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Ventricular Peritoneal Shunts

Ventricular Peritoneal Shunts is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Ventricular peritoneal (VP) shunts are usually placed for hydrocephalus:
    • Conduit between CSF and peritoneal cavity (or right atrium)
  • Obstruction: Shunt malfunction impairs drainage of CSF:
    • Increases intracranial pressure (ICP)
    • Rate of increase in ICP determines severity
    • 30–40% mechanical malfunction rate in 1st year
  • Overdrainage syndrome:
    • Upright posture increases CSF outflow
    • Decreases ICP
    • Produces postural headache and nausea (as after lumbar puncture)
  • Infection:
    • Shunt is a foreign body
    • Staphylococcus epidermidis and other Staphylococcus species in 75% of infections
    • Gram-negative organisms also implicated
    • Multidrug-resistant Staphylococcus aureus (MRSA) has been reported
    • Most occur soon after placement
    • Shunt removal usually required
  • Slit ventricle syndrome:
    • Prolonged overdrainage causes decreased ventricular size
    • Intermittent increases in ICP occur owing to proximal obstruction

Pediatric Considerations
  • Complications more common in children, especially neonates
  • If cranial sutures are open, CSF may accumulate without much ICP increase
  • Produces relatively nonspecific signs and symptoms:
    • Drowsy
    • Headache
    • Nausea and Vomiting

Etiology

  • Shunt may be needed to treat increased ICP due to:
    • Congenital malformations
    • Idiopathic intracranial hypertension (pseudotumor cerebri)
    • Post CVA
    • Tumor or other mass lesions
    • Post head trauma
    • Subarachnoid hemorrhage
    • Scarring at base of brain after bacterial meningitis

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Citation

Rosen, Peter, et al., editors. "Ventricular Peritoneal Shunts." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts.
Ventricular Peritoneal Shunts. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts. Accessed April 26, 2019.
Ventricular Peritoneal Shunts. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts
Ventricular Peritoneal Shunts [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ventricular Peritoneal Shunts ID - 307464 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -