Internal Bleeding (cont.)
What are the signs and symptoms of internal bleeding?
The symptoms of internal bleeding depend upon where the
bleeding is located, how much bleeding has occurred, and what structures and
functions in the body are affected. Blood outside the circulatory system (the heart and blood vessels) is
very irritating to tissues, causing inflammation and pain. Examples of some
internal bleeding situations are listed below.
Intracranial bleeding from trauma or from a leaking
aneurysm often causes
pain but may also present with altered mental function. Neurological exam
results range from a near-normal exam to confusion to coma. Symptoms of stroke,
including weakness, slurred speech, and loss of vision, may also be associated
with intracerebral bleeding. The signs and symptoms depend upon where and how
much blood there is in the brain. If the bleeding continues, symptoms become
progressive and easier to recognize.
Intra-abdominal bleeding may be hidden and present only
with pain, but if there is enough blood loss, the patient may complain of
weakness, lightheadedness, shortness of breath, and other symptoms
of shock and
decreased blood pressure. Once again, the symptoms depend upon where in the abdomen the
bleeding occurs.
- If there is gastrointestinal bleeding, the patient may
vomit bright red blood,
or if it has been in the stomach for a period of time, the vomit may look like
coffee grounds. Bowel movements may be bloody or they may be
black and
tarry, again depending upon the location of the bleeding in the gastrointestinal
tract.
- If the internal bleeding causes blood to spill into the peritoneum, there
can be a significant amount of pain with any movement, and the abdomen can
become tense and feel rigid to touch.
- Sometimes intra-abdominal blood will track toward the skin and can be
appreciated on physical examination. Cullen's sign is the term used to refer to
the appearance of bruising surrounding the
umbilicus. Grey-Turner sign is
bruising in the flanks.
Blood seen in the urine may be due to internal bleeding
at any site within the urinary tract, from the kidney to the bladder. Often
bladder infections are associated with
blood in the urine but other causes need to be considered based
upon the particular symptoms as well as the patient's age and medical history,
especially males who may have had prostate surgery. Men and women who have had
radiation therapy may develop inflammation of the bladder wall which can cause a
significant amount of bleeding.
Bleeding may occur deep within muscles after injury, and
rarely, compartment syndrome may occur. Should so much bleeding occur that the
pressure build-up within the muscle is greater than the patient's blood
pressure, blood cannot get to the muscle cells, and they begin to die. Symptoms
include intense pain, difficulty moving the joints below the injury, and loss of
sensation. Most commonly this is seen in the shin and forearm and may or may not be associated
with a broken bone.
Bleeding may also occur into joints, causing significant pain and loss of
range of motion. This most frequently is seen in patients who are on
anti-coagulation medications. An injury may or may not be needed to cause the
bleeding.
Next: How is internal bleeding diagnosed? »
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