internal hemorrhage

hemorrhage

[hem´ŏ-rij] the escape of blood from a ruptured vessel; it can be either external or internal. Blood from an artery is bright red in color and comes in spurts; that from a vein is dark red and comes in a steady flow. Aside from the obvious flow of blood from a wound or body orifice, massive hemorrhage can be detected by other signs, such as restlessness, cold and clammy skin, thirst, increased and thready pulse, rapid and shallow respirations, and a drop in blood pressure. If the hemorrhage continues unchecked, the patient may complain of visual disturbances, ringing in the ears, or extreme weakness.capillary hemorrhage oozing of blood from minute vessels.cerebral hemorrhage a hemorrhage into the cerebrum; one of the three main causes of cerebral vascular accident (stroke syndrome).concealed hemorrhage internal hemorrhage.fibrinolytic hemorrhage that due to abnormalities of fibrinolysis and not hypofibrinogenemia.internal hemorrhage that in which the extravasated blood remains within the body.intracranial hemorrhage bleeding within the cranium, which may be extradural, subdural, subarachnoid, or cerebral.petechial hemorrhage subcutaneous hemorrhage occurring in minute spots.postpartum hemorrhage that which follows soon after labor.primary hemorrhage that which soon follows an injury.secondary hemorrhage that which follows an injury after a considerable lapse of time.

in·ter·nal hem·or·rhage

bleeding into organs or cavities of the body. Synonym(s): concealed hemorrhage

in·ter·nal hem·or·rhage

(in-tĕr'năl hem'ŏr-ăj) Bleeding into organs or cavities of the body.
Synonym(s): concealed hemorrhage.

hemorrhage

(hem'(o-)raj) [ hem- + -rrhage] Blood loss. The term is usually used for episodes of bleeding that last more than a few minutes, compromise organ or tissue perfusion, or threaten life. The most hazardous forms of blood loss result from arterial bleeding, internal bleeding, or bleeding into the cranium. The risk of uncontrolled bleeding is greatest in patients who have coagulation disorders or take anticoagulant drugs.hemorrhagic (hem-o-raj'ik), adjective See: table

Symptoms

Orthostatic dizziness, weakness, fatigue, shortness of breath, and palpitations are common symptoms of hemorrhage. Signs of hemorrhage include tachycardia, hypotension, pallor, and cold moist skin.

Treatment

Pressure should be applied directly to any obviously bleeding body part, and the part should be elevated. Cautery may be used to stop bleeding from visible vessels. Ligation of blood vessels, surgical removal of hemorrhaging organs, or the instillation of sclerosants is often effective in managing internal hemorrhage. Procoagulants (such as vitamin K, fresh frozen plasma, cryoprecipitate, desmopressin) may be administered to patients with primary or drug-induced bleeding disorders. Transfusions of red blood cells may be given if bleeding compromises heart or lung function or threatens to do so because of its pace or volume.

For trauma patients with massive bleeding, the experienced nurse or emergency care provider may apply pneumatic splints or antishock garments during patient transportation to the hospital. These devices may prevent hemorrhagic shock.

CAUTION!

Standard precautions should be used for all procedures involving contact with blood or wounds.

antepartum hemorrhage

Excessive blood loss during the prenatal period, most commonly associated with spontaneous or induced abortion, ruptured ectopic pregnancy, placenta previa, or abruptio placentae.

arterial hemorrhage

A hemorrhage from an artery. In arterial bleeding, which is bright red, the blood ordinarily flows in waves or spurts; however, the flow may be steady if the torn artery is deep or buried.

First Aid

Almost all arterial bleeding can be controlled with direct pressure to the wound. If it cannot be controlled with applied pressure, the responsible artery may need to be surgically ligated. See: arterial bleeding for table; pressure point

capillary hemorrhage

Bleeding from minute blood vessels, present in all bleeding. When large vessels are not injured, capillary bleeding may be controlled by simple elevation and pressure with a sterile dry compress.

carotid artery hemorrhage

Bleeding from the carotid artery. This type of hemorrhage can be rapidly fatal because it may be profuse and may deprive the brain of oxygen.

First Aid

The wound should be compressed with the thumbs placed transversely across the neck, both above and below the wound, and the fingers directed around the back of the neck to aid in compression. Urgent surgical consultation is required.

cerebral hemorrhage

Bleeding into the brain, a common cause of stroke. See: stroke

Etiology

It usually results from rupture of aneurysm, extremely high blood pressure, brain trauma, or brain tumors.

Symptoms

Most people with intracerebral bleeding experience headache. This type of hemorrhage may cause symptoms of stroke (such as unconsciousness, apnea, vomiting, hemiplegia) and death. There may be speech disturbance, incontinence of the bladder and rectum, or other findings, depending on the area of brain damage.

Treatment

Supportive therapy is needed to maintain airway and oxygenation. Neurosurgical consultation should be promptly obtained. Hydration and fluid and electrolyte balance should be maintained. Rehabilitation may include physical therapy, speech therapy, and counseling.

choroidal hemorrhage

Bleeding into the choroid of the eye, a complication of systemic anticoagulation, hypertension, macular degeneration, some ocular surgeries, and ocular metastases of malignant tumors. Visual impairment resulting from the bleeding is usually significant.

eight-ball hemorrhage

A hyphema in which the anterior chamber of the eye fills completely with blood.

fetomaternal hemorrhage

Abbreviation: FMH
The transfer of fetal blood cells through the placenta into the maternal circulation, usually at the time of delivery. Less than 1 ml is considered normal, but greater than 30 ml, as in trauma or placental abruption, is a major cause of fetal morbidity and death. The condition often occurs during pregnancy and may result in the immunization of the mother against Rh antigens in the fetus, esp. when the mother is Rh-negative and the child is Rh-positive. See: Kleihauer-Betke test

fibrinolytic hemorrhage

A hemorrhage due to a defect in the fibrin component in blood coagulation.

gastrointestinal hemorrhage

Gastrointestinal bleeding.

internal hemorrhage

Occult bleeding.

intracranial hemorrhage

Abbreviation: ICH
Bleeding into the cranium. It is a devastating form of stroke with a high rate of mortality.

Patient care

Patients with ICH should be treated emergently with infusions of recombinant factor VIIa in an intensive care unit, where minute-to-minute monitoring of intracranial pressures, blood glucose levels, neurological status, and hemodynamics can be carried out. Patients should initially be kept at bedrest with the head of the bed elevated. Fever should be suppressed and seizures prevented with the administration of anticonvulsant drugs. As the patient stabilizes, rehabilitation supervised by occupational therapists, physical therapists, and speech therapists should be initiated.

hemorrhage of the knee

Bleeding from the knee.

Treatment

If the bleeding is at the knee or below, a pad should be applied with pressure. If the bleeding is behind the knee, a pad should be applied at the site and the leg bandaged firmly. The bandage should be loosened at 12-min to 15-min intervals to prevent arterial obstruction.

lung hemorrhage

Hemorrhage from the lung, with bright red and frothy blood, frequently coughed up.

nasal hemorrhage

Epistaxis.

petechial hemorrhage

Hemorrhage in the form of small rounded spots or petechiae occurring in the skin or mucous membranes.

postmenopausal hemorrhage

Bleeding from the uterus after menopause.

postpartum hemorrhage

Abbreviation: PPH
Hemorrhage that occurs after childbirth. It is a major cause of maternal morbidity and mortality in childbirth. Early postpartum hemorrhage is defined as a blood loss of more than 500 ml of blood during the first 24 hr after delivery. The most common cause is loss of uterine tone caused by overdistention. Other causes include prolonged or precipitate labor; uterine overstimulation; trauma, rupture, or inversion; lacerations of the lower genital tract; or blood coagulation disorders. Late postpartum hemorrhage occurs after the first 24 hr have passed. It usually is caused by retained placental fragments.

Patient care

Many instances of PPH can be prevented with the administration of oxytocin, misoprostol, or other uterotonic medications. The woman's prenatal, labor, and delivery records are reviewed. The presence of risk factors is noted, and the woman's pulse, blood pressure, fundal and bladder status, and vaginal discharge are assessed every 15 min. If the fundus is boggy, it is massaged to stimulate uterine contractions, and then the status of the woman's bladder is assessed. If the bladder is distended, the patient is encouraged to void and then postvoiding fundal status is assessed; if the fundus remains firm after massage, the fundus and vaginal flow are reassessed in 5 min. See: fundal massage

If bleeding does not respond to the above measures or if the fundus remains firm and the patient exhibits bright red vaginal discharge, retained placental fragments or cervical or vaginal laceration should be suspected; the practitioner who delivered the baby should be notified. Continued massage at this point is contraindicated; the physician or nurse midwife may order uterotonic agents to stimulate uterine contractions. Vital signs should be closely monitored. Common findings in hemorrhage include an increase in pulse rate, often associated with a drop in blood pressure. Pharmacological agents such as methylergonovine or prostaglandin F2 analogs may be administered intramuscularly or intravenously. If blood loss has been extensive, intravenous infusions or blood transfusion may be needed to combat hypovolemic shock. If the patient exhibits signs of a clotting defect, prompt life-saving treatment is imperative. See: disseminated intravascular coagulation

The patient is prepared for and the primary caregiver is assisted with examination of the uterine cavity, removal of any placental fragments, or repair of any lacerations. To reduce the patient's anxiety, all procedures are explained, support and comfort are provided, and the mother is assured that her newborn is receiving good care.

primary hemorrhage

A hemorrhage immediately following any trauma.

retroperitoneal hemorrhage

Bleeding into the retroperitoneal space.

secondary hemorrhage

1. A hemorrhage occurring some time after primary hemorrhage, usually caused by sepsis and septic ulceration into a blood vessel. It may occur after 24 hr or when a ligature separates, usually between the 7th and 10th days. 2. Bleeding from the mother's uterus or the infant's umbilicus, resulting from a septic infection.

splinter hemorrhage

A small linear hemorrhage under the fingernails or toenails. It may be due to subacute bacterial endocarditis.

subarachnoid hemorrhage

Abbreviation: SAH
Bleeding into the subarachnoid space of the brain, usually because of the rupture of an intracranial aneurysm or arteriovenous malformation, and occasionally because of hypertensive vascular disease. The bleeding causes intense headache pain, often with nausea and vomiting, loss of consciousness, paralysis, and, in some cases, coma, decerebrate posturing, and brain death. About 30,000 Americans are affected annually. Prompt diagnosis is facilitated by neuroimaging or lumbar puncture. A neurosurgical consultation should be obtained.

SUBCONJUNCTIVAL HEMORRHAGE

subconjunctival hemorrhage

Rupture of the superficial capillaries with associated hemorrhage into the subconjunctival space.

Etiology

Subconjunctival hemorrhage can result from blunt trauma to the eye or from increased intracranial or intraocular pressure.

Symptoms

Patients have visible bleeding between the sclera and the conjunctiva.

Treatment

A subconjunctival hemorrhage normally resolves within 1 to 7 days.

illustration

thigh hemorrhage

Bleeding at the upper part of the thigh, near the groin.

Treatment

A pad or gauze should be inserted into the wound and pressure applied. Failure of the bleeding to stop requires surgical consultation.

typhoid hemorrhage

Gastrointestinal (GI) bleeding due to ulceration of the upper GI tract, typically during the second or third week of untreated typhoid.

uterine hemorrhage

Hemorrhage into the cavity of the uterus. The three types of pathologic uterine hemorrhage are essential uterine hemorrhage (metropathia haemorrhagica), which occurs with pelvic, uterine, or cervical diseases; intrapartum hemorrhage, which occurs during labor; and postpartum hemorrhage, which occurs after the third stage of labor. The last may be caused by rupture, lacerations, relaxation of the uterus, hematoma, or retained products of conception, including the placenta or membrane fragments.

Etiology

Common causes are trauma; congenital abnormalities; pathologic processes (such as tumors; infections, esp. of the alimentary, respiratory, and genitourinary tracts); and generalized vascular disorders such as purpuras and coagulation defects. Hemorrhage may also result from premature separation of the placenta, particularly with extravasation into the uterine musculature, and from retained products of conception after abortion or delivery. See: abruptio placentae; Couvelaire uterus

Treatment

An umbrella pack will apply pressure to the uterine arterial supply. When ultrasonography reveals that retained placental fragments are the source of hemorrhage, they are usually removed by suction or surgical curettage. If the uterus is flaccid, it can usually be stimulated to contract by administering intravenous oxytocin. The patient may need transfusion and, in some cases, surgery to prevent fatal hemorrhage.

variceal hemorrhage

See: esophageal varix

venous hemorrhage

Hemorrhage from a vein, characterized by steady, profuse bleeding of rather dark blood.

Patient care

The patient should be reassured while direct pressure to the wound is applied and the affected body part is elevated. If bleeding does not stop after 15 min of direct pressure, evaluation by a health care provider is advisable. Vital signs should be monitored whenever bleeding does not stop with direct pressure, and IV fluids should be initiated as necessary to prevent hypovolemic shock.

vicarious hemorrhage

Hemorrhage from one part as a result of suppression of bleeding in another part. See: vicarious menstruation.

Location	Descriptive Term
Biliary tract	Hemobilia
Fallopian tubes	Hemosalpinx
Lower GI tract	Hematochezia; melena
Upper GI tract	Hematemesis
Joints	Hemarthosis
Lungs/Bronchi (coughed up)	Hemoptysis
Nasal passages	Epistaxis
Skin	Ecchymosis
Urinary tract	Hematuria

Patient discussion about internal hemorrhage

Q. Blood in stools before and after polyp removel, Avms of the deodenel loop, inside hems, and 3cin tubuo adenoma Hi, On Nov of 06 I had a colonoscopy done and they didnt find any thing that could be mking me bleed and go to the rest room often. Then in Nov of 07 did a EDg and found I have AVMs of the deodenel loop.She Burned them and I didnt have any more bleeding till June of thei yr.On 6/6/08 i had another EDg done she burned more AVMs and on Mon I started bleeding again. This time she did a colonoscopy and found I had inside hems and a 3cin tubuolvillous adenoma inflamed.She cut, burned, and took it out in peices.She saye she will go back in Nov of this yr and look again. Two weeks after I had this done I had started to bleed again and had bad such bad pain in my hip I had to hold on to walk. that same day i started to bleed again. I bled out big clots and a bowl full of blood! A few days later the pain went away but was still bleeding ever time I had bowl movement!I can bleed up to 4 days at a times sometimes. I have been taking HC supp. and it seems to have stoped the bleeding and pain! A. It is normal that after a polyp removal you will continue bleeding some more. However, if you feel like there is a lot of bleeding, and/or you are not feeling well, you should see a doctor as soon as possible to stop the bleeding or look for the source of bleeding.

More discussions about internal hemorrhage