Internal Bleeding (cont.)
What causes internal bleeding?
Bleeding most often occurs due to injury, and depending upon the
circumstances, the amount of force required to cause bleeding can be quite
variable.
Blunt trauma
Most people understand that falling from a height or being involved in a car
accident can inflict great force and trauma upon the body.
If blunt force is involved, the outside of the body may not necessarily be
damaged, but enough compression may occur to internal organs to cause injury and bleeding.
- Imagine a football player being speared by a helmet to the abdomen. The
spleen or
liver may be compressed
by the force and cause bleeding inside the organ. If the hit is hard enough, the
capsule or lining of the organ can be
torn, and the bleeding can spill into the
peritoneum (the space
in the abdominal
cavity that contains abdominal organs such as the intestines, liver, and spleen).
- If the injury occurs in the area of the back or flank,
where the kidney is
located, retroperitoneal bleeding (retro=behind; behind the
abdominal cavity)
may occur.
- The same mechanism causes bleeding due to crush
injuries. For example, when a weight falls on a foot, the weight doesn't give,
nor does the ground. The force needs to be absorbed by either the bone or the
muscles of the foot. This can cause the bone to break and/or the muscle fibers
to tear and bleed.
- Other structures are compressible and may cause
internal bleeding. For example, the eye can be compressed in the orbit when it is hit by a fist or a
ball. The globe deforms and springs back to its original shape. Intraorbital
hemorrhage may occur.
Deceleration trauma
Deceleration may cause organs in the body to be shifted inside the body. This
may shear blood vessels away from the organ and cause bleeding to occur. This is
often the mechanism for intracranial bleeding
such as epidural or
subdural hematomas.
Force applied to the head causes an acceleration/deceleration injury to the
brain, causing the brain to "bounce around" inside the skull. This can
tear some of the small veins on the surface of the brain and cause bleeding.
Since the brain is encased in the skull, which is a solid structure, even a small
amount of blood can increase pressure inside the skull and decrease brain
function.
Fractures
Bleeding may occur with broken bones. Bones contain the bone marrow in which
blood production occurs. They have rich blood supplies, and significant amounts
of blood can be lost with fractures. The break of a long bone such as the femur (thigh bone) can
result in the loss of one unit (350-500cc) of blood. Flat bones such as the pelvis
require much more force to cause a fracture, and many blood
vessels that surround the structure can be torn by the trauma and cause massive
bleeding.
Pregnancy
Bleeding in pregnancy is never normal, though not
uncommon in the first trimester, and is a sign of a potential miscarriage. Early
on, the concern is a potential ectopic or tubal pregnancy, in which the placenta and the fetus
implant in the Fallopian tube or another location outside of the uterine cavity.
As the placenta grows, it erodes through the tube or other involved organs and
may cause fatal bleeding.
Bleeding after 20 weeks of pregnancy may be due to
placenta previa or placental abruption, and urgent medical care should be accessed. Placenta previa
describes the situation in which the placenta attaches to the uterus close to
the opening of the cervix and may cause
painless vaginal bleeding. Abruption occurs when the placenta partially
separates from the uterine wall and causes significant pain with or without bleeding from the vagina.
Spontaneous bleeding
Internal bleeding may occur spontaneously, especially in
those people who take anticoagulation medications or who have inherited bleeding
disorders. Routine bumps that occur in daily life may cause significant bleeding issues.
Medication
Internal bleeding may be caused as a side effect of
medications (most often from nonsteroidal antiinflammatory drugs
such as ibuprofen and aspirin) and alcohol. These substances can cause inflammation and bleeding of the esophagus,
stomach, and duodenum, the first part of the small intestine as it leaves the
stomach.
Alcohol abuse
Long-term alcohol abuse can also cause liver damage, which can cause
bleeding problems through a variety of mechanisms.
Next: What are the signs and symptoms of internal bleeding? »
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