Internal bleeding is an outpouring of blood in the body cavity, in which it does not leak out through damaged skin. This condition is extremely insidious, since there is no obvious leakage of blood, 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 hemorrhage. They are as follows:
- mechanical - occurs when the 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 more mild, often with blurry symptoms;
- diapedetic - with this mechanism, the integrity of the vessel wall is violated at the microscopic level, blood flows through the wall in insignificant quantities, symptoms are often absent, therefore, there are difficulties with the diagnosis.
Symptoms of internal bleeding into the abdominal cavity also depend on the type of affected vessel. Depending on this, these types of bleeding are distinguished:
- arterial - in violation of the integrity of the arterial wall;
- venous - with damage to a vein;
- capillary - leakage of blood from the smallest vessels of the body (capillaries);
- mixed - simultaneous damage to several types of vessels.
The most dangerous leakage of blood from large arteries. It is arterial bleeding that 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 degree of 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 severity - loss from 15 to 20%;
- severe - decrease in blood volume by 30%;
- extremely severe or terminal - loss of more than 30% of the total blood volume.
A hemorrhage of more than 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, which is caused by an ulcer or malignant tumor.
- Cirrhosis of the liver, which causes an increase in pressure in the venous vessels. Rupture of these vessels leads to severe bleeding from the esophagus and stomach.
- Stratification of the abdominal aorta due to thinning of its wall with the formation of aneurysm (sack-like bulging).
- Rupture of the gastric mucosa (Mallory-Weiss syndrome).
- Ectopic pregnancy or apoplexy, that is, an ovarian rupture in women.
- Rupture of the ovarian cystic cavity due to increased physical exertion.
- Postpartum hemorrhage or hemorrhage during childbirth. Although in most cases blood flows out, internal bleeding is sometimes 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 refers to intraperitoneal, 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 can occur during pregnancy.
Main symptoms
Symptoms of internal bleeding into the abdominal cavity in adults can be divided into two groups:
Local symptoms occur due to accumulation of blood in the abdominal cavity and irritation of the nerve endings of the peritoneum. Due to these local symptoms, intra-abdominal bleeding is easily confused with peritonitis (inflammation of the peritoneum). The main signs of peritoneal irritation are presented below:
- A positive symptom of Shchetkin-Blumberg. To call him, the surgeon presses his fingers on the patient's anterior abdominal wall. 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 during breathing. This is due to the fact that the patient is painful to contract muscles.
- Spilled soreness across the abdomen.
Common signs of internal bleeding into the abdominal cavity are not strictly specific. They occur with any loss of blood. The most important of these signs include:
- Pallor of the skin.
- Drop in blood pressure.
- Cold sweat.
- Feeling dizzy.
- Fatigue and lethargy.
- Heart palpitations.
Clinical manifestations depending on the severity of blood loss
Symptoms of blood loss develop gradually and become more severe as the condition worsens.
A mild degree of 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 RT. Art., an increase in heart rate to 100-110 beats per 1 minute, a change in the color of the skin (their pallor), cooling of the extremities.
Severe blood loss is characterized by an even greater decrease in blood pressure and a slowdown in heartbeat. The patient's skin acquires a bluish tint, the cyanoticity 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.
With terminal blood loss, pressure drops below 50 mm Hg. Art., the pulse is practically not felt. The patient’s consciousness is disturbed up to coma. There are signs of loss of a large amount of fluid: dropping of the eyeballs, a large number of skin folds, sagging skin, dry mucous membranes.
In the last stages, the patient's condition is extremely serious. Diuresis is completely absent, the pressure drops to zero. Possible stopping of bleeding and clinical death. In such cases, urgent cardiopulmonary resuscitation is necessary.
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 an ectopic pregnancy, rupture of a cyst, and ovarian apoplexy.
Symptoms of internal bleeding into the abdominal cavity during ectopic pregnancy are quite specific. When the pipe ruptures, sharp pain occurs in the lower abdomen, the patient's condition deteriorates sharply. Blood pressure, pulse drops, cold sweat appears throughout the body.
Symptoms of internal bleeding into the abdominal cavity from the ovary are similar to those with a rupture of the tube. Gynecological and ultrasound examinations help to distinguish these two conditions.
Diagnostics: the first stage
In the presence of symptoms of internal bleeding into the abdominal cavity in a child or adult, diagnosis begins with a medical history. If the patient's condition is satisfactory and he is able to contact the doctor, he will be questioned in detail about the symptoms and complaints.
Already during a conversation 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 the gastrointestinal tract. Symptoms will not differ significantly from each other, but the patient may indicate the fact of swallowing glass or a blow to the stomach.
Next go to an objective examination. Inspect the skin, determining their color and moisture. Be sure to measure the blood pressure and pulse of the patient, since these data can determine the approximate amount of blood loss.
Palpation of the abdominal cavity is carried out, the symptom of Shchetkin-Blumberg is checked.
Laboratory diagnostics
After a conversation with the patient and an objective examination, the doctor prescribes the necessary laboratory and instrumental analyzes.
Most often, the following laboratory tests are done:
- blood analysis;
- analysis of feces for the presence of occult blood;
- study of vomit.
A general blood test is performed to determine the presence of anemia. With massive acute blood loss, posthemorrhagic anemia develops, and with chronic bleeding iron deficiency anemia is possible.
Instrumental diagnostics
Instrumental diagnostics allows you to find the source of bleeding. The most informative are the following methods:
- colonoscopy - an endoscopic examination of the small intestine, which reveals inflammatory or cancerous changes in its mucous membrane;
- esophagogastroduodenoscopy - a study of the esophagus, 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;
- computed tomography is the most informative study for imaging abdominal organs.
If after the above examinations are unclear, 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, emergency 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 cool item will do.
- If a specific bleeding site is known, the 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
An ambulance transports the patient to the surgical department. There he is provided with specialized assistance.
With a satisfactory condition of the patient does not require urgent surgery. The victim is hospitalized in a hospital for further observation.
Conservative treatment of hemorrhage consists in conducting infusion therapy. In order to restore the volume of blood lost to the patient, droppers are placed with saline solutions (isotonic sodium chloride, "Disol", "Trisol"). With massive bleeding, an infusion of substances with a higher molecular weight than saline solutions is indicated. For this, "Reopoliglukin", a blood plasma, is introduced.
Hemostatic agents are also administered: Ethamsylate, aminocaproic acid.
Specialized care: surgical treatment
In the serious condition of the patient or the absence of the effect of drug therapy, they switch to surgical treatment. An emergency laparotomy is performed. The surgeon makes an incision in the middle of the anterior wall of the abdominal cavity. He then removes the blood and conducts an audit of all organs in order to find the source of blood loss.
After the surgeon has found damage, he stops the bleeding. This can be done by ligating a ruptured vessel, applying clips, removing an affected organ, or resecting a damaged area of the intestine.
If there are symptoms of internal bleeding in the abdominal cavity after surgery, an urgent re-laparotomy is performed.
Reviews
Those who have experienced bleeding in the abdominal cavity say this is an extremely serious condition. For many, chronic bleeding was asymptomatic for a long time until general signs of anemia appeared. But these symptoms were not expressed enough, so patients did not go to the doctor for a long time. Blood loss was detected by chance when a complete blood count was given.
In others, on the contrary, bleeding occurred acutely. Extreme abdominal pain, nausea and vomiting appeared. This picture arose in victims of multiple injuries, in women with ectopic pregnancy. Patients unanimously say that only thanks to the quick arrival of the ambulance did they manage to survive.
Internal bleeding is an extremely serious condition. When the first signs of blood loss appear, you must call an ambulance as soon as possible!