Hemorrhage - a pathological hemorrhage of varying degrees of severity in those or other parts of the trunk, arising from external influences or internal pathologies of the body. Patients prone to developing hemorrhages note the spontaneous appearance of these visual signs of increased bleeding, which is not so much a cosmetic defect as it may be a symptom of a more severe pathology of blood and blood vessels. Sometimes the appearance of hemorrhage is accompanied by the release of blood into the external environment, but in most cases there is an interstitial accumulation of blood.
Causes of hemorrhage
The development of hemorrhage may be due to both traumatic effects on the unchanged vascular wall, and without the presence of a trauma, provided pathologically altered vessels. Vaginal genetic abnormalities ( hemophilia , von Willebrand syndrome ) can cause vascular wall permeability, however, pathological bleeding is most often observed among patients suffering from acquired blood and blood vessel pathology in the form of thrombocytopathy , breach of the clotting system, hemorrhagic vasculitis and DIC syndrome .
The formation of hemorrhages on the skin and in the subungual bed is promoted by various background diseases of the dermatological profile (chronic dermatoses , psoriasis ). Most dermatologists generally consider the development of subungual hemorrhage in the patient on the background of complete well-being of the first clinical signs of psoriasis debut.
For all hemorrhages of different localization, the relationship of their occurrence is characteristic in the presence of predisposing factors, which include depression and psycho-emotional tension, long-term use of drugs of the hormonal profile group, as well as traumatic effects.
Symptoms of hemorrhage
Clinical manifestations, their intensity and specificity directly depend on the localization of hemorrhages. So, the most common clinical form of this pathology is the subcutaneous hemorrhages that arise as a result of medical manipulations, in particular intramuscular and subcutaneous injections. Intravenous administration of the drug can also be accompanied by the development of hemorrhages due to the available through damage to the venous vessel, which is extremely rare. The degree of hemorrhagic manifestations in this situation directly depends on the thickness of the injection needle and the properties of the drug administered.
The duration of the course of subcutaneous hemorrhages can vary considerably, which is explained by the individual regenerative abilities of each organism. However, all subcutaneous hemorrhages that occur with intramuscular injections are characterized by a longer flow in comparison with subcutaneous, since the muscle tissue contains a larger number of vessels whose diameter exceeds the diameter of the subcutaneous vessels. In most situations, subcutaneous hemorrhages do not require the use of specific medication and are leveled off for a short time.
If some amount of red blood cells enters the skin thickness, which is the case with pathological permeability of the vascular wall of the capillaries, signs of hemorrhage on the skin form. Visually, these pathological changes are manifested in the form of intensely hyperemic spots, sometimes merging, or in the form of a single point rash. Hemorrhages localized on the skin are characterized by pathomorphological changes in the form of a change in the color of the hemorrhage from intensely red to brown-yellow, which is explained by hemoglobin transformations.
As a rule, the presence of hemorrhages on the skin does not require the use of medical measures and they disappear for a short period of time independently. A variety of hemorrhages of the skin are subungual hemorrhages, which have the appearance of spot spots or linear sections of different color and shape, localized under the nail bed. In addition to the presence of hemorrhages, the nail plate itself changes, which becomes dull yellow, uneven and has a higher fragility. Very often subungual hemorrhages are accompanied by a fungal lesion, which requires immediate medical treatment.
In a situation where the patient has signs of inflammatory changes in the gastric mucosa, which is observed with a gastritis of an erosive type, hemorrhages of the stomach develop. When the organs of the gastrointestinal tract are affected, so-called submucosal hemorrhages develop, which for a long time can be absolutely asymptomatic. The first symptoms that indicate the development of hemorrhages of the stomach are unmotivated weakness, dizziness , nausea, which has no connection with food intake. In the stage of unfolded clinical symptoms, frequent episodes of emesis are observed in the patient, and vomit has a characteristic dark color, which is a pathognomonic symptom of gastrointestinal bleeding. This pathological condition requires the attentive attitude of the attending physician and is the basis for hospitalization of the patient for the purpose of using specific medication.
Internal hemorrhages also include haemorrhages in liver cirrhosis, which are observed when the blood flow is highly expressed. The most pathognomonic sign of hemorrhage in cirrhosis is esophageal bleeding, which can have varying degrees of intensity. In the following, the patient, in addition to vomiting, has a stool with an admixture of blood of a dark color.
Hemorrhages on the face are most often localized in the projection of the eyeballs and in the paraorbital region, and are small spots of dark or bright red color, depending on the duration of their course. Hemorrhages point in the belly of the eye are not accompanied by the development of pain syndrome or visual disturbances, however some patients note the appearance of the sensation of flies flashing before the eyes and bifurcation of objects. In a situation where the patient observes the appearance of signs of expulsive hemorrhage, as complications of surgical intervention on the organs of vision or traumatic effects on the paraorbital region, it is necessary to hospitalize him in an emergency hospital for an ophthalmological profile. Signs indicating the development of this complication are a strong throbbing headache , nausea and the urge to vomit, dizziness, a feeling of "bursting" in the eyeball.
The most severe clinical form of hemorrhages is subarachnoid, in which there is an accumulation of a large volume of fresh blood in the subarachnoid space. This pathological condition refers to the category of acute emergency conditions and is accompanied by the development of severe clinical symptoms in the form of an intense pain syndrome in the head of a pulsating nature, varying degrees of impairment of consciousness from short-term fainting to deep coma, the appearance of positive meningeal signs. It is impossible to establish subarachnoid hemorrhage visually, however such special methods as computed tomography and cerebrospinal fluid analysis allow the diagnosis to be correctly verified in a short time.
Treatment of hemorrhage
When establishing the diagnosis and determining the tactics of managing a patient who has signs of hemorrhage, it should be borne in mind that some forms of this pathological condition tend to develop complications, so that all patients of this profile need dynamic observation. Complications of hemorrhage is an inflammatory transformation of hemorrhage, as well as the development of posthemorrhagic anemic syndrome, which in severe cases can lead to the development of lethal outcome.
The expediency of using medicamentous measures is established, taking into account the severity of the patient's condition, the clinical form of hemorrhage, its intensity and the ability to provoke complications. For example, with intradermal and subcutaneous non-extensive hemorrhages, one can not use therapeutic measures at all, and with large hemorrhages, it is sufficient to use local treatment (application of Heparin or Troxsevazine ointment twice a day to the affected area).
When hemorrhages in the eyeball, ophthalmologists, as a rule, use combined treatment (local in the form of eye drops "Emoksipin" 1 drop twice a day, and medicamental). In a situation where drug treatment is ineffective, ophthalmologists recommend surgical removal of the blood clot by the vitrectomy method.
Hemorrhages in the stomach, found during endoscopic examination, need treatment only for the main background disease (erosive gastritis), but at the first sign of gastrointestinal bleeding even low intensity hospitalization of the patient in a surgical hospital is indicated. The basic stage of treatment in this situation is substitution therapy with intravenous infusion of freshly frozen plasma and parenteral administration of Vikasol in a daily dose of 30 mg.
? Hemorrhagia - which doctor will help ? If there is or suspected development of hemorrhage, you should immediately seek advice from such doctors as a hematologist or dermatologist.