With parenchymal bleeding. Parenchymal bleeding. Video: emergency care for severe bleeding

Injuries to the abdomen or chest can result in externally invisible parenchymal bleeding. This is a dangerous blood loss from the most vulnerable human organs. In the article, we will talk about the features of bleeding from the parenchymal organs and first aid for them.

Parenchymal organs

All internal organs of a person can be divided into two large groups:

Cavity;
Parenchymal.

With the cavities, everything is extremely clear - this is the stomach, intestines, bladder. They have a cavity and a wall supplied with vessels. Bleeding from these organs will be associated only with vascular damage. If the vessel is small, then it is able to contract on its own, narrowing its lumen, the bleeding will stop. But what are the 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 the parenchyma.... It is permeated with many tiny vessels. When the 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, independently stopping bleeding.

Where are the parenchymal organs

Causes

The development of parenchymal blood loss is preceded by a violation of the integrity of the organ. The rupture of the parenchyma and small capillaries becomes a direct source of hemorrhage.

Causes that can lead to damage to the parenchymal organ:

Injuries;
Infections;
Malignant tumors;
Vascular tumors - hemangiomas.

Trauma to the abdomen and chest is often the result of road traffic accidents. Under the influence of an impact on the dashboard, steering wheel or other parts of the car, the parenchymal organ ruptures. Similar changes occur when the abdominal cavity is injured.

The greatest danger in blunt abdominal trauma is fraught with two-moment ruptures. At first, blood accumulates under the capsule of the organ, forming a bruise. At this time, the state of health does not suffer. After a while, the hematoma grows, hyperextension of the organ capsule occurs, it ruptures and symptoms of internal bleeding develop.

An infection such as tuberculosis often affects the lung tissue. Certain forms of tuberculosis cause destruction of lung tissue. The cavity forming in this case is called the tuberculous cavity. Bleeding arising from the cavity is manifested by a violent cough with bloody frothy sputum.

Cancer tumors can affect many organs, including parenchymal ones. Growing into the tissue of the organ, the tumor destroys it. At some point, bleeding from the area affected by the tumor may occur.

This predisposes a large number of vessels that always penetrate the tumor. Bleeding is especially large due to hemangioma - a tumor completely consisting of blood vessels.

Features of blood loss

The rupture of the 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 the delivery of oxygen and nutrients.

It provides normal immunity, maintains blood pressure. The loss of even a small amount of blood is manifested by symptoms of anemia.

Acute blood loss with parenchymal bleeding is an urgent condition. The lack of circulating blood volume primarily affects the pressure. It decreases, as the blood supply to the vessels decreases. All organs suffer from a lack of oxygen. The body tries to maintain nutrition to the last in the most important parts of the body - the brain, kidneys, heart.

One of the first to suffer is the kidneys - at low pressure, they are not able to perform their function. The kidneys stop filtering urine, and its formation decreases. With severe blood loss, the kidneys completely stop working, and no urine is formed at all.

All other organs suffer from blood loss. For the brain, this is manifested by loss of consciousness. For the heart - severe pain and heart rhythm disturbances.

Symptoms

Signs of parenchymal bleeding depend on the amount of blood lost. In total, blood takes about 7% of the body weight in the human body.

Doctors measure the amount of blood lost due to bleeding as a percentage of the total circulating blood volume:

To 10%- easy bleeding;
10-20% - moderate bleeding;
21-30% - heavy bleeding;
Over 30%- massive, critical blood loss.

The 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.

The victim is worried about:

Great weakness;
Dizziness;
Flickering before the eyes of flashes, blackheads;
Loss of consciousness;
Nausea, vomiting;
Pain in the area of the affected organ;
Lack of urine;
Cold sweat;
Pale skin.

When trying to feel the pulse, its weak filling and frequency are determined. Doctors call this pulse "threadlike", 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. Find out why she is.

In a state of severe blood loss, the pulse persists only on large arteries, such as the carotid one. But even there it is weak and very frequent.

Measurement of blood pressure is mandatory. Values lower than 90/60 mm Hg are considered hypotension. Blood loss is always accompanied by low blood pressure.

This is due to poor vascular filling. The lower the pressure, the more frequent and weak the pulse.

The ratio of the 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 is determined in the area of the affected organ. In the same place, the abdomen becomes extremely hard. This is due to irritation of the peritoneum with blood poured into the cavity.

Complications

Severe blood loss is terrible not only in itself. Ultimately, it is complicated by life-threatening conditions.

These pathologies require emergency surgery simultaneously with highly qualified help 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 pressure below 60 mm Hg. Shock assistance is provided in the intensive care unit with the help of transfusion of erythrocyte mass, plasma and colloidal solutions.

DIC syndrome is a fatal complication of bleeding. Blood loss reaches critical values, such that the blood loses its ability to clot. Moreover, it can begin to pour out not only from the injured place, but also from any organs. The mortality rate for disseminated intravascular coagulation is high even in the intensive care unit.

First aid

If parenchymal bleeding is suspected, the most important thing is to take it to the clinic. This must be done as quickly as possible. Every minute a person loses more and more blood. With a loss of more than a third of the circulating blood, bleeding becomes critical. Irreversible changes develop in the organs.

The more time has passed since the onset of hemorrhage, the less likely a successful outcome.

You can increase your chances of survival by providing first aid correctly:

Ice wrapped in a cloth is applied to the injury area.
The person sits down as comfortably as possible. During transportation, he is as little disturbed as possible.
Do not give any pills, do not feed or offer alcohol.
A small amount of water or tea may be offered.

After the victim is taken to the admission department of the clinic, he will be additionally 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 assistance consists of an operation. It is started urgently, with a little preoperative preparation.

It usually involves transfusing blood products or solutions to replenish lost blood and raise blood pressure.

There are several ways to stop parenchymal hemorrhage:

Even an experienced surgeon can find it difficult when the question arises of how to stop parenchymal bleeding. Combinations of methods can be used.

Simultaneously with the operation, hemostatic drugs are prescribed:

Vikasol;
Etamsilat;
Aminocaproic acid.

They promote the formation of blood clots in the smallest vessels of the parenchyma. After stopping the hemorrhage, the drugs are canceled. A few weeks after discharge from the hospital, blood-thinning drugs, such as aspirin, warfarin, are contraindicated in a person.

Video - first aid for bleeding

Content

The outflow of blood from the vessels, in which it does not stand out outside, but flows out into the internal cavities of the body, is called parenchymal. This bleeding is accompanied by a lot of blood loss and, as a rule, does not stop without emergency help.

Organs that are parenchymal

In the human body, there are two groups of internal organs: parenchymal and hollow. The first includes those that consist of a mass of cells (parenchyma), which is covered from above with a dense connective capsule (stroma). This is a reliable protection of the 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 gland and others.

Internal bleeding reasons

The tissue of the parenchymal organs has a rich blood circulation, so the slightest damage can cause severe internal bleeding. Common reasons:

trauma;
viral infections that violate the integrity of tissues (tuberculosis and others);
oncology in the last stage;
rupture of benign education.

Each parenchymal organ has its own bleeding characteristics. The main reasons for the outflow of blood from the vessels:

Parenchymal organs	Typical causes of bleeding
	Injured by fragments of the ribs when they are broken.
	Blunt trauma or a perforating wound to the abdomen.
Spleen	From the blow, first the blood enters the capsule, then after a few days from hyperextension, it bursts, pouring liquid into the cavity.
Pancreas	Cysts, malignant tumors
	Rupture of cysts, compression, or violent blow.

What is dangerous

The consequence of bleeding is a hematoma or hemorrhage. In the latter case, the blood soaks into 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 blood on their own, due to the absence of spasm of the vessels passing inside and their structure. If the blood loss is not stopped in time, the person will die.

Signs of hemorrhage

More often, internal bleeding develops quickly. Sometimes it is slow, so clinical manifestations may either be absent or not noticeable. Signs of this condition include:

dizziness;
fast and severe fatigue;
pallor of the skin;
drop in blood pressure;
increased heart rate;
chills;
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;
discoloration of urine;
acute pain in the peritoneum;
coughing up blood.

With blood loss of any intensity, the patient has a gradual decrease in iron and red blood cells in the blood, as a result of which the symptoms of anemia increase. After a while, all internal organs, especially the heart and brain, will suffer from oxygen starvation in a person. With significant bleeding, hemorrhagic shock develops. Each affected organ has its own signs of parenchymal bleeding:

Parenchymal organs	Typical symptoms
	Pain in the liver, impaired consciousness, headaches, bloody vomiting, blood in the feces.
	Urine staining red, pronounced pain in the lower back, nausea, vomiting, fever.
	Severe dry cough, mucous sputum mixed with blood clots, rapid breathing, wheezing.
Spleen	Tension of the muscles of the anterior abdominal wall, pain on the left side, tinnitus, vomiting, shortness of breath.

Stopping parenchymal bleeding

If a person has signs that indicate internal blood loss, he urgently needs to be taken to a medical facility. The usual methods of stopping bleeding in this case are not suitable.

It is possible to stop the outflow of blood only by surgery, while the life and health of the victim depend on the correct first aid provided.

First aid

After calling an ambulance, the patient is advised to maintain a horizontal position with the lower limbs raised up. If possible, cold should be placed at the site of the alleged blood loss (ice, frozen food, cloth soaked in cold water). The ambulance's job is to administer medications that stop blood and maintain blood pressure.

Surgery

The main way to stop parenchymal bleeding is surgical. After the examination (blood test, X-ray of the lungs, ultrasound of the abdominal cavity), an emergency operation is performed. In case of questionable test data, the doctor may start with laparoscopic diagnostics. 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 a part of an organ.

In parallel with the surgical intervention, the victim is transfused with blood and saline solutions. The main tasks of intensive care are to prevent the development of multiple organ failure (stress in the body) and disseminated intravascular coagulation syndrome (blood clotting disorders).

Video

What types of bleeding are there and why do they occur?

There are many classifications of this pathological condition, and experts teach them all. However, we are interested in the division of bleeding into varieties, first of all, from a practical point of view. For the successful provision of first aid, the following classification is relevant. It shows the types of bleeding depending on the nature of the damaged vessel.

Arterial bleeding

It comes from arteries containing oxygenated blood flowing from the lungs to all organs and tissues. This is a serious problem, since these vessels are usually located deep in the tissues, close to the bones, and situations when they are injured are the result of very strong influences. Sometimes this type of bleeding stops on its own, since the arteries have a pronounced muscular membrane. When such a vessel is injured, the latter spasms.

Venous bleeding

Signs and consequences of bleeding

Common signs of bleeding include dizziness , weakness, shortness of breath, severe thirst, pallor of the skin and mucous membranes, decreased pressure, increased heart rate ( tachycardia ), light-headedness and fainting. The severity and rate of development of the listed symptoms is determined by the rate of blood flow. Acute blood loss tolerated more difficult than chronic, because in the latter case, the body has time to partially "adapt" to the changes taking place.

General

Patient complaints:

Weakness, unmotivated drowsiness;
Dizziness;
Thirst;
Feeling of palpitations and shortness of breath.

External symptoms of blood loss that are observed with any type of bleeding are as follows:

Pallor of the skin and mucous membranes;
Cold sweat;
Increased heart rate;
Dyspnea;
Disorders of urination up to a complete lack of urine;
Drop in blood pressure;
Frequent, weak pulse;
Impairment of consciousness up to its loss.

Local

External outpouring of blood

The main local symptom is the presence of a wound on the surface of the skin or mucous membrane and the visible bleeding from it. However, the nature of bleeding is different and is in direct proportion to the type of vessel.

Capillary is manifested by that blood collects in large drops, oozing from the entire surface of the wound. Its loss per unit of time is usually small. Its color is red.
Signs of venous bleeding: blood can flow out quite quickly when a large vein is injured or several at once, it flows from the wound in strips. Its color is dark red, sometimes burgundy. If large veins in the upper body are damaged, intermittent bleeding from the wound may occur (however the rhythm is synchronized not with the pulse, but with the breath).
Signs of arterial bleeding: blood pours out from the site of injury with pulsating jolts - "fountains" (their frequency and rhythm coincide with heartbeats and pulse), its color is bright scarlet, red. Blood loss per unit time is usually rapid and significant.

Manifestations of latent bleeding

Common symptoms of bleeding

Symptoms of bleeding depend on the type of bleeding and the type of damaged vessels.

Classic signs:

The skin is pale, moist;
Heart palpitations (tachycardia);
Decrease in blood pressure.

Patient complaints:

general weakness and malaise, anxiety,
dizziness, especially when lifting the head,
"Flies" before the eyes, "darkening" in the eyes,
nausea,
feeling short of breath.

Local bleeding symptoms

With external bleeding:

direct outflow of blood from the damaged vessel.

With internal bleeding:

Gastrointestinal bleeding: vomiting of blood, unchanged or altered ("coffee grounds"); discoloration of feces, black stools (melena).
Pulmonary hemorrhage: hemoptysis or frothy blood from the mouth and nose.
Bleeding from the kidneys; scarlet color of urine.
Accumulation of blood in cavities (chest, abdominal, joint cavity, etc.). When bleeding into the abdominal cavity, the abdomen is swollen, the motor activity of the digestive tract is reduced, and pain is possible. With the accumulation of blood in the chest cavity, breathing weakens, the motor activity of the chest is reduced. When bleeding into the joint cavity, there is an increase in its volume, sharp pain, dysfunction.

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The peculiarity of parenchymal organs is that they have a "fleshy" and abundantly supplied 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, taking blood through the portal vein);
kidneys (secrete metabolic products with urine formed by them);
lungs (they exchange gas and release carbon dioxide into the atmosphere);
spleen (destroys spent blood cells and participates in its deposition).

The figure shows a feature of the structure of the liver parenchyma

The parenchymal organs are composed 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 outflow of blood from a vessel into the external environment or internal cavities of the body. Soaking the surrounding tissue with blood is called hemorrhage. A cavity formed in tissue and filled with blood is a hematoma.

In case of injury, rupture of a cyst or necrosis of a tumor, 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 flows out of the vascular bed through the defect. At first, blood loss may go unnoticed, since we do not see blood, and general complaints can correspond to a large number of other diseases. Gradual blood loss leads to anemia.

As a result of a decrease in erythrocytes and hemoglobin in the blood, internal organs, including the brain and heart, suffer from hypoxia. With profuse blood loss, hemorrhagic shock develops. This is a severe complication of severe bleeding, while there is a significant decrease in pressure with the 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, disguised as other diseases. Bleeding from the parenchyma of the liver, kidneys, lungs, spleen can have its own characteristics. Common symptoms are signs of acute blood loss. First of all, weakness, dizziness, loss of consciousness is possible. The skin becomes pale, cold. If you try to determine the pulse on the forearm, then it will be very poorly felt, the so-called "thread-like pulse". The heart will beat faster. Blood pressure will be reduced, and it may not be detected at all.

Check your pulse if shock is suspected

Features for each parenchymal organ

Along with the general signs of latent blood loss, for each parenchymal organ, its own symptoms may be observed.

Liver

Located in the right hypochondrium. As a rule, the liver of people with hepatitis, alcohol abuse, and malaria is more susceptible to damage. All these conditions lead to its enlargement and overstretching of the capsule. As a result of trauma - "where it is weak, there it breaks." With liver injury, blood flows into the abdominal cavity. Along with blood, bile also gets there, which provokes the development of biliary peritonitis later. Pain, shock and internal bleeding predominate. Development of subcapsular hematoma with subsequent rupture is possible.

Kidney

Injury to the kidney can result from quite severe exposure. Bleeding can be accompanied by severe back pain and shock. A characteristic sign may be gross hematuria - red staining of urine. In the presence of an oncological process, long-term chronic blood loss is possible, leading to the development of severe anemia.

Lungs

Pulmonary hemorrhage is also parenchymal. It can be caused by trauma, cancer, tuberculosis. May be clinically manifested by respiratory failure. Blood can collect in the pleural space, thereby compressing the lung.

Hemoptysis is one of the signs of pulmonary hemorrhage

Spleen

The spleen deposits blood. With her injury, life-threatening blood loss can develop. As in the liver, subcapsular ruptures can also form in the spleen. This kind of damage can be misleading. The clinic of acute blood loss will develop not after an injury, but in a few days, when the capsule bursts under the pressure of the blood bursting from the inside. Spleen injury, unfortunately, is not uncommon in childhood.

How to suspect internal bleeding, what measures to take

What should be alarming:

anamnesis (the 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 alleged bleeding, severe weakness);
appearance (pale skin, cold sweat, pointed facial features);
clinic (palpitations and low blood pressure).

In the hospital for the diagnosis of abdominal trauma, an ultrasound of the abdominal cavity is performed

First aid for suspected internal bleeding is to deliver the patient to the surgical hospital as quickly as possible. Methods for stopping bleeding, such as a tourniquet, a pressure bandage, do not work here. Only a surgeon in the operating room can provide real help and effectively stop bleeding.

Before the ambulance arrives:

put the victim horizontally with raised legs;
put cold on the area of alleged bleeding.

An ambulance will transport the patient to the hospital, and will also introduce special hemostatic drugs (etamzilate, vicasol, aminocaproic acid).

Bleeding will not stop with these measures, but blood loss may be slightly reduced. Ambulance doctors will also begin infusing saline into a vein to maintain falling blood pressure.

Body position when pressure drops

Surgery

The main help to the patient is provided in the operating room. For diagnostic purposes, they pre-take tests, do an ultrasound of the abdominal cavity, an x-ray of the lungs. Then an emergency operation is performed. If the data of diagnostic methods are questionable, they can start with diagnostic laparoscopy.

Ways to stop parenchymal bleeding:

hemostatic sponges;
hemming of the oil seal;
resection of a 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, transfusion of blood, saline solutions is carried out. Intensive therapy is aimed at preventing the development of disseminated intravascular coagulation and multiple organ failure.

Parenchymal bleeding is a threat to life and health. Severe bleeding, which may not be recognized and lead to large blood loss, will not stop on its own. Requires urgent surgical care. It is important to be very wary of the signs described above and seek immediate medical attention. In this situation, the count goes for hours, not even for 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 form of disease. This condition can be dangerous to human life and health. If there is a severe internal hemorrhage, such as after a car accident, the person needs a life-saving surgery.

General characteristics of internal bleeding

Such bleeding occurs when the tissues of the 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 can be hidden or mild, therefore, if you suspect the development of such a process, you should immediately contact a specialist. The medical institution will conduct a full examination, which will reveal 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 a person's life. Transfusion is carried out during the operation 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.

What organs can suffer from such a problem

Parenchymal bleeding usually occurs in the following organs:

The peculiarity of these organs is that they consist of a thick and blood-supplied parenchyma. This is due to the fact that the main functions of organs are to filter out substances unnecessary for the body.

This type of bleeding can occur:

due to mechanical damage, in which tissue rupture 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, otherwise the bleeding may be so severe that it will be impossible to stop it without an emergency operation. As a result of this phenomenon, there is a sharp decrease in the content of erythrocytes and iron in the blood, which leads to oxygen starvation.

With profuse bleeding, the patient may experience hemorrhagic shock. Rapid blood loss leads to cardiac muscle arrest and death.

Danger of condition

Parenchymal bleeding is a life-threatening condition. With this phenomenon, blood flows into the surrounding tissue, organ cavity, body cavity.

By the type of bleeding, they are divided into the following types:

The first type is formed when the liver is injured, it is characterized by characteristic clinical manifestations that begin to develop rather 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, an inflammatory process develops in the abdominal cavity.

The danger of the condition lies in the fact that the parenchymal organs are not capable of self-stopping blood, 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 the vessels passing through their tissues.

Clinical manifestations of the disease

Such bleeding, which develops quickly enough, immediately manifests itself. However, if bleeding is slow, then clinical manifestations may be absent or completely invisible.

Symptoms of this condition include:

strong and rapid fatigue;
dizziness;
constant desire to drink;
pallor of the skin;
chills;
pressure drop.

In addition, there are special clinical manifestations that arise depending on the affected organ.

Particular attention should be paid to the following conditions:

The appearance of bleeding in the lungs often appears with a fracture of the ribs, when sharp bones pierce the tissues of the respiratory system. And also the defeat can be caused by tuberculosis or cancer.

The spleen is most often ruptured by mechanical injury (for example, as a result of an accident). In this case, immediate surgical intervention is required, any delay can cost the patient's life.

The kidneys are prone to injury when squeezed or ruptured. In this condition, the urine is sharply stained, severe pain is observed.

In any case, the condition requires immediate specialist intervention. If symptoms of internal bleeding are observed, an ambulance should be called immediately.

First aid and surgery

Pay attention first of all to the following manifestations:

the presence of abdominal injuries;
mechanical damage to the chest;
the formation of hematomas and bruising;
sharp pain in the area of the damaged organ;
emerging sweat;
chills and fever;
cardiopalmus;
a sharp drop in pressure.

Before the doctors arrive, you must:

Lay the patient down and raise the legs.
Cool the suspected damage site.

When an ambulance arrives, specialists will transport the victim to the hospital and administer medications such as:

Medicines will not be able to stop the bleeding, but they will improve the patient's condition. In order to maintain the pressure, specialists will begin to inject a special solution intravenously.

Once the patient is admitted to the hospital, they will immediately be sent to the operating room for emergency procedures.

Before carrying out a surgical intervention, the following measures will be carried out in advance:

If all studies are within the normal range, then doctors will conduct 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 oil seal;
amputation of the affected part;
electrocoagulation;
stitching 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, saline is infused and supportive therapy is given to prevent the development of disseminated intravascular coagulation (disseminated intravascular coagulation) and multiple organ failure.

Such bleeding usually becomes a threat to the patient's life, therefore, it does not tolerate delay. The earlier the surgery is performed, the better the outcome will be. With a successful surgical intervention, the patient's life can be saved.

Contacting a medical institution

As soon as the victim is taken to a medical facility, specialists will begin to carry out the following activities:

Examination of the patient for blunt or acute trauma.
Checking for the development of an infectious disease.
Delivery of tests for oncology.
External examination and palpation.
Measurement of such basic parameters as pulse, pressure, temperature.

After a surgical intervention (a way to stop parenchymal bleeding) is performed, the patient will have to undergo long-term treatment in a hospital setting. Even surgical manipulations 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 there is a mixed type of internal hemorrhage. 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 the parenchymal organs.

Parenchymal bleeding symptoms:

The blood vessels of the parenchymal organs are intimately connected with the parenchyma, so they do not collapse, bleeding is usually profuse, prolonged, and stops with great difficulty. The peculiarity of these bleeding is massive due to abundant vascularization of the organ parenchyma.

Causes of Parenchymal Bleeding:

Parenchymal bleeding occurs when the parenchymal organs (liver, spleen, kidneys) are damaged.

Treatment for Parenchymal Bleeding:

Stopping bleeding can be difficult and require a variety of techniques from the surgeon. You have to use fibrin film, hemostatic sutures, electrocoagulation, etc. & nbsp & nbsp

Suturing the liver as a method to stop parenchymal bleeding

Where to go:

Medicines, drugs, tablets for the treatment of Parenchymal bleeding:

Bryntsalov-A CJSC Russia

Antihemorrhagic drugs. Fibrinolysis inhibitors.

LLC "Pharmaceutical company" Health "Ukraine

Why is parenchymal bleeding dangerous and how to stop it?

Parenchymal organs

All internal organs of a person can be divided into two large groups:

With the cavities, everything is extremely clear - this is the stomach, intestines, bladder. They have a cavity and a wall supplied with vessels. Bleeding from these organs will be associated only with vascular damage. If the vessel is small, then it is able to contract on its own, narrowing its lumen, the bleeding will stop. But what are the 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 the 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, independently stopping bleeding.

Where are the parenchymal organs to the content

Causes

The development of parenchymal blood loss is preceded by a violation of the integrity of the organ. The rupture of the parenchyma and small capillaries becomes a direct source of hemorrhage.

Causes that can lead to damage to the parenchymal organ:

Injuries;
Infections;
Malignant tumors;
Vascular tumors - hemangiomas.

The greatest danger in blunt abdominal trauma is fraught with two-moment ruptures. At first, blood accumulates under the capsule of the organ, forming a bruise. At this time, the state of health does not suffer. After a while, the hematoma grows, hyperextension of the organ capsule occurs, it ruptures and symptoms of internal bleeding develop.

An infection such as tuberculosis often affects the lung tissue. Certain forms of tuberculosis cause destruction of lung tissue. The cavity forming in this case is called the tuberculous cavity. Bleeding arising from the cavity is manifested by a violent cough with bloody frothy sputum.

Cancer tumors can affect many organs, including parenchymal ones. Growing into the tissue of the organ, the tumor destroys it. At some point, bleeding from the area affected by the tumor may occur.

This predisposes a large number of vessels that always penetrate the tumor. Bleeding is especially large due to hemangioma - a tumor completely consisting of blood vessels.

Features of blood loss

The rupture of the 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 the delivery of oxygen and nutrients.

It provides normal immunity, maintains blood pressure. The loss of even a small amount of blood is manifested by symptoms of anemia.

Acute blood loss with parenchymal bleeding is an urgent condition. The lack of circulating blood volume primarily affects the pressure. It decreases, as the blood supply to the vessels decreases. All organs suffer from a lack of oxygen. The body tries to maintain nutrition to the last in the most important parts of the body - the brain, kidneys, heart.

One of the first to suffer is the kidneys - at low pressure, they are not able to perform their function. The kidneys stop filtering urine, and its formation decreases. With severe blood loss, the kidneys completely stop working, and no urine is formed at all.

All other organs suffer from blood loss. For the brain, this is manifested by loss of consciousness. For the heart - severe pain and heart rhythm disturbances.

Symptoms

Signs of parenchymal bleeding depend on the amount of blood lost. In total, blood takes about 7% of the body weight in the human body.

Doctors measure the amount of blood lost due to bleeding as a percentage of the total circulating blood volume:

The 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.

Great weakness;
Dizziness;
Flickering before the eyes of flashes, blackheads;
Loss of consciousness;
Nausea, vomiting;
Pain in the area of the affected organ;
Lack of urine;
Cold sweat;
Pale skin.

In a state of severe blood loss, the pulse persists only on large arteries, such as the carotid one. But even there it is weak and very frequent.

Measurement of blood pressure is mandatory. Values lower than 90/60 mm Hg are considered hypotension. Blood loss is always accompanied by low blood pressure.

This is due to poor vascular filling. The lower the pressure, the more frequent and weak the pulse.

The ratio of the 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 is determined in the area of the affected organ. In the same place, the abdomen becomes extremely hard. This is due to irritation of the peritoneum with blood poured into the cavity.

Complications

Severe blood loss is terrible not only in itself. Ultimately, it is complicated by life-threatening conditions.

These pathologies require emergency surgery simultaneously with highly qualified help 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 pressure below 60 mm Hg. Shock assistance is provided in the intensive care unit with the help of transfusion of erythrocyte mass, plasma and colloidal solutions.

DIC syndrome is a fatal complication of bleeding. Blood loss reaches critical values, such that the blood loses its ability to clot. Moreover, it can begin to pour out not only from the injured place, but also from any organs. The mortality rate for disseminated intravascular coagulation is high even in the intensive care unit.

First aid

If parenchymal bleeding is suspected, the most important thing is to take it to the clinic. This must be done as quickly as possible. Every minute a person loses more and more blood. With a loss of more than a third of the circulating blood, bleeding becomes critical. Irreversible changes develop in the organs.

The more time has passed since the onset of hemorrhage, the less likely a successful outcome.

You can increase your chances of survival by providing first aid correctly:

Ice wrapped in a cloth is applied to the injury area.
The person sits down as comfortably as possible. During transportation, he is as little disturbed as possible.
Do not give any pills, do not feed or offer alcohol.
A small amount of water or tea may be offered.

First steps for parenchymal bleeding to the content

Treatment

After the victim is taken to the admission department of the clinic, he will be additionally examined.

Usually these are the most minimal diagnostic procedures that take little time:

Determination of blood group and Rh factor;
Determination of hemoglobin;
Ultrasound procedure.

Parenchymal bleeding is unable to stop on its own. Almost always, medical assistance consists of an operation. It is started urgently, with a little preoperative preparation.

It usually involves transfusing blood products or solutions to replenish lost blood and raise blood pressure.

There are several ways to stop parenchymal hemorrhage:

Using a hemostatic sponge;
Sewing the oil seal;
Removal of part of the organ;
Electrical coagulation.

Even an experienced surgeon can find it difficult when the question arises of how to stop parenchymal bleeding. Combinations of methods can be used.

Simultaneously with the operation, hemostatic drugs are prescribed:

They promote the formation of blood clots in the smallest vessels of the parenchyma. After stopping the hemorrhage, the drugs are canceled. A few weeks after discharge from the hospital, blood-thinning drugs, such as aspirin, warfarin, are contraindicated in a person.

Internal bleeding (parenchymal): first aid

A distinctive feature of parenchymal bleeding is that a person loses a large amount of blood. By itself, the outpouring of blood will not stop, so the victim needs emergency assistance.

What organs are called parenchymal?

The main function of these organs is to cleanse the blood. Due to this, they have a fleshy parenchyma. These organs remove metabolic products from the blood. This category includes:

Liver. This organ recycles harmful substances that enter the blood.
Kidneys. Through these organs, excess fluid, 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, blood cells die, which have already served their purpose.

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 the outpouring of blood.

Causes

What causes bleeding? Parenchymal hemorrhage can result from:

If a person has impaired blood clotting, then it will be more difficult to stop the bleeding. This happens in people with certain congenital diseases. Also, poor coagulability appears with age or while taking medications that thin the blood. Such drugs, by the way, are often prescribed to patients with cardiac diseases.

What does the process of hemorrhage look like in the body?

Parenchymal bleeding is bleeding, in which blood flows out (into the external environment or into any cavity inside the body) from the vessel. The cavity between the layers of tissue, which is filled with blood, is called a hematoma. Outwardly on the body, this is easy to notice.

When a vessel is damaged, parenchymal bleeding begins. In the beginning, you can ignore it. The symptoms described by the patient can be confused with other pathologies. And it is often difficult to assume that a person has parenchymal bleeding.

Stopping blood loss on your own in this case is impossible. Only medical attention is needed. If it is not provided, then over time the person develops anemia. With such a disease, the number of red blood cells in the blood decreases and the level of hemoglobin falls. 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 severe. The patient has a decrease in pressure and multiple organ failure develops. 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, he may lose consciousness. The appearance deteriorates, the skin becomes pale and cold. On the forearm, the pulse is poorly felt. 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 bleeding of the liver. This organ is located on the right side, under the ribs. As a rule, the liver is affected in people who have hepatitis or have alcohol dependence. Those who have suffered from a disease such as malaria are also susceptible to parenchymal bleeding of the liver. The ailments listed above cause an increase in the volume of the liver, as a result of which the capsule stretches and tissue damage. Blood begins to pour into the abdominal cavity. Bile also goes there. This leads to the development of such a pathology as biliary peritonitis. A person with this type of bleeding has severe abdominal pain, signs of shock appear. Subcapsular hematoma may subsequently occur.
Features of parenchymal renal bleeding. It can be caused by a strong physical effect on the kidneys of a person (for example, a blow). Signs include severe pain in the lumbar region. Also, in a patient with such bleeding, urine turns red. This phenomenon is called gross hematuria. If an oncological disease develops in the body, then this type of bleeding can be prolonged and lead to anemia.
Features of parenchymal bleeding of the lungs. The damage can be caused by trauma, tuberculosis, or cancer. Pulmonary insufficiency usually develops with this bleeding. The accumulation of blood in the pleural cavity is often observed, 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 after several days. There are statistics that confirm that the spleen is often injured in childhood.

Main symptoms for all types

What signs indicate internal bleeding is present in the body?

First of all, you need to take a closer look at the work of the body if a person is injured in the abdomen, chest or lower back. Symptoms include:

The presence of hematomas on the body or rib fractures.
Patient complaints about pain in possible areas of bleeding, general weakness of the body.
Deterioration of a person's appearance, namely, pallor of the skin, the appearance of cold sweats. Facial features become sharp.
Rapid heartbeat, low blood pressure.

Help

If a person has signs that indicate internal bleeding, then he urgently needs to be taken to the surgery department. The usual stopping methods, which include the application of 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). Patient care should be provided in the following order:

It is recommended to keep the victim in a horizontal position, with the legs raised up.
Ice should be applied to the site of the alleged bleeding.

The task of the ambulance team is to transport the patient to the hospital and administer drugs that will help stop the bleeding. Also, medications are administered to a person to maintain normal blood pressure.

How is the surgical treatment carried out?

In order to diagnose bleeding, the patient undergoes an ultrasound scan and an X-ray of the internal organs. If the diagnosis is confirmed, then an emergency surgery is prescribed.

There are several ways to stop bleeding.

Using a hemostatic sponge.
Sewing the oil seal.
Resection (removal) of any part of the organ.
Electrocoagulation (cauterization) of blood vessels.
Embolization.
The imposition of special complex sutures on the 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 blood effusion will not go away on its own. Therefore, at the slightest suspicion, you should immediately call doctors and go to a surgical hospital.

An accurate diagnosis will be made there and an emergency operation will be performed. Any delay can lead to the death of a person. It is important to monitor the state of the body and well-being, especially if there were any injuries that could damage organs such as the liver, lungs, kidneys and spleen.

Also, the presence of hematomas and smudges on the body, pain and dizziness should alert a person and force him to seek qualified help from specialists. It is 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 provided 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

By the type of the bleeding vessel, bleeding is divided into arterial, venous, arteriovenous, capillary and parenchymal.

Arterial bleeding... Bleeding from a damaged artery. The blood flows out quickly, under pressure, often in a pulsating stream, sometimes gushing. 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 damage (lateral, complete, etc.).

With profuse (profuse) arterial bleeding, the wound is in the projection of a large artery; the outpouring blood is bright red (scarlet), beats with a strong pulsating stream. Due to the high blood pressure, usually, the bleeding does not stop on its own. Damage to the main artery is dangerous, both rapidly progressing blood loss and ischemia of the tissues that it must supply with 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 color of blood. The blood loss rate 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, a pulsating stream can be observed due to transmission pulsation. When bleeding from the veins of the neck, the dangers of air embolism should be kept in mind. If large veins of the upper half of the body are damaged, blood can flow out in an intermittent stream, synchronously with breathing (due to the suction action of the chest), and not the pulse.

There are significant clinical differences in bleeding with damage to deep (large, trunk) and superficial (saphenous) veins. Bleeding in case of damage to the main veins is no less, and sometimes even more dangerous than arterial, because it quickly leads to a drop in pressure in the mouths of the vena cava, which is accompanied by a decrease in the force of heart contractions. Such bleeding can lead to air embolism, which is especially common in case of damage to the veins of the neck, intraoperative damage to the vena cava. Veins, in contrast to arteries, have an underdeveloped muscular membrane, and the rate of blood loss almost does not decrease due to vasospasm.

Bleeding from damaged saphenous veins, as a rule, is less dangerous, since the rate of blood loss is much lower and there is practically no danger of air embolism.

Capillary bleeding... Bleeding from capillaries, in which blood oozes evenly from the entire surface of damaged tissues. This bleeding is caused by damage to the capillaries and other microvessels. In this case, as a rule, the entire wound surface bleeds, which, after drying, is again covered with blood. 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 importance with 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 both arterial and venous bleeding. Combined damage to an artery and vein located next to each other, as part of one neurovascular bundle, is especially common. The clinical picture consists of a combination of symptoms of various types of bleeding, and, at the stage of first aid, it is not always possible to reliably determine the source and nature of bleeding.

Parenchymal bleeding... Bleeding from the parenchyma of an internal organ. It is observed with damage to the parenchymal organs: liver, spleen, kidneys, lungs, pancreas. Such bleeding, as a rule, does not stop on its own. Since the listed organs mainly consist of parenchyma, they are called parenchymal. Bleeding when damaged is called parenchymal .

B) BY THE MECHANISM OF OCCURRENCE

Depending on the cause that led to the release of blood from the vascular bed, two types of bleeding are distinguished:

Physiological bleeding among women.

Pathological bleeding- other.

By origin, pathological bleeding is divided into

- traumatic caused by mechanical damage to the vascular wall (including during surgery), and

- non-traumatic associated with pathological changes in the vascular (with neoplasm, inflammatory process, increased permeability of the vascular wall, damage by ionizing radiation, etc.).

Causes of bleeding can 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 in a pathological process : ulceration of atherosclerotic plaque, destructive process in tissues (focus of purulent inflammation, stomach ulcer, disintegrating tumor);

increased permeability of the vascular wall (with intoxication of the body, sepsis, vitamin C deficiency), leading to leakage of blood 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 bleeding from stopping and promotes the development of prolonged bleeding, massive blood loss.

More about the causes of bleeding

Traumatic bleeding - bleeding caused by a violation of the integrity of blood vessels during trauma (injury, rupture of the vessel wall or heart), includingsurgical bleeding (during surgery).

These injuries (injuries) can be open, in which the outflow of blood occurs through the wound channel to the outside, or closed. For example, with closed fractures, vessels may rupture with bone fragments. Also, traumatic ruptures of internal organs, muscles and other anatomical structures lead to the development of internal bleeding in closed injuries.

Closed vascular lesions are very dangerous, since difficulties in their recognition often lead to diagnostic errors and untimely assistance. In this case, hemorrhages in the body cavity, as well as retroperitoneal and intermuscular hematomas, can be very significant in terms of the volume of blood loss, leading to severe acute hypovolemia and hemorrhagic shock.

Non-traumatic bleeding - these are bleeding caused by pathological changes in the walls of blood vessels or the heart.

The mechanism of occurrence is distinguished

- bleeding from rupture(haemorrhagia per rhexin),

- bleeding from corrosion(haemorrhagia per diabrosin - arrosive bleeding,

- bleeding from oozing(haemorrhagia per diapedesin) with increased vascular wall permeability.

Rupture of the pathologically altered wall of a vessel or heart.

With aneurysm of a vessel or heart, hemorrhoids, varicose veins, myocardial infarction, sclerotic changes in the arteries, tubal ectopic pregnancy, etc. Rupture of the vessel wall or heart is promoted by an increase in blood pressure.

In this regard, we can separately highlight vicarious bleeding- bleeding from small vessels of the mucous membrane of the nasal walls, caused by excessive blood pressure, for example, in a hypertensive crisis. Or bleeding with 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

In case of erosion (destruction) of the vascular wall (with the germination of the vascular wall by a malignant tumor and decay - destruction of the tumor;

With necrosis, including the ulcerative process;

With caseous necrosis in the wall of the tuberculous cavity;

With destructive inflammation, including purulent inflammation, when the vessel wall can melt in the focus of inflammation;

With enzymatic melting of the vascular wall with pancreatic juice containing proteases, lipases, amylases in pancreatic necrosis, etc.).

Increasing the permeability of the walls of microvessels.

Diapedetic hemorrhage ( due to an increase in the permeability of the walls of blood vessels) occurs due to the leakage of blood from microvessels (arterioles, capillaries and venules). An increase in the permeability of the vascular wall is observed in hemorrhagic diathesis, including systemic vasculitis, avitaminosis (especially avitaminosis C), uremia, sepsis, scarlet fever, other infectious and infectious-allergic diseases, as well as poisoning with benzene, phosphorus.

A certain role in the development of bleeding is played by the state of the blood coagulation system. Violation of the process of thrombus formation in itself does not lead to bleeding and is not its cause, but 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 smallest, injury can lead to fatal bleeding. The most famous diseases with a violation of the blood clotting process are hemophilia, Werlhof's disease. DIC syndrome, cholemia also leads to a decrease in blood clotting. Often there are decreases in blood coagulation of medicinal origin, which occur when using indirect anticoagulants that disrupt the synthesis in the liver VII, IX, X of blood coagulation factors; direct anticoagulants (eg, heparin); thrombolytic drugs (for example, streptase, streptokinase, urokinase, streptoliasis, etc.), as well as non-steroidal anti-inflammatory drugs (for example, acetylsalicylic acid, butadione, etc.) that disrupt platelet function.

Bleedingandvost- a tendency to prolonged, low-intensity bleeding; observed in violation of the mechanism of blood coagulation and (or) an increase in the permeability of the vascular wall.

Hemorrhagic diathesis- This is a condition characterized by increased bleeding, a tendency to prolonged bleeding, which is observed with blood coagulation disorders and (or) an increase in the permeability of the vascular wall.

The Greek word diatesis means a tendency, a predisposition to something, such as certain illnesses or inadequate responses to common stimuli.

C) RELATING 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 comes from a wound (or from a trophic skin ulcer) directly into the external environment, outward, on the surface of the body.

IIMixed bleeding e is bleeding into the lumen of a hollow organ communicating with the external environment through the natural openings of the body. With mixed bleeding, blood first accumulates in the cavities communicating (normally) with the external environment, and then, through the natural openings of the body, it is released outward, unchanged or altered. A typical example is bleeding into the lumen of the organs of the gastrointestinal tract: with gastric bleeding, blood first accumulates in the stomach, and then is excreted in the form of bloody vomit, vomiting of "coffee grounds" is possible (hemoglobin under the action of hydrochloric acid turns into black hydrochloric 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 hemorrhage (in the respiratory tract);

3. Bleeding into the 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 semen).

4. Uterine bleeding (metrorrhagia).

5. Nosebleeds (epistaxis).

6. Bleeding into the biliary tract (hemobilia).

Gastrointestinal, pulmonary bleeding, bleeding into the urinary tract, etc. are explicit and hidden.

Explicit (overt) bleeding manifests itself with clear clinical signs.

Latent (occult) bleeding determined only by special research methods.

Obvious bleeding- these are such bleeding, in which blood, even in an altered form, appears outside after a certain period of time, which can be seen with the naked eye. For example, bloody vomit of unaltered blood or coffee grounds; bloody stools that are red, dark, or even black (melena); hematuria in the form of bloody urine; coughing up blood or scarlet frothy blood during cough tremors.

Hidden bleeding - these are such small bleeding that with the naked eye (macroscopically) it is impossible to see the blood flowing out from the natural openings of the body, since there is only a small amount of blood (occult blood) in the test material (feces, urine). It is detected only by special laboratory tests (with latent 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 tissue, organs.

Internal bleeding may cause bleeding in the body cavity, not communicating (normally) with the external environment: cranial cavity, joint cavity (hemarthrosis), pleural cavity (hemothorax), abdominal cavity (hemoperitoneum), into the pericardial cavity (hemopericardium), as well as blood can flow from the vessels in tissue, in the form of a hematoma(formed as a result of tissue separation, with the formation of a cavity in them filled with liquid or coagulated blood), or ashemorrhages with tissue saturation with blood (the occurrence of petechiae, ecchymosis). With interstitial bleeding (hemorrhage), blood flowing from the vessels can soak the tissues surrounding the damaged vessel. Hemorrhages in the integument of the body (skin, mucous membranes), with their soaking with blood (which leads to the formation of petechiae and ecchymosis), are also a type of internal bleeding. Distinguish petechiae - punctate hemorrhages; ecchymosis (bruising, bruising) - larger than petechiae, hemorrhages in these tissues. Petechiae- punctate, small spotted hemorrhages in the skin, as well as in mucous or serous membranes, the size of which, on average, from a pinhead to a pea. Ecchymosis(ancient Greek κχύμωσις- “outpouring” from κ- “from-” and χέω- “pour”) - more extensive hemorrhages in the skin or mucous membrane, the diameter of which usually exceeds 2 cm. Ecchymosis is also called a bruise (in everyday life), bruising (in medicine) - an area of superficial tissue (skin, mucous membrane) saturated with blood flowing out of a damaged vessel (damaged vessels).

Hematomas usually formed in denser tissues (brain tissue, liver) or delimited by fascia (on the limbs). Loose tissues (adipose tissue, muscles), more often, are simply soaked in blood.

As the pressure in the hematoma cavity rises, the bleeding stops, however, in the future, rupture of the tissue delimiting the hematoma may occur, and the bleeding recurs. This mechanism of early secondary bleeding is characteristic of subcapsular ruptures of the liver and spleen parenchyma (two-stage ruptures of an organ with the development of intra-abdominal bleeding).

Small hematomas may resolve over time.

Larger hematomas usually organize, i.e. are replaced by fibrous connective tissue and turn into a scar.

If a large hematoma exists long enough, the surrounding tissues turn into a scar, and the hematoma is surrounded by a fibrous connective tissue capsule. This is how a pseudocyst is formed. In addition, hematomas can fester, turning into phlegmon, and in the presence of a strong capsule, into abscesses.

Learn more about internal bleeding.

1. Intracavitary (cavity) 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 (with injury or rupture of blood vessels, organs of the abdominal cavity 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 cavity (intra-abdominal, intrapleural) bleeding observed at hemoperitoneum, hemothorax with the outflow of blood flowing from the cavity to the outside, through a penetrating wound or through drains. At the same time, the intensity of the outward flow of blood often does not correspond to the intensity of internal bleeding.

2. Interstitial (interstitial) bleeding (hemorrhage) - This is the outflow of blood into the thickness of the tissue.

Interstitial (interstitial) are bleeding in which blood or impregnates fabrics, or accumulates in interstitial spaces, forming a hematoma.

a) Vnutritive hemorrhage with tissue impregnation (hemorrhagic infiltration, hemorrhagic tissue imbibition):

Small punctate (petechial) hemorrhages caused by capillary hemorrhage in the thickness of the skin, mucous membrane and serous membranes - hemorrhagic petechiae;

Multiple spontaneous hemorrhages in the skin, mucous membranes of crimson color (red with a purple tint) - thrombocytopenic purpura;

- spotted planar hemorrhage in 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 absorption,

Formation of a cyst at the site of hemorrhage,

Encapsulation and germination by connective tissue,

Accession of infection and suppuration.

b) Hemat O ma (haematoma; hemat- + -oma; blood tumor) - occurs with interstitial bleeding with tissue stratification and the formation of a cavity in them, containing liquid or clotted blood accumulated in it.

Varieties of hematomas by their localization (by location):

subcutaneous hematoma,

intermuscular hematoma,

subperiosteal hematoma,

retroperitoneal (in the retroperitoneal tissue) hematoma,

perirenal (in perirenal tissue) hematoma,

extrapleural hematoma (between the soft tissues of the chest wall and parietal pleura),

paraurethral hematoma (in paraurethral tissue),

mediastinal hematoma (mediastinal hematoma),

intra-wound hematoma (with intra-wound bleeding, hematoma in the wound canal, formed as a result of hemorrhage into the cavity of a gunshot or puncture 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 brain substance),

intraventricular hematoma (with hemorrhage into the ventricle of the brain),

hematocele (hemorrhage with accumulation of blood between the membranes of the testicle, in the tissues of the scrotum).

The blood poured into tissues and cavities was a good breeding ground for microorganisms. Thus, any hematoma, any accumulation of blood with internal bleeding. are predisposing factors for the development of suppuration.

Outcomes of hematomas:

Suppuration of hematoma (formation of an abscess) during infection

Resorption of hematoma;

Organization of a hematoma (germination of a hematoma by connective tissue) with the formation of a scar;

Encapsulation of a hematoma with the formation of a pseudocyst;

Pulsatinghematoma- This is a hematoma formed as a result of interstitial arterial bleeding and retaining communication with the lumen of the damaged artery.

Bursting hematoma- This is a pulsating hematoma associated with a damaged major trunk artery, rapidly increasing in volume and compressing the surrounding tissues; in the case of compression of the collateral vessels passing through them, ischemic gangrene of the limb may occur. A pulsating hematoma can form a false arterial aneurysm (post-traumatic or arrosive).

Aneurysm(from the Greek ananeuryno - to expand) is a local (local) expansion of the lumen of a blood vessel or heart cavity due to pathological changes in their walls (more often atherosclerotic) or developmental anomalies.

True aneurysm - it is an aneurysm, the walls of which have the layers inherent in a given blood vessel.

Congenital aneurysm- aneurysm resulting from an anomaly in the development of the vascular wall:

Arterial aneurysm

Venous aneurysm

Arteriovenous aneurysm, characterized by communication between an artery and an associated vein.

Dissecting aneurysm(more often the aorta) is an aneurysm (aorta) in the form of an intramural canal formed as a result of a tear in the inner lining of the vessel and stratification of the vessel wall with blood flowing 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 in the event of trauma 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: in case of chest injury, a combination of intrapleural bleeding (hemothorax) and bleeding into the airways (pulmonary bleeding) is possible, and in the presence of chest injury, external bleeding from damaged vessels of the chest wall wound is possible. The intensity of each of these bleeding can be different.

D) BY THE TIME OF ARISE

By the time of occurrence of bleeding 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 damage.

Secondary bleeding are early (usually from several hours to 4-5 days after injury) and late (more than 4-5 days after injury).

Early secondary bleeding develop in the first hours or days after injury due to the ejection of a blood clot from the vessel or slipping of the ligature from the vessel (with an increase in blood pressure), as well as due to the end of the spasm of the vessel. Early secondary bleeding can be caused by damage to the vessels by a bone fragment or a thrombus separation, due to poor transport immobilization, careless shifting of the victim, etc. It is very important to remember about the possibility of secondary early bleeding during anti-shock therapy, when, caused by it, an increase in blood pressure can contribute to the expulsion of the thrombus by current blood.

Late secondary (or arrosive) bleeding develop a few days after injury due to melting of a thrombus by a purulent process, arrosion (destruction) of the vessel wall in the focus of purulent inflammation. Often, late secondary bleeding is a consequence of the destruction of the vessel wall as a result of prolonged pressure with a bone fragment or foreign body (bedsore), purulent fusion of a thrombus, erosion of the vessel wall, rupture of an aneurysm.

E) ON THE CURRENT

All bleeding can be acute or chronic.

Acute bleeding the most dangerous, the bleeding is observed in a short period of time. The rapid loss of 30% of the circulating blood volume (BCC) leads to acute anemia, brain hypoxia and may result in the death of the patient.

Chronic bleeding... In chronic bleeding, blood loss occurs slowly and gradually, in small portions, and therefore the body has time to adapt to a slight decrease in BCC. Sometimes for many days there is a slight, sometimes periodic release of blood. Chronic bleeding can be observed with stomach and duodenal ulcers, malignant tumors, hemorrhoids, uterine fibroids, etc.

By the recurrence of bleeding there are:

■ one-time;

repeated;

multiple.