Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What does a bruise look like, and why does it
change color?
Bruises change
in appearance over time, and it is possible to tell by looking at a bruise how
old it is. When it first appears, a bruise will be reddish looking, reflecting
the color of the blood in the skin. By one to two days, the reddish iron from the blood
undergoes a change and the bruise will appear blue or purple.
By day six, the color changes to green and by day eight to nine, the bruise
will appear yellowish-brown. In general, the bruised area will
be repaired by the body in two to three weeks after which the skin will
return to normal.
What if the bruise doesn't get
better or the area stays swollen?
On occasion, instead of going away, the area of a bruise
will become firm and may actually start increasing in size. It may also continue
to be painful. There are two major causes for this. First, if a large collection
of blood is formed under the skin or in the muscle, instead of trying to clean up the area,
the body may wall the blood off causing what is called a hematoma. A hematoma is
nothing more than a small pool of blood that is walled off. This may need to be
drained by your health-care
practitioner.
A second and much less common problem occurs when the
body deposits calcium, the material that makes up the majority of bone, in the
area of injury. The area becomes tender and firm. This process is called
heterotopic ossification or myositis
ossificans.
This condition is diagnosed by x-ray and requires a
trip to your
health-care practitioner.
What are some less common causes
of bruising, and what do they indicate?
The terminology describing different types of bruising
often refers to not only their appearance but also to their cause.
Petechiae refer to very
small, 1- to 3-millimeter accumulations of blood beneath the skin. These
can appear like multiple tiny red dots on any part of the body (most commonly
the legs). Most often these are multiple, and they can suggest that there is
serious health problem present. Examples of these are an infection of
the valves of the heart (endocarditis) or
abnormal function of the blood-clotting elements (platelets). Bruising around
the navel (belly button) can be a result of bleeding within the abdomen.
Bruising behind the ear (Battle's sign) can indicate that there is a skull fracture. Lastly, bruises that are raised, firm, multiple,
and occur without any injury can be a sign of various types of
"autoimmune" diseases (diseases in which the body attacks
its own blood vessels). Each of these should be evaluated by a health-care practitioner.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Foot pain may be caused by injuries (sprains, strains, bruises, and fractures), diseases (diabetes, Hansen disease, and gout), viruses, fungi, and bacteria (plantar warts and athlete's foot), or even ingrown toenails. Pain and tenderness may be accompanied by joint looseness, swelling, weakness, discoloration, and loss of function. Minor foot pain can usually be treated with rest, ice, compression, and elevation and OTC medications such as acetaminophen and ibuprofen. Severe pain should be treated by a medical professional.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
A broken toe is one of the most common fractures among individuals. There are many causes of a broken toe, whether it is the big toe, middle toes, or little toe (pinky). Common symptoms of a broken toe include pain, swelling, stiffness, and bruising. A broken toe can be treated with buddy taping the toe. There are instances where a physician should be consulted for a broken toe.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Cuts, scrapes, and puncture wounds are common, and most people will experience one of these in their lifetime. Evaluating the injury, and thoroughly cleaning the injury is important. Some injuries should be evaluated by a doctor, and a tetanus shot may be necessary. Treatment will depend upon the severity of the injury.
There are two categories to cold weather-related injuries. 1) no freezing of body tissue (trench foot and chilblains), and 2) freezing of body tissues (frostbite). Chilblains in general, will not need medical attention (unless there is infection). Trench foot and frostbite, however, require medical attention. Symptoms of frostbite include pain, burning, numbness, and eventually a complete loss of sensation in the affected body part. The young, elderly, and patients with certain medical conditions (diabetes, hypothyroidism, circulatory problems, and psychiatric illnesses), are more susceptible to cold weather-related injuries. People who abuse alcohol and illicit drug user are also at risk for cold weather-related injuries.
Shaken baby syndrome is a form of child abuse in which violent shaking of an infant causes the brain to move inside the skull, causing bruising of the brain and tearing of blood vessels. The shaking results in bleeding around the brain, bleeding in the eyes, spinal cord and neck injuries, bruises, and rib fractures. Infants who survive may suffer brain damage and blindness.
Compartment syndrome is a condition in which swelling and an increase in pressure within a limited space presses and compresses blood vessels, nerves, or tendons that run through the compartment. There are two types of compartment syndrome, acute compartment syndrome is treated with surgery (fasciotomy) and chronic compartment syndrome, which is treated with rest and modality to the affected limb. Symptoms of compartment syndrome include pain, change in sensation, change in color, paralysis, or numbness in the affected limb.
The most common cause of a black eye is due to an injury to the face or head. Most black eye injuries are minor and heal on their own, however, some may lead to significant injury. In addition to trauma to the face, cosmetic surgery can cause a black eye(s) as a side effect. People should be aware of the situations in which medical care should be sought immediately for a black eye.
Idiopathic means that the cause of the condition isn't known. Thrombocytopenic means there's a lower than normal number of platelets in the blood. Purpura refers to purple bruises caused by bleeding under the skin. Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets.
Yellow fever is an infectious disease transmitted by infected mosquitoes. Side effects are rare with the yellow fever vaccine. Symptoms include fever, chills, back pain, nausea, vomiting, and headache. Treatment is aimed at relieving symptoms.
Bernard-Soulier disease is a rare inherited bleeding disorder caused by a defect in the platelet glycoprotein complex 1b-IX-V. Symptoms and signs include bruising, nosebleeds, gum bleeding, and problems with anything that induces bleeding, such as surgery, ulcers, trauma, and menstruation. Treatment involves avoiding medications that interfere with clot formation, such as naproxen, ibuprofen, and aspirin. People with Bernard-Soulier syndrome should avoid contact sports.
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