;
reduce muscle tension.

In nutrition, the patient should strictly adhere to the following recommendations:

exclude from daily menu or at least reduce the use of foods that increase the degree of gas formation;
practice the principle of fractional nutrition;
drink at least one and a half liters of clean water;
try to eat foods in liquid or puree form.

Often, IAH is a consequence of the patient's obesity. In this case, the doctor prescribes to the patient therapeutic diet, selects the complex right exercises, capable of reducing the performance of VD and tells in detail how the pressure from their implementation is reduced.

Why should IH be treated?

Intra-abdominal hypertension (IAH) prevents many organs that are in the peritoneum and adjacent to it from functioning normally (in this case, the risk of developing multiple organ failure (MOF) increases). As a result, a person develops the IAH syndrome - a complex of symptoms that are formed under the influence of high VD and are accompanied by the development of PON.

In parallel with this, increased VD negatively affects:

inferior pudendal vein and provokes a decrease in venous return;
diaphragm - it moves to the chest. As a result, a person has a mechanical compression of the heart. This violation provokes pressure pressure in a small circle. Also, a violation of the position of the diaphragm increases the value of intrathoracic pressure. This negatively affects tidal volume and lung capacity, respiratory biomechanics. The patient has an increased risk of developing acute respiratory failure;
compression of the parenchyma and renal vessels, as well as hormonal background. As a result, a person develops an acute kidney failure, reduced glomerular filtration and anuria (with AHI above 30 mm Hg);
intestinal compression. As a result, it disrupts microcirculation and provokes thrombosis. small vessels, ischemic lesion intestinal wall, its puffiness, complicated by intracellular acidosis. These pathological conditions provoke transudation and exudation of fluid, and an increase in AHI;
intracranial pressure (its increase is observed) and perfusion pressure of the brain (it decreases).

Ignoring AHI provokes the death of the patient.

), intracranial, intraocular and intra-abdominal (intra-abdominal). It is the latter value that provides the difference between intrathoracic and intra-abdominal pressure, because the first must be lower than atmospheric pressure to maintain homeostasis, and the second - higher.

There are a number of conditions in which there is a violation of the intra-abdominal pressure

Causes of intra-abdominal pressure

Most people do not attach any importance to symptoms such as causeless bloating, aching, pulling or pressing pain in the abdominal part, as well as discomfort that occurs when eating. But these clinical manifestations may mean the development of a very unfavorable process, which is referred to as an increase in IAP. What is most unpleasant, it is almost impossible to identify the disease right away.

Become etiotropic factors high blood pressure in the abdominal cavity may different processes among which the following are the most common:

Profuse accumulation of gases. This phenomenon, as a rule, develops due to the manifestation of stagnant processes. In turn, these phenomena may well arise as a result of individual characteristics human body or surgical pathologies.
Irritable bowel syndrome, as well as alimentary obesity and constipation. Gastronomic preferences of the patient, as well as copious reception food, eating, which includes gas-forming products, can provoke violations of IAP.
Decreased tone of the vegetative region of the NS (visceral nervous system, which is functionally divided into sympathetic and parasympathetic divisions).
Not uncommon clinical cases when diseases such as hemorrhoids and Crohn's disease become the cause of an increase in intra-abdominal pressure.
quality and quantitative composition intestinal microflora.
Surgical pathologies that were operated out of time and / or with the admission of violations during the procedure surgical intervention, and led to the development of the adhesive process in the human body.
Intestinal obstruction - a violation of the patency of the distal gastrointestinal tract may well lead to an increase in intra-abdominal pressure. In turn, the closure of the lumen can be caused organic causes(that is, some neoplasm clogs the lumen: a tumor, a fecal stone, undigested food residues, etc.) or spasmodic, when the hypertonicity of the muscle wall is associated with the activity of smooth muscle cells.

Symptoms

The most significant manifestations of the considered nosology are the following symptoms:

Pain syndrome. The pain in this case can be both acute and aching, stabbing, pressing in nature, and there is also a high probability of its irradiation to the most different departments abdomen and other parts of the body.
Sometimes patients complain about dull pain in the region of the kidneys, but it is not the kidneys themselves that hurt, but the irradiation of pain of an abdominal nature manifests itself.
Nausea and vomiting, which bring no relief at all, sometimes there are jerky sensations in the peritoneum.
dyspeptic syndrome. For the simple reason that in to a large extent excretion is disturbed stool due to increased intra abdominal pressure, patients suffering from this ailment note significant stool disorders - and constipation is much more common than.

How is IAP measured?

The measurement of intra-abdominal pressure in practice is carried out in two ways: surgically and using a catheter specially designed for this, which is inserted into the abdominal cavity through the bladder. In the first case under consideration, the indicator can be measured only during abdominal surgery. The surgeon places a special sensor into the abdominal cavity or the liquid medium of the large intestine, which determines the desired value.

Regarding the method of measurement, which is implemented using a catheter in the bladder, it is much less informative and is used only in situations where, for one reason or another, to implement surgical method impossible.

The disadvantage of direct (immediate) measurement is the technical complexity of the clinical diagnostic procedure and its too high price.

Indirect methods, to which, in fact, the transbubble method belongs, gives real opportunity measure intra-abdominal pressure during the long-term treatment. However, it should be noted that such measurements are a priori impossible for various injuries. Bladder, as well as with existing pelvic hematomas.

IAP levels

Able physiological norm in adults, the intra-abdominal pressure is 5–7 mm Hg. Art. Its slight increase - up to 12 mm Hg. Art. may be provoked postoperative period, as well as alimentary obesity, pregnancy. Accordingly, in all cases when this indicator, after the influence of one or another factor, returns to paramount values, the dynamics can be fully considered a physiological norm.

Increased or decreased intra-abdominal pressure is determined by dynamically comparing the patient's current values with the norm, which should be less than 10 units.

Clinically significant intra-abdominal hypertension is pathological syndrome However, despite the enormous amount of work carried out in this direction, the exact level of IAP that corresponds to the condition under consideration is still the subject of heated debate and there is no consensus in the current literature regarding the level of IAP at which IAH can be diagnosed.

But still, in 2004, at the World Society of the Abdominal Compartment Syndrome (WSACS) conference, AHI was regulated in the following way(more precisely, clinicians have established such a term):

Intra-abdominal hypertension is a persistent increase in IAP up to 12 mm Hg or more, which is noted with at least three standard measurements performed at intervals of 4–6 hours. This definition a priori excludes the registration of short, short-term IAP fluctuations that do not have absolutely no clinical significance.

British researcher in 1996 developed clinical classification YAG, which, after minor changes, is now presented in the following form:

I degree 12 - 15 mm Hg;
II degree 16-20 mm Hg;
III degree 21-25 mm Hg;
IV degree more than 25 mm Hg.

Note that an intra-abdominal pressure of 26 or more clearly leads to respiratory, cardiovascular, and renal failure.

Treatment

The course of necessary therapeutic measures will be determined by the etiology of intra-abdominal hypertension, in other words, an effective decrease in the numbers of increased IAP is possible only by eliminating its origin, because the condition in question is nothing more than a symptom complex provoked by a pathology of a primary nature. Accordingly, an individually selected treatment regimen can be implemented conservative methods(reception, diet, physiotherapeutic procedures), and radical (surgical intervention).

Timely initiated therapy may well stop the development of the disease for initial stage and thanks to this, it will quickly enough allow to normalize the work of internal organs.

If the intra-abdominal pressure indicators exceed 25 mm. rt. Art., then the operation is performed in an urgent manner according to the methods of abdominal surgery.

The doctor may prescribe medications from such pharmaceutical groups:

sedatives;
muscle relaxants;
vitamin and mineral complexes.

The appointment of physiotherapy procedures will help to cope with the problem, it is carried out with the following goals:

to normalize the water and electrolyte balance;
stimulation of diuresis;
installation of a drain pipe or therapeutic enema.

The diet is selected in each case individually. However, any diet in this situation will be united by the following principles:

absolute exclusion from the diet of all those products that lead to flatulence and increased gas formation;
fractional and frequent meals- in small portions of food and with a time interval of its consumption of 2-3 hours;
balanced, normal fluid intake per day;
the optimal consistency of the food consumed - it should be liquid or puree, in order to stimulate the bowels.

Taking into account the fact that in some cases an increase in intra-abdominal pressure occurs due to alimentary obesity, the need to reduce the calorie content of the selected diet is obvious.

In addition, the ongoing complex medical measures correlates with the above classification - respectively, when various degrees pathology manifest apply different methods treatment:

Dynamic monitoring by a specialized doctor and ongoing infusion therapy.
Observation and therapy, if an abdominal compartment syndrome is detected, a decompression laparotomy is prescribed to the patient.
Continued treatment.
Carrying out vital resuscitation(in which the dissection of the anterior wall of the abdomen is performed).

Special attention deserves physiotherapy and exercise therapy, without which you will never be able to get what you want. clinical effect. IN complex treatment one of the most effective means is remedial gymnastics. The whole point is that physical exercise, acting on the body indirectly, through vegetative nerve centers, have a pronounced regulatory, healing action on motor, secretory, absorptive and excretory function organs of the gastrointestinal tract, as well as counteract emerging congestion in the abdominal cavity. But it is precisely these phenomena, like no other, that contribute to a significant violation nervous regulation and intra-abdominal pressure, which serves both as a physiological regulator of blood circulation occurring in the abdominal cavity, and as a regulator of the motor activity of the intestines and biliary tract.

Therapeutic exercises, the action of which is aimed at normalizing the indicators of abdominal pressure, should be started immediately after the cessation of the pronounced pain syndrome without waiting until the exacerbation of the disease has passed.

During the period of clinical exacerbation of these pathologies therapeutic gymnastics it is necessary to perform lying on your back, using simple exercises for the arms, legs, torso, while sparing diseased organs as much as possible (complex No. 8), paying considerable attention to breathing, especially diaphragmatic.

Bodybuilding with increased intra-abdominal pressure is categorically contraindicated. Harm from it can lead to the so-called visceral protrusion, otherwise referred to as a hernia, in which the contents of the hernial sac seem to fall through the muscle wall into an artificially formed hole, the walls of which are the fascia of the muscles. And the only possible method treatment will be laparoscopy followed by surgery.

Decrease possible harm From physical exertion and sports (especially in a child), the use of a special bondage (corset) will help, thanks to which it will be possible to reduce compression of the abdominal cavity.

Please note that doing abdominal exercises leads to an increase in intra-abdominal pressure. Anatomy Features human body are such that the YAG through esophageal opening in the diaphragm will break the negative pressure chest cavity, which will form the basis of the pathogenesis of already widespread thoracic disorders.

Exercises that increase intra-abdominal pressure

Below is a list of exercises that, on the contrary, will lead to an increase in intra-abdominal pressure, respectively, their implementation is impossible in people suffering from the symptom in question:

Raising the legs (both only the body and the simultaneous lifting of the body and legs) from a prone position.
Power twisting, carried out in a prone position.
Deep side bends.
Power balances performed on the hands.
Push ups.
Making deep bends.
Squats and deadlifts performed with large weights (more than 10 kg).

INTRA-ABDOMINAL PRESSURE, V various places abdominal cavity in each this moment It has various meanings. The abdominal cavity is a hermetically sealed bag filled with liquid and organs of a semi-liquid consistency, partly containing gases. This content exerts hydrostatic pressure on the bottom and on the walls of the abdominal cavity. Therefore, in the usual vertical position, the pressure is highest value below, in the hypogastric region: according to the latest measurements of Nakasone (Nakasone), in rabbits +4.9 cm water column. In the upward direction, the pressure decreases; slightly above the navel becomes 0, i.e. atmospheric pressure; even higher, in the epigastric region, it becomes negative (-0.6 cm). If you put the animal in vertical position head down, then the relationship is perverted: an area with greatest pressure becomes the epigastric region, with the smallest hypogastric. At the person it is impossible to measure V. d. directly; it is necessary, instead of him, to measure the pressure in the rectum, bladder or stomach, where for this purpose a special probe is inserted, connected to a manometer. However, the pressure in these organs does not correspond to V. d., since their walls have their own tension, which changes the pressure. Herman (Hormann) found at standing people pressure in the rectum from 16 to 34 cm water; in the knee-elbow position, the pressure in the intestine sometimes becomes negative, up to -12 cm water. The factors that change V. in terms of its increase are 1) an increase in the contents of the abdominal cavity and 2) a decrease in its volume. In the first sense, there are fluid accumulations in ascites and gases in flatulence, in the second, diaphragm movements and abdominal tension. With diaphragmatic breathing, the diaphragm protrudes into the abdominal cavity with each breath; true, while the front abdominal wall is fed forward, but since its passive voltage increases at the same time, as a result, V. d. becomes larger. With a quiet breath, V. d. has respiratory fluctuations within 2-3 cm water column. A much greater influence on V. d. is exerted by the tension of the abdominal press. When straining, you can get pressure in the rectum up to 200-300 cm water column. Such an increase in V. d. is observed with difficult defecation, during childbirth, with "sipping", when blood is squeezed out of the veins of the abdominal cavity, as well as during the lifting of large weights, which can cause the formation of hernias, and in women, displacements and prolapse uterus. Lit.: O k u n e v a I. I., SteinbakhV. E. And Shcheglova L.N., Experience in studying the effect of lifting and transferring burdens on a woman's body, Occupational Health, 1927, № AND; Hormann K., Die intraabdominellen Druckverhaltnisse. Arcniv f. Gynakologie, B. LXXV, H. 3, 1905; Propping K., Bedeu-tung des intraabdominellen Druckes fur die Behandlung d. Peritonitis, Arcniv fur klinische Chirurgie, B. XCII, 1910; Rohrer F. u. N a k a s o n e K., Physiologie der Atembewegung (Handbuch der normalen u. patho-logischen Physiologie, hrsg. v. Bethe A., G. v. Berg-mann u. anderen, B. II, B., 1925). H. Vereshchagin.

See also:

INTRA-ADOMINAL ATTACHMENTS, see Peritonitis.
INTRAOCULAR PRESSURE, voltage state eyeball, a cut is felt when touching the eye and a cut is an expression of pressure exerted intraocular fluids on the dense elastic wall of the eyeball. This state of eye strain allows...
INTRASKINAL REACTION, or and n-trakutannaya (from lat. intra-inside and cutis-skin), along with dermal, subcutaneous and conjunctival, is used with a trace. purpose: 1) to detect allergic condition, i.e. hypersensitivity to a certain...
INTRACARDIAC PRESSURE, measured in animals: unopened chest using a heart tube (Chaveau and Mageu) inserted through the cervical blood vessel into one or another cavity of the heart (except for the left atrium, which ...
INTERNAL DEATH, occurs or due to detachment gestational sac from the wall of the uterus in one direction or another, "or on the soil infectious process that affects a pregnant woman. In the first case, the cause of death...

If a proctologist diagnosed hemorrhoids, this does not mean that you have to leave the sport. However, the disease imposes a number of restrictions:

Reduce your working weight by half. To maintain shape, it is recommended to increase the number of repetitions in the approach to 15-20 or more times;
By doing basic exercises load on the body is maximum. This is due to the use of large weights and the need to observe correct technique. Reduce the number of basic exercises by replacing them with auxiliary isolated ones;
The deadlift and squat affect the increase in intra-abdominal pressure the most. During the period of treatment, refuse to perform them;
Breathe correctly during training, exhale for effort, inhale for relaxation. With measured breathing, you can reduce the load on the veins.

Exercises that normalize intra-abdominal pressure

Hang on the horizontal bar. As you exhale, raise your straight legs to the crossbar. Hold for a second and slowly lower your legs. Perform 10-15 times. In addition to normalization intravenous pressure this exercise helps to load the lower press well;
Lean forward, legs bent, hands resting on hips, head down, shoulders relaxed. Inhale, exhale, inhale and hold your breath for 30 seconds. Exhale, relax and rise smoothly, straightening your back.

Conclusion

Not fatal, but very unpleasant disease. To prevent its formation, follow the above recommendations. Remember what's best the best treatment- prevention.