Injuries to the abdomen or chest may result in externally invisible parenchymal bleeding. This is dangerous blood loss from the most vulnerable human organs. In the article we will talk about the features of bleeding from parenchymal organs and first aid for them.
Parenchymal organs
All human internal organs can be divided into two large groups:
- Cavity;
- Parenchymatous.
With the cavitary, everything is very clear - this is the stomach, intestines, bladder. They have a cavity and a wall supplied with vessels. Bleeding from these organs will only be associated with vascular damage. If the vessel is small, then it is able to contract on its own, narrowing its lumen, and the bleeding will stop. But what are parenchymal organs?
They have a completely different structure:
- Liver;
- Lungs;
- Pancreas;
- Kidneys;
- Spleen.
There is no cavity in them, only the main tissue responsible for the function of this organ is parenchyma. It is permeated with many tiny vessels. When a parenchymal organ is damaged, bleeding develops from each of these capillaries.
An unpleasant feature of the parenchyma and its vessels is the inability to contract, stopping the bleeding on its own.
Where are parenchymal organs located? Causes
The development of parenchymal blood loss is preceded by a violation of the integrity of the organ. Parenchymal rupture and small capillaries become a direct source of hemorrhage.
Reasons that can lead to damage to a parenchymal organ:
- Injuries;
- Infections;
- Malignant tumors;
- Vascular tumors – hemangiomas.
Abdominal and chest injuries often occur as a result of road traffic accidents. Under the influence of an impact on the dashboard, steering wheel or other parts of the car, a parenchymal organ ruptures. Similar changes occur when injured abdominal cavity.
The greatest danger in cases of blunt abdominal trauma is two-stage ruptures. First, blood accumulates under the organ capsule, forming a bruise. At this time, your health does not suffer. Over time, the hematoma grows, overstretching of the organ capsule occurs, it ruptures and symptoms of internal bleeding develop.
An infection such as tuberculosis often affects lung tissue. Certain forms of tuberculosis cause destruction of lung tissue. The cavity that forms is called a tuberculous cavity. Bleeding arising from the cavity appears severe cough with bloody, frothy sputum.
Cancerous tumors can affect many organs, including parenchymal ones. Growing into the tissue of an organ, the tumor destroys it. At some point, bleeding may occur from the area affected by the tumor.
Predisposes to this a large number of vessels that always penetrate the tumor. Bleeding is especially large due to hemangioma, a tumor consisting entirely of blood vessels.
Features of blood loss
Rupture of a parenchymal organ is manifested by bleeding from the site of injury. Blood flowing inside the body is not visible externally. Internal parenchymal bleeding develops. Blood is responsible for delivering oxygen and nutrients.
It ensures normal immunity and maintains blood pressure. The loss of even a small amount of blood results in symptoms of anemia.
Acute blood loss in case of parenchymal bleeding - an emergency condition. A lack of circulating blood volume primarily affects blood pressure. It decreases as the blood supply to the vessels decreases. All organs suffer from lack of oxygen. The body tries to the last to maintain nutrition in the most important parts of the body - the brain, kidneys, heart.
The kidneys are one of the first to suffer - with low pressure they are not able to perform their function. The kidneys stop filtering urine, and its production decreases. With severe blood loss, the kidneys completely stop working, and no urine is produced at all.
All other organs also suffer from blood loss. For the brain, this manifests itself as loss of consciousness. For the heart - severe pain and heart rhythm disturbances.
Symptoms
Signs of parenchymal bleeding depend on the volume of blood lost. In total, about 7% of body weight in the human body is blood.
Doctors measure the amount of blood lost due to bleeding as a percentage of the total circulating blood volume:
- To 10%- light bleeding;
- 10-20% - moderate bleeding;
- 21-30% - heavy bleeding;
- Over 30%- massive, critical blood loss.
Symptoms of parenchymal bleeding are caused by a lack of blood and oxygen starvation all organs. With severe blood loss, they develop rapidly, within a few minutes. Weak parenchymal bleeding can worsen a person’s condition for a day or more.
The victim is concerned about:
- Severe weakness;
- Dizziness;
- Flashing flashes and black dots before the eyes;
- Loss of consciousness;
- Nausea, vomiting;
- Pain in the area of the affected organ;
- Lack of urine;
- Cold sweat;
- Pale skin.
When you try to feel the pulse, its weak filling and frequency are determined. Doctors call this pulse “thread-like” because it is almost not felt. With absence pulse waves on the wrist, you should try to identify them on the neck, in the area of the carotid artery. Find out why she .
In a state of severe blood loss, the pulse is maintained only in large arteries such as the carotid artery. But even there it is weak and very frequent.
Blood pressure measurement is mandatory. Values lower than 90/60 mmHg are considered hypotension. Blood loss is always accompanied by low blood pressure.
This is due to poor filling of blood vessels. The lower the pressure, the more frequent and weak the pulse.
The ratio of pulse to upper pressure is called the Algover index. Normally it is 0.5, and with bleeding it increases to one or more. The value of the Algover index indicates the severity of blood loss.
With parenchymal bleeding from the liver, pancreas or spleen, abdominal symptoms can be identified. On palpation, pain in the area of the affected organ is determined. In this same place, the stomach becomes extremely hard. This is due to irritation of the peritoneum by blood pouring into the cavity.
Complications
Severe blood loss is scary not only in itself. Ultimately, it becomes complicated by life-threatening conditions.
These pathologies require emergency surgery along with highly qualified care from resuscitators:
- Hemorrhagic shock;
- Disseminated intravascular coagulation syndrome (DIC).
Hemorrhagic shock develops when 30 percent or more of blood is lost. It is manifested by loss of consciousness, almost complete absence of pulse and blood pressure below 60 mmHg. Treatment for shock is provided in the ward intensive care using transfusion of red blood cells, plasma and colloid solutions.
DIC is a fatal complication of bleeding. Blood loss reaches critical levels, such that the blood loses its ability to clot. Moreover, it can begin to flow not only from the injured area, but also from any organs. Mortality in DIC is high even in an intensive care unit.
First aid
If parenchymal bleeding is suspected, the most important thing is to get it to the clinic. This needs to be done as quickly as possible. Every minute a person loses more and more blood. When more than a third of the circulating blood is lost, bleeding becomes critical. Irreversible changes develop in organs.
The more time passes from the moment of hemorrhage, the less likely it is to have a successful outcome.
You can increase your chances of survival by providing first aid correctly:
- Ice wrapped in a cloth is applied to the area of injury.
- The person sits as comfortably as possible. During transport he is disturbed as little as possible.
- You cannot give any pills, you cannot feed or offer alcohol.
- You can offer a small amount of water or tea.
After the victim is delivered to the clinic’s emergency department, he will be further examined.
Usually these are the most minimal diagnostic procedures that take little time:
Parenchymal bleeding is unable to stop on its own. Almost always, medical care involves surgical intervention. It is started urgently, with little preoperative preparation.
It usually involves transfusions of blood products or solutions to replace the volume of lost blood and raise blood pressure.
There are several ways to stop parenchymal hemorrhage:
Even an experienced surgeon finds it difficult when the question arises of how to stop parenchymal bleeding. Combinations of methods may be used.
Simultaneously with the operation, hemostatic medications are prescribed:
- Vikasol;
- Etamsylate;
- Aminocaproic acid.
They promote the formation of blood clots in the smallest vessels of the parenchyma. After the hemorrhage stops, the drugs are discontinued. A few more weeks after discharge from the hospital, blood thinning drugs such as aspirin and warfarin are contraindicated for the person.
Video - first aid for bleeding
Content
The flow of blood from the vessels, in which it is not released outward, but flows into the internal cavities of the body, is called parenchymal. Such bleeding is accompanied by large blood loss and, as a rule, does not stop without emergency help.
Organs that are parenchymal
There are two groups in the human body internal organs: parenchymatous and hollow. The first includes those that consist of a mass of cells (parenchyma), which is covered on top with a dense connective capsule (stroma). This reliable protection working tissue of the organ. From the dense surface of the capsule, partitions (trabeculae) penetrate into the parenchyma, which divide the mass of cells into small cells and lobules. Parenchymal organs are:
- liver;
- spleen;
- adrenal glands;
- brain;
- pancreas;
- prostate and others.
Causes of internal bleeding
The tissue of parenchymal organs has a rich blood circulation, so the slightest damage can cause severe internal bleeding. Common reasons:
- injuries;
- viral infections that violate the integrity of tissues (tuberculosis and others);
- oncology in the last stage;
- rupture of a benign formation.
Each parenchymal organ has its own bleeding characteristics. The main causes of bleeding from blood vessels:
|
Parenchymal organs |
Characteristic reasons bleeding |
|
They are injured by fragments of the ribs when they are fractured. |
|
|
Blunt trauma or perforating injury to the abdomen. |
|
|
Spleen |
From the blow, blood first gets under the capsule, then after a few days, due to overstretching, it ruptures, pouring liquid into the cavity. |
|
Pancreas |
Cysts, malignant tumors |
|
Rupture of cysts, compression or strong blow. |
Why is it dangerous?
The consequence of bleeding is a hematoma or hemorrhage. In the latter case, the blood permeates the surrounding tissues, in which a cavity filled with it is formed. The danger of parenchymal hemorrhage is that the organs are not able to stop the bleeding on their own, due to the lack of spasm of the vessels passing inside and their structure. If blood loss is not stopped in time, the person will die.
Signs of hemorrhage
More often than not, internal bleeding develops quickly. Sometimes it's slow, so clinical manifestations may either be completely absent or invisible. Signs of this condition include:
- dizziness;
- rapid and severe fatigue;
- pallor skin;
- drop in blood pressure;
- increased heart rate;
- chills;
- I'm thirsty.
In addition, there are general clinical manifestations of blood loss that occur regardless of which parenchymal organ is affected. Particular attention should be paid to the following symptoms:
- dyspnea;
- weakness;
- pressure in the chest area;
- change in urine color;
- sharp pain in the peritoneum;
- coughing up blood.
With blood loss of any intensity, the patient experiences a gradual decrease in iron and red blood cells in the blood, as a result of which the symptoms of anemia increase. Over time, all internal organs, especially the heart and brain, will suffer from oxygen starvation. With significant bleeding, hemorrhagic shock develops. Each affected organ has its own signs of parenchymal bleeding:
|
Parenchymal organs |
|
|
Pain in the liver area, impaired consciousness, headaches, bloody vomiting, blood in the stool. |
|
|
Discoloration of urine in a pronounced red color pain syndrome in the lower back, nausea, vomiting, increased body temperature. |
|
|
Severe dry cough, mucous sputum mixed with blood clots, rapid breathing, wheezing. |
|
|
Spleen |
Muscle tension in the anterior abdominal wall, pain on the left side, tinnitus, vomiting, shortness of breath. |
Stopping parenchymal bleeding
If a person has signs indicating internal blood loss, they should be taken to a medical facility immediately. Conventional methods of stopping bleeding are not suitable in this case.
The only way to stop bleeding is surgically, while the life and health of the victim depend on correctly provided first aid.
First aid
After calling an ambulance, it is recommended that the patient be placed in a horizontal position with his arms raised lower limbs. If possible, cold should be applied to the site of suspected blood loss (ice, frozen foods, soaked in cold water textile). The task of emergency physicians is to administer medications that stop the bleeding and support arterial pressure.
Surgery
The main way to stop parenchymal bleeding is surgical. After an examination (blood test, x-ray of the lungs, ultrasound of the abdominal cavity), an emergency operation is performed. If test data is questionable, the doctor may start with laparoscopic diagnosis. Ways to stop internal blood loss:
- suturing the omentum;
- hemostatic sponges;
- special complex seams;
- embolization of the feeding vessel;
- electrocoagulation of vessels and surfaces;
- resection of part of an organ.
In parallel with the surgical intervention, the victim is given a transfusion of blood and saline solutions. The main objectives of intensive care are to prevent the development of multiple organ failure (body stress) and DIC (blood clotting disorder).
Video
What types of bleeding are there and why do they occur?
Classifications of this pathological condition a lot and experts teach them all. However, we are interested in dividing bleeding into types, first of all, from a practical point of view. The following classification is important for successful first aid. It shows the types of bleeding depending on the nature of the damaged vessel.
Arterial bleeding
It comes from the arteries containing oxygenated blood flowing from the lungs to all organs and tissues. Makes up serious problem, since these vessels are usually located deep in the tissues, close to the bones, and situations where they are injured are the result of very strong impacts. Sometimes this type of bleeding stops on its own, since the arteries have a pronounced muscular layer. When such a vessel is injured, the latter goes into spasm.
Venous bleeding
Signs and consequences of bleeding
Common signs of bleeding include dizziness , weakness, shortness of breath, severe thirst, pale skin and mucous membranes, decreased blood pressure, increased heart rate ( tachycardia ), presyncope and fainting. The severity and rate of development of these symptoms is determined by the rate of bleeding. Acute blood loss It is more difficult to tolerate than chronic disease, since in the latter case the body has time to partially “adapt” to the changes taking place. Patient complaints: External symptoms of blood loss that are observed with any type of bleeding are as follows: Basic local symptom- this is the presence of a wound on the surface of the skin or mucous membrane and visible bleeding from it. However, the nature of bleeding varies and is directly dependent on the type of vessel. Symptoms of bleeding depend on its type and the type of damaged vessels. Classic signs: Patient complaints: Local symptoms of bleeding For external bleeding: For internal bleeding: FEATURES OF GASTROINTESTINAL BLEEDING IN PATIENTS WITH ACUTE AND CHRONIC INFECTIOUS DISEASESAre common
Local
External effusion of blood
Manifestations of hidden bleeding
Common symptoms of bleeding
The peculiarity of parenchymal organs is that they have “fleshy” and abundantly supplied with blood parenchyma. This is due to their functional purpose - blood purification and removal of metabolic products from it.
Parenchymal organs include:
- liver (participates in the processing of harmful substances, receiving blood through the portal vein);
- kidneys (excrete metabolic products with the urine they produce);
- lungs (gas exchange and excretion occur in them carbon dioxide in atmosphere);
- spleen (destroys spent blood cells and participates in its deposition).
The figure shows the peculiarity of the structure of the liver parenchyma
Parenchymal organs consist of delicate tissue and are abundantly supplied with blood. Even minor trauma to them can lead to internal bleeding.
The mechanism of blood loss and changes in the body
Bleeding is the flow of blood from a vessel into the external environment or internal cavities of the body. Blood soaking into surrounding tissue is called hemorrhage. A cavity formed in the tissue and filled with blood is a hematoma.
In case of injury, cyst rupture or tumor necrosis, the wound surface begins to bleed profusely. Such bleeding will not stop on its own. The structural feature of the parenchyma is such that the walls of the vessels are fused with the stroma and do not collapse.
Blood leaks from the vascular bed through the defect. At first, blood loss may go unnoticed, since we do not see blood, and general complaints may correspond to a large number of other diseases. Gradual blood loss leads to anemia.
As a result of a decrease in red blood cells and hemoglobin in the blood, internal organs, including the brain and heart, suffer from hypoxia. With excessive blood loss, hemorrhagic shock develops. This severe complication severe bleeding, with a significant decrease in pressure with subsequent development of multiple organ failure. Rapid blood loss can lead to cardiac arrest and death.
How to suspect
Signs of parenchymal bleeding can be erased and disguised as other diseases. Bleeding from the parenchyma of the liver, kidneys, lungs, and spleen may have its own characteristics. General symptoms are signs of acute blood loss. First of all, you will be worried about weakness, dizziness, and possible loss of consciousness. The skin becomes pale and cold. If you try to determine the pulse on the forearm, it will be very difficult to palpate, the so-called “thread-like pulse”. The heart will beat faster. Blood pressure will be reduced, and may not be detected at all.
If you suspect shock, check your pulse
Features for each parenchymal organ
On a par with common features hidden blood loss, each parenchymal organ may have its own symptoms.
Liver
Located in the right hypochondrium. As a rule, the liver of people who suffer from hepatitis, abuse alcohol, or have had malaria is more susceptible to damage. All these conditions lead to its enlargement and overstretching of the capsule. As a result of injury - “where it is weak, it breaks.” When the liver is injured, blood leaks into the abdominal cavity. Along with blood, bile also gets there, which provokes the development of biliary peritonitis subsequently. Pain syndrome, shock and internal bleeding predominate. The development of a subcapsular hematoma with subsequent rupture is possible.
Kidneys
Kidney injury can occur from fairly strong impacts. Bleeding may be accompanied by severe lower back pain and shock. A characteristic feature There may be gross hematuria - red coloration of urine. In the presence of an oncological process, prolonged chronic blood loss is possible, leading to the development of severe anemia.
Lungs
Pulmonary hemorrhage is also parenchymal. It can be caused by trauma, oncology, tuberculosis. Clinically may manifest respiratory failure. Blood may accumulate in pleural cavity, thereby compressing the lung.
Hemoptysis is one of the signs of pulmonary hemorrhage
Spleen
The spleen stores blood. If it is injured, it may develop life-threatening blood loss As in the liver, subcapsular tears can also form in the spleen. This kind of damage can be misleading. The clinical picture of acute blood loss will develop not after the injury, but after a few days, when the capsule bursts under the pressure of the blood bursting from the inside. Trauma to the spleen, unfortunately, is not a rare occurrence in childhood.
How to suspect internal bleeding, what measures to take
What you should be wary of:
- medical history (presence of trauma to the abdomen, chest, lower back);
- visual examination (presence of hematomas, bruises, abrasions on the skin of the chest, abdomen, fracture of one or more ribs);
- complaints (pain in the area of suspected bleeding, severe weakness);
- appearance (pale skin, cold sweat, pointed facial features);
- clinic (palpitations and low blood pressure).
In the hospital, an ultrasound of the abdominal cavity is performed to diagnose abdominal trauma.
First aid for suspected internal bleeding is to transport the patient to a surgical hospital as quickly as possible. Methods to stop bleeding such as a tourniquet or a pressure bandage do not work here. Only a surgeon in an operating room can provide real help and effectively stop the bleeding.
Before the ambulance arrives:
- lay the victim horizontally with his legs raised;
- apply ice to the area of suspected bleeding.
The ambulance will transport the patient to the hospital and will also administer special hemostatic drugs (etamsylate, vikasol, aminocaproic acid).
These measures will not stop bleeding, but blood loss may decrease slightly. The paramedics will also begin the infusion. saline solution into a vein to maintain falling blood pressure.
Body position when pressure drops
Surgery
The main care for the patient is provided in the operating room. For diagnostic purposes, preliminary tests are taken, an ultrasound of the abdominal cavity, and an X-ray of the lungs are done. Next, emergency surgery is performed. If the diagnostic data are questionable, they can start with diagnostic laparoscopy.
Ways to stop parenchymal bleeding:
- hemostatic sponges;
- hemming of the omentum;
- resection of part of an organ;
- electrocoagulation of the surface and blood vessels;
- embolization of the feeding vessel.
- special complex seams.
In parallel with the operation and after it, blood and saline solutions are transfused. Intensive therapy is aimed at preventing the development of DIC and multiple organ failure.
Parenchymal bleeding is a threat to life and health. Serious bleeding, which may go unrecognized and result in significant blood loss, will not stop on its own. Requires emergency surgical care. It is important to be very wary of the signs described above and seek medical help immediately. In this situation, the count is in hours, not even in days.
Signs of parenchymal bleeding and first aid
Parenchymal bleeding is the process of hemorrhage into the body cavity, that is, internal. This phenomenon can provoke mechanical damage or some forms of disease. This condition can be dangerous to human life and health. If there is severe internal bleeding, such as after a car accident, a person needs surgery to save his life.
General characteristics of internal bleeding
Such bleeding occurs when the tissues of internal organs are injured. Diagnosis of this condition is usually very difficult.
Most often bleeding occurs:
- due to mechanical damage;
- as a result of neoplasms;
- due to serious illness.
Symptoms may be hidden or mild, so if you suspect the development of such a process, you should immediately contact a specialist. The medical institution will conduct full examination, which will allow us to identify the cause and make predictions.
Fatal blood loss is approximately 2.5 liters for an adult. In this case, a blood transfusion is performed to save the person's life. Transfusions are performed during surgery and for several days after it. As a result of large blood loss, there is a slow heartbeat, a decrease in red blood cells and other important substances that make up the blood.
Which organs may suffer from this problem?
Parenchymal bleeding usually occurs in the following organs:
The peculiarity of these organs is that they consist of thick and blood-supplied parenchyma. This is due to the fact that the main functions of the organs are to filter substances that the body does not need.
This type of bleeding can occur:
- due to mechanical damage in which tissue ruptures occurred;
- due to organ disease, especially due to the appearance of tumors;
- due to infectious lesions;
- as a result of cancer.
Poor blood clotting can aggravate the situation. Patients who suffer from poor blood clotting are at risk, since hemorrhage can occur not only from mechanical damage, but at any time.
In this case, the blood loss may be insignificant and not cause any particular harm to the patient’s health; in another case, the bleeding may be so severe that it will be impossible to stop it without emergency surgery. As a result of this phenomenon, a sharp decline the content of red blood cells and iron in the blood, which leads to oxygen starvation.
If there is heavy bleeding, the patient may experience hemorrhagic shock. Rapid blood loss leads to cardiac arrest and death.
Danger of condition
Parenchymal bleeding is a life-threatening and health-threatening condition. With this phenomenon, blood flows into the surrounding tissue, organ cavity, body cavity.
Based on the type of bleeding, they are divided into the following types:
The first type is formed when the liver is injured and is distinguished by characteristic clinical manifestations that begin to develop quite quickly. With this type of hemorrhage, there is a high probability of developing hemorrhagic shock.
The capillary type develops rather slowly, so its onset is often missed. Blood flows out in small portions, which leads to a sharp decrease in iron and red blood cells in the body. In addition, it is developing inflammatory process in the abdominal cavity.
The danger of the condition lies in the fact that the parenchymal organs are not capable of stopping the bleeding on their own, which requires surgical intervention. The inability of organs to ensure the process of stopping blood is due to their structure and the absence of spasm of blood vessels passing inside their tissues.
Clinical manifestations of the disease
Such bleeding, which develops quite quickly, immediately makes itself known. However, if the bleeding is slow, then clinical manifestations may be absent or completely invisible.
Symptoms of this condition include:
- severe and rapid fatigue;
- dizziness;
- constant desire to drink;
- pale skin;
- chills;
- pressure drop.
In addition, there are special clinical manifestations that occur depending on the affected organ.
Particular attention should be paid to the following conditions:
Bleeding in the lungs often occurs when ribs are broken, when sharp bones pierce the tissues of the respiratory organs. And also the lesion can be caused by tuberculosis or oncology.
The spleen most often ruptures due to mechanical trauma (for example, as a result of an accident). In this case, immediate surgical intervention is required; any delay may cost the patient’s life.
The kidneys are susceptible to injury when tumors are compressed or ruptured. In this condition, the urine becomes sharply colored and severe pain is observed.
In any case, the condition requires immediate intervention from specialists. If symptoms of internal bleeding are observed, you should immediately call an ambulance.
First aid and surgery
First of all, you should pay attention to the following manifestations:
- presence of abdominal injuries;
- mechanical damage to the chest;
- formation of hematomas and bruises;
- sharp pain in the area of the damaged organ;
- sweat;
- chills and fever;
- cardiopalmus;
- a sharp decrease in pressure.
Before the doctors arrive, you must:
- Lay the patient down and elevate the legs.
- Cool the suspected area of damage.
When will it arrive ambulance, then specialists will transport the victim to the hospital and administer medications such as:
Medicines will not stop the bleeding, but will improve the patient's condition. In order to maintain pressure, specialists will begin to administer a special solution intravenously.
Once the patient is admitted to the hospital, he will immediately be taken to the operating room where emergency procedures will be performed.
Before performing a surgical intervention, the following measures will be carried out:
If all tests are within normal limits, doctors will perform an emergency operation. Otherwise, diagnostic laparoscopy is performed.
There are several ways to stop such hemorrhage, among them are:
- drying with a special sponge;
- hemming of the omentum;
- amputation of the affected part;
- electrocoagulation;
- sewing using special seams.
During the operation, a blood transfusion is performed, and this procedure is also done several times during the recovery process. In addition, it pours saline solution and maintenance therapy is carried out aimed at preventing the development of DIC syndrome (disseminated intravascular coagulation) and multiple organ failure.
Such bleeding usually becomes a threat to the patient’s life, so it cannot be delayed. The sooner surgery is performed, the better the outcome. With successful surgery, the patient's life can be saved.
Contacting a medical facility
As soon as the victim is delivered to a medical facility, specialists will begin to carry out the following activities:
- Assess the patient for blunt or sharp trauma.
- Check for the development of an infectious disease.
- Taking tests for oncology.
- External examination and palpation.
- Measurement of such basic parameters as pulse, pressure, temperature.
After surgical intervention is performed (a method of stopping parenchymal bleeding), the patient will have to long-term treatment in a hospital setting. Even surgical procedures cannot always stop the development of this process. This is due to the fact that the organs have a specific structure with a very “delicate” structure.
Particularly dangerous options are those when internal hemorrhage occurs. mixed type. In this case, the lack of medical care leads to the death of a person.
Parenchymal bleeding
Description:
Parenchymal bleeding is the outflow of blood from the vessels of parenchymal organs.
Symptoms of Parenchymal bleeding:
The blood vessels of the parenchymal organs are intimately connected to the parenchyma, so they do not collapse, bleeding is usually profuse, prolonged, and stops with great difficulty. The peculiarity of these bleedings is their massiveness due to the abundant vascularization of the organ parenchyma.
Causes of Parenchymal bleeding:
Parenchymal bleeding occurs when parenchymal organs (liver, spleen, kidneys) are damaged.
Treatment of parenchymal bleeding:
Stopping bleeding may be difficult and may require the surgeon to use various methods. It is necessary to use fibrin film, hemostatic sutures, electrocoagulation, etc.
Liver suturing as a method of stopping parenchymal bleeding
Where to go:
Medicines, drugs, tablets for the treatment of Parenchymal bleeding:
CJSC "Bryntsalov-A" Russia
Antihemorrhagic agents. Fibrinolysis inhibitors.
LLC "Pharmaceutical company "Zdorovye" Ukraine
Why is parenchymal bleeding dangerous and how to stop it?
Injuries to the abdomen or chest may result in externally invisible parenchymal bleeding. This is dangerous blood loss from the most vulnerable human organs. In the article we will talk about the features of bleeding from parenchymal organs and first aid for them.
Parenchymal organs
All human internal organs can be divided into two large groups:
With the cavitary, everything is very clear - this is the stomach, intestines, bladder. They have a cavity and a wall supplied with vessels. Bleeding from these organs will only be associated with vascular damage. If the vessel is small, then it is able to contract on its own, narrowing its lumen, and the bleeding will stop. But what are parenchymal organs?
They have a completely different structure:
There is no cavity in them, only the main tissue responsible for the function of this organ is the parenchyma. It is permeated with many tiny vessels. When a parenchymal organ is damaged, bleeding develops from each of these capillaries.
An unpleasant feature of the parenchyma and its vessels is the inability to contract, stopping the bleeding on its own.
Where are the parenchymal organs located?
Causes
The development of parenchymal blood loss is preceded by a violation of the integrity of the organ. Rupture of the parenchyma and small capillaries become a direct source of hemorrhage.
Reasons that can lead to damage to a parenchymal organ:
- Injuries;
- Infections;
- Malignant tumors;
- Vascular tumors – hemangiomas.
Abdominal and chest injuries often occur as a result of road traffic accidents. Under the influence of an impact on the dashboard, steering wheel or other parts of the car, a parenchymal organ ruptures. Similar changes occur when the abdominal cavity is injured.
The greatest danger in cases of blunt abdominal trauma is two-stage ruptures. First, blood accumulates under the organ capsule, forming a bruise. At this time, your health does not suffer. Over time, the hematoma grows, overstretching of the organ capsule occurs, it ruptures and symptoms of internal bleeding develop.
An infection such as tuberculosis often affects lung tissue. Certain forms of tuberculosis cause destruction of lung tissue. The cavity that forms is called a tuberculous cavity. Bleeding arising from the cavity is manifested by a strong cough with bloody, foamy sputum.
Cancerous tumors can affect many organs, including parenchymal ones. Growing into the tissue of an organ, the tumor destroys it. At some point, bleeding may occur from the area affected by the tumor.
A large number of vessels that always penetrate the tumor predisposes to this. Bleeding is especially large due to hemangioma, a tumor consisting entirely of blood vessels.
Features of blood loss
Rupture of a parenchymal organ is manifested by bleeding from the site of injury. Blood flowing inside the body is not visible externally. Internal parenchymal bleeding develops. Blood is responsible for delivering oxygen and nutrients.
It ensures normal immunity and maintains blood pressure. The loss of even a small amount of blood results in symptoms of anemia.
Acute blood loss due to parenchymal bleeding is an emergency condition. A lack of circulating blood volume primarily affects blood pressure. It decreases as the blood supply to the vessels decreases. All organs suffer from lack of oxygen. The body tries to the last to maintain nutrition in the most important parts of the body - the brain, kidneys, heart.
The kidneys are one of the first to suffer - with low pressure they are not able to perform their function. The kidneys stop filtering urine, and its production decreases. With severe blood loss, the kidneys completely stop working, and no urine is produced at all.
All other organs also suffer from blood loss. For the brain, this manifests itself as loss of consciousness. For the heart - severe pain and heart rhythm disturbances.
Symptoms
Signs of parenchymal bleeding depend on the volume of blood lost. In total, about 7% of body weight in the human body is blood.
Doctors measure the amount of blood lost due to bleeding as a percentage of the total circulating blood volume:
Symptoms of parenchymal bleeding are caused by a lack of blood and oxygen starvation of all organs. With severe blood loss, they develop rapidly, within a few minutes. Weak parenchymal bleeding can worsen a person’s condition for a day or more.
- Severe weakness;
- Dizziness;
- Flashing flashes and black dots before the eyes;
- Loss of consciousness;
- Nausea, vomiting;
- Pain in the area of the affected organ;
- Lack of urine;
- Cold sweat;
- Pale skin.
When you try to feel the pulse, its weak filling and frequency are determined. Doctors call this pulse “thread-like” because it is almost not felt. If there are no pulse waves on the wrist, you should try to determine them on the neck, in the area of the carotid artery.
In a state of severe blood loss, the pulse is maintained only in large arteries such as the carotid artery. But even there it is weak and very frequent.
Blood pressure measurement is mandatory. Values lower than 90/60 mmHg are considered hypotension. Blood loss is always accompanied by low blood pressure.
This is due to poor filling of blood vessels. The lower the pressure, the more frequent and weak the pulse.
The ratio of pulse to upper pressure is called the Algover index. Normally it is 0.5, and with bleeding it increases to one or more. The value of the Algover index indicates the severity of blood loss.
With parenchymal bleeding from the liver, pancreas or spleen, abdominal symptoms can be identified. On palpation, pain in the area of the affected organ is determined. In this same place, the stomach becomes extremely hard. This is due to irritation of the peritoneum by blood pouring into the cavity.
Complications
Severe blood loss is scary not only in itself. Ultimately, it becomes complicated by life-threatening conditions.
These pathologies require emergency surgery along with highly qualified care from resuscitators:
- Hemorrhagic shock;
- Disseminated intravascular coagulation syndrome (DIC).
Hemorrhagic shock develops when 30 percent or more of blood is lost. It is manifested by loss of consciousness, almost complete absence of pulse and blood pressure below 60 mmHg. Treatment for shock is provided in the intensive care unit with the help of transfusions of red blood cells, plasma and colloid solutions.
DIC is a fatal complication of bleeding. Blood loss reaches critical levels, such that the blood loses its ability to clot. Moreover, it can begin to flow not only from the injured area, but also from any organs. Mortality in DIC is high even in an intensive care unit.
First aid
If parenchymal bleeding is suspected, the most important thing is to get it to the clinic. This needs to be done as quickly as possible. Every minute a person loses more and more blood. When more than a third of the circulating blood is lost, bleeding becomes critical. Irreversible changes develop in organs.
The more time passes from the moment of hemorrhage, the less likely it is to have a successful outcome.
You can increase your chances of survival by providing first aid correctly:
- Ice wrapped in a cloth is applied to the area of injury.
- The person sits as comfortably as possible. During transport he is disturbed as little as possible.
- You cannot give any pills, you cannot feed or offer alcohol.
- You can offer a small amount of water or tea.
First steps in case of parenchymal bleeding to contents
Treatment
After the victim is delivered to the clinic’s emergency department, he will be further examined.
Usually these are the most minimal diagnostic procedures that take little time:
- Determination of blood group and Rh factor;
- Determination of hemoglobin;
- Ultrasonography.
Parenchymal bleeding is unable to stop on its own. Almost always, medical care involves surgical intervention. It is started urgently, with little preoperative preparation.
It usually involves transfusions of blood products or solutions to replace the volume of lost blood and raise blood pressure.
There are several ways to stop parenchymal hemorrhage:
- Using a hemostatic sponge;
- Hemming the oil seal;
- Removal of part of an organ;
- Electrical coagulation.
Even an experienced surgeon finds it difficult when the question arises of how to stop parenchymal bleeding. Combinations of methods may be used.
Simultaneously with the operation, hemostatic medications are prescribed:
They promote the formation of blood clots in the smallest vessels of the parenchyma. After the hemorrhage stops, the drugs are discontinued. A few more weeks after discharge from the hospital, blood thinning drugs such as aspirin and warfarin are contraindicated for the person.
Internal bleeding (parenchymal): first aid
A distinctive feature of parenchymal bleeding is that a person loses a large amount of blood. The bleeding itself will not stop, so the victim needs emergency help.
What organs are called parenchymal?
The main function of these organs is to purify the blood. Due to this, they have fleshy parenchyma. These organs remove waste products from the blood. This category includes:
- Liver. This organ processes harmful substances entering the blood.
- Kidneys. Through these organs excess liquid, toxins and other metabolic products are excreted from the body along with urine.
- Lungs. Participate in the process of gas exchange.
- Spleen. In the tissues of this organ, the death of blood cells that have already served their purpose occurs.
These organs are very delicate, they are actively supplied with blood, since their functions are related to its purification and processing. Any damage to these organs leads to bleeding.
Causes
What can cause bleeding? Parenchymal hemorrhage may result from:
If a person has a blood clotting disorder, it will be more difficult to stop the bleeding. This happens to some people congenital diseases. Poor clotting also appears with age or while taking medications that thin the blood. Such medications, by the way, are often prescribed to patients with cardiac diseases.
What does the process of hemorrhage in the body look like?
Parenchymal bleeding is when blood flows out (into the external environment or into any cavity inside the body) from a vessel. The cavity between the layers of tissue that fills with blood is called a hematoma. Externally, this is easy to notice on the body.
When a vessel is damaged, parenchymal bleeding begins. In the beginning, you may not pay attention to it. The symptoms that the patient describes can be confused with other pathologies. And it is often difficult to assume that a person is experiencing parenchymal bleeding.
Stopping blood loss on your own in this case impossible. Only medical attention is needed. If it is not provided, then over time the person will develop anemia. With this disease, the number of red blood cells in the blood decreases and the level of hemoglobin drops. In this state, there is insufficient nutrition of other organs of the human body. Namely, the brain and heart suffer most from hypoxia.
With large blood loss, a person develops hemorrhagic shock. This condition is considered serious. The patient experiences a decrease in blood pressure and develops multiple organ failure. If blood loss is rapid, cardiac arrest and death are possible.
Parenchymal bleeding. Signs
As mentioned above, it happens that the signs of this condition can be confused with other diseases. Usually bleeding is accompanied by general weakness. The person begins to feel dizzy and may lose consciousness. The appearance deteriorates, the skin becomes pale and cold. The pulse in the forearm is difficult to palpate. The heart rate increases and blood pressure is very low.
There are capillary and parenchymal bleeding. Of course, the most dangerous are the latter. Individual symptoms can be distinguished depending on the affected organ:
- Features of parenchymal hemorrhage of the liver. This organ is located with right side, under the ribs. As a rule, the liver is affected in people who suffer from hepatitis or have an alcohol addiction. Those who have suffered a disease such as malaria are also susceptible to parenchymal hemorrhage of the liver. The ailments listed above cause an increase in the volume of the liver, resulting in stretching of the capsule and tissue damage. Blood begins to pour into the abdominal cavity. This is where the bile comes out. This leads to the development of a pathology such as bile peritonitis. A person with this type of bleeding experiences strong pain in the abdomen, signs appear state of shock. Subsequently, a subcapsular hematoma may occur.
- Features of parenchymal bleeding of the kidneys. It may be caused by strong physical impact on the human kidneys (for example, a blow). Signs include severe pain in the lumbar region. Also, in a patient with such bleeding, the urine turns red. This phenomenon is called macrohematuria. If the body develops cancer, then this type of bleeding can be prolonged and lead to anemia.
- Features of parenchymal bleeding of the lungs. The damage may be caused by injury, tuberculosis, or cancer. Typically, this type of bleeding develops pulmonary failure. There is often an accumulation of blood in the pleural cavity, which increases the pressure on the lung.
- Features of parenchymal bleeding of the spleen. Damage to this organ is a threat to human life. With this type of bleeding, subcapsular ruptures of the spleen are formed. Acute blood loss is not always observed immediately after injury; it can develop over several days. There are statistics that confirm that the spleen is often injured in childhood
Main symptoms for all types
What signs indicate that there is internal bleeding in the body?
First of all, you need to take a close look at how the body works if a person has suffered an injury to the abdomen, chest or lower back. Symptoms include:
- The presence of hematomas on the body or rib fractures.
- Patient complaints about painful sensations in possible areas of bleeding, general weakness of the body.
- Deterioration in a person’s appearance, namely, pale skin, the appearance of cold sweat. Facial features become sharp.
- Rapid heartbeat, low blood pressure.
Help
If a person has signs that indicate internal bleeding, then he should be urgently taken to the surgery department. Conventional stopping methods, which include applying a tourniquet, will not help in this case. A surgeon on the operating table can provide real help to a patient with internal bleeding. There are several recommendations on how to behave if there is a suspicion that a person has a parenchymal injury (bleeding). Assistance to the patient should be provided in the following order:
- It is recommended to ensure that the victim is in a horizontal position, with his legs raised up.
- Ice should be applied to the site of suspected bleeding.
The ambulance team's task is to transport the patient to the hospital and administer drugs that will help stop the bleeding. The person is also given medications to maintain normal blood pressure.
How does surgical treatment occur?
In order to diagnose bleeding, the patient undergoes an ultrasound and x-ray of internal organs. If the diagnosis is confirmed, then emergency surgery is prescribed.
There are several ways to stop bleeding.
- Use of a hemostatic sponge.
- Sewing the seal.
- Resection (removal) of any part of an organ.
- Electrocoagulation (cauterization) of blood vessels.
- Embolization.
- Application of special complex sutures to vessels.
The patient also receives a blood transfusion.
What to do in this case?
If there is a suspicion of parenchymal bleeding, first aid is to call an ambulance. It should be understood that this type of bleeding will not go away on its own. Therefore, at the slightest suspicion, you should immediately call doctors and go to a surgical hospital.
There an accurate diagnosis will be made and emergency surgery will be performed. Any delay can lead to the death of a person. It is important to monitor the condition of the body and well-being, especially if you have received any injuries that could damage organs such as the liver, lungs, kidneys and spleen.
Also, the presence of bruises and bruises on the body, pain and dizziness should alert a person and force him to seek qualified help from specialists. It’s good if there are relatives or people nearby who are able to provide assistance.
It is important to provide the patient with physical peace and emotional support.
Conclusion
Now you know what parenchymal bleeding is, how it manifests itself and what needs to be done in this situation. We hope that the information presented in the article was useful to you. It is worth recalling once again that you should not even try to cope with parenchymal bleeding on your own.
A) ANATOMICAL CLASSIFICATION
Based on the type of bleeding vessel, bleeding is divided into arterial, venous, arteriovenous, capillary and parenchymal.
Arterial bleeding. Bleeding from a damaged artery. Blood flows out quickly, under pressure, often in a pulsating stream, sometimes gushing out. The blood is bright scarlet. The rate of blood loss is quite high. The volume of blood loss is determined by the diameter of the vessel and the nature of the injury (lateral, complete, etc.).
With profuse (heavy) arterial bleeding, the wound is in the projection of a large artery; the gushing blood is bright red (scarlet), beating in a strong pulsating stream. Due to high blood pressure, bleeding usually does not stop on its own. Damage to the main artery is dangerous, both due to rapidly progressing blood loss and ischemia of the tissues to which it must supply blood. The rate of blood loss is high, which often does not allow the development of compensatory mechanisms and can quickly lead to death.
Venous bleeding. Bleeding from a damaged vein. Uniform flow of dark cherry-colored blood. The rate of blood loss is less than with arterial bleeding, but with a large diameter of the damaged vein it can be very significant. Only when the damaged vein is located next to a large artery can a pulsating jet be observed due to transmission pulsation. When bleeding from the veins of the neck, you need to remember the danger of air embolism. If large veins of the upper half of the body are damaged, blood may flow out in an intermittent stream, synchronous with breathing (due to the suction action of the chest), and not with the pulse.
There are significant clinical differences in bleeding when the deep (large, main) and superficial (subcutaneous) veins are damaged. Bleeding due to damage to the main veins is no less, and sometimes even more dangerous, than arterial bleeding, since it quickly leads to a drop in pressure at the mouth of the vena cava, which is accompanied by a decrease in the strength of heart contractions. Such bleeding can lead to air embolism, which especially often develops with damage to the veins of the neck or intraoperative damage to the vena cava. Veins, unlike arteries, have an underdeveloped muscular layer, and the rate of blood loss is almost not reduced due to vessel spasm.
Bleeding from damaged saphenous veins is usually less dangerous, since the rate of blood loss is much lower and there is virtually no risk of air embolism.
Capillary bleeding. Bleeding from capillaries, in which blood oozes evenly from the entire surface of damaged tissue. This bleeding is caused by damage to capillaries and other microvessels. In this case, as a rule, the entire wound surface bleeds, which, after drying, becomes covered with blood again. Such bleeding is observed when any vascularized tissue is damaged (only a few tissues do not have their own vessels: cartilage, cornea, dura mater). Capillary bleeding usually stops on its own.
Capillary bleeding is of clinical significance when there is a large area of the wound surface, disorders of the blood coagulation system and damage to well-supplied tissues.
Arteriovenous bleeding. In the presence of simultaneous arterial and venous bleeding. Particularly common is combined damage to an artery and vein located nearby, as part of one neurovascular bundle. The clinical picture consists of a combination of symptoms of various types of bleeding, and, at the first aid stage, it is not always possible to reliably determine the source and nature of the bleeding.
Parenchymal bleeding. Bleeding from the parenchyma of any internal organ. It is observed when parenchymal organs are damaged: liver, spleen, kidneys, lungs, pancreas. Such bleeding usually does not stop on its own. Since the listed organs mainly consist of parenchyma, they are called parenchymatous. Bleeding when damaged is called parenchymal .
B) ACCORDING TO THE MECHANISM OF APPEARANCE
Depending on the reason that led to the release of blood from the vascular bed, two types of bleeding are distinguished:
Physiological bleeding among women.
Pathological bleeding- other.
According to their origin, pathological bleeding is divided into
- traumatic caused by mechanical damage to the vascular wall (including during surgery), and
- non-traumatic, Related pathological changes vascular (with neoplasm, inflammatory process, increased permeability of the vascular wall, damage by ionizing radiation, etc.).
Causes of bleeding may be different:
mechanical damage to the vessel wall : injury to a vessel with an open injury or rupture of a vessel with a closed injury;
destruction (destruction) of the vessel wall during a pathological process : ulceration of atherosclerotic plaque, destructive process in tissues (focus purulent inflammation, stomach ulcer, decaying tumor);
increased permeability of the vascular wall (for intoxication of the body, sepsis, vitamin deficiency C), leading to blood leaking through the walls of blood vessels.
Blood clotting disorder ( with hemophilia, thrombocytopenia, disseminated intravascular coagulation, overdose of anticoagulants, cholemia) in itself is not the cause of bleeding. But, it prevents the bleeding from stopping and contributes to the development of prolonged bleeding and massive blood loss.
Read more about the causes of bleeding
Traumatic bleeding - bleeding caused by a violation of the integrity of blood vessels due to injury (wound, rupture of the vessel wall or heart), includingsurgical bleeding (during surgery).
These lesions (injuries) may be open, in which blood flows out through the wound channel, or closed. For example, with closed fractures, blood vessels may be ruptured by bone fragments. Also, to the development of internal bleeding during closed injuries, lead to traumatic ruptures of internal organs, muscles and other anatomical formations.
Closed vascular injuries pose a great danger, since difficulties in recognizing them often lead to diagnostic errors and untimely provision of assistance. In this case, hemorrhages in the body cavity, as well as retroperitoneal and intermuscular hematomas can be very significant in terms of blood loss, leading to severe acute hypovolemia and hemorrhagic shock.
Non-traumatic bleeding – these are bleedings caused by pathological changes in the walls of blood vessels or the heart.
According to the mechanism of occurrence, they distinguish
- bleeding from rupture(haemorrhagia per rhexin),
- bleeding from corrosion(haemorrhagia per diabrosin - arrosive bleeding,
- bleeding from leakage(haemorrhagia per diapedesin) with increased permeability of the vascular wall.
Rupture of a pathologically altered wall of a vessel or heart.
With an aneurysm of a vessel or heart, hemorrhoids, varicose veins, myocardial infarction, sclerotic changes in the arteries, tubal ectopic pregnancy, etc. Rupture of the wall of a vessel or heart is promoted by an increase in blood pressure.
In this regard, we can separately highlight vicarious hemorrhage– bleeding from small vessels of the mucous membrane of the nasal walls, caused by excess blood pressure, for example during a hypertensive crisis. Or bleeding from secondary hemorrhoids caused by increased pressure in the portal vein (portal hypertension), most often with cirrhosis of the liver.
Corrosion (arrosion) of the vessel wall .
- bleeding through a defect in the vascular wall formed as a result of a pathological process (purulent-necrotic, tumor, etc.).
Arrosive (arrosive) bleeding arises
When the vascular wall is corroded (destructed) (when the vascular wall grows with a malignant tumor and disintegrates - destruction of the tumor;
With necrosis, including ulcerative process;
With caseous necrosis in the wall of the tuberculous cavity;
With destructive inflammation, including purulent inflammation, when melting of the vessel wall at the source of inflammation may occur;
With enzymatic melting of the vascular wall with pancreatic juice containing proteases, lipases, amylases in pancreatic necrosis, etc.).
Increased permeability of microvascular walls.
Diapedetic hemorrhage ( due to increased permeability of vessel walls) occurs as a result of blood leakage from microvessels (arterioles, capillaries and venules). An increase in the permeability of the vascular wall is observed in hemorrhagic diathesis, including systemic vasculitis, vitamin deficiency (especially vitamin deficiency C), uremia, sepsis, scarlet fever, other infectious and infectious-allergic diseases, as well as benzene and phosphorus poisoning.
The state of the blood coagulation system plays a certain role in the development of bleeding. Violation of the thrombus formation process in itself does not lead to bleeding and is not its cause, but it significantly aggravates the situation. Damage to a small vein, for example, usually does not lead to visible bleeding, since the system of spontaneous hemostasis is triggered, but if the state of the coagulation system is impaired, then any, even the most minor injury can lead to fatal bleeding. The most well-known diseases affecting the blood clotting process are hemophilia and Werlhof's disease. Disseminated intravascular coagulation syndrome and cholemia also lead to decreased blood clotting. Often there are decreases in blood coagulation of medicinal origin, which occur when using indirect anticoagulants that disrupt the synthesis of blood coagulation factors VII, IX, X in the liver; direct anticoagulants (for example, heparin); thrombolytic drugs (for example, streptase, streptokinase, urokinase, streptolyase, etc.), as well as non-steroidal anti-inflammatory drugs (for example, acetylsalicylic acid, butadione, etc.), which disrupt platelet function.
BleedingAndness- tendency to prolonged, low-intensity bleeding; observed when there is a violation of the blood coagulation mechanism and (or) an increase in the permeability of the vascular wall.
Hemorrhagic diathesis is a condition characterized by increased bleeding, a tendency to prolonged bleeding, which is observed with blood clotting disorders and (or) increased permeability of the vascular wall.
The Greek word diathesis means a tendency or predisposition to something, such as certain diseases or inappropriate reactions to ordinary stimuli.
C) IN RELATION TO THE EXTERNAL ENVIRONMENT
All bleeding is divided into three main types: external, internal and mixed. There are also various combinations of these types of bleeding in one patient.
I. External bleeding occurs from a wound (or from a trophic skin ulcer) directly into the external environment, outward, onto the surface of the body.
IIMixed bleeding e - this is bleeding into the lumen of a hollow organ that communicates with the external environment through the natural openings of the body. In mixed bleeding, blood first accumulates in cavities that communicate (normally) with the external environment, and then, through the natural openings of the body, is released out, unchanged or altered. A typical example is bleeding into the lumen of the gastrointestinal tract: with gastric bleeding, blood first accumulates in the stomach and is then released in the form of bloody vomiting; vomiting of “coffee grounds” is possible (hemoglobin under the influence of hydrochloric acid turns into black hydrochloric acid hematin) and ( or) bloody stools, often black (melena). In addition to bleeding into the lumen of the gastrointestinal tract, bleeding into the lumen of the tracheobronchial tree and into the urinary tract - hematuria - can be considered mixed.
1. Esophageal, gastric, intestinal bleeding (into the lumen of the esophagus, gastrointestinal tract);
2. Pulmonary hemorrhages (V Airways);
3. Bleeding in urinary tract (hematuria); urethral bleeding (into the lumen of the urethra, which is manifested by urethrorrhagia - the release of blood from the urethra outside the act of urination); hemospermia (presence of blood in seminal fluid).
4. Uterine bleeding (metrorrhagia).
5. Nosebleeds (epistaxis).
6. Bleeding into the bile ducts (hemobilia).
Gastrointestinal, pulmonary bleeding, bleeding in the urinary tract, etc. occur obvious And hidden.
Overt bleeding manifests itself with obvious clinical signs.
Hidden (occult) bleeding determined only by special research methods.
Obvious bleeding- these are bleedings in which blood, even in a changed form, appears outside after a certain period of time, which is visible to the naked eye. For example, bloody vomiting of unchanged blood or coffee grounds; bloody stools that are red, dark, or even black (melena); hematuria in the form of bloody urine; hemoptysis or discharge of scarlet foamy blood during coughing.
Hidden bleeding - These are such small bleedings in which the naked eye (macroscopically) cannot see the blood coming out from the natural orifices of the body, since there is only a small amount of blood in the material being examined (feces, urine) ( hidden blood). It is detected only by special laboratory tests (for hidden gastrointestinal bleeding and microhematuria) and (or) instrumental (endoscopic) research methods.
III. Internal bleeding occurs inside the body:
In body cavities that do not normally communicate with the external environment,
In tissues, organs.
Internal bleeding may cause bleeding in body cavities that do not (normally) communicate with the external environment: cranial cavity, joint cavity (hemarthrosis), pleural cavity (hemothorax), abdominal cavity (hemoperitoneum), into the pericardial cavity (hemopericardium), and blood can also pour out from the vessels in the tissue, in the form of a hematoma(formed as a result of tissue separation, with the formation of a cavity filled with liquid or coagulated blood), or ashemorrhages with tissue soaking in blood (the appearance of petechiae, ecchymoses). With interstitial bleeding (hemorrhage), blood flowing from the vessels can saturate the tissues surrounding the damaged vessel. Hemorrhages into the integument of the body (skin, mucous membranes), with their soaking in blood (which leads to the formation of petechiae and ecchymoses), are also a type of internal bleeding. There are petechiae - pinpoint hemorrhages; ecchymosis (bruising, bruising) - hemorrhages into these tissues larger than petechiae. Petechiae- pinpoint, small spotty hemorrhages in the skin, as well as in the mucous or serous membranes, the size of which, on average, is from the head of a pin to the size of a pea. Ecchymoses(ancient Greek ἐκχύμωσις - “outpouring” from ἐκ- “from-” and χέω- “pour”) - more extensive hemorrhages into the skin or mucous membrane, the diameter of which usually exceeds 2 cm. Ecchymosis is also called a bruise (in everyday life), hemorrhage (in medicine) - a section of surface tissue (skin, mucous membrane) soaked in blood flowing from a damaged vessel (damaged vessels).
Hematomas usually form in denser tissues (brain tissue, liver) or are delimited by fascia (on the limbs). More loose tissues (fatty tissue, muscles), more often, are simply saturated with blood.
As the pressure in the hematoma cavity increases, the bleeding stops, but in the future the tissue delimiting the hematoma may rupture, and the bleeding recurs. This mechanism of early secondary bleeding is characteristic of subcapsular ruptures of the parenchyma of the liver and spleen (two-stage ruptures of the organ with the development of intra-abdominal bleeding).
Small hematomas may resolve over time.
Hematomas, bigger size, are usually organized, i.e. are replaced by fibrous connective tissue and turn into scar.
If a large hematoma exists long enough, the surrounding tissue turns into a scar, and the hematoma becomes surrounded by a fibrous connective tissue capsule. This is how a pseudocyst is formed. In addition, hematomas can fester, turning into phlegmon, and, if there is a strong capsule, into abscesses.
Read more about internal bleeding.
1. Intracavitary (cavitary) bleeding , when blood flows into any large serous cavity of the body that does not normally communicate with the external environment:
A) hemorrhage with accumulation of blood in the abdominal cavity– hemoperitoneum (in case of injury or rupture of blood vessels, abdominal organs or abdominal wall);
b) hemorrhage with accumulation of blood in the pleural cavity– hemothorax;
V) hemorrhage with accumulation of blood in the pericardial cavity– hemopericardium.
G) hemorrhage with accumulation of blood in the joint cavity - hemarthrosis.
Open cavitary (intra-abdominal, intrapleural) bleeding observed when hemoperitoneum, hemothorax with bleeding from the cavity to the outside, through a penetrating wound or through drains. At the same time, the intensity of blood flow outward often does not correspond to the intensity of internal bleeding.
2. Interstitial bleeding (hemorrhage) - This is the flow of blood into the thickness of the tissue.
Interstitial (interstitial) are bleeding in which blood or saturates fabrics or accumulates in the interstitial spaces, forming a hematoma.
A) INintratissue hemorrhage with tissue penetration (hemorrhagic infiltration, hemorrhagic tissue imbibition):
Small pinpoint (petechial) hemorrhages caused by capillary hemorrhage into the thickness of the skin, mucous membrane and serous membranes - hemorrhagic petechiae;
Multiple spontaneous hemorrhages in the skin, mucous membranes of a purplish color (red color with a purple tint) - thrombocytopenic purpura;
- spotted planar hemorrhage into the thickness of the skin or mucous membrane – bruise(bruise, suffusio, ecchymosis);
Hemorrhage into the brain substance in the form of a focus of hemorrhagic softening - intracerebral hemorrhage;
Hemorrhage into the subarachnoid space of the brain or spinal cord - subarachnoid hemorrhage;
Outcome of hemorrhage may be different:
Blood resorption
Formation of a cyst at the site of hemorrhage,
Encapsulation and germination by connective tissue,
Infection and suppuration.
b) Hemat O ma (haematoma; hemato- + -oma; blood tumor) - occurs during interstitial bleeding with tissue dissection and the formation of a cavity containing liquid or coagulated blood accumulated in it.
Types of hematomas according to their localization (by location):
subcutaneous hematoma,
intermuscular hematoma,
subperiosteal hematoma,
retroperitoneal (in the retroperitoneal tissue) hematoma,
perirenal (in the perinephric tissue) hematoma,
extrapleural hematoma (between soft tissues chest wall and parietal pleura),
paraurethral hematoma (in paraurethral tissue),
mediastinal hematoma (mediastinal hematoma),
intrawound hematoma (with intrawound bleeding, a hematoma in the wound canal formed as a result of hemorrhage into the cavity of a gunshot or stab wound, without significant external bleeding from the wound),
subcapsular (subcapsular) hematoma of any parenchymal organ (spleen, kidney, liver),
intracranial hematoma (with hemorrhage into the cranial cavity),
suprathecal (epidural) hematoma (with hemorrhage between the dura mater and the bones of the skull or spine),
intrathecal (subdural) hematoma (with hemorrhage under the dura mater),
intracerebral (intracerebral) hematoma (with hemorrhage into the substance of the brain),
intraventricular hematoma (with hemorrhage into a ventricle of the brain),
hematocele (hemorrhage with accumulation of blood between the membranes of the testicle, in the tissues of the scrotum).
Blood poured into tissues and cavities provided a good breeding ground for microorganisms. Thus, any hematoma, any accumulation of blood due to internal bleeding. are predisposing factors for the development of suppuration.
Outcomes of hematomas:
Suppuration of a hematoma (formation of an abscess) during infection
Resorption of hematoma;
Organization of a hematoma (germination of the hematoma by connective tissue) with the formation of a scar;
Encapsulation of a hematoma with the formation of a pseudocyst;
Pulsatinghematoma is a hematoma formed as a result of interstitial arterial bleeding and maintaining communication with the lumen of the damaged artery.
Expanding hematoma– this is a pulsating hematoma associated with a damaged large main artery, rapidly increasing in volume and compressing surrounding tissues; in the event of compression of the collateral vessels passing through them, ischemic gangrene of the limb may occur. A false arterial aneurysm (post-traumatic or arrosive) can form from a pulsating hematoma.
Aneurysm(from the Greek aneuryno - expand) is a local (local) expansion of the lumen of a blood vessel or heart cavity due to a pathological change in their walls (usually atherosclerotic) or developmental anomalies.
True aneurysm - This is an aneurysm, the walls of which have layers inherent to this blood vessel.
Congenital aneurysm– an aneurysm resulting from an abnormal development of the vascular wall:
Arterial aneurysm,
Venous aneurysm,
Arteriovenous aneurysm, characterized by the presence of a communication between the artery and the accompanying vein.
Dissecting aneurysm(usually the aorta) is an aneurysm (of the aorta) in the form of an intrawall canal formed as a result of a tear in the inner lining of the vessel and dissection of the vessel wall with blood entering through the tear.
False aneurysm is a pathological cavity communicating with the lumen of the vessel. It is formed by the formation of a connective tissue capsule around a pulsating hematoma formed as a result of injury to the vascular wall (post-traumatic aneurysm); less often when the vessel wall is destroyed by a pathological (inflammatory or tumor) process that has spread to the vessel wall (arrosive aneurysm).
IVVarious combinations of the main types of bleeding in one patient. For example: with a chest injury, a combination of intrapleural bleeding (hemothorax) and bleeding into the respiratory tract (pulmonary hemorrhage) is possible, and if there is a chest injury, external bleeding from damaged vessels of the chest wall wound is also possible. The intensity of each of these bleedings may vary.
D) BY TIME OF APPEARANCE
According to the time of occurrence of bleeding, there are primary and secondary.
Primary bleeding caused by damage to the vessel at the time of injury. It appears immediately after damage to the vessel and continues after the damage.
Secondary bleeding They can be early (usually from several hours to 4-5 days after damage) and late (more than 4-5 days after damage).
Early secondary bleeding develop in the first hours or days after injury due to the expulsion of a blood clot from a vessel or the slipping of a ligature from a vessel (with an increase in blood pressure), as well as due to the end of a vessel spasm. Early secondary bleeding may be caused by damage to blood vessels from a bone fragment or detachment of a blood clot, due to poor transport immobilization, careless repositioning of the victim, etc. It is very important to remember the possibility of secondary early bleeding during anti-shock therapy, when the resulting increase in blood pressure can contribute to the expulsion of the blood clot by current blood.
Late secondary (or arrosive) bleeding develop several days after the injury due to the melting of the blood clot by a purulent process, arrosion (destruction) of the vessel wall in the focus of purulent inflammation. Often, late secondary bleeding is a consequence of destruction of the vessel wall as a result of prolonged pressure from a bone fragment or foreign body (bedsore), purulent melting of a blood clot, erosion of the vessel wall, or rupture of an aneurysm.
D) WITH THE CURRENT
All bleeding can be acute or chronic.
Acute bleeding the most dangerous, bleeding is observed in a short period of time. A rapid loss of 30% of circulating blood volume (CBV) leads to acute anemia, brain hypoxia and can result in the death of the patient.
Chronic bleeding. With chronic bleeding, blood loss occurs slowly and gradually, in small portions, and therefore the body has time to adapt to a slight decrease in blood volume. Sometimes for many days there is a slight, sometimes periodic, bleeding. Chronic bleeding may occur with stomach ulcers and duodenum, malignant tumors, hemorrhoids, uterine fibroids, etc.
According to the frequency of bleeding there are:
■ one-time;
repeated;
multiple.
