Internal Bleeding - Diagnosis

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How is internal bleeding diagnosed?

The diagnosis of internal bleeding begins with a thorough history taken by the health care professional. This is followed by a physical examination, concentrating on the area of the body where the internal bleeding may have occurred. For example, if there is concern about bleeding in the brain, the physical examination will focus on the neurologic system, or if it is intra-abdominal bleeding, the exam will be directed toward the abdomen.

Blood tests may be performed to check for a low red blood cell count, or anemia. However, if the bleeding occurs rapidly, the initial hemoglobin reading or red blood cell count may be normal.

The suspicion of internal bleeding will often require an imaging test to look for the bleeding source.

  • If there is concern that there is gastrointestinal bleeding, a gastroenterologist may use fiber optic scopes to look into the esophagus and stomach (endoscopy) or into the colon (colonoscopy) to identify the source. If found, the physician may be able to stop the bleeding using electricity to cauterize or burn the blood vessel that is bleeding.
  • Computerized tomography (CT) is the most common test to look for bleeding in the brain. It is also able to identify brain swelling and fractures of the skull.
  • Ultrasound may be used to look for blood in the abdomen. While it has its place in the management of trauma, ultrasound is especially useful in evaluating obstetric and gynecologic problems such as bleeding from an ovarian cyst or an ectopic or tubal pregnancy.
  • Computerized tomography is an effective tool in looking for intra-abdominal and retroperitoneal bleeding. It can evaluate the potential injury site, the severity of organ damage, whether the bleeding is contained within an organ (such as the liver, kidney or spleen) or whether the bleeding has spilled into the peritoneum. It is also a helpful test in assessing pelvic fractures.
  • If the source of bleeding is thought to be due to a damaged artery, angiography may be used to evaluate the arterial blood flow.

In some situations in which the patient is critically ill from internal bleeding, the decision may be made to undergo emergency surgery to find and repair the bleeding site. This may occur in trauma victims with abdominal or chest injuries that have unstable vital signs (decreased level of consciousness, low blood pressure, and other signs of shock) and are at risk for bleeding to death if they were to wait for diagnostic tests.

Return to Internal Bleeding

See what others are saying

Comment from: Mary, 65-74 Female (Patient) Published: January 27

I had 10 IV iron infusions and after several months I went back to the doctor and hematologist and she said the counts are way under again. I had scan and show no bleeding, and she says I need 10 more iron infusions. I wonder if the iron infusions will help again as the count read the same when I started going to doctor.

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Comment from: Laporoscopy/colonosc, 35-44 Female (Patient) Published: October 21

I started having the red bowels and running stomach for about 2 or 3 months nonstop. The doctors did some blood tests but nothing seems to be found wrong, but the bleeding continued. They then referred me to do further tests. They took me for laparoscopy and colonoscopy only to find that it is Grand-Pa headache powder. I've been told to stop using it and I stopped, but it's been a month now and bleeding has not stopped yet. They told me it will take time but I wonder how long it will take for bleeding and running stomach to stop.

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