Parenchymal is bleeding, in which blood does not stand out, and due to damage to internal organs or some of their pathologies, flows into the internal cavities of the body (abdominal, pleural).
Types of bleeding
Bleeding is the expiration of blood from blood vessels. Most often, their cause is their damage. This may be the result of an injury (which happens most often) or the consequences of pathological changes in the body. Such a "melting" of blood vessels can be observed in tuberculosis, oncological conditions, ulcers of internal organs.
Bleeding is usually divided into external, when blood from a damaged vessel is poured out through a wound or natural openings, and internal. In this case, blood accumulates in the cavities. The following types of external bleeding are distinguished:
- capillary - occur due to superficial damage, blood is released in small quantities, drop by drop;
- venous - occurs as a result of deeper injuries (cut, stab wounds) with a large amount of blood of a dark red color;
- arterial - the cause is deep damage in which the artery wall is damaged, while the blood is poured out by a pulsating stream and has a bright scarlet color;
- mixed bleeding can also occur with deep damage, while in the wound both arteries and veins bleed.
Internal bleeding
Internal bleeding can also be classified by the localization of the process. With strokes and injuries of the chest, bleeding can occur, in which blood is poured into the pleural cavity. In this case, it accumulates there, compresses the lungs. Outwardly, this is manifested by shortness of breath and increasing shortness of breath.
Bleeding in the abdominal cavity can be a consequence of diseases of the organs located in it, in women it can be the cause of an ectopic pregnancy, but most often the cause of internal bleeding in the abdominal cavity is a blunt trauma to the abdomen, which is accompanied by rupture of the liver or spleen. In this case, they say that the bleeding is parenchymal. In addition, with such bleeding, blood can not only pour into the abdominal cavity, but also accumulate in the thickness of tissues, soaking them.
What is a parenchyma
Parenchyma is the tissue that is the basis of many internal organs. Anatomically, it is formed, depending on the task of the organ, by epithelial, nervous, muscle, myeloid or lymphoid tissue. Parenchymal organs are the liver, spleen, kidneys, various glands and even the brain. A feature of these organs is that in each of them the specialized structures are formed by the parenchyma, which allow the organ to perform its functions. In the liver, these are its lobules, in the kidneys - nephrons, in the spleen - follicles. In addition to the parenchyma, in the structure of such organs, the stroma is distinguished - the connective tissue base, which performs supporting and trophic functions. With damage to the smallest blood vessels (capillaries) supplying these organs, parenchymal bleeding occurs. Often its presence is difficult to diagnose and therefore, by the time they begin to provide assistance, a large loss of blood is possible. That is why timely diagnosis and stopping of parenchymal bleeding is a surgeon's priority.
Causes of parenchymal bleeding
The first place among the reasons unconditionally takes injury. Regardless of what caused it — a traffic accident, hit, or fall from a height — even a minor impact may be enough to cause parenchymal bleeding. This is due to the fact that even a slight tear in the capsule of the organ (and it is usually very tender), like blood vessels that feed the parenchyma and therefore are in large numbers here, is damaged and blood begins to flow into the body cavity.
In addition to injuries, the following pathologies can cause parenchymal bleeding:
- tumors, both malignant and benign;
- infections (tuberculosis);
- pathology of parenchymal organs (hemangioma);
- parasitic lesions;
- pathology of the blood coagulation system.
Blood loss mechanism
The result of bleeding in the body can be hemorrhage (in this case, the outflowing blood permeates the surrounding tissue) or a hematoma. Then a cavity filled with blood forms in the tissue. With parenchymal bleeding, both of these options are possible. The danger is that the vessels that feed the parenchyma do not fall in their structure, which means that the bleeding will continue. Even if it is not intense, all the same, the symptoms of anemia will increase, as a result, the organs and brain will suffer from hypoxia. With significant blood loss, hemorrhagic shock develops - a serious condition in which blood pressure decreases significantly and signs of multiple organ failure progress .
Signs of parenchymal bleeding
Despite the obvious danger to the patient's life, such bleeding is not always possible to detect immediately. It often happens that blood loss occurs over time, with little or no effect on overall well-being. Parenchymal bleeding in the early stages can be suspected of general weakness, drowsiness, dizziness. The patient is thirsty, "flies" and darkening in the eyes, cold sweat. Possible fainting. The degree of blood loss can be judged by such factors as pulse, blood pressure and other objective signs.
With slight blood loss, a slight decrease in pressure and increased heart rate (up to 80–90 beats per minute) is possible. In some cases, it generally passes without obvious signs, which creates an even greater danger, since parenchymal bleeding cannot stop on its own.
For moderate blood loss, an increase in heart rate to 100 beats per minute and higher and a decrease in systolic blood pressure below 90 mm Hg are characteristic. Art. rapid breathing, pallor of the skin, cold sticky sweat, cold extremities, dry mouth, severe weakness, apathy, adynamia, lethargy are also noted.
In the case of severe blood loss, systolic pressure decreases below 80 mm, and the heart rate can exceed 110 beats per minute. Breathing is shallow, very rapid, yawning, pathological drowsiness, hand tremors, decreased urine output, sharp pallor, marbling of the skin, lethargy or confusion, excruciating thirst, cyanosis of the limbs, acrocyanosis are observed.
Life-threatening blood loss
Massive internal bleeding is characterized by a decrease in pressure to 60 and an increase in heart rate to 140-160 beats per minute. Cheyne-Stokes breathing (the respiratory movements first deepen and quicken, but at 5-7 inspirations their intensity begins to decrease, after which there is a pause). Consciousness is confused or absent, delirium, the skin is sharply pale, sometimes with a grayish tint. Facial features are sharpened, eyes are sagging.
Fatal blood loss (as a rule, it is one third of the volume, that is, 1.5–2 liters) is accompanied by the development of a coma. In this case, the pressure decreases below 60 mm or is not determined at all, pulse contractions are reduced to 2-10 strokes, cramps, agonistic breathing are observed, the pupils are dilated, the skin is dry, “marbled”. Typically, this condition is irreversible - inevitably comes agony, and then death.
Parenchymal bleeding - first aid
Everyone knows that very often timely first aid can save a patient's life. Unfortunately, this cannot be said about internal bleeding. Parenchymal bleeding cannot be stopped or reduced by improvised means, the most important thing that can be done for the victim is to deliver him to a surgical hospital as soon as possible, that is, to call an ambulance.
So that the patient’s condition does not worsen, before her arrival, you can provide the following help with parenchymal bleeding:
- give the victim a horizontal position, with raised legs in the event that hemorrhage in the abdominal cavity is possible, or a semi-sitting position if hemothorax is suspected;
- place cold on the area of suspected bleeding.
Note! Patients with symptoms of internal bleeding are strictly forbidden to warm the affected area, provoke vomiting or do enemas and give medications that stimulate cardiac activity.
Treatment
To date, the only way to stop parenchymal bleeding is through surgery. As a rule, this happens during an emergency operation, before which laboratory tests are performed to evaluate the hematocrit, the level of hemoglobin and red blood cells, an ultrasound scan of the abdominal cavity, an x-ray.
There are several ways to stop parenchymal bleeding. It:
- organ resection;
- omentum drying;
- electrocoagulation of blood vessels;
- suturing of blood vessels;
- embolization of the supply vessel;
- the use of hemostatic sponges.
Along with stopping bleeding, the most important task is to compensate for blood loss, restore the volume of circulating fluid and improve microcirculation. To this end, blood, plasma and blood substitutes are transfused, as well as maintaining a 5% glucose solution, saline solution.