Pathophysiology of coagulopathy and acidosis in prolonged abdominal surgery! - USMLE Forums
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Old 09-01-2011
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Surgery Pathophysiology of coagulopathy and acidosis in prolonged abdominal surgery!

Why is there development of coagulopathy, acidosis in prolonged abdominal surgery for multiple trauma with multiple transfusion ? what is the pathophysiology behind it ?
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The major contibuting factors are Severe bleeding, hypotension, hypothermia, hypo perfusion and lactic acidois. Consumption of clotting factors in clot formation and administration of large quantities of initial resuscitation fluids further complicates coagulopathy by diluting the clotting factors.
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Old 09-01-2011
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Usually in multiple trauma setting esp to abdomen (because of large volume loss), there is an inevitable need of tranfusion of PRBCs, Platelets and other components of blood, other than IV fluids alone. Hence, in such situations there are chances of coagulopathy (Unavoidable at times) - because of transfusion and hypothermia. So, if it happens, stop the surgery; pack it and wrap it up and shift the pt to SICU and after a day or 2, when the temperature and platelet parameters are back to normal, bring the patient to OR for the procedure!
Lactic acidosis happens because multiple trauma also causes muscle strain and injury!

Hope I answered your question!
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