Bleeding in the abdomen symptoms. Abdominal bleeding symptoms

Opening internal bleeding is a health and life-threatening condition that occurs due to various reasons. Most often, blood penetrates into the cavities of the body, as well as the spaces formed by it.

Internal bleeding - what is it?

This is a rapid loss of blood, in which it does not flow out of the body, but ends up in certain places inside. This could be the uterus in women, the space between the joints, the stomach, bladder, lungs, intestines.

Symptoms of this state depends on its location. Hemorrhage can occur in the abdominal cavity, intermuscular, etc.

The causes of pathology are, as a rule, of two types: mechanical damage (trauma, shock) and chronic illness.

The danger of this phenomenon is increased by untimely provision of first aid, ignoring signs by patients, and late diagnosis.

If you seek medical help in time, you can minimize serious complications, determine the location of the bleeding and stop it.

Symptoms of pathology

Intra-abdominal bleeding is one of the most common in mechanical injuries. The symptoms of this form are quite serious.

The patient is very nauseous and opens bloody vomiting, if the pathology is in the gastrointestinal tract cavity. Diarrhea occurs when there is internal bleeding in the upper esophagus or small intestine. If there is a lesion in the large intestine, red discharge will come from the anus.

Gastrointestinal bleeding is one of the most dangerous. Symptoms include fever, and the patient may feel abdominal pain. If, then the person is tormented by a strong bloody cough, and the place of accumulation of secretions is the pleural cavity. Shortness of breath appears, there is not enough air.

With uterine bleeding, blood flows in the middle of the cycle and pours out of the vagina. However, many symptoms in a number of species are not clearly expressed, which makes it difficult diagnostic measures and leads to a deterioration in the patient's condition.

So, the symptoms of bleeding that occurred inside the body:

1. Deterioration in health.
2. Sudden weakness, lethargy, apathy.
3. Chills, heat, fever, sweating, pallor.
4. Acute feeling of fear.
5. Nausea, vomiting.
6. Thirst.
7. Loss of self-control.
8. Dizziness, fainting.
9. Severe cough with blood.
10. Dyspnea.
11. Sudden pain inside or its complete absence.

If no one is nearby, you need to call the ambulance service, then take a horizontal position. If possible, you should also call your loved ones if they are nearby. In this case, being alone is not only scary, but also dangerous..

You cannot take any pills or drink water. You need to apply ice to your head, chest, and stomach. It is important to try not to panic or make sudden movements.

Common signs of bleeding

The main signs for all forms of bleeding that occur inside the body: weakness in the body, lethargy, blood pressure (BP) decreases significantly, the skin turns pale, and cold sweat appears.

Suspicion of such a condition should arise if there were provoking factors (impacts with blunt, piercing objects; injuries), diseases were diagnosed internal organs.

The patient may lose appetite, feel very thirsty, and even lose consciousness. How serious a person’s condition is can be recognized by certain signs.

If the bleeding is minor, then the pulse is intense - up to 80 beats per minute, and blood pressure decreases, other symptoms may be absent.

If the bleeding is moderate, the upper pressure drops to 90 mm. Hg Art. and below, the heart rate increases. In this case, the skin turns pale, hands and feet become cold, breathing quickens, nausea, weakness, dizziness appear, and all psychomotor reactions slow down.

In severe cases, the patient’s blood pressure drops significantly, the pulse is rapid, breathing is intermittent, cold sweat appears, drowsiness appears, trembling of the arms and legs, the eyes darken, vomiting begins, the skin turns pale, cyanosis develops, and the person’s condition is critical.

If the blood loss is massive, then the pressure drops sharply, the pulse is very fast - up to 160 beats per minute, the patient’s consciousness is confused, pale skin, delirium, cold sweat are observed, facial features become sharpened.

Fatal blood loss: slow pulse, low blood pressure, respiratory arrest, convulsions, dilated pupils, dry and pale skin, agony and death.

Kinds

There are several types of bleeding: arterial, capillary, venous. The cause of arterial disease is damage to the artery by a sharp, cutting object, a gunshot wound; trauma resulting from blunt impact.

It is very difficult to stop bleeding on your own. Blood flows like a fountain inside and outside the organs; the victim can lose a critical volume of blood in a few minutes, which will lead to death.

Capillary - common. In this case, the surface of internal organs may bleed, these include the liver, kidneys, and spleen.

Symptoms are mild at the very beginning, which complicates the diagnostic process. A stomach ulcer can cause it, and hemorrhage also occurs in the brain tissue. In this case, it is necessary to urgently provide assistance to the patient.

Venous is formed if the walls of the veins are damaged. The patient instantly develops symptoms of anemia, anemia, and a state of shock occurs. At venous bleeding Dangerous conditions may occur in which the escaping fluid accumulates in the pleural and retroperitoneal cavities.

Causes

Why does such a pathology occur? The factors of its formation can be different, at first glance, even impossible. Among them:

• poor blood clotting (heredity);
• rib fractures, mechanical injuries, wounds;
• infections, pathologies, cirrhosis of the liver, ulcers, tuberculosis, incorrect location of internal organs, their displacement, enlargement due to illness;
• during pregnancy - ovarian rupture, cysts, ectopic location of the ovum;
• disintegration of a malignant tumor;
• arterial hypertension, atherosclerosis.

There may be many more reasons, so it is important to respond to them in a timely manner. sudden changes in your state of health, especially if there were provoking factors, and also diagnosed chronic diseases intestines, stomach and other vital organs.

Methods for determining the location of internal damage

If a person feels bad, how to find objective sign internal bleeding and recognize its source?

If hemorrhage occurs in the abdominal cavity, followed by a rupture of the spleen or liver, then general symptoms include dizziness, weakness, low blood pressure and tachycardia. The patient experiences heaviness in the abdomen, pain in the left and right shoulder, and upon palpation of the peritoneum there is pain in the upper part.

It is difficult, but possible, to independently determine bleeding and its nature..

If there is a rupture of the tubes or ovaries, then there is pain in the lower abdomen, in the anus, deterioration in health, and there is red discharge from the genitals.

When bleeding occurs in the retroperitoneal space (ruptures of the kidneys, aorta), the patient experiences general symptoms, which are not very pronounced.

There is pain in lumbar region, if you lightly tap on the spine, it will intensify.

If the lesion is in the stomach or intestines, then bloody vomiting or diarrhea and no abdominal pain are observed.

How to stop bleeding

If there is a suspicion of internal hemorrhage, then the first health care will play at home important role for the outcome of the situation. Before the doctors arrive, the patient should be laid down so that the muscles relax. If the victim has a cough, then his body is given a semi-sitting position.

Be sure to open a window in the room and apply cold to the suspected area of ​​damage.

It is important to control a person’s breathing and pulse. If he gets worse, artificial respiration needs to be done and carried out.

Do not give painkillers, water, medicine, stretch the body, tightly bandage the injury site, or move the victim.

Drug therapy

The best treatment for internal hemorrhages is timely help and surgery. Therapy for this pathology is carried out in a hospital setting, in the departments of gynecology, surgery, neurosurgery - depending on the source of blood loss.

Doctors first stop the blood, replace its loss, and improve circulation. Physical solutions and glucose are used; other medications are prescribed in accordance with the patient’s condition.

In what cases is surgery required?

Surgery is necessary if the patient's condition is critical. After the person has been given first aid, he is hospitalized. Specialists take into account the source of bleeding, and then take measures.

If the place of concentration of fluid is the pleural cavity, then the treatment is carried out by traumatologists, if the lungs are treated - by surgeons, in case of intracranial damage - by neurosurgeons, in case of uterine damage - by gynecologists.

Surgery will be required if the source is in the gastrointestinal tract.

The main task of the doctor is to stop the bleeding, compensate for the amount of loss and improve blood supply. Patients often experience shock, in which internal organs do not receive enough oxygen.

In such cases, patients are given a transfusion, glucose and saline are administered. If the case is severe, the bleeding is stopped by cauterization, but most often surgery is required.

In case of pulmonary hemorrhage, bronchial tamponade is performed. If the abdominal part is filled with blood, then an urgent laparotomy is performed. If the damage is intracranial, then trepanation is performed. In case of an ulcer, damaged vessels are removed; in case of cracks in the intestines, surgery is performed and they are sutured.

If a woman has an ectopic pregnancy (a tube ruptures), the pathology can only be eliminated surgically.

Internal bleeding during pregnancy

This condition is also called premature placental abruption, and it requires urgent intervention from a specialist.

Clinical manifestations of this condition:

• discharge can be abundant, average, or absent altogether;
• pain in the lower abdomen, the uterus “turns to stone,” which is easy to feel upon palpation;
• the cardiac activity of the fetus is disrupted, hypoxia occurs (determined by ultrasound);
• The woman's body temperature rises.
• health worsens.

Abruption is provoked by maternal alcohol consumption, drug addiction, smoking, anemia, low red blood cell count, abdominal trauma, allergies to medications, and fluctuations in blood pressure.

Consequences

Any bleeding poses a threat to a person, and internal bleeding even more so. In this condition, blood pressure suddenly drops and hemoglobin decreases.

If blood gets into the cavities of internal organs, their activity is disrupted. If the vessels are compressed, tissue necrosis occurs. Blood that remains in the cavities of organs for some time (not circulating) becomes a suitable place for bacteria to multiply and develop infections.

If the patient is not provided timely assistance, there is a high probability of death. The body is bleeding, the activity of the heart and brain is disrupted. If a person manages to get help, then a long recovery period awaits him, and everything depends on the severity of the condition.

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

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

Internal bleeding is called because the spilled 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 physiological openings - mouth, anus, vagina - it is advisable to classify them as internal.

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

Uterine bleeding is eliminated by a gynecologist, intestinal bleeding by a proctologist, pulmonary bleeding by a thoracic surgeon, post-traumatic bleeding by a traumatologist, and intracranial bleeding by a neurosurgeon.

Late provision of medical care when a person contacts doctors late or has 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 layers of the pleura, i.e. in the slit-like space between the special membranes surrounding each lung

Hemarthrosis – in the joint

Abdominal - into the cavity of the peritoneum, pleura

Explicit – easily determined by visual inspection

Arrosive - when the vascular wall is damaged due to the germination or disintegration of a neoplasm, a destructive or necrotic process (with tissue death)

Diapedetic - with blood leaking through the vascular wall during scurvy, scarlet fever, malaria

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

Massive – up to 2.5 l

Lethal - from 2.5 to 3 l

Absolutely lethal - over 3–3.5 l

Venous – when the vein wall ruptures

Arterial - from an artery

Mixed - from different vessels

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

Secondary – some time 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.

1. Open and closed injuries of the abdomen and lumbar region with damage or rupture of internal organs, most often the spleen or liver, less often the intestines and pancreas. Massive is caused by a blow during a fight or during a car accident, compression compression - when pressed with a heavy object, etc.
2. A rib fracture leads to bleeding into the pleural cavity.
3. Traumatic brain injury. Bleeding inside the skull is life-threatening because the volume of the skull is limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after an injury, but also several hours or days after it.
4. 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 in an ulcer of the duodenum or stomach.
5. Gynecological diseases and pathological conditions - apoplexy (rupture) of the ovary, ectopic pregnancy, malignant neoplasm, rupture of an ovarian cyst. In obstetrics and gynecology, uterine bleeding can provoke abortion, previa or premature placental abruption. It may begin after childbirth due to rupture birth canal or uterus, late delivery of the placenta.
6. Ruptured aortic aneurysm.
7. Hemophilia – hereditary disease men with a malfunction of the blood clotting process.

Symptoms

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

General symptoms of blood loss

Common signs of internal bleeding are weakness, darkening or clouding of the eyes, drowsiness, dizziness, cold sweat, and thirst. Loss of consciousness is possible. The intensity of blood loss is determined by pulse rate, blood pressure and characteristic complaints of the patient.

• Minor blood loss often does not manifest itself in any way, but for some, the pulse increases slightly and blood pressure (BP) decreases slightly.
• Manifestations of bleeding moderate severity: 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 sweat, dizziness, severe weakness, slow reactions, fainting.
• With severe blood loss, symptoms are more pronounced. A drop in blood pressure of more than 80 mmHg is noted. Art., tachycardia more than 110 beats per minute, shortness of breath, hand tremors, excruciating thirst against the background of a decrease in the volume of urine excreted, apathy. There may also be a sharp pallor of the mucous membranes and skin, cyanosis of the limbs and area around the lips, clouding or loss of consciousness.
• Clinical manifestations of massive hemorrhage include cyanosis of the skin and mucous membranes, confusion, and delirium. They fall inside eyeballs, facial features become sharper, pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
• With fatal and absolutely fatal blood loss, we are 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 released. The patient falls into a coma, his skin is dry, pale with a marbled pattern. The result is agony, death.

Signs of hemothorax

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

Signs of uterine bleeding

Symptoms of internal bleeding in women can be pulling, bursting or sharp pain in the lower abdomen radiating 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

• Tar-colored chair foul odor– melena – indicates bleeding from the upper intestine or other digestive organs.
• When there is a hemorrhage in the stomach, a person begins to vomit with bloody clots; into the lumen of the duodenum, it becomes the color of coffee grounds.
• Bleeding from hemorrhoids appears bright bloody discharge from the anus.
• Blood that gets into the renal area, urinary tract, comes out with urine - hematuria.

For any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss a person can go to a medical facility and get help, 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.

From the correctness of rendering first aid often a person's life depends. Before the doctors arrive, the patient must be laid down; further actions must be carried out only after he has assumed a horizontal position, and in case of hemothorax, a semi-sitting position. Apply ice to the area of ​​the suspected source of the problem, focusing on the complaints. Then, as quickly 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 suppositories, use laxatives, do an enema (for intestinal bleeding), offer painkillers and medications that stimulate the heart.

Neglecting the above steps can lead to increased blood loss and death.

Inpatient medical care

Based on the symptoms and initial medical examination, they presumably find out which organ was damaged, and the patient is hospitalized in the appropriate department. If there are objective symptoms of large blood loss, go to intensive care.

Main goals of treatment:

1. Stopping bleeding.
2. Restoring the lost volume of blood constantly circulating in the body (BCV).
3. Normalization of microcirculation.

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

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

To replenish the bcc, intravenous drips are 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 abdominal cavity symptoms

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

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

Internal bleeding can be caused by:

• non-penetrating trauma due to impact,
• internal injury from a foreign object that ends up in the organ cavity when swallowed or a ligature that comes off a vessel (during surgical interventions),
• damage to blood vessels and organs as a result of closed bone fractures,
• cracks in the walls of the stomach or intestines caused by ulcers, tumors or simply excessive food consumption,
• aneurysms of cerebral, abdominal and pulmonary aortas,
• ectopic pregnancy disorder
• and many more factors that a person may not even be aware of

Characteristics and signs of internal bleeding

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

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

Special signs of gastrointestinal bleeding:

• Vomiting with blood clots or coffee grounds color
• Bloody or tar-colored stool

Special signs of bleeding into the abdominal cavity:

Special signs of pulmonary hemorrhage:

• Cough with blood-streaked sputum
• Cough accompanied by mouth full blood

Special signs of internal bleeding if the kidneys or bladder are damaged:

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 connected directly to the parenchyma, they do not collapse, which makes it difficult to stop bleeding. And it is in such cases that large blood losses are possible.

Special signs of cerebral hemorrhages:

• Headache attack
• Dizziness
• Loss of consciousness
• Nausea
• Vomit
• Speech Impairment
• Movement synchronization disorders
• Convulsions

First aid for suspected internal bleeding:

• Call a car emergency assistance for transportation to the nearest surgical department (it is important to gain time).
• If bleeding is suspected in the area of ​​the upper body (pulmonary, gastric, intracranial, etc.), place the victim in a “half-sitting” position with bent knees.
• If bleeding in the abdominal cavity is suspected, place the victim in a “lying down” position and apply a cold compress or a heating pad with ice to the abdominal area.
• If internal bleeding is suspected, the victim is strictly prohibited from drinking, eating, taking analgesics or other medications until special instructions doctor

Bleeding into the abdominal cavity

Bleeding into the abdominal cavity is the leakage 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. When 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 in the abdominal cavity is played by examination of the patient, dynamics of hemoglobin and hematocrit levels, laparocentesis and laparoscopy. Treatment of bleeding into the abdominal cavity is surgical - laparotomy with revision of internal organs; Antishock, hemostatic and transfusion therapy are carried out in parallel.

Bleeding into the abdominal cavity

Bleeding into the abdominal cavity (intra-abdominal bleeding, hemoperitoneum) in gastroenterology can be a symptom of a disease or damage to internal organs and tissues. The danger of bleeding into the abdominal cavity, like any internal bleeding, is its hidden nature, which can pose a threat to the patient’s life. As a result of bleeding into the abdominal cavity, hemoperitoneum occurs - 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

Bleeding into the abdominal cavity is based on traumatic and non-traumatic causes. Bleeding into the abdominal cavity can be caused by mechanical trauma to the chest and abdominal trauma: closed - due to 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 occurs, genitourinary system, as well as blood vessels located in the folds of the peritoneum, the thickness of the mesentery and the greater omentum. Bleeding into the abdominal cavity in the postoperative period is usually associated with the slipping (cutting) of a ligature applied to the vessels of the mesentery or organ stumps.

Bleeding into the abdominal cavity of non-traumatic origin develops spontaneously with the complicated course of certain diseases and pathological processes of internal organs. Bleeding can be observed with tumors of the abdominal organs; conditions leading to decreased blood clotting; ectopic pregnancy; rupture of an aneurysm of the abdominal aorta, rupture of the spleen due to 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 abdominal pain, aggravated by movement. A patient with bleeding into the abdominal cavity tries to take a sitting position to relieve abdominal pain (the “stand up” symptom).

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

Diagnosis of bleeding into the abdominal cavity

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

Superficial 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 severe 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, dullness of sound is noted in sloping areas. Auscultation of the abdomen reveals a decrease in bowel sounds. When a hollow organ ruptures, local manifestations of bleeding into the abdominal cavity may be masked by signs of incipient peritonitis.

Digital rectal and vaginal examinations reveal bulging and severe pain in the anterior wall of the rectum and posterior vaginal fornix. If a disturbed tubal pregnancy is suspected, puncture of the abdominal cavity through the wall of the posterior vaginal fornix is ​​of great diagnostic importance. Laboratory blood tests for bleeding into the abdominal cavity show an increasing decrease in hemoglobin levels, red blood cell counts, and hematocrit.

In case of internal bleeding, plain radiography helps 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 in the abdominal cavity are endoscopic examinations - laparocentesis (puncture of the abdominal cavity with the connection of a groping catheter) and diagnostic laparoscopy.

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

Treatment of bleeding into the abdominal cavity

A patient with suspected bleeding into the abdominal cavity is immediately hospitalized in compliance with the general rules: position - lying on his back, cold on the stomach, exclusion of water and food intake. In the surgical hospital, careful dynamic monitoring of pulse rate and blood pressure, hemoglobin and hematocrit levels is carried out. Before establishing accurate diagnosis The use of painkillers (narcotics) 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 recently leaked blood into the abdominal cavity), administration of analeptic drugs. This helps to increase and replenish blood volume, improve the rheological properties of blood and microcirculation.

If the fact of bleeding in the abdominal cavity is established, emergency surgical intervention (laparotomy) is indicated, including inspection of the abdominal organs to detect the source of bleeding and stop it, eliminating existing damage.

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

How to spot internal bleeding

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

Types of internal bleeding and their manifestations

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 fists;
• chronic diseases that lead to thinning of the walls of blood vessels and their rupture. In this case, blood fills either a natural cavity (stomach, uterus in women, lungs) or a cavity created by it.

No matter how much blood is poured out, the body strives to push it out. It comes out along with feces, stomach contents, from the internal genital organs in women, and is expectorated with sputum from the bronchi and lungs. However, you should not think that the bleeding will stop on its own; the wound will heal on its own. 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, you can recognize the problem by vomiting mixed with bloody clots of a dark, almost black color. Another characteristic sign of internal bleeding into the digestive organs is stool that resembles tar in color and consistency. It can appear 1–2 or even 9–10 hours after the onset of blood loss.

Cranial

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

• high blood pressure;
• diabetes;
• brain tumors;
• vascular aneurysm;
• encephalitis.

Small pelvis

We are talking about uterine bleeding. It can occur in women for various reasons. Changes in hormonal levels, tumors, ectopic pregnancy, miscarriage, placental abruption during pregnancy, rupture of the uterus or ovaries - all these factors hidden from human eyes provoke internal bleeding. They may open after or during your period. One of the signs of internal bleeding is blood coming out profusely in the form of large clots dark color. Accompanied by the process aching pain in the lower abdomen.

In the abdominal cavity

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

• ectopic pregnancy;
• tumors;
• low blood clotting.

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

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

In the respiratory system

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

• The pulse rate decreases noticeably with heart injuries and increases if the lungs are damaged;
• difficulty breathing, lack of oxygen if blood fills the pleural cavity;
• there are chest pains of varying strength;
• characterized by restless behavior, distortion of facial features;
• cough accompanied by the release of blood scarlet color with an admixture of foam.

Main signs and symptoms

Along with specific ones, experts note numerous general symptoms of 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, the person falls into a coma.

By some signs you can judge which vessels are damaged. Capillary bleeding is very weak and does not pose any particular danger to life. Parenchymal, in which all channels are involved, is very long-lasting and abundant. Arterial is characterized by the release of bright red blood, and it flows jerkily. The main signs of venous bleeding are the slow, uniform flow of dark-colored blood.

First aid for internal bleeding

It is difficult to determine the source of internal bleeding without examining a doctor. However, if the sufferer is left without help at all, the situation can significantly worsen. Some simple actions will alleviate the condition of the victim and give him a chance for a successful outcome:

• try to provide the victim with peace and maximum possible comfort;
• if, based on some signs, you can assume that internal hemorrhage has occurred in the upper part of the body, make the person recline. Otherwise, lay on your back;
• make sure that the victim moves as little as possible;
• Apply something cold (a bag of frozen food, cold water, ice cubes) to the area where you think the internal bleeding is occurring;
• You should not give the sufferer any medications, drinks other than water, or carry out any procedures. What is necessary in each specific case can only be determined by a specialist;
• do everything so that the doctor arrives as soon as possible.

By watching the video below, you will learn how to properly assist a person suffering from internal bleeding on the street. A professional doctor tells how to competently, armed with the familiar items at hand, relieve a patient’s suffering before the emergency doctor appears. You will learn about the first symptoms of internal bleeding, which will give you a signal to act, because in no case should such a problem be left to chance.

Internal bleeding: symptoms, diagnosis

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

Bleeding - what is it?

Bleeding refers to any situation where blood escapes from the blood vessels. There are external and internal bleeding. External ones are considered to be those in which blood flows into 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, and heart lining.

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

Capillary bleeding is characterized by saturation. Blood is released rather slowly in the form of droplets that resemble dew. Capillaries are the most small vessels person. This bleeding can be stopped by tightly bandaging the wound. If there are no problems with the coagulation system, then medical attention is not needed in this case.

During venous bleeding, dark, streaming blood is released from the wound surface. Serious blood loss 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 and quickly flows out of the wound. It is necessary to apply a tourniquet above the damaged area. Apply a tight bandage to the wound. The tourniquet can be kept for no more than an hour.

Parenchymal bleeding can occur with injuries to the cancellous bone, cavernous tissue and parenchymal organs. Such bleeding is very life-threatening; the victim must be taken to the hospital as quickly as possible. You cannot stop this type of bleeding on your own; it can be profuse.

In case of mixed bleeding, blood may flow from various vessels, and also combined with parenchymal ones. Most often, such blood loss occurs due to injuries to 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 human health and even life. The severity of the victim’s condition with this pathology directly depends on how large the vessel is damaged, that is, on its diameter. The larger the affected vessel, the more dangerous the bleeding, and the greater the blood loss may be.

There are the following types of internal bleeding:

• into the abdominal cavity, when internal organs rupture - 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 is wrong inside the body.

Causes of internal bleeding

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

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

Intestinal bleeding

Intestinal bleeding may occur when various diseases intestines (both large and small). Most often it is caused by a duodenal ulcer. Bleeding can also be caused by tumor rupture and simple trauma. The patient may feel dizzy, spots flashing before the eyes, and sticky cold sweat. If bleeding in upper sections intestines, vomiting may occur coffee grounds, the stool will be black or dark cherry colored. 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 bleeding of internal organs

If a person suddenly turns pale, clammy sweat appears, blood pressure drops sharply, pulse increases, internal bleeding can be suspected. The symptoms of this pathology will leave no doubt if you are careful. Drowsiness and indifference to the outside world may also occur literally five minutes after the person has been sociable and active.

Bleeding in the stomach

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

What to do if bleeding of internal organs occurs?

If a person experiences a deterioration in health, indicating that he has internal bleeding, the symptoms of which are basically similar to each other, you should immediately call an ambulance. Before paramedics arrive or if the patient has to be transported independently, you must first of all place him on his back. Apply cold to the suspected area of ​​bleeding. You should not try to stop internal bleeding on your own; treatment should only be carried out by a doctor.

Methods for stopping internal bleeding in 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 condition is life-threatening. After completing a medical history, specialists collect a small amount feces and emetics to send them for analysis. This test is done to check for the presence of blood in them.

After diagnosing the disease, doctors provide assistance with internal bleeding - diagnostic procedures, for example, endoscopy, x-rays, rectomanosigmoidoscopy, colonoscopy and some others. All these measures are carried out in order to determine where exactly the source of bleeding is located. In some cases, a therapeutic and diagnostic injection of a sclerosing agent is used, and electrocoagulation can be used. Also effective method is laser radiation.

But the most effective is radical method– surgical. This procedure is especially often used 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.

All therapeutic measures are aimed at achieving several goals during bleeding.

1. The use of drugs that reduce the activity of gastric secretion.
2. The bleeding is stopped as quickly as possible.
3. Additionally, blood is injected if the loss is large.
4. There is a fight against DIC syndrome.
5. It is also important to bring a person out of a state of shock; the fight against collapse is carried out.

Who is susceptible to such bleeding?

There is a certain risk group - people who have more likely Internal bleeding may occur. We have already discussed the symptoms of this condition. These are patients who have pathologies such as:

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

But these diseases are not necessarily accompanied by bleeding. You should not panic; you must remember that the bleeding 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 diseases that are at risk, you need to remember all medical prescriptions. For example, about strict adherence to a diet, correct mode eating, necessary organization healthy image life. It is important to monitor your health and contact specialists in a timely manner.

Intra-abdominal bleeding

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

Intra-abdominal bleeding is a deadly condition. But if you know its main symptoms and take timely measures, complications can be avoided.

Causes

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

• chest injuries (for example, fractures of the lower ribs can cause damage to internal organs from bone fragments);
• blunt abdominal injuries caused by compression, falls, or strong blows;
• gunshot or knife penetrating wounds to the abdominal area;
• damage after certain operations (gastric or liver resection, nephrectomy, appendectomy, cholecystectomy) associated with complications, slipping of ligatures used for ligating blood vessels, or surgical errors.

Non-traumatic causes mainly include complications of diseases of internal organs:

• rupture of aortic aneurysm;
• severe damage or rupture of the fallopian tube during 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 hemorrhagic diathesis, obstructive jaundice, malaria).

Symptoms

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

Possible following signs hemoperitoneum:

• 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 of the eyes;
• fainting or shock;
• pain in the area of ​​the damaged organ (such pains are called abdominal, they are pronounced, 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 about symptoms and first aid, watch 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. By palpation, the doctor will determine the possible nature and location of the damage. But to clarify the diagnosis, diagnostic procedures will be required. The most complete picture is revealed by:

• ultrasonography,
• radiography,
• as well as 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. Moving before doctors arrive is contraindicated. Cold may be applied to the abdominal cavity. Ingestion of liquids or food is strictly contraindicated.

Measures should be taken immediately and intensive care should be started. It includes resuscitation, antihemorrhagic and antishock measures:

• infusion of blood substitute solutions,
• administration of analeptics (these drugs have a stimulating effect on the vasomotor and respiratory centers of the brain),
• reinfusion (collection of blood spilled 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 covering the internal organs and lining the abdominal cavity.

Prevention

To reduce the risk of developing intra-abdominal bleeding, you should undergo routine 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

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 (a number of chronic diseases can be responsible for its occurrence), 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 indicating the presence of intra-abdominal bleeding.

Causes

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

The first of them includes traumatic factors, represented by:

• Mechanical damage to the chest. Considering the diverse nature of the injuries received (in addition to fractures of the bones that make up the frame 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 large group 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 parenchymal or hollow organs of the gastrointestinal tract, genitourinary system and the mass of blood vessels passing inside greater omentum, mesentery and peritoneal folds.
• Damage resulting from performing certain 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 is usually caused by slipping or cutting through the threads (ligatures) used to ligate the mesenteric vessels or suture the resected organ.

Intra-abdominal bleeding can occur as a result of:

• oncological lesions of the gastrointestinal tract and pelvis;
• rupture of an abdominal aortic aneurysm;
• varicose veins of the stomach and esophageal tube;
• ovarian apoplexy (spontaneous, rapidly progressing hemorrhage in the tissue of this organ with subsequent leakage of blood into the abdominal cavity);
• cyst rupture;
• significant damage or complete break fallopian tube during ectopic pregnancy;
• superficial ruptures of the mucous membranes of the abdominal esophageal tube and the cardiac part of the stomach (the so-called Mallory-Weiss syndrome);
• complications of diseases (malaria, hemorrhagic diathesis, obstructive jaundice) that provoke a significant deterioration in blood clotting;
• pathological growth 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 abdominal cavity

Clinical symptoms of 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:

• Light (up to 10% of the total volume of circulating blood). The victim loses from 500 to 700 ml.
• Moderate (up to 20% of bcc). The volume of blood loss varies within ml.
• Heavy (up to 30% bcc). The victim’s body 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 include:

• pallor of the mucous membranes and skin;
• cold sweat;
• dizziness;
• severe headaches;
• feeling of fullness 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 (decreased volume of urine produced by kidney structures);
• the appearance of local or mixed abdominal pain, which tends to intensify with movement;
• the occurrence of presyncope or state of shock;
• the “vanka-stand up” symptom, which consists of the patient’s attempts to take a sitting position, which helps to slightly reduce the intensity of abdominal pain.

If 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 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 in the functioning of the heart muscle, a progressive drop in blood pressure is observed. If medical assistance was not provided on time, the injured person experiences hemorrhagic shock.
• A significant volume of spilled blood 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 cannot be ruled out.
• 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 layers of the peritoneum (the membrane lining the abdominal cavity and covering the internal organs).

Diagnostics

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

• The first diagnostic procedure is visual inspection abdomen, aimed at identifying possible traumatic injuries (represented by bruises, abrasions, open wounds).
• Further examination of the abdomen is carried out using palpation (superficial and deep), percussion and auscultation. During superficial 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 irritation of the peritoneum. Due to the tenderness of the abdominal wall or the area in which the affected organ is located, deep palpation should be carried out with extreme caution. When performing percussion of the abdomen, the doctor will note the presence of severe pain (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 decreased level of bowel sounds.
• During a vaginal and digital rectal examination of a patient with suspected intra-abdominal bleeding, it turns out that the posterior vaginal vault and the anterior wall of the rectum are bulging and acutely painful. If the doctor suspects that there is a disorder tubal pregnancy, he will perform a puncture of the abdominal cavity, penetrating into it through the vaginal wall.
• 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 level and hematocrit value (the volume of red blood cells in the blood).
• Using plain radiography (this diagnostic technique is non-contrast), the specialist is convinced of the presence of blood accumulated in the abdominal cavity.
• Using ultrasound examination of the abdominal and pelvic organs, it is possible to localize the source of bleeding and the location of accumulation of anechoic (non-sound-reflecting) fluid.
• The most complete and reliable information about intra-abdominal bleeding is provided by the procedure diagnostic laparoscopy. In order to view the abdominal cavity, several small punctures are made in the anterior wall of the abdomen, through which special device– 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 ability to carry out all diagnostic actions without opening the abdominal cavity (transsection).
• Another endoscopic technique that makes it possible to detect intra-abdominal bleeding is laparocentesis, a therapeutic and diagnostic procedure that involves puncturing the anterior abdominal wall followed by inserting a penetrating 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 in 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 remove any pathological contents from the abdominal cavity, the result of the procedure is considered negative, and the puncture performed 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, when diagnosing intra-abdominal bleeding, the help of specialized specialists is necessary: ​​hematologists, gynecologists, coloproctologists, traumatologists, thoracic surgeons.

First aid for bleeding into the abdominal cavity

If there is a suspicion of intra-abdominal bleeding, the patient should be immediately hospitalized. The intake of water and food is excluded.

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

In conditions surgical hospital carry out dynamic monitoring of blood pressure, heart rate, hematocrit value and hemoglobin level.

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

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

• in dynamic monitoring of the patient;
• in intravenous administration saline solutions(represented by saline solution, Refortan, Ringer's solution, rheosorbilact);
• in the infusion 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 of collecting blood recently poured into the retroperitoneal space or abdominal cavity and re-infusing it into the patient’s body);
• administration 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 requiring cutting of the abdominal wall), during which the surgeon performs an inspection of the internal organs in order to find the source of bleeding, stop it and simultaneously eliminate the identified damage.

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:

• Complete routine medical examinations in a timely manner.
• Immediately treat any diseases of the internal organs.
• Seek qualified medical attention if you are injured, as a thorough examination may reveal internal bleeding. The sooner therapy begins, the lower the likelihood of developing severe complications.

Intra-abdominal bleeding

may be a consequence of abdominal injuries, 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) is damaged, ovarian apoplexy, disrupted ectopic pregnancy, rupture of an aortic aneurysm, etc. V. k. can also develop after operations on the abdominal organs due to a decrease in blood clotting (for example, with obstructive jaundice), slipping or cutting through ligatures applied to the vessels of organs, especially parenchymal ones. As a result of V. c., an accumulation of blood occurs in the abdominal cavity ().

The clinical picture of V. to. depends mainly on the intensity and duration of bleeding, the volume of blood loss (Blood loss) . With profuse VK, a picture of acute hemorrhagic shock develops - fainting or motor, pallor of the skin and visible mucous membranes, cold, adynamia, dizziness, darkening of the eyes (up to 120-140 beat. in 1 min) and arterial.

When examining the abdomen of a patient with V., they look for signs of injury, hematoma, or abrasion. The anterior part is soft on superficial palpation, moderately painful, and has limited participation in breathing. . In the sloping parts of the abdomen, percussion sound may be dull, painful, bowel sounds are weakened or cannot be heard. During digital examination of the rectum, overhang of its anterior wall can be determined; during vaginal examination - flattening of the vaults, their soreness, overhang of the posterior vault. Due to irritation of the diaphragmatic peritoneum by the gushing blood, it occurs in the area of ​​the shoulder girdle and scapula, tends to assume a sitting position, which reduces abdominal pain (symptom of vanka-stand-up). A blood test reveals a decrease in hematocrit. A decrease in hemoglobin and the number of red blood cells is usually detected several hours after the start of bleeding.

If V. is suspected, the patient should be urgently hospitalized. When the clinical manifestations of V. are erased, the posterior vaginal vault (see Gynecological examination) and the introduction of a groping catheter are of great diagnostic importance, which allows detection in the abdominal cavity. A study of the hemoglobin level of this blood makes it possible to judge the intensity and duration of V. to. Laparoscopy plays a leading role in the diagnosis of V. to. . X-ray examination with V. to. allows only to establish the presence of free fluid in the abdominal cavity.

Differential is carried out with a retroperitoneal hematoma, hematoma of the anterior wall, with a perforated ulcer of the stomach and duodenum. X-ray examination of a retroperitoneal hematoma reveals 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 a retroperitoneal hematoma and with a hematoma of the anterior abdominal wall, as a rule, there is no free fluid in the abdominal cavity. Careful dynamic observation is necessary, measuring pulse rate and value every 1-2 hours, determining the amount of hemoglobin and hematocrit value. Until a diagnosis is made, painkillers and narcotics are contraindicated. In the case of massive V., intensive therapy (transfusion of fluid and blood substitutes, administration of cardiovascular analeptics) is started without delay, and resuscitation measures are carried out according to indications. in a surgical department includes laparotomy, identifying the source of bleeding and stopping it. During the operation for V. k. no more than 12-24 years old 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. with V. K. is always serious.

Bibliography: Current problems of hemostasiology. edited by B.V. Petrovsky et al., M., 1981; Jerota D. Surgical examination of the abdominal cavity. from rum., M., 1972; Kochnev O.S. Emergency gastrointestinal tract, Kazan, 1984, bibliogr.; Operative surgery, ed. I. Littmann, trans. from Hungarian, Budapest, 1985; Guide to Emergency Abdominal Surgery, ed. V.S. Savelyeva, M., 1986.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Bolshaya Russian Encyclopedia. 1994 3. Encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “Intra-abdominal bleeding” is in other dictionaries:

I Bleeding (haemorrhagia) is the leakage of blood from blood vessels when the integrity or permeability of their walls is damaged. Based on their origin, K. is divided into traumatic, caused by mechanical damage to the vascular wall (including during surgical... ... Medical encyclopedia

I Belly (abdomen) the lower half of the body. Above it borders with the chest, below with the girdle of the lower extremities along the line from the pubic symphysis along the inguinal folds to the anterior superior iliac spines, then along the iliac crests to the base of the sacrum. IN… … Medical encyclopedia

A disease caused by disturbances in the development and growth of the trophoblast of the outer cell mass of the embryo, from which the epithelial cover of the chorionic villi is formed. It is assumed that T. b. develops as a result special properties eggs; give... ... Medical encyclopedia

I Complication is a pathological process or pathological condition that has been added to the underlying disease due to the characteristics of its pathogenesis or as a consequence of diagnostic or therapeutic measures. Complication is not necessary... ... Medical encyclopedia

I Liver (hepar) is an unpaired organ of the abdominal cavity, the largest gland in the human body, which performs a variety of functions. The liver neutralizes toxic substances that enter it with blood from the gastrointestinal tract; in it... Medical encyclopedia - clinical syndrome, which develops when damaged and acute diseases organs of the abdominal cavity and retroperitoneal space and requiring emergency surgical care. The following main symptoms are typical for an acute abdomen: abdominal pain... ... Medical encyclopedia

Such bleeding can be suspected only by changes in the general condition of the victim and by symptoms of fluid accumulation in a particular cavity.

Bleeding into the abdominal cavity is manifested by pallor, weak rapid pulse, thirst, drowsiness, darkening of the eyes, fainting. When bleeding into the chest cavity, these symptoms are combined with shortness of breath.

When bleeding into the cranial cavity, signs of compression of the brain come to the fore - headache, impaired consciousness, breathing difficulties, paralysis, etc.

In modern surgery, special attention is paid to internal bleeding. This is due to the fact that internal bleeding is much more difficult to diagnose compared to open bleeding. This means that the medical assistance provided may be delayed. Internal bleeding is characterized by the outpouring of blood into the natural cavities of the body or artificially created spaces.

Depending on the amount of blood shed, there are three degrees of bleeding: moderate, moderate and severe.

The main reasons include: rib fractures with rupture of intercostal vessels and damage to lung tissue, malignant neoplasms of internal organs, closed damage liver, spleen, intestines, complications of diseases of organs such as the esophagus (with varicose veins), stomach and duodenum, liver, female genitals.

Main signs of internal bleeding:

• Sticky cold sweat
• Pallor
• Shallow breathing
• Pulse is frequent and weak

Signs and symptoms that are not so pronounced and may only become apparent after some time:

• Blue discoloration of the skin (formation of a hematoma in the area of ​​injury)
• Soft tissues that are tender, swollen, or hard to the touch
• The victim feels nervous or restless
• Rapid weak pulse rapid breathing, nausea or vomiting, decreased level of consciousness
• Pale skin that feels cool or damp to the touch
• Feeling of unquenchable thirst
• Bleeding from natural orifices of the body (nose, mouth, etc.)

First aid for internal bleeding:

• Provide complete rest
• Place the victim in a semi-sitting position
• Apply ice or cold water
• Urgently transport the victim to a surgical hospital

Frequency of internal bleeding

Most often, bleeding occurs when the gastrointestinal tract is affected. Therefore, it is worth getting acquainted with the methods emergency care gastrointestinal bleeding. In total, there are about 20 diseases, the most significant and common among which are: acute erosive gastritis and stomach cancer varicose veins esophageal veins, cirrhotic liver disease. In the case of stomach cancer, the danger is a disintegrating tumor. The only sign that allows the patient to suspect something is wrong is the darkening of the stool, which occurs due to the coagulated blood contained in it. If vomiting occurs, the vomited masses, again due to coagulated blood, have the color of coffee grounds.

Symptoms of internal bleeding depend on its location and the degree of blood loss. In some cases, it is necessary to distinguish bleeding from the esophagus or stomach from bleeding from a damaged lung. When lung pathology foamy, unchanged scarlet blood is released.

Diseases of the female reproductive system can also cause internal bleeding. Most common cause is a tubal abortion. When a fallopian tube ruptures, blood accumulates in the abdominal cavity, creating a feeling of tension and some pressure in the pelvis, especially on the rectum. By the way, bleeding from anus is also quite common. Subsequently, irritation of the peritoneum occurs with blood, which leads to the development of a state of shock, loss of consciousness, and fainting. The pulse in this case becomes frequent and thread-like. Upon examination, abdominal bloating, stool and gas retention are revealed. The patient becomes pale and covered in cold sweat.

Symptoms of hemothorax (blood in the chest)

How to identify and recognize internal bleeding in the chest? If blood accumulates in pleural cavity the development of so-called hemothorax occurs. The pleural cavity is a small space that separates the lungs from the chest. The reasons leading to the development of hemothorax include the following: falls from a height, injuries with damage to the ribs and intercostal vessels, knife wounds, lung cancer, lung abscesses(that is, the formation of abscesses in the lung tissue).

When blood accumulates in the pleural cavity, there is difficulty breathing when inhaling and when coughing, sharp pain in the chest, a disturbance in the general condition - dizziness, weakness, fainting, pale skin, increased heart rate and breathing, sweating. Percussion of the patient's chest reveals a shortening of the percussion sound over the affected half, weakening or complete absence of breathing. On an x-ray, it is possible to determine signs of mediastinal displacement towards the healthy lung.

Hemarthrosis (blood in the joint cavity)

A common joint lesion is the development of hemarthrosis, which means the accumulation of blood in the joint cavity. A similar condition occurs as a result of injury, less often with hemophilia, scurvy. The anemic symptom is expressed insignificantly, in contrast to the local symptoms. The clinic distinguishes three degrees. With grade 1 hemarthrosis, mild pain is noted, the contours of the joint are slightly smoothed, and the range of motion is not changed. In general, the volume of blood in the joint is up to 15 ml. Grade 2 is characterized by severe pain, which intensifies with exercise, and smoothness of the joint is noted. There is an increase in the circumference of the affected joint by 1.5 - 3 cm compared to a healthy one. In the case of hemarthrosis of the knee joint, voting of the patella is observed. The blood content in the cavity is up to 100 ml. At grade 3, the pain syndrome is acute, the outlines of the joint are completely changed. The joint's circumference increases to 5 cm, and mobility is severely limited. Blood volume is more than 100 ml.

General symptoms

Thus, there are signs of bleeding that occur in any case, regardless of the source of the bleeding. TO early signs include: pallor of the skin and visible mucous membranes, cold sweat, general weakness, dizziness, darkening of the eyes, if the lungs are affected - cough with streaks of blood, if the digestive system is involved in the process - hematemesis or bloody diarrhea, symptoms of peritoneal irritation, which occurs when internal organs (spleen, liver, kidney) rupture. With moderate bleeding, a number of symptoms may be either mild or not appear at all

In other words, bleeding leads to the development of anemia. In addition to the above symptoms, anemia is manifested by increased heart rate and hypotension, that is, a decrease in blood pressure. The changed parameters directly depend on the degree of blood loss: with moderate - pulse no more than 75 beats per minute, systolic pressure drops to 100 mm Hg. Art.; with average - the pulse rises to 100 beats per minute, blood pressure decreases to 90-80 mm Hg. Art.; in severe cases, the pulse rises to 120-140 beats per minute, systolic blood pressure drops below 80 mm Hg. Art.

Diagnostics

In case of combined trauma, laparocentesis is performed; it is a simple, fast, affordable and gentle method for diagnosing injuries to the abdominal organs and internal bleeding. An ultrasound of the abdominal organs is also sometimes performed.

An important point in confirming the diagnosis is laboratory blood tests. The analysis reveals a decrease in the number of red blood cells, the amount of hemoglobin and a drop in hematocrit.

If such symptoms and diagnostic data are detected, it is necessary to immediately identify the cause of the underlying disease and begin treatment. It should be remembered that the earlier the cause of internal bleeding is identified, the more effective and rapid the recovery process will be.

Internal bleeding is one of the most dangerous types of bleeding, requiring immediate hospitalization.