Internal Bleeding
Overview:
Blood is meant to be circulated by the heart through blood vessels to supply the body's organs with oxygen and nutrients. These blood vessels include arteries, veins, and capillaries. When the integrity of the blood vessel wall is damaged, there is a clotting mechanism in place to repair the damage and minimize the amount of blood that leaves the injured blood vessel.
The symptoms of internal bleeding vary depending upon what part of the body is involved or what organ system is damaged. Symptoms may be dramatic, arise gradually, or the patient may have no initial complaints. For example, a patient may complain of total loss of vision in an eye if bleeding occurred within the globe; or a patient with a ruptured abdominal aortic aneurysm may be unconscious, in shock with no blood pressure, and a feeble pulse; occasionally small subdural hematomas are found in people getting a CT scan for other reasons and have no symptoms at all.
Some internal bleeding may cause significant pain and then gradually resolve spontaneously. For example, an ovarian cyst rupture is quite common and causes some blood to leak into the peritoneal cavity (the space that contains the abdominal organs). Blood outside of blood vessels can be very irritating and the patient may complain of acute onset of pain. However, the treatment for most ruptured cysts is time and symptom control until the body absorbs the blood and the inflammation resolves.
The amount of bleeding and the location are associated with the presentation and outcome. A small amount of blood (1 or 2 ounces) in the skull can cause significant loss of brain function due to an increased build up of pressure, since it is like a solid box and doesn't have the ability to expand to accommodate extra volume. Should that same small amount of blood accumulate quickly in the pericardium (the sac that surrounds the heart) it might prevent the heart from adequately beating but should the internal bleeding take days or weeks to accumulate, the heart could adjust and continue to function.
When the internal bleeding begins to form a clot, it may be termed a hematoma.
From: http://krackod.wix.com/bleeding-and-wounds#!internal-bleeding
Causes of Internal Bleeding:
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Damage to the blood vessels occurs due to trauma. The amount of internal bleeding that occurs depends upon the severity of the force applied, the blood vessel that is injured, and the condition of the patient prior to injury.
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Blood vessel walls may be weakened because of chronic high blood pressure, which can cause them to dilate and form aneurysms that are at higher risk of bleeding because of weak vessel walls. However some aneurysms may also be congenital (present from birth). Regardless, the aneurysms are at risk for leaking or rupturing, and depending upon their location, may have devastating consequences. For example, an aneurysm of a cerebral artery (those that supply blood to the brain) may bleed and cause ahemorrhagic stroke; while a patient may bleed to death due to an aortic aneurysm that ruptures, causing severe internal bleeding into the abdominal cavity.
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Orthopedic injuries almost always cause internal bleeding. Bone marrow is where blood cell production takes place and it has a generous blood supply for this to occur. When a bone breaks, significant bleeding may be expected.
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Compression injuries occur when an external force is applied to the body and an organ is compressed between two hard surfaces. For example, if a football player is tackled, the force of the tackle may compress the spleen between the ribs and the backbone enough to make it rupture and bleed. Or imagine a weight falling on a foot compressing the tissues and the bones of the foot between the weight and the ground; there is potential for bleeding because blood vessels have ruptured.
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Deceleration injuries occur when the moving body is stopped very quickly. If a person hits their head in a fall, the brain may fall for a fraction of a second longer than the skull that initially hits the ground. This can cause the arteries that run on the surface of the brain to tear and bleed forming epidural or subdural hematomas. Some individuals have inherited bleeding disorders that cause spontaneous bleeding. Minimal trauma or even no apparent injury can cause internal bleeding. The most common bleeding disorders are Von Willebrand's disease and hemophilia.
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Clotting factors are manufactured in the liver and any damage to the liver will increase bleeding risk. While viral infections may cause hepatitis leading to liver failure, alcohol abuse is the most common reason for the liver to fail. Aside from the lack of clotting factors in the blood, liver failure or cirrhosis can also cause blood to flow abnormally in the liver or portal system, which leads to the formation of swollen veins in the esophagus and other parts of the body. Called varices, these veins have the tendency to aggressively bleed.
Symptoms of Internal Bleeding:
The symptoms of internal bleeding depend upon the circumstances. Sometimes it is the location of the bleeding and not the amount that makes the difference. Sometimes it is the amount of blood that is lost and sometimes it is a combination of the two. Here are some common symptoms:
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Shock. The signs and symptoms of shock may include rapid heartbeat, low blood pressure, cool and sweaty skin, and decrease mental function or confusion.
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Orthostatic hypotension (becoming dizzy when attempting to stand) can occur in patients with internal bleeding.
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Bleeding usually causes pain in the area of the body affected. Blood that leaks outside of a blood vessel is very irritating and causes an inflammatory response.
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Blood that irritates the diaphragm (the muscle that separates the chest from the abdomen) may cause pain in the chest or pain that radiates to the shoulder.
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Blood may eventually track towards the surface of the skin and can be seen as bruising. Bruising of the flank (Grey-Turner's sign) or around the umbilicus (Cullen's sign) indicate intra-abdominal bleeding.
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Bleeding in the brain is usually associated with decreased mental function which may include vomiting, lethargy, coma, seizure.
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Signs and symptoms of bleeding in the eye are decreased or hazy vision, floating objects in the vision, or blindness.
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Some bony joints have little room and bleeding can cause immediate and significant pain.
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Bleeding from the kidney or bladder may be recognized from blood in the urine.
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Black tarry stools may indicate bleeding in the stomach or small intestine.
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Bleeding from an orthopedic injury, usually of the forearm or shin, may cause gradual increase of the pressure within the muscle compartments causing blood supply to the affected area to be compromised. This can lead to intense pain, tingling, numbness, and decreased motion.
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Blood from a body orifice (mouth, nose, ears, anus, vagina, or urethra) may be a symptom of internal bleeding.
Unfortunately, most of the symptoms of internal bleeding can occur with other medical problems and frequently it takes a doctor to order medical tests to determine the cause of the symptoms listed above.
From: http://www.internalbleedingsymptoms.net/treatment-for-internal-bleeding/
Treatment of Internal Bleeding
Specific treatment for internal bleeding depends upon the source of the bleeding. The common goal for treatment is to find the source of bleeding and stop it. At the same time, treatment will be directed to repair or stabilize any damage that the bleeding caused. Once the acute situation has resolved, treatment will try to correct the underlying cause of bleeding to prevent future episodes.
Surgery is reserved for those patients with internal bleeding where the bleeding cannot be controlled by less aggressive treatment or where the bleeding is causing damage because of its location.
(Wedro & Davis, 2014)
