Clinic of intra-abdominal bleeding. Bleeding in the abdomen symptoms. Common signs of bleeding

Intra-abdominal bleeding (synonymous names - hemoperitoneum, intra-abdominal bleeding) is understood as an outpouring of blood into the retroperitoneal space or into the abdominal cavity due to damage blood vessels and internal organs (both hollow and parenchymal) localized in this area.

The mortal danger of internal bleeding lies in the difficulty of its timely detection, since in the absence external damage(the culprits of its occurrence can be a number of chronic diseases) the symptoms of the pathology are often blurred, and the pain may be completely absent.

Immediate hospitalization can save a person's life, which is why it is so important to know the signs that indicate the presence of intra-abdominal bleeding.

Causes

Intra-abdominal bleeding can be the result of exposure to factors that can be clearly divided into two categories.

The first of these includes traumatic factors, represented by:

Mechanical damage to the chest. Given the diverse nature of the resulting injuries (in addition to fractures of the bones that make up the skeleton of the chest, this includes injuries to the lungs and heart, provoked by the impact of the resulting bone fragments), we can say that we are talking about a large group of injuries. In the vast majority of cases, chest injuries pose either a potential or direct threat to the life of the injured person, so their receipt is an indication for immediate hospitalization of the patient.
Closed resulting strong blows, falls (from a height or onto hard objects) and tissue compression.
Open abdominal injuries resulting from stab and gunshot wounds. Bleeding occurs due to rupture of parenchymal or hollow organs gastrointestinal tract, genitourinary system and the mass of blood vessels passing inside the greater omentum, mesentery and peritoneal folds.
Damage that occurs after performing certain abdominal operations. This category includes: appendectomy (removal of the appendix), liver resection or, cholecystectomy (removal of the gallbladder), (removal of the kidney). Intra-abdominal bleeding that develops during postoperative period, as a rule, is due to slipping or cutting of the threads (ligatures) used to ligate the vessels of the mesentery or suturing the resected organ.

The occurrence of intra-abdominal bleeding can occur as a result of:

oncological lesions of the gastrointestinal tract and small pelvis;
varicose veins of the stomach and;
ovarian apoplexy (spontaneous, rapidly progressive hemorrhage in the tissues of this organ, followed by blood leakage into the abdominal cavity);
cyst rupture;
significant damage or complete rupture of the fallopian tube during ectopic pregnancy;
superficial ruptures of the mucous membranes of the abdominal esophageal tube and the cardial part of the stomach (the so-called Mallory-Weiss syndrome);
disease complications (malaria, hemorrhagic diathesis, obstructive jaundice), provoking a significant deterioration in blood clotting;
pathological proliferation of the vascular network of the liver (the so-called hemangioma of this organ);
long-term use of anticoagulants or fibrinolytics - drugs that slow down blood clotting.

Symptoms of bleeding into the abdomen

Clinical symptoms in intra-abdominal bleeding are determined by the volume and rate of blood loss: the higher the rate of decrease in circulating blood volume (BCV), the sooner signs develop hemorrhagic shock.

The degree of blood loss can be:

Lung (up to 10% of the total volume of circulating blood). The victim loses from 500 to 700 ml.
Moderate (up to 20% BCC). The volume of blood loss ranges from 1000-1400 ml.
Severe (up to 30% BCC). The body of the victim loses from one and a half to two liters of blood.
Massive (over 30% BCC). Blood loss of more than two liters of blood falls under this category.

Signs of hemodynamic changes are observed as a result of a single-stage blood loss exceeding 0.5 liters of blood. With moderate bleeding human body can cope by mobilizing internal reserves (its compensatory mechanisms do not fail at the same time). Massive blood loss leads the victim to a state of deep hemorrhagic shock within one to two hours.

Typical symptoms of intra-abdominal bleeding are:

pallor of mucous membranes and skin;
cold perspiration;
dizziness;
severe headaches;
a feeling of congestion in the ears;
general weakness;
the appearance of "flies" flashing before the eyes or darkening in the eyes;
severe tachycardia (increased heart rate, at which the pulse rate exceeds 130 beats / min);
a sharp drop in blood pressure;
clouding of consciousness;
oliguria (a decrease in the volume of urine produced by the structures of the kidneys);
the appearance of local or mixed pains in the abdomen, which tend to intensify with movement;
the occurrence of a pre-syncope or shock state;
a symptom of "roly-up", consisting in the patient's attempts to take a sitting position, which helps to slightly reduce the intensity of abdominal pain.

If the accumulated blood irritates the diaphragmatic peritoneum, abdominal pain may radiate to the shoulder, shoulder blade, or chest area.

Patients with bleeding into the retroperitoneal space are characterized by back pain. Profuse intra-abdominal bleeding is often accompanied by intense abdominal pain, leading to loss of consciousness.

Acute massive blood loss is fraught with the development of collapse - a life-threatening condition characterized by extremely low level blood pressure, leading to a significant deterioration in the blood supply to internal organs.

Complications

Diagnostics

At the slightest suspicion of the presence of intra-abdominal bleeding, the patient should undergo an immediate examination in a medical hospital.

The first diagnostic manipulation is a visual examination of the abdomen. aimed at identifying possible traumatic injuries (represented by bruises, abrasions, open wounds).
Further examination of the abdomen is carried out by palpation methods.(superficial and deep), percussion and auscultation. During superficial orienting palpation of the abdomen, the specialist will certainly pay attention to the fact that the anterior wall of the abdomen - soft and moderately painful - does not perform respiratory movements in full, and will also reveal some signs of peritoneal irritation. Due to the soreness of the abdominal wall or the area in which the affected organ is located, deep palpation should be done with extreme caution. Performing percussion of the abdomen, the doctor will note the presence of a pronounced pain syndrome (this feature intra-abdominal bleeding) and muffled sound in sloping areas due to the accumulation of blood in the abdominal cavity. In the presence of intra-abdominal bleeding, auscultation of the abdomen will reveal a reduced level of bowel sounds.
During vaginal and digital rectal examination patients with suspected intra-abdominal bleeding, it turns out that posterior fornix the vagina and the anterior wall of the rectum bulge and are acutely sore. If the doctor has a suspicion of a disturbed tubal pregnancy, he will perform a puncture of the abdominal cavity, penetrating into it through the wall of the vagina.
In the presence of intra-abdominal bleeding, complete blood count will indicate a rapidly increasing decrease in the number of red blood cells, hemoglobin levels and hematocrit (the volume of red blood cells in the blood).
With plain radiography(this diagnostic technique is non-contrast) the specialist is convinced of the presence of blood accumulated in the abdominal cavity.
With the help of ultrasound organs of the abdominal cavity and small pelvis, it is possible to establish the localization of the source of bleeding and the place of accumulation of anechoic (not reflecting sound) fluid.
The diagnostic laparoscopy procedure provides the most complete and reliable information about intra-abdominal bleeding. In order to carry out an overview of the abdominal cavity, several small punctures are made in the anterior wall of the abdomen, through which a special device is inserted - a laparoscope equipped with a miniature endovideo camera connected to a monitor with multiple magnification. The main advantage of this minimally invasive procedure is the possibility of performing all diagnostic actions without opening the abdominal cavity (transsection).
Another endoscopic technique that allows to detect intra-abdominal bleeding is laparocentesis - a therapeutic and diagnostic procedure that involves performing a puncture of the anterior wall of the abdomen, followed by the introduction of a rummaging catheter (silicone tube with holes). After insertion of the catheter, the contents of the abdominal cavity are aspirated using a twenty-gram syringe. Detection of a large (over 20 ml) amount of blood and other pathological contents (blood with feces or urine, turbid greenish-gray liquid or dark brown) is an indication for urgent surgical intervention. If during laparocentesis it was not possible to extract any pathological contents from the abdominal cavity, the result of the procedure is considered negative, and the performed puncture is called “dry”.

Intra-abdominal bleeding should be differentiated from:

hematomas of the anterior abdominal wall;
retroperitoneal hematoma;
perforated ulcer of the duodenum and stomach.

In some cases, the diagnosis of intra-abdominal bleeding requires the help of narrow specialists: hematologists, gynecologists, coloproctologists, traumatologists, and thoracic surgeons.

First aid for bleeding in the abdominal cavity

If there is a suspicion of intra-abdominal bleeding, the patient is subject to immediate hospitalization. Reception of water and food is excluded.

The patient should be transported in a supine position, be sure to apply cold to the stomach.

In a surgical hospital, dynamic monitoring of blood pressure, heart rate, hematocrit value and hemoglobin level is carried out.

Until the establishment accurate diagnosis the use of any painkillers (including narcotic) drugs is prohibited.

If the intra-abdominal bleeding turned out to be insignificant, accompanied by moderate blood loss and signs of spontaneous arrest, and the diagnostics did not reveal any severe injuries and significant accumulations of blood in the abdominal cavity, the specialists of the surgical department will choose a treatment tactic consisting of:

in the dynamic observation of the patient;
in intravenous administration saline solutions (represented by saline, refortan, Ringer's solution, rheosorbilact);
v infusion administration hemostatic drugs (etamsylate, aminocaproic acid).

In relation to patients with acute blood loss and a sharp drop in blood pressure, a whole range of resuscitation, anti-shock and anti-hemorrhagic measures are used, which boil down to:

infusion administration of blood substitutes;
reinfusion (manipulation consisting in the collection of blood that has recently poured into the retroperitoneal space or into the abdominal cavity and its re-infusion into the patient's body);
the introduction of analeptic medicines, which have a stimulating effect on the centers (vasomotor and respiratory) of the medulla oblongata.

The above measures help to replenish and increase the volume of circulating blood, improve microcirculation and rheological properties of blood (primarily its mechanical characteristics, represented by viscosity and fluidity).

If severe blood loss of any etiology is detected, an emergency laparotomy is performed ( surgical operation requiring cutting of the abdominal wall), during which the surgeon performs an audit of the internal organs in order to find the source of bleeding, stop it and eliminate the identified damage along the way.

Parallel surgical intervention infusion therapy is carried out, aimed at maintaining the vital functions of the body.

Prevention

There are no specific measures to prevent intra-abdominal bleeding. To reduce the risk of their occurrence, each person should:

Timely scheduled medical examinations.
Immediately treat any diseases of the internal organs.
Seek qualified medical attention in case of injury, as in this case a thorough examination may reveal the presence of internal bleeding. The sooner therapy begins, the lower the likelihood of severe complications.

With internal bleeding, blood accumulates in the organs and cavities of the body. It cannot be determined visually!

First aid for internal bleeding:

With internal bleeding into the weed of the pelvis and abdomen, you can help by pressing the abdominal aorta to the spine with your fist. It is advisable to put a handkerchief or several layers of gauze between the skin and the hand.

With gastrointestinal bleeding, the patient is allowed to swallow pieces of ice.

You can not warm the injured area, give laxatives, give enemas or give medicines that stimulate the activity of the heart!

Causes

Internal bleeding is the outflow of blood into the cavity of the body or organs of a person and into the interstitial spaces. The cause of this condition may be related to trauma or chronic pathologies.

The following diseases and conditions can lead to internal bleeding:

injuries with damage to internal organs (liver, lungs, spleen);
peptic ulcer of the duodenum and stomach;
rupture of the internal cyst;
closed fractures;
exfoliating aortic aneurysm;
gynecological diseases (ovarian apoplexy, ectopic pregnancy);
varicose veins of the esophagus and stomach;
decaying malignant tumors.

These conditions can be provoked by accidents, strong blows, falling from a height, active physical activity, alcohol abuse, and a heavy meal.

Symptoms

With internal bleeding, the following signs develop that require first aid. Clinically, the condition is accompanied by objective (external manifestations) and subjective (feelings of the victim) symptoms. The first one includes:

pointed facial features;
pallor of the skin and mucous membranes;
low rates HELL;
hand tremor;
tachycardia (pulse more than 100 beats per minute);
cold sweat, perspiration;
dyspnea;
muscle tension;
cold extremities;
fainting.

Subjective signs:

dizziness;
drowsiness, weakness;
darkening in the eyes;
yawn;
nausea;
noise in the head;
dry mouth;
tinnitus;
nausea, vomiting;
confused mind.

With a hemorrhage in the abdominal cavity, pain occurs during palpation (palpation) and heaviness in the abdomen, the Roly-Vstanka symptom - the development of pain in the left or right shoulder, neck in a supine position, while sitting, the pain disappears, but dizziness appears.

Gastrointestinal bleeding is characterized by the absence of abdominal pain, melena (black feces), brown vomiting ( coffee grounds).

With a rupture of the abdominal aorta, trauma to the kidneys and adrenal glands, blood accumulates in the retroperitoneal space, pain in the lower back occurs, and when tapping on this area, it becomes unbearable. Red blood cells may also appear in the urine.

With the outpouring of blood into the muscles, bruising and hematomas occur in the area of damage. In this case, the main help is cold.

If bleeding is caused by gynecological diseases, then hyperthermia, pain, heaviness, a feeling of fullness in the lower abdomen, pressure on the anus, sensation of swelling of the mucous tissues inside.

Injury to a vessel in the lungs is usually accompanied by a cough, with which foamy blood or its streaks come out.

With cerebral bleeding, the tissues of the organ are compressed, resulting in unbearable headaches, vomiting, impaired speech and motor activity, convulsions.

The severity of the condition can be judged by the indicators of pulse and blood pressure. Systolic pressure below 80 mm Hg. Art. and pulse above 110 beats per minute. indicates a serious condition and the need for assistance and urgent hospitalization. With a blood loss of more than 2-3.5 liters, a coma develops, after which there is agony and death.

Diagnostics

It can be quite difficult to diagnose internal bleeding; for this, first of all, they perform an examination, measure blood pressure and pulse, tap and palpate the abdominal cavity, and listen to the chest. To assess the severity of blood loss and volume necessary assistance perform laboratory studies of hemoglobin and hematocrit (erythrocyte volume).

Diagnostic methods depend on the cause of internal hemorrhage:

In the pathology of the gastrointestinal tract: esophagogastroduodenoscopy, digital examination of the rectum, colonoscopy, gastric probing and sigmoidoscopy;
With lung damage - bronchoscopy;
In case of bladder disease - cystoscopy.

Ultrasound, radiological and radiological techniques are also widely used. If there is a suspicion of outpouring of blood into the abdominal cavity, laparoscopy is performed, and for intracranial hematoma, echoencephalography and radiography of the skull are performed.

Specialized medical care

Victims receive full assistance and are treated in a hospital. The department of which depends on the type of bleeding, the therapy is carried out by doctors of different profiles: gynecologists, thoracic surgeons, neurosurgeons, traumatologists, etc.

Basic goals medical assistance:

urgent stop of internal hemorrhage;
restoration of microcirculation;
replacement of lost blood;
prevention of empty heart syndrome with the help of BCC replenishment;
prevention of hypovolemic shock.

In all cases, infusion therapy is performed (the volume depends on internal blood loss): transfusion of polyglucin, saline, stabilizol, gelatinol, glucose, blood and its preparations (albumin, fresh frozen plasma, erythrocyte mass), plasma substitutes. At the same time, blood pressure, CVP and diuresis are controlled.

If blood pressure does not rise due to infusions, norepinephrine, dopamine and adrenaline come to the rescue. With hemorrhagic shock, heparin, trental, steroid hormones and chimes are prescribed.

In some cases, internal hemorrhage is stopped by cauterization or tamponade of the bleeding area. But more often urgent surgical intervention under anesthesia. If the development of hemorrhagic shock is suspected, transfusion measures are mandatory.

With gastric bleeding, resection is indicated, with a duodenal ulcer - vagotomy and suturing the vessel. The outpouring of blood from a fissure of the esophagus is stopped endoscopically in combination with cold, antacids and hemostatic drugs. If the assistance provided does not bring results, the cracks are sutured.

With internal bleeding from the lungs, it is necessary to plug the bronchus. Accumulated blood from the pleural cavity is removed by puncture; in severe cases, a thoracotomy is necessary with suturing of the site lung injury or vessel ligation. Emergency laparotomy is performed in all cases of ruptures of the abdominal organs, and craniotomy is necessary for intracranial hematoma.

For internal gynecological hemorrhages, vaginal tamponade or surgery is performed, sometimes with removal of the ovary, fallopian tube, or uterus.

Intra-abdominal bleeding may be the result of injuries to the abdomen, thoracoabdominal injuries, as well as a complication of various pathological processes in the organs of the abdominal cavity or retroperitoneal space. Occurs when the integrity of the vessels of the abdominal wall, omentum, intestinal mesentery and parenchymal organs (liver, spleen, pancreas), ovarian apoplexy, disturbed ectopic pregnancy, ruptured aortic aneurysm, etc. Intra-abdominal bleeding may also develop after operations on the abdominal organs due to a decrease in blood clotting (for example, with obstructive jaundice), slippage or eruption of ligatures applied to the vessels of organs, especially parenchymal ones. As a result intra-abdominal bleeding there is an accumulation of blood in the abdominal cavity (hemoperitoneum).

Clinical picture intra-abdominal bleeding depends mainly on the intensity and duration of bleeding, volume blood loss. With profuse intra-abdominal bleeding a picture of acute hemorrhagic shock develops - fainting or motor agitation, pallor of the skin and visible mucous membranes, thirst, cold sweat, weakness, dizziness, darkening of the eyes, tachycardia (up to 120-140 oud. in 1 min) and arterial hypotension.

When examining the abdomen of a patient with intra-abdominal bleeding pay attention to the presence of signs of injury, hematoma, abrasions. The anterior abdominal wall on superficial palpation is soft, moderately painful, participates in breathing to a limited extent. Deep palpation reveals pain in the area. damaged organ. characteristic feature intra-abdominal bleeding is a positive symptom of Blumberg - Shchetkin with a soft anterior abdominal wall (see. Acute abdomen). In the sloping parts of the abdomen, dullness of percussion sound is possible, percussion is painful, bowel sounds are weakened or not audible. With a digital examination of the rectum, the overhang of its anterior wall can be determined; at vaginal examination- flattening of the arches, their soreness, overhanging of the posterior arch. Due to irritation of the diaphragmatic peritoneum by the outflow of blood, pain occurs in the area of the shoulder girdle and scapula, the patient tends to take a sitting position, which reduces pain in the abdomen (a symptom of a roly-poly). A blood test reveals a decrease in hematocrit. A decrease in hemoglobin and the number of red blood cells is usually detected a few hours after the onset of bleeding.

If you suspect intra-abdominal bleeding the patient must be urgently hospitalized. With blurred clinical manifestations intra-abdominal bleeding puncture of the posterior fornix of the vagina is of great diagnostic value (see. Gynecological examination) and laparocentesis with the introduction of a groping catheter, which allows you to detect blood in the abdominal cavity. The study of the hemoglobin level of this blood makes it possible to judge the intensity and duration intra-abdominal bleeding. Leading role in diagnosis intra-abdominal bleeding plays laparoscopy. X-ray examination at intra-abdominal bleeding allows only to establish the presence free liquid in the abdominal cavity.

Differential diagnosis is carried out with retroperitoneal hematoma, hematoma of the anterior wall, with perforated gastric and duodenal ulcers. X-ray examination with a retroperitoneal hematoma reveals the expansion of the shadow and blurring of the contours of the lumbar muscles, and with a perforated ulcer - free gas in the abdominal cavity. With retroperitoneal hematoma and hematoma of the anterior abdominal wall, there is usually no free fluid in the abdominal cavity. Careful dynamic observation is necessary with the measurement of pulse rate and blood pressure every 1-2 hours, determination of the amount of hemoglobin and hematocrit. Painkillers and narcotic drugs are contraindicated until the diagnosis is established. In the case of a massive intra-abdominal bleeding start without delay intensive care(transfusion of fluid and blood substitutes, the introduction of cardiovascular analeptics), according to indications, resuscitation is carried out. Surgical intervention in the conditions of the surgical department includes laparotomy, identification of the source of bleeding and its stop. During the operation for intra-abdominal bleeding prescription not more than 12-24 h and in the absence of damage to the hollow organs, it is possible to reinfuse the blood that has poured into the abdominal cavity. Forecast at intra-abdominal bleeding always serious.

Bibliography: Actual problems of hemostasiology. ed. B.V. Petrovsky et al., M., 1981; Jerota D. Surgical examination of the abdominal cavity, trans. from rum., M., 1972; Kochnev O.S. emergency surgery gastrointestinal tract, Kazan, 1984, bibliogr.; Operative surgery, ed. I. Littmann, trans. from Hungarian., Budapest, 1985; Guidelines for emergency surgery of the abdominal organs, ed. V.S. Savelyeva, M., 1986.

Internal bleeding is an acute life-threatening condition in which, through a rupture of the vessel wall, blood flows out of the bloodstream either into the lumen of a hollow organ (uterus, stomach, lungs) or into a cavity artificially created by the amount of leaked blood (for example, intermuscular space). Such bleeding is never a separate independent disease - but only either a sign or a consequence of the underlying pathological condition.

This pathology often develops as a result of trauma or chronic disease. Severe types of such bleeding with large blood loss (more than 1.5 liters) are very dangerous, can be fatal. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Spilled blood can compress nearby vessels, disrupt the functioning of internal organs, exit through the mouth, for example, with gastric bleeding, and be accompanied by other serious manifestations.

Internal bleeding is called due to the fact that the outflowing blood does not flow outside the body. Therefore, uterine, gastric or intestinal bleeding is not always interpreted as internal; although given that blood sometimes does not immediately exit through the physiological openings - mouth, anus, vagina - it is advisable to refer to them as internal.

The common causes, symptoms, and treatment of internal bleeding in men and women are the same.

The elimination of uterine bleeding is handled by a gynecologist, intestinal - by a proctologist, pulmonary - by a thoracic surgeon, post-traumatic - by a traumatologist, intracranial - by a neurosurgeon.

Untimely provision of medical care when a person turns to doctors late or difficulties with differential diagnosis increase the risk to his health, and even life.

Types of internal bleeding

Internal bleeding is classified into many types, based on location, cause, time of occurrence, amount of blood loss, etc.

Gastric - into the lumen of the stomach

Gastrointestinal - blood loss into the cavity of the esophagus or other hollow organ

Hemopericardium - filling the pericardial sac with blood

Hemothorax - between the sheets of the pleura, i.e., in the slit-like space between the special membranes surrounding each lung

Hemarthrosis - in the joint

Cavitary - into the cavity of the peritoneum, pleura

Explicit - easily determined by visual inspection

Arrosive - in case of damage to the vascular wall due to germination or decay of the neoplasm, destructive or necrotic process (with tissue death)

Diapedetic - with leakage of blood through the vascular wall with scurvy, scarlet fever, malaria

Severe - blood loss no more than one and a half liters of blood

Massive - up to 2.5 liters

Lethal - from 2.5 to 3 liters

Absolutely fatal - over 3-3.5 liters

Venous - with a rupture of the vein wall

Arterial - from an artery

Mixed - from different vessels

Parenchymal - blood flows from the vessels of the parenchymal organ (this is the spleen, liver, lungs, pancreas, kidneys and others - these are internal organs built from solid tissue)

Secondary - after a while after the injury. In the first 1-5 days it is considered early, after 10-15 days - late

Each type of bleeding has its own causes, the most common of which are injuries and illnesses in acute or chronic form.

Open and closed injuries of the abdomen and lumbar region with damage or rupture of internal organs, more often the spleen or liver, less often the intestines and pancreas. Massive cause a blow during a fight or during a car accident, compression pressure - when pressed down with a heavy object, etc.
Fracture of the ribs leads to the outflow of blood into pleural cavity.
Traumatic brain injury. Bleeding inside the skull is life-threatening, because the volume of the cranium is limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after the injury, but also after a few hours or days after it.
chronic diseases digestive tract. Bleeding into the cavity of the corresponding organ occurs with varicose veins of the esophagus, erosive gastritis, cirrhosis of the liver, peptic ulcer, malignant tumor process, the formation of a through hole with a duodenal ulcer or stomach ulcer.
Gynecological diseases and pathological conditions - ovarian apoplexy (rupture), ectopic pregnancy, malignant neoplasm, ovarian cyst rupture. In obstetrics and gynecology, uterine bleeding can provoke an abortion, presentation or premature detachment of the placenta. It can start after childbirth due to a rupture birth canal or uterus, late delivery of the placenta.
Ruptured aortic aneurysm.
Hemophilia is a hereditary disease of men with a failure of the blood clotting process.

Symptoms

Symptoms depend on the amount of blood loss and its location. There are common signs and characteristic of a particular species.

Common symptoms of blood loss

Common signs of internal bleeding - the appearance of weakness, darkening or clouding in the eyes, drowsiness, dizziness, cold sweat, thirst. Loss of consciousness is not ruled out. The intensity of blood loss is determined by the pulse rate, blood pressure and characteristic complaints of the patient.

Small blood loss often does not manifest itself in any way, but in some people the pulse slightly quickens, blood pressure (BP) slightly decreases.
Manifestations of bleeding moderate: Heart rate up to 100 beats per minute, decrease in systolic pressure to 80 mm Hg. Art., moderate shortness of breath, dry mouth, cold hands and feet, cold perspiration, dizziness, great weakness, slow reactions, fainting.
With severe blood loss, the symptoms are more pronounced. Note the fall in blood pressure more than 80 mm Hg. Art., tachycardia more than 110 beats per minute, shortness of breath, hand trembling, excruciating thirst against the background of a decrease in urine output, apathy. There may also be a sharp blanching of the mucous membranes and skin, cyanosis of the extremities and the area around the lips, clouding or loss of consciousness.
Among the clinical manifestations of massive hemorrhage, cyanosis of the skin and mucous membranes, confusion, and delirium are observed. The eyeballs sink inside, facial features become sharper, the pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
With fatal and absolutely fatal blood loss, we are already talking about a threat to life. The pupils dilate, convulsions appear, the number of heart beats (bradycardia) sharply decreases to 2-10 beats per minute, breathing becomes agonal, urine and feces are spontaneously excreted. The patient falls into a coma, his skin is dry, pale and marbled. The result is agony, death.

Signs of hemothorax

Hemothorax is the entry of blood into the pleural cavity. In addition to general symptoms, it manifests itself as a sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. On x-ray, the mediastinum (the space in the middle part of the chest cavity) is displaced towards the healthy lung.

Signs of uterine bleeding

Symptoms of internal bleeding in women can be pulling, bursting or sharp pains in the lower abdomen with irradiation to the lower back and anus, the urge to defecate, a feeling of swelling of the mucous membranes.

Signs of hemorrhage in the urinary and digestive organs

A tar-colored stool with a fetid odor - melena - indicates bleeding from the upper intestine or other digestive organs.
With a hemorrhage in the stomach, a person begins to vomit with blood clots, into the lumen of the duodenum 12 - it becomes the color of coffee grounds.
Bleeding from hemorrhoids is manifested by bright bloody discharge from the anus.
Blood entering the kidney area urinary tract, comes out with urine - hematuria.

With any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss, a person himself can reach a medical facility and get help, but it is better not to risk it, because it is not known whether the bleeding has stopped, whether the general condition will worsen further or not.

The life of a person often depends on the correctness of the provision of first aid. Before the arrival of doctors, you need to put the patient, further actions should be carried out only after he takes a horizontal position, and with hemothorax, a semi-sitting position. On the area of the alleged source of the problem, focusing on complaints, put ice. Then, as soon as possible, transport the victim in this position to the nearest medical facility. institutions or wait for the ambulance to arrive.

It is strictly forbidden: to heat the bleeding area, apply a pressure bandage, insert candles, use a laxative, do an enema (for intestinal bleeding), offer to drink painkillers and drugs that stimulate the heart.

Neglect of the above actions can lead to increased blood loss and death.

Stationary medical care

Based on symptoms and primary medical examination, presumably find out which organ was damaged, and the patient is hospitalized in the appropriate department. In the presence of objective symptoms of a large loss of blood - in intensive care.

The main goals of treatment:

Stop bleeding.
Restoration of the lost volume of blood constantly circulating in the body (BCC).
Normalization of microcirculation.

Often, massive blood loss can be stopped by emergency surgery:

with a stomach ulcer, it is resected - a part of it is removed along with the ulcer;
with pneumothorax, a thoracotomy is performed - the chest is opened, the cause of bleeding is found and eliminated;
with a hematoma in the cranial cavity, trepanation is performed: through the holes made in the bones of the skull, the neurosurgeon gains access to the structures of the brain and the resulting hematoma, the blood from which is sucked;
in some cases, internal bleeding can be stopped by tamponade: for example, to tamponade a bronchus, a sterile gauze swab or foam sponge is inserted into it through a bronchoscope.

To replenish the BCC in/in-drip administered infusion solutions, blood substitutes, blood products. The remaining funds are used for their intended purpose.

The prognosis depends on the competent provision of pre-medical and timely medical care.

Bleeding in the abdomen symptoms

Internal bleeding is one of the most dangerous types of bleeding, requiring immediate hospitalization. Therefore very important point to save the life of the victim is the timely determination of signs of internal bleeding, invisible to the naked eye.

Internal bleeding is characterized by hemorrhage in the cavity of internal organs (intestines, stomach, bladder, uterus), interstitial gaps ( subcutaneous tissue, intermuscular space, between aponeuroses) and cavities (abdominal, pleural, cranial) as a result of a violation of the integrity of the walls of venous or arterial vessels.

The cause of internal bleeding can be:

non-penetrating injury from impact,
internal injury by a foreign object that was in the organ cavity when swallowed or a ligature that jumped off the vessel (during surgical interventions),
vascular and organ damage closed fractures bones,
cracks in the walls of the stomach or intestines caused by ulcers, tumors, or simply excessive food intake,
aneurysms of cerebral vessels, abdominal and pulmonary aorta,
ectopic pregnancy disorder
and many more factors that a person may not even be aware of

Characteristic features and signs of internal bleeding

General signs characteristic of blood loss in any type of internal bleeding:

Pale skin,
Dizziness (possible loss of consciousness),
cold extremities,
Perspiration,
A sharp drop in blood pressure
Fast and weak pulse
Tachycardia,
Drowsiness or, on the contrary, growing anxiety,
Weakened or difficult breathing.

Special signs of gastrointestinal bleeding:

Vomiting with blood clots or coffee grounds
Feces with blood or tar-colored impurities

Special signs of bleeding into the abdominal cavity:

Special signs of pulmonary hemorrhage:

Cough with blood-streaked sputum
Cough with mouthful of blood

Special signs of internal bleeding in case of damage to the kidneys or bladder:

Features of parenchymal bleeding (in case of damage to the parenchyma (structural material) of internal organs: kidneys, liver, spleen):

Since the blood vessels of the above organs are directly connected to the parenchyma, they do not collapse, which makes it difficult to stop bleeding. And it is in such cases that large blood loss is possible.

Special signs of hemorrhage in the brain:

Headache attack
Dizziness
Loss of consciousness
Nausea
Vomit
Speech disorder
Violations of the synchronism of movements
convulsions

First aid for suspected internal bleeding:

Call an emergency vehicle for transportation as soon as possible. surgery department(it is important to gain time).
If bleeding is suspected in the region of the upper body (pulmonary, gastric, intracranial, etc.), the victim should be placed in a “half-sitting” position with bent knees.
If bleeding in the abdominal cavity is suspected, the victim is given a “lying” position and a cold compress or a heating pad with ice is applied to the abdomen.
If internal bleeding is suspected, the victim is strictly forbidden to drink, eat, take analgesics or other medicines until the doctor specifically instructs.

Bleeding into the abdomen

Bleeding into the abdominal cavity is the outflow of blood into the peritoneal cavity or retroperitoneal space due to a violation of the integrity of the blood vessels located here, parenchymal or hollow organs. With bleeding into the abdominal cavity, weakness, pallor, cold sweat, rapid pulse, drop in blood pressure, abdominal pain, fainting or shock develop. The main role in the diagnosis of bleeding into the abdominal cavity is played by the examination of the patient, the dynamics of hemoglobin and hematocrit levels, laparocentesis and laparoscopy. Surgical treatment of bleeding into the abdominal cavity - laparotomy with revision of internal organs; in parallel, anti-shock, hemostatic and transfusion therapy is carried out.

Bleeding into the abdomen

Bleeding into the abdominal cavity (intra-abdominal bleeding, hemoperitoneum) in gastroenterology can be a symptom of any disease or damage to internal organs and tissues. The danger of bleeding into the abdominal cavity, like any internal bleeding, lies in its latent nature, which can pose a threat to the life of the patient. As a result of bleeding into the abdominal cavity, hemoperitoneum occurs - the accumulation of blood in the peritoneal cavity and retroperitoneal space. Bleeding into the abdominal cavity is complicated by the development of hypovolemic and neurogenic shock. Hypovolemic shock is associated with a rapid decrease in circulating blood volume (by 25% or more) and hemodynamic disturbances; neurogenic (traumatic) shock is associated with excessive pain impulses.

Causes of bleeding into the abdominal cavity

At the heart of bleeding into the abdominal cavity are the causes of traumatic and non-traumatic nature. Bleeding into the abdomen may be due to mechanical injury chest and abdominal trauma: closed - on impact, compression; open - with a gunshot or stab wound, as well as injuries associated with abdominal operations. In this case, a traumatic rupture of the parenchymal or hollow organs of the gastrointestinal tract, the genitourinary system, as well as blood vessels located in the folds of the peritoneum, thicker than the mesentery and the greater omentum occurs. Bleeding into the abdominal cavity in the postoperative period is usually associated with slipping (eruption) of the ligature applied to the vessels of the mesentery or organ stump.

Bleeding into the abdominal cavity of non-traumatic origin develops spontaneously in the complicated course of certain diseases and pathological processes internal organs. Bleeding can be observed with tumors of the abdominal organs; conditions leading to a decrease in blood clotting; ectopic pregnancy; rupture of an aneurysm of the abdominal aorta, rupture of the spleen in malaria, rupture of a cyst and ovarian apoplexy. Bleeding into the retroperitoneal space is much less common.

The clinical picture of bleeding into the abdominal cavity is determined by the severity of blood loss - its intensity, duration and volume.

Signs of intra-abdominal bleeding are pallor of the skin and mucous membranes, general weakness, dizziness, cold perspiration, a sharp drop in blood pressure, severe tachycardia (pulse rate beats per minute), local or diffuse pain in the abdomen, aggravated by movement. A patient with bleeding into the abdominal cavity to reduce abdominal pain tries to take a sitting position (a symptom of "roly-up").

If the diaphragmatic peritoneum is irritated by accumulated blood, the pain may radiate to the chest, shoulder blade and shoulder; with bleeding into the retroperitoneal space, pain in the back is noted. In the case of profuse bleeding into the abdominal cavity, the pain syndrome becomes intense, loss of consciousness is possible; with acute massive blood loss, a collapse develops.

Diagnosis of bleeding in the abdominal cavity

A patient with suspected bleeding into the abdominal cavity is subject to urgent examination in a hospital. Examination of the abdomen is carried out to identify characteristic signs of injury ( open wounds, abrasions, bruises).

Surface-orienting palpation reveals softness and slight soreness of the anterior abdominal wall, its limited participation in breathing, and mild symptoms of peritoneal irritation. Deep palpation is carried out carefully, as it causes sharp pain in the area of the damaged organ or the entire abdominal wall. Percussion of the abdomen in the presence of bleeding into the abdominal cavity is very painful, due to the accumulation of blood, there is a dullness of sound in sloping places. Abdominal auscultation showed a decrease in bowel sounds. When a hollow organ is ruptured, local manifestations of bleeding into the abdominal cavity may be masked by signs of incipient peritonitis.

Digital rectal and vaginal examinations reveal swelling and sharp pain in the anterior wall of the rectum and posterior vaginal fornix. If a disturbed tubal pregnancy is suspected, an important diagnostic value is assigned to the puncture of the abdominal cavity through the wall of the posterior fornix of the vagina. Laboratory research blood during bleeding into the abdominal cavity shows an increasing decrease in the level of hemoglobin, the number of erythrocytes and hematocrit.

A plain x-ray in case of internal bleeding helps to determine the presence of free fluid (blood) in the abdominal cavity. Ultrasound of the pelvic organs and ultrasound of the abdominal cavity reveals the source of bleeding in the internal organs and the accumulation of anechoic fluid. The main methods for diagnosing bleeding into the abdominal cavity are endoscopic studies - laparocentesis (puncture of the abdominal cavity with the connection of a rummaging catheter) and diagnostic laparoscopy.

The differential diagnosis of bleeding into the abdominal cavity is carried out with a perforated gastric and duodenal ulcer, retroperitoneal hematoma and hematoma of the anterior abdominal wall. If necessary, narrow specialists are involved in the diagnosis - a gynecologist, a traumatologist, a thoracic surgeon, a coloproctologist, a hematologist, etc.

Treatment of bleeding into the abdominal cavity

A patient with suspected bleeding into the abdominal cavity is immediately hospitalized in compliance with general rules: position - lying on the back, cold on the stomach, exclusion of water and food intake. In a surgical hospital, careful dynamic monitoring of the pulse rate and the value of blood pressure, hemoglobin and hematocrit levels is carried out. Until an accurate diagnosis is established, the use of painkillers (narcotic) drugs is contraindicated.

In case of acute blood loss and a sharp drop in blood pressure, anti-shock and anti-hemorrhagic infusion therapy is carried out: transfusion of blood substitutes (or reinfusion of blood that has recently leaked into the abdominal cavity), administration of analeptic drugs. This helps to increase and replenish BCC, improve the rheological properties of blood and microcirculation.

When establishing the fact of bleeding into the abdominal cavity, an emergency surgical intervention (laparotomy) is indicated, including a revision of the abdominal organs to detect the source of bleeding and stop it, and eliminate existing injuries.

The prognosis for bleeding into the abdominal cavity is quite serious, depending on the cause and intensity of bleeding, as well as the speed and volume of surgical intervention.

How to identify internal bleeding

Detecting internal bleeding is very difficult. At the initial stage, its symptoms are very blurred, similar to those of other diseases. Something wrong can be suspected with severe external injuries, but some chronic diseases also cause a similar condition. The danger is that the person does not always experience pain. However, if urgent measures are not taken, the life of the sufferer will be in danger. How to recognize signs of internal bleeding and how to help before the doctors arrive? Read more about this later in the article.

Types of internal bleeding and their manifestation

Significant internal blood loss occurs for two reasons:

mechanical damage to internal organs due to a blow, a fall from a height, an industrial injury, or even after a showdown with the help of fists;
chronic diseases that lead to thinning of the walls of blood vessels, their rupture. At the same time, blood fills either the natural (stomach, uterus in women, lungs), or the cavity created by it.

No matter how much blood is shed, the body tends to push it out. It comes out along with feces, the contents of the stomach, from the internal genital organs in women, is expectorated with sputum from the bronchi and lungs. However, do not think that the bleeding will stop on its own, the wound will heal by itself. At the first manifestations of internal blood loss, you should consult a doctor as soon as possible.

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Gastrointestinal

According to doctors, cirrhosis of the liver, ulcers, varicose veins of the stomach or duodenum provoke every third internal bleeding. In this case, the problem can be recognized by vomiting with an admixture of bloody clots of a dark, almost black color. Another characteristic sign of internal bleeding into the digestive organs is stool, which resembles tar in color and consistency. It can appear in 1–2 and even 9–10 hours after the onset of blood loss.

craniocerebral

Otherwise, this kind of internal bleeding is called a stroke. In such a situation, the fluid does not find a way out and accumulates in the cranium. Only blood clots can be removed surgically. The danger of blood clots in the brain cannot be underestimated: they can cause complete or partial paralysis, disruption of the organs for which the affected area is responsible, and even death. In addition to a severe head injury, a stroke often leads to:

high blood pressure;
diabetes;
brain tumors;
vascular aneurysms;
encephalitis.

Pelvis

It's about uterine bleeding. It can occur in women different reasons. Changes hormonal background, tumors, ectopic pregnancy, miscarriage, placental abruption during childbearing, rupture of the uterus or ovaries - all these factors hidden from human eyes provoke internal bleeding. They can open after the end of menstruation or during it. One of the signs of internal bleeding is that the blood comes out profusely in the form of large dark-colored clots. Accompanied process aching pains in the lower abdomen.

In the abdominal cavity

Powerful internal bleeding in this area is possible for various reasons:

ectopic pregnancy;
tumors;
low blood clotting.

What makes this type of bleeding special is the fact that a person experiencing sharp pain in the peritoneum, in order to calm it down a little, he is forced to sit with his knees pulled up to his chest. Most often, doctors are faced with external mechanical damage:

abdominal trauma;
chest injuries;
ruptures of internal organs: liver, ovaries, spleen.

In the organs of the respiratory system

The accumulation of blood in the lungs and its release are associated with complications after certain diseases (tumors in the chest, tuberculosis), with injuries to the ribs, heart, and the respiratory organs themselves. At the same time, along with typical characteristic features, there are also some specific features:

the pulse rate noticeably decreases with heart injuries and increases if the lungs are affected;
difficulty breathing, lack of oxygen if blood has filled the pleural cavity;
there are pains in the chest of varying strength;
characterized by restless behavior, distortion of facial features;
cough is accompanied by the release of scarlet blood mixed with foam.

Main signs and symptoms

Along with specific experts note numerous general symptoms internal bleeding, regardless of which specific organ or part of the body is affected. These signs include:

severe dizziness;
inability to do daily activities, weakness;
unnatural pallor of the skin and whites of the eyes;
apathy, drowsiness, inability to concentrate;
nausea, vomiting;
fainting;
especially severe cases marked by confusion, inability to adequately perceive and respond to what is happening;
with injuries incompatible with life, a person falls into a coma.

By some signs it is possible to judge which vessels are damaged. Capillary bleeding is very weak and does not pose a particular danger to life. Parenchymal, in which all channels are involved, is very long and abundant. Arterial is characterized by the ejection of blood of a bright red color, and it pours out jerkily. The main signs of venous bleeding are unhurried uniform outflow of blood of a dark color.

First aid for internal bleeding

It is difficult to determine the source of internal bleeding without a doctor's examination. However, if the sufferer is left without help at all, the situation can noticeably worsen. A few simple steps will help alleviate the condition of the victim and give him a chance for a successful outcome:

try to provide the victim with peace and the greatest possible comfort;
if by some indication you can assume that an internal hemorrhage has occurred in the upper body, arrange the person reclining. Otherwise, lay on your back;
make sure that the victim moves as little as possible;
put something cold on it (a bag of frozen food, cold water, ice cubes) to the place where you think internal bleeding occurs;
you should not give the sufferer any medicines, drinks other than water, carry out any procedures. What is necessary in each case, can only be determined by a specialist;
make sure the doctor arrives as soon as possible.

After watching the video below, you will learn how to properly help a person suffering from internal bleeding in the street. A professional doctor tells how competently, armed with the usual improvised items, to alleviate the patient's pain before the appearance of an ambulance doctor. You will learn about the first symptoms of internal bleeding, which will give you a signal to act, because you should never leave such a problem to chance.

Internal bleeding: symptoms, diagnosis

Probably everyone has come across such a concept as “bleeding”. It would seem that it would not be difficult for anyone to recognize him. But everything is always clear only with external ones, but if internal bleeding occurs, the symptoms of which can be hidden, everything is much more complicated. After all, no one will immediately understand in which tissues and organs it happened. And it depends further treatment the affected tissue.

Bleeding - what is it?

Bleeding refers to any situation where the blood goes beyond the limits of the vessels. Distinguish between external and internal bleeding. External are those in which blood flows into the external environment through natural openings or wounds, for example, uterine or from the final sections of the intestine. Internal bleeding occurs when the blood does not come out, but remains inside the body, forming hematomas in the organs - accumulations of blood. An example is when blood flows into the pleura, abdominal cavity, joints, heart shirt.

In addition to the division into external and internal, as well as hidden or explicit, they are divided according to which vessel is damaged:

Capillary bleedings differ in saturation. Blood is released rather slowly in the form of droplets that resemble dew. Capillaries are the smallest human blood vessels. You can stop this bleeding by tightly bandaging the wound. If there are no problems with the coagulation system, then medical assistance is not needed in this case.

With venous bleeding, dark flowing blood is released from the wound surface. Serious bleeding is possible. The victim must be taken to medical institution, tight bandaging is used as first aid.

When bleeding from an artery, the blood pulsates and flows. It is scarlet in color, quickly flows out of the wound. It is necessary to apply a tourniquet above the damaged area. On the wound - a tight bandage. The tourniquet can be kept for no more than an hour.

Parenchymal bleeding can occur with injuries of the bone cancellous bone, cavernous tissue and perenchymal organs. Such bleeding is very life-threatening, the victim must be taken to the hospital as soon as possible. Such bleeding cannot be stopped on its own, it can be profuse.

With mixed bleeding, blood can flow from various vessels, as well as be combined with parenchymal ones. Most often, such blood loss occurs with injuries of organs in which the vascular network is well developed.

Types of internal bleeding

Internal bleeding, the symptoms of which are very insidious, pose a great danger to health and even human life. The severity of the condition of the victim with this pathology directly depends on how large the vessel has suffered, that is, on its diameter. The larger the affected vessel, the more dangerous bleeding and the greater the blood loss.

There are such types of internal bleeding:

in the abdominal cavity, when the internal organs are torn - the spleen, liver - abdominal bleeding;
from the pelvic organs: uterus, ovaries, fallopian tubes;
gastrointestinal bleeding.

All these pathologies have their own signs and characteristics that allow the doctor to suspect something was wrong inside the body.

Causes of internal bleeding

Internal bleeding, the symptoms of which may be erased, never occurs as the main pathology. They are caused either by an underlying disease, or an injury, or a number of different circumstances. Internal bleeding can occur due to the following reasons:

abdominal injuries, both open and closed, in which internal organs such as the small intestine, spleen, liver can be damaged;
a ruptured ovary can lead to internal bleeding;
ruptured pelvic or ovarian cyst;
traumatic injuries of the lower back;
ulcers of the intestine and stomach;
varicose veins of the stomach or esophagus;
aortic dissection (with aneurysm);
malignant tumors of the abdominal and retroperitoneal space of the stomach, intestines in the stage of decay;
damage to the esophagus.

intestinal bleeding

intestinal bleeding may occur when various diseases intestines (both large and small). The most common cause is a duodenal ulcer. Also, bleeding can cause tumor rupture and simple trauma. The patient may feel dizzy, flashing flies before his eyes, sticky cold sweat. If bleeding in upper divisions intestines, there may be vomiting of coffee grounds, the feces will be black or dark cherry. Intestinal bleeding most often requires urgent surgical intervention. In any case, stopping internal bleeding and treating its consequences are carried out in a hospital under the supervision of medical personnel.

Symptoms of internal bleeding

If a person suddenly turns pale, he has a sticky sweat, a sharp drop in blood pressure, an increased pulse, internal bleeding can be suspected. The symptoms of this pathology will leave no doubt, if you are careful. There may also be drowsiness, indifference to the outside world literally five minutes after the person was sociable and active.

Bleeding in the stomach

Internal bleeding of the stomach is one of the most dangerous conditions. A person feels the general symptoms characteristic of internal bleeding. In addition, he most often appears to vomit coffee grounds and black feces. Such bleeding can be caused by a stomach ulcer, a malignant decayed tumor, or an abdominal injury.

What to do if there is bleeding of internal organs?

If a person has a deterioration in well-being, indicating that he has internal bleeding, the symptoms of which are basically similar to each other, you should immediately call ambulance. Before the arrival of health workers or if the patient has to be transported on his own, you must first of all lay him on his back. Apply cold to the suspected area of bleeding. Do not try to stop internal bleeding on your own, only a doctor should treat.

Methods for stopping internal bleeding of the abdominal cavity

At the first symptoms of internal bleeding, you should immediately consult a doctor. You should not console yourself with the illusion that it will stop, because such a state is life-threatening. After compiling a medical history, specialists collect not a large number of feces and vomit to send them for analysis. This study is done to check for the presence of blood in them.

After diagnosing the disease, doctors provide assistance with internal bleeding - diagnostic manipulations, for example, such as endoscopy, X-ray, recto-manosigmoidoscopy, colonoscopy and some others. All these activities are carried out in order to determine exactly where the source of bleeding is. In some cases, a therapeutic and diagnostic injection of a sclerosing agent is used, electrocoagulation can be used. Also effective method is laser light.

But the most effective is the radical method - surgical. Especially often this procedure is resorted to when the bleeding is acute, and there is no time for unnecessary actions. But after surgery, there is no guarantee that it will not open again. Therefore, the patient is observed in the hospital for some time.

Everything medical measures aimed at the implementation of several goals during bleeding.

The use of drugs that reduce the activity of gastric secretion.
Stop bleeding as soon as possible.
Additionally, blood is injected if its losses are large.
There is a struggle with DIC-syndrome.
It is also important to bring a person out of a state of shock, the fight against collapse is being carried out.

Who is subject to such bleeding?

There is a certain risk group - people who are more likely to experience internal bleeding. We have already considered the symptoms of this condition. These are patients who have pathologies such as:

nonspecific ulcerative colitis;
oncological diseases of the abdominal organs;
erosive gastritis;
intestinal intussusception;
any gastroenterological hypertrophic diseases;
polyposis;
stomach ulcer;
some benign tumors of the gastrointestinal tract.

But these diseases are not necessarily accompanied by bleeding. You should not panic, you need to remember that the blood in these cases can almost always be stopped. The main thing is to implement necessary measures to stop it and do not delay contacting a doctor. Having such diseases that are at risk, you need to remember all medical prescriptions. For example, about strict adherence to a diet, the correct diet, the necessary organization of a healthy lifestyle. It is important to monitor your health and contact specialists in time.

Intra-abdominal bleeding

Intra-abdominal bleeding or, as it is called in medical practice, hemoperitoneum - an outflow of blood into the abdominal cavity or into the retroperitoneal space associated with damage to organs and blood vessels that lie in this area. Most often, damage to the vessels located in the omentum, mesentery, folds and ligaments of the peritoneum leads to hemoperitoneum. As for the organs, in most cases, such as the pancreas, liver and spleen are affected.

Intra-abdominal bleeding is a deadly condition. But if you know its main symptoms and take action in time, then complications can be avoided.

Causes

All causes of intra-abdominal bleeding can be divided into two main groups. The first includes the causes of a traumatic nature:

chest injuries (for example, fractures of the lower ribs can provoke damage to internal organs by bone fragments);
blunt abdominal trauma resulting from squeezing, falling, strong blows;
gunshot or knife penetrating wounds of the abdomen;
damage after some operations (resection of the stomach or liver, nephrectomy, appendectomy, cholecystectomy) associated with complications, slippage of ligatures used to ligate vessels, or surgeons' mistakes.

The causes of a non-traumatic nature include, mainly, complications of diseases of the internal organs:

ruptured aortic aneurysm;
severe damage or rupture of the uterine (fallopian) tube during an ectopic pregnancy;
ruptures of cysts of internal organs;
ovarian apoplexy;
liver hemangioma;
long-term use of drugs that reduce blood clotting (fibrinolytics or anticoagulants);
diseases accompanied by a significant decrease in blood clotting (these include such as hemorrhagic diathesis, obstructive jaundice, malaria).

Symptoms

Symptoms of intra-abdominal bleeding will depend on its intensity, location and size of damaged vessels or organs, as well as the nature of the damage. So, with minor bleeding, the manifestations will be blurry and unexpressed, and with strong and sudden bleeding, they will be obvious and sharp.

The following signs of hemoperitoneum are possible:

general weakness, loss of strength, muscle atrophy;
blanching of the mucous membranes of the skin;
increased sweating;
increased heart rate (sometimes up to 120 or even 140 beats per minute);
dizziness;
darkening in the eyes;
fainting or shock state;
soreness in the area of the damaged organ (such pains are called abdominal, they are pronounced, they can radiate to the shoulders, chest, shoulder blades or back and force the patient to take a sitting position, which alleviates the condition);
loss of consciousness;
the abdominal cavity is soft, not compacted.

For more information on symptoms and first aid, see the following video:

Diagnostics

If hemoperitoneum is suspected, the patient must be urgently taken to the hospital for an accurate diagnosis and medical care. The specialist will examine the patient. On palpation, the doctor will determine the possible nature and localization of damage. But to clarify the diagnosis will require diagnostic procedures. The most complete picture is revealed:

ultrasonography,
radiography,
and diagnostic laparoscopy.

Blood tests can also be informative, allowing you to determine the level of hemoglobin (with blood loss, it will decrease), hematocrit and other indicators.

Treatment

If intra-abdominal bleeding is suspected, the patient should be immediately placed on a flat horizontal surface. Movement before the arrival of doctors is contraindicated. Cold may be applied to the abdomen. The intake of liquids or food is strictly contraindicated.

Measures should be taken immediately and intensive care should be started. It includes resuscitation, anti-hemorrhagic and anti-shock measures:

infusion administration of blood substitute solutions,
the introduction of analeptics (these drugs have a stimulating effect on the vasomotor, as well as respiratory centers brain),
reinfusion (collection of blood poured into the retroperitoneal space or abdominal cavity and its re-infusion).

Also, in most cases, surgical intervention is required, the purpose of which may be to restore the integrity or remove damaged organs, as well as ligation of blood vessels.

Complications

With significant blood loss, there is a risk of death. But even if the bleeding has stopped, an infection can develop, which in most cases leads to peritonitis - inflammation of the membranes that cover the internal organs and lining the abdominal cavity.

Prevention

To reduce the risk of developing intra-abdominal bleeding, you should undergo scheduled examinations on time and treat any diseases of the internal organs, as well as consult a doctor in case of injuries. It is extremely important to detect intra-abdominal bleeding in time and take the necessary measures.

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Bleeding into the abdominal cavity: symptoms, consequences and treatment

Under intra-abdominal bleeding (synonymous names - hemoperitoneum, intra-abdominal bleeding) is understood as an outpouring of blood into the retroperitoneal space or into the abdominal cavity, caused by damage to blood vessels and internal organs (both hollow and parenchymal) localized in this area.

The mortal danger of internal bleeding lies in the difficulty of its timely detection, since in the absence of external damage (the culprits of its occurrence can be a number of chronic diseases), the symptoms of the pathology are often blurred, and pain may be completely absent.

Immediate hospitalization can save a person's life, which is why it is so important to know the signs that indicate the presence of intra-abdominal bleeding.

Causes

Intra-abdominal bleeding can be the result of exposure to factors that can be clearly divided into two categories.

The first of these includes traumatic factors, represented by:

Mechanical damage to the chest. Given the diverse nature of the resulting injuries (in addition to fractures of the bones that make up the skeleton of the chest, this includes injuries to the lungs and heart, provoked by the impact of the resulting bone fragments), we can say that we are talking about a large group of injuries. In the vast majority of cases, chest injuries pose either a potential or direct threat to the life of the injured person, so their receipt is an indication for immediate hospitalization of the patient.
Closed abdominal injuries resulting from strong blows, falls (from a height or onto hard objects) and tissue compression.
Open abdominal injuries resulting from stab and gunshot wounds. Bleeding occurs due to rupture of the parenchymal or hollow organs of the gastrointestinal tract, genitourinary system and the mass of blood vessels passing inside the greater omentum, mesentery and peritoneal folds.
Damage that occurred after performing some abdominal operations. This category includes: appendectomy (removal of the appendix), resection of the liver or stomach, cholecystectomy (removal of the gallbladder), nephrectomy (removal of the kidney). Intra-abdominal bleeding that develops during the postoperative period, as a rule, is due to slipping or cutting of the threads (ligatures) used to tie the vessels of the mesentery or suturing the resected organ.

The occurrence of intra-abdominal bleeding can occur as a result of:

oncological lesions of the gastrointestinal tract and small pelvis;
rupture of an aneurysm of the abdominal aorta;
varicose veins of the stomach and esophageal tube;
ovarian apoplexy (spontaneous, rapidly progressive hemorrhage in the tissues of this organ, followed by blood leakage into the abdominal cavity);
cyst rupture;
significant damage or complete rupture of the fallopian tube during ectopic pregnancy;
superficial ruptures of the mucous membranes of the abdominal esophageal tube and the cardial part of the stomach (the so-called Mallory-Weiss syndrome);
complications of diseases (malaria, hemorrhagic diathesis, obstructive jaundice), provoking a significant deterioration in blood clotting;
pathological proliferation of the vascular network of the liver (the so-called hemangioma of this organ);
long-term use of anticoagulants or fibrinolytics - drugs that slow down blood clotting.

Symptoms of bleeding into the abdomen

Clinical symptoms in intra-abdominal bleeding are determined by the volume and rate of blood loss: the higher the rate of decrease in circulating blood volume (CBV), the sooner signs of hemorrhagic shock develop.

The degree of blood loss can be:

Lung (up to 10% of the total volume of circulating blood). The victim loses from 500 to 700 ml.
Moderate (up to 20% BCC). The volume of blood loss fluctuates within ml.
Severe (up to 30% BCC). The body of the victim loses from one and a half to two liters of blood.
Massive (over 30% BCC). Blood loss of more than two liters of blood falls under this category.

Typical symptoms of intra-abdominal bleeding are:

pallor of mucous membranes and skin;
cold perspiration;
dizziness;
severe headaches;
a feeling of congestion in the ears;
general weakness;
the appearance of "flies" flashing before the eyes or darkening in the eyes;
severe tachycardia (increased heart rate, in which the pulse rate exceeds 130 beats / min);
a sharp drop in blood pressure;
clouding of consciousness;
oliguria (a decrease in the volume of urine produced by the structures of the kidneys);
the appearance of local or mixed pains in the abdomen, which tend to intensify with movement;
the occurrence of a pre-syncope or shock state;
a symptom of "roly-up", consisting in the patient's attempts to take a sitting position, which helps to slightly reduce the intensity of abdominal pain.

If the accumulated blood irritates the diaphragmatic peritoneum, abdominal pain may radiate to the shoulder, shoulder blade, or chest area.

Acute massive blood loss is fraught with the development of collapse - a life-threatening condition characterized by an extremely low level of blood pressure, leading to a significant deterioration in the blood supply to internal organs.

Complications

Massive blood loss often ends in death.
The loss of a large amount of blood is fraught with the development of acute anemia. Against the background of deterioration of the work of the heart muscle, a progressive drop in blood pressure is observed. If medical assistance was not provided on time, the affected person experiences hemorrhagic shock.
A significant amount of blood spilled can provoke an extremely dangerous condition, characterized by compression of organs and tissues. Such patients are subject to immediate hospitalization. Otherwise, the possibility of death is not excluded.
If an infection enters the body of a patient with stopped intra-abdominal bleeding, it is fraught with the development of peritonitis, an inflammatory process that affects the sheets of the peritoneum (the membrane lining the abdominal cavity and covering the internal organs).

Diagnostics

At the slightest suspicion of the presence of intra-abdominal bleeding, the patient should undergo an immediate examination in a medical hospital.

The first diagnostic manipulation is a visual examination of the abdomen, aimed at identifying possible traumatic injuries (represented by bruises, abrasions, open wounds).
Further examination of the abdomen is carried out by palpation (superficial and deep), percussion and auscultation. During superficial orienting palpation of the abdomen, the specialist will certainly pay attention to the fact that the anterior wall of the abdomen - soft and moderately painful - does not perform respiratory movements in full, and will also reveal some signs of peritoneal irritation. Due to the soreness of the abdominal wall or the area in which the affected organ is located, deep palpation should be done with extreme caution. Performing percussion of the abdomen, the doctor will note the presence of a pronounced pain syndrome (this is a characteristic sign of intra-abdominal bleeding) and muffled sound in sloping areas due to the accumulation of blood in the abdominal cavity. In the presence of intra-abdominal bleeding, auscultation of the abdomen will reveal a reduced level of bowel sounds.
During vaginal and digital rectal examination of a patient with suspected intra-abdominal bleeding, it turns out that the posterior vaginal fornix and the anterior wall of the rectum bulge and are acutely painful. If the doctor has a suspicion of a disturbed tubal pregnancy, he will perform a puncture of the abdominal cavity, penetrating into it through the wall of the vagina.
In the presence of intra-abdominal bleeding, a complete blood count will indicate a rapidly increasing decrease in the number of red blood cells, hemoglobin levels and hematocrit (the volume of red blood cells in the blood).
With the help of plain radiography (this diagnostic technique is non-contrast), the specialist is convinced of the presence of blood accumulated in the abdominal cavity.
With the help of ultrasound examination of the abdominal cavity and small pelvis, it is possible to establish the localization of the source of bleeding and the place of accumulation of anechoic (non-reflecting sound) fluid.
The diagnostic laparoscopy procedure provides the most complete and reliable information about intra-abdominal bleeding. In order to carry out an overview of the abdominal cavity, several small punctures are made in the anterior wall of the abdomen, through which a special device is inserted - a laparoscope equipped with a miniature endovideo camera connected to a monitor with multiple magnification. The main advantage of this minimally invasive procedure is the possibility of performing all diagnostic actions without opening the abdominal cavity (transsection).
Another endoscopic technique that allows to detect intra-abdominal bleeding is laparocentesis - a therapeutic and diagnostic procedure that involves performing a puncture of the anterior wall of the abdomen, followed by the introduction of a rummaging catheter (silicone tube with holes). After insertion of the catheter, the contents of the abdominal cavity are aspirated using a twenty-gram syringe. The detection of a large (over 20 ml) amount of blood and other pathological contents (blood with feces or urine, turbid greenish-gray or dark brown liquid) is an indication for urgent surgical intervention. If during laparocentesis it was not possible to extract any pathological contents from the abdominal cavity, the result of the procedure is considered negative, and the performed puncture is called “dry”.

Intra-abdominal bleeding should be differentiated from:

hematomas of the anterior abdominal wall;
retroperitoneal hematoma;
perforated ulcer of the duodenum and stomach.

In some cases, the diagnosis of intra-abdominal bleeding requires the help of narrow specialists: hematologists, gynecologists, coloproctologists, traumatologists, and thoracic surgeons.

First aid for bleeding in the abdominal cavity

If there is a suspicion of intra-abdominal bleeding, the patient is subject to immediate hospitalization. Reception of water and food is excluded.

The patient should be transported in a supine position, be sure to apply cold to the stomach.

In a surgical hospital, dynamic monitoring of blood pressure, heart rate, hematocrit value and hemoglobin level is carried out.

Until an accurate diagnosis is established, the use of any painkillers (including narcotic drugs) is prohibited.

in the dynamic observation of the patient;
in the intravenous administration of saline solutions (represented by saline, refortan, Ringer's solution, rheosorbilact);
in the infusion administration of hemostatic drugs (etamsylate, aminocaproic acid).

In relation to patients with acute blood loss and a sharp drop in blood pressure, a whole range of resuscitation, anti-shock and anti-hemorrhagic measures are used, which boil down to:

infusion administration of blood substitutes;
reinfusion (manipulation consisting in the collection of blood that has recently poured into the retroperitoneal space or into the abdominal cavity and its re-infusion into the patient's body);
the introduction of analeptic drugs that have a stimulating effect on the centers (vasomotor and respiratory) of the medulla oblongata.

If severe blood loss of any etiology is detected, an emergency laparotomy is performed (a surgical operation that requires cutting the abdominal wall), during which the surgeon performs an audit of the internal organs in order to find the source of bleeding, stop it and eliminate the identified damage along the way.

In parallel with the surgical intervention, infusion therapy is carried out, aimed at maintaining the vital functions of the body.

Prevention

There are no specific measures to prevent intra-abdominal bleeding. To reduce the risk of their occurrence, each person should:

Timely scheduled medical examinations.
Immediately treat any diseases of the internal organs.
Seek qualified medical attention in case of injury, as in this case a thorough examination may reveal the presence of internal bleeding. The sooner therapy begins, the lower the likelihood of severe complications.

Internal bleeding is the outpouring of blood into the body cavity, in which there is no outflow of blood through damaged skin. This condition is extremely insidious, as there is no obvious bleeding, and sometimes it is difficult to make a diagnosis.

Therefore, everyone should know the signs of internal bleeding into the abdominal cavity, methods of diagnosis and treatment methods.

Types of bleeding

The severity of symptoms of internal bleeding into the abdominal cavity largely depends on the mechanism of occurrence of hemorrhage. They are as follows:

mechanical - occurs when a vessel ruptures, accompanied by a massive outpouring of blood and severe symptoms;
arrosive - it is based on necrosis (death) of the vascular wall, while bleeding is less pronounced, often with blurred symptoms;
diapedetic - with this mechanism, the integrity of the vessel wall is broken at the microscopic level, blood flows through the wall in small quantities, symptoms are often absent, therefore, it is difficult to make a diagnosis.

Symptoms of internal bleeding into the abdominal cavity also depend on the type of the affected vessel. Depending on this, the following types of bleeding are distinguished:

arterial - in violation of the integrity of the arterial wall;
venous - in case of damage to the vein;
capillary - the flow of blood from the smallest vessels of the body (capillaries);
mixed - simultaneous damage to several types of vessels.

The most dangerous is the leakage of blood from large arteries. Exactly arterial bleeding most often leads to death, so a lot of blood is lost, which is difficult to stop. This is due to the large diameter and thick wall of the arteries.

The severity of blood loss

When diagnosing internal bleeding into the abdominal cavity, the severity must be indicated. She may be:

mild - loss of up to 15% of the total volume of blood circulating in the vascular bed;
moderate - loss from 15 to 20%;
severe - a decrease in blood volume by 30%;
extremely severe or terminal - loss of more than 30% of the total blood volume.

Hemorrhage in excess of 60% is considered fatal.

Main reasons

Signs of internal bleeding into the abdominal cavity develop with such pathological conditions:

Injuries of parenchymal internal organs: liver, spleen, ovaries in women.
Bleeding from the wall of the stomach or intestines that is caused by an ulcer or malignant tumor.
Cirrhosis of the liver, which causes an increase in pressure in the venous vessels. The rupture of these vessels leads to severe bleeding from the esophagus and stomach.
Dissection of the abdominal aorta due to thinning of its wall with the formation of an aneurysm (saccular bulging).
Rupture of the gastric mucosa (Mallory-Weiss syndrome).
Ectopic pregnancy or apoplexy, that is, rupture of the ovary in women.
Rupture of the cystic cavity of the ovary due to increased physical activity.
postpartum hemorrhage or hemorrhages during childbirth. Although in most cases the blood flows out, sometimes internal bleeding is possible. For example, detachment of the placenta in the center and the formation of a hematoma behind the placental tissue.

Some may argue that uterine bleeding belong to the intra-abdominal, because the uterus is an organ of the pelvic cavity. But in pregnant women it reaches large sizes and goes far beyond it. Therefore, symptoms of internal bleeding into the abdominal cavity in women may occur during pregnancy.

Main symptoms

Symptoms of internal bleeding into the abdominal cavity in adults can be divided into two groups:

local;
are common.

Local signs arise due to the accumulation of blood in the abdominal cavity and irritation of the nerve endings of the peritoneum. Because of these local symptoms, intra-abdominal bleeding is easily confused with peritonitis (inflammation of the peritoneum). The main signs of peritoneal irritation are presented below:

positive symptom Shchetkin-Blumberg. To call it, the surgeon presses his fingers on the anterior abdominal wall of the patient. Then he abruptly releases his hand. The appearance of pain when releasing the hand indicates irritation of the peritoneum.
Tension of the anterior abdominal wall, immobility when breathing. This is due to the fact that it is painful for the patient to contract the muscles.
Diffuse soreness all over the abdomen.

General signs of internal bleeding into the abdominal cavity are not strictly specific. They occur with any loss of blood. The most important of these features include:

Paleness of the skin.
Drop in blood pressure.
Cold sweat.
Feeling dizzy.
Tiredness and lethargy.
Increased heart rate.

Clinical manifestations depending on the severity of blood loss

Symptoms of blood loss develop gradually and become more severe as the condition worsens.

Mild blood loss is usually asymptomatic. The patient's condition is satisfactory.

Bleeding of moderate severity is manifested by a decrease in systolic pressure to 80 mm Hg. Art., an increase in heart rate up to 100-110 beats per 1 minute, a change in the color of the skin (their pallor), cold extremities.

Severe blood loss is characterized by an even greater decrease in blood pressure and a slowing of the heartbeat. The patient's skin acquires a bluish tint, the cyanosis of the nasolabial triangle is especially visible. Due to the loss of a large amount of blood, a decrease in diuresis (oliguria) is observed. The patient is lethargic and drowsy.

At terminal pressure drops below 50 mm Hg. Art., the pulse is almost not palpable. The patient's consciousness is disturbed up to coma. There are signs of loss of a large amount of fluid: sinking eyeballs, a large number of skin folds, sagging skin, dry mucous membranes.

In the last stages, the patient's condition is extremely severe. Diuresis is completely absent, the pressure drops to zero. Stop bleeding and clinical death. In such cases, urgent cardiopulmonary resuscitation.

Features of internal bleeding in women

Separately, it is worth paying attention to the outpouring of blood into the abdominal cavity in women. The most common causes are ectopic pregnancy, cyst rupture and ovarian apoplexy.

Symptoms of internal bleeding into the abdominal cavity during an ectopic pregnancy are quite specific. When a pipe breaks, sharp pain in the lower abdomen, the patient's condition deteriorates sharply. Blood pressure drops, pulse drops, cold sweat appears all over the body.

Symptoms of internal bleeding into the abdominal cavity from the ovary are similar to those of a ruptured tube. Help to distinguish these two conditions data of gynecological and ultrasound examinations.

Diagnosis: the first stage

If there are symptoms of internal bleeding into the abdominal cavity in a child or adult, diagnosis begins with anamnesis. If the patient's condition is satisfactory and he is able to contact the doctor, he is asked in detail about his symptoms and complaints.

Already when talking with the patient, you can determine the probable cause of bleeding. For example, with symptoms of internal bleeding into the abdominal cavity due to glass, trauma, liver disease, or will not differ significantly from each other, but the patient may indicate the fact of swallowing glass or a blow to the stomach.

Next, we move on to an objective examination. Examine the skin, determining their color and moisture. Be sure to measure the patient's blood pressure and pulse, since these data can be used to determine the approximate amount of blood loss.

The abdominal cavity is palpated, the Shchetkin-Blumberg symptom is checked.

Laboratory diagnostics

After a conversation with the patient and an objective examination, the doctor prescribes the necessary laboratory and instrumental tests.

The most common lab tests are:

blood test;
analysis of feces for the presence hidden blood;
study of vomit.

A general blood test is performed to determine the presence of anemia. With massive acute blood loss develops posthemorrhagic anemia, and in chronic bleeding it is possible Iron-deficiency anemia.

Instrumental diagnostics

Instrumental diagnostics allows you to find the source of bleeding. The most informative methods are:

colonoscopy - endoscopic examination small intestine, which reveals inflammatory or cancerous changes in its mucous membrane;
esophagogastroduodenoscopy - of the stomach and duodenum, which finds changes in the mucosa of these departments;
ultrasound - allows you to see damage to the structure of parenchymal organs, the presence of free fluid in the abdominal cavity;
CT scan- the most informative study for visualization of the abdominal organs.

If after carrying out the above examinations there are ambiguities, the surgeon performs a diagnostic laparoscopy. A small hole is made in the abdominal wall and a camera is inserted. The doctor sees a detailed image of all organs on the screen and thus finds the source of bleeding.

First aid

If there are signs of internal bleeding into the abdominal cavity, urgent care can be provided even before the arrival of qualified specialists. The following steps must be followed:

Call an ambulance.
Lay the patient horizontally.
Put something cold on the abdomen: a bubble with pieces of ice, a cold bottle, meat from the freezer. Any cold object will do.
If a specific place of bleeding is known, cold is placed on it. If not, then to the area of greatest pain.
If transportation of the patient is necessary, it is also carried out in a horizontal position.

Specialized care: conservative treatment

The ambulance transports the patient to the surgical department. There he is given specialized assistance.

If the patient's condition is satisfactory, no urgent surgical intervention is required. The victim is admitted to the hospital for further observation.

Conservative treatment of blood loss is to conduct infusion therapy. In order to restore the volume of lost blood, the patient is given droppers with saline solutions (isotonic sodium chloride, "Disol", "Trisol"). With massive bleeding, the infusion of substances with a higher molecular weight than that of saline solutions is indicated. To do this, enter "Reopoliglyukin", blood plasma.

Hemostatic substances are also introduced: "Etamzilat", aminocaproic acid.

Specialized care: surgical treatment

If the patient's condition is severe or there is no effect from drug therapy move on to surgery. An emergency laparotomy is performed. The surgeon makes an incision in the middle of the anterior abdominal wall. Then he removes the blood and conducts an audit of all organs in order to find the source of blood loss.

After the surgeon has found the injury, he stops the bleeding. This can be done by bandaging a torn vessel, applying clips, removing the affected organ, or resection of the damaged section of the intestine.

If symptoms of internal bleeding into the abdominal cavity appear after surgery, an urgent re-laparotomy is performed.