Internal bleeding - Causes, Symptoms, Diagnosis and Treatment

Internal bleeding - A condition in which blood flows out into a natural cavity or body (stomach, bladder, uterus, lungs, and other joint cavity.) Or in a space formed artificially extravasated blood (retroperitoneal, intermuscular, etc). It may develop as a result of injury or chronic disease. Symptoms of internal bleeding depends on its location and extent of bleeding. Most often they are of a general nature Dizziness, weakness, drowsiness, loss of consciousness, etc. Due to the absence of characteristic signs of internal bleeding is much harder to diagnose. In a significant number of cases represent a direct threat to the life of the patient.

  • Classification
  • Reasons
  • Symptoms
  • Diagnosis
  • First Aid
  • Specialized medical care
  • Internal bleeding - treatment

  • Internal bleeding


    bleeding - loss of blood in which the blood does not expire outward and into one of the cavities of the human body. The cause may be trauma or chronic disease. The massive nature of the blood loss, late referral of patients for help and diagnostic difficulties in detecting this disease increase the seriousness of the problem and internal bleeding turn into a serious threat to the lives of patients.

    damage to blood vessels in case of injuries) and arrosive (due to damage to the vascular wall necrosis, germination and decay of tumors or destructive process). In addition, isolated diapedetic bleeding resulting from the increased permeability of the walls of small blood vessels (eg, in scurvy, or sepsis).

    Given the volume of blood loss: light (up to 500 ml or 10-15% of the circulating blood volume), medium (500-1000 mL or 16-20% BCC), heavy (1000-1500 ml or 21-30% BCC), massive (more than 1500 mL or more than 30% bCC), lethal (more than 2500-3000 ml or more than 50-60% bCC), an absolutely lethal (more than 3000-3500 ml or more than 60% bCC).

    Given the nature of the damaged vessel: arterial, venous, capillary and mixed (for example, a vein or artery and vein of capillaries). When blood flows from the capillary of a parenchymal organ (liver, spleen, etc.), it is called parenchymatous bleeding.

    In view of localization: gastrointestinal (in the cavity of the esophagus, stomach or intestine), in the pleural cavity (hemothorax), in the pericardial sac (hemopericardium) into the joint cavity and so forth.

    Given space streamed blood congestion: abdominal (pleural, peritoneal, etc. of the cavity) and interstitial (the thickness in the impregnation of fabrics).

    Given the apparent presence or absence of signs of bleeding: explicit, in which the blood, even after some time and in a modified form, "out" through natural openings (eg, painting a chair in black), and hidden, in which it remains in the body cavity.

    Given the time of occurrence: primary, arising immediately after traumatic damage to the vascular wall, and secondary, developing a short time after the injury. In turn secondary bleeding divided into early (1-5 days develops due to slippage or ligature ejection thrombus) and late (usually occur at 10-15 days of purulent fusion thrombus, necrosis of the vessel wall, etc.) .

    bleeding into the abdominal cavity may occur as a result of blunt trauma to the abdomen with damage to the spleen and liver, at least - of the pancreas, intestine or mesentery (impact, fall from height, car accident, etc.).

    Bleeding into the pleural cavity usually occurs with multiple fractures of the ribs and damage to the intercostal vessels and pleura. In rare cases, the cause fractures are 1-2 ribs.

    The bleeding in the cranial cavity is one of the most dangerous complications of traumatic brain injury. Since the skull, in contrast to other natural cavities, it is rigidly fixed volume, even a small amount of blood streamed causes compression of brain structures and poses a threat to the life of the patient. Note that the intracranial hemorrhage may develop not only immediately after the injury, but after a few hours or even days, sometimes - on a background of complete well-being.

    Bleeding into the joint cavity it can be caused by intra-articular fractures, and injury. The immediate danger to life is not, but it can cause serious complications if left untreated.

    A significant proportion of the total number of internal bleeding up bleeding into the cavity of an organ developing as a result of chronic diseases of the gastrointestinal tract: malignant tumors, ulcers of the stomach and intestines, erosive gastritis, esophageal varices in cirrhosis of the liver, etc. In the surgical practice also often found Mallory-Weiss syndrome - fractures of the esophagus due to alcohol abuse or a single heavy meal.

    Another gynecological disease is a common cause of internal bleeding:. Ruptures ovarian ectopic pregnancy, etc. In gynecological practice, there are internal bleeding after abortion. There are also internal bleeding previa or premature detachment of the placenta, postpartum hemorrhage with retained placenta exit ruptures of the uterus and birth canal.

    drowsiness, paleness of the skin and mucous membranes, dizziness, cold sweat, thirst, blackout. Possible fainting. On bleeding intensity can be judged as to change the heart rate and blood pressure and other clinical signs.

    At a small hemorrhage there is a slight increased heart rate (80 beats /min) and a slight decrease in blood pressure, in some cases, clinical signs may not be present.

    The internal bleeding moderate severity. It shows a drop in systolic blood pressure to 90-80 mm. Hg. Art. and increased heart rate (tachycardia) to 90-100 beats /min. The skin is pale, cold extremities and noted a slight shortness of breath. Possible dry mouth, fainting, dizziness, nausea, weakness, severe fatigue, slow reaction.

    In severe cases a decrease in systolic blood pressure to 80 mm. Hg. Art. and below, increased heart rate up to 110 or more beats /min. Noted a strong increase in frequency and respiratory failure rate, clammy cold sweat, yawning, pathological sleepiness, tremor, darkening of the eyes, apathy, lethargy, nausea and vomiting, decrease in the amount of urine, painful thirst, blackout, severe pallor of the skin and mucous membranes, cyanotic extremities, lips and nasolabial triangle.

    With massive internal bleeding the pressure reduced to 60 mm Hg. Art., says increased heart rate to 140-160 beats /min. Characterized by recurrent breathing (Cheyne-Stokes), the absence of or confusion, delirium, severe pallor, sometimes - a bluish-gray tint, cold sweat. A look indifferent, his eyes sunken, his features sharpened.

    When a fatal hemorrhage develops coma. Systolic pressure is reduced to 60 mm Hg. Art. or not is determined. Agonal breath, severe bradycardia with heart rate 2-10 beats /min., Convulsions, dilated pupils, involuntary release of feces and urine. The skin is cold, dry, "marble." In the future, the agony and death occurs.

    Nausea and vomiting of dark blood ( "coffee grounds") indicate the flow of blood into the lumen of the stomach or esophagus. Tarry stools may occur with internal bleeding in the upper digestive tract or small intestine. Isolation of intact red blood from the anus indicates hemorrhoids or bleeding from the lower large intestine. If blood comes into the abdominal cavity revealed blunting of sound in shallow locations on percussion and symptoms of peritoneal irritation on palpation.

    In pulmonary hemorrhage occurs cough with frothy blood, bright, with accumulation of blood in the pleural cavity - severe shortness of breath, difficulty breathing, shortness of breath. Expiration of the blood of the female genital organs indicates bleeding in the uterus, at least - of the vagina. When bleeding in the kidneys or urinary tract hematuria observed.

    However, a number of symptoms may not occur or be weakly expressed, in particular - at low or moderate severity internal bleeding. This makes it difficult to diagnose and sometimes becomes the reason that patients go to doctors already in the late stages, with a significant deterioration due to significant blood loss.

    hematocrit, and hemoglobin amount of red blood cells.

    Selection of special methods of investigation is carried out taking into account the suspected cause of internal bleeding: in diseases of the gastrointestinal tract may be performed digital examination of the rectum, nasogastric intubation, esophagogastroduodenoscopy, colonoscopy and sigmoidoscopy, with lung diseases - bronchoscopy, with the defeat of the bladder - cystoscopy. In addition, used X-ray, ultrasound and radiological techniques.

    Diagnosis of hidden internal bleeding in which the blood flows into the closed cavity (abdominal, thoracic, cranial cavity, pericardium, and so on. D.), Also made with regard to the intended source of blood loss.

    The disappearance of the lower contour of the lung on chest radiograph and darkening in the lower divisions with clear horizontal boundary indicates hemothorax. In doubtful cases, X-ray is performed.

    If you suspect a bleeding into the abdominal cavity laparoscopy is performed under suspicion of intracranial hematoma - X-ray of the skull and echoencephalography.

    trauma, nontraumatic hemothorax and pulmonary hemorrhage - thoracic surgery, intracranial hematomas - neurosurgeons, uterine bleeding - gynecologists. In blunt abdominal trauma and gastrointestinal bleeding is carried hospitalization in the department of general surgery.

    The main problem in this case - an urgent stop internal bleeding, blood loss compensation and improvement of microcirculation. From the outset of treatment for preventing empty heart syndrome (cardiac reflex due to reduced volume a bcc) recovery in circulating fluid and preventing hypovolemic shock produced jetting transfusion 5% glucose solution, saline, blood, and plasma-substitutes.

    Sometimes stop internal bleeding produced by cauterization or tamponade of the bleeding site. However, in most cases required emergency surgery under general anesthesia. If there are signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation for surgery, surgery, post-surgery) performed transfusion events.

    In pulmonary hemorrhage produced bronchial tamponade. In medium and small hemothorax pleural puncture is performed, when a large hemothorax - thoracotomy wound suturing lung or vascular ligation, the loss of blood in the abdominal cavity - Emergency laparotomy with suturing wounds liver, spleen, or other damaged organ, intracranial hematoma - craniotomy.

    Gastric ulcer is produced gastrectomy, duodenal ulcer - suturing of the vessel in conjunction with vagotomy. When Mallory Weiss syndrome (esophageal bleeding from the cracks) performed endoscopic bleeding stop in conjunction with the cold, the appointment of antacids, aminocaproic acid and blood clotting stimulants. If conservative treatment is ineffective, surgery is shown (flashing cracks).

    Internal bleeding due to an ectopic pregnancy is an indication for emergency surgery. In dysfunctional uterine bleeding produce tamponade of the uterus, with massive bleeding as a result of abortion, birth trauma and postpartum perform surgery.

    Infusion therapy is carried out under the control of blood pressure, cardiac output, central venous pressure and hourly urine output. The volume of infusion is determined by taking into account the severity of blood loss. Apply blood substitutes hemodynamic actions: polyglukin, reopoligljukin, zhelatinol, infuktol, stabizol, Refortan, salt solutions (laktosol, sol Ringer's saline.), And sugars (glyukosteril, glucose) and blood products (albumin, fresh frozen plasma, packed red blood cells ).

    If blood pressure can not be normalized, despite ongoing infusion therapy, administered to stop bleeding after dopamine, norepinephrine or epinephrine. For the treatment of hemorrhagic shock used trental, chimes, heparin and steroids. After removal of threats to the life of the correction of acid-base balance.