Blood is meant to be circulated by the heart through blood vessels to supply the body’s organs with oxygen and nutrients. These blood vessels include arteries, veins, and capillaries. When the integrity of the blood vessel wall is damaged, there is a clotting mechanism in place to repair the damage and minimize the amount of blood that leaves the injured blood vessel.
The symptoms of internal bleeding vary depending upon what part of the body is involved or what organ system is damaged. Symptoms may be dramatic, arise gradually, or the patient may have no initial complaints. For example, a patient may complain of total loss of vision in an eye if bleeding occurred within the globe; or a patient with a ruptured abdominal aortic aneurysm may be unconscious, in shock with no blood pressure, and a feeble pulse; occasionally small subdural hematomas are found in people getting a CT scan for other reasons and have no symptoms at all.
Some internal bleeding may cause significant pain and then gradually resolve spontaneously. For example, an ovarian cyst rupture is quite common and causes some blood to leak into the peritoneal cavity (the space that contains the abdominal organs). Blood outside of blood vessels can be very irritating and the patient may complain of acute onset of pain. However, the treatment for most ruptured cysts is time and symptom control until the body absorbs the blood and the inflammation resolves.
The amount of bleeding and the location are associated with the presentation and outcome. A small amount of blood (1 or 2 ounces) in the skull can cause significant loss of brain function due to an increased build up of pressure, since it is like a solid box and doesn’t have the ability to expand to accommodate extra volume. Should that same small amount of blood accumulate quickly in the pericardium (the sac that surrounds the heart) it might prevent the heart from adequately beating but should the internal bleeding take days or weeks to accumulate, the heart could adjust and continue to function.
The only way to control internal bleeding is through surgery. Therefore immediate transport to the hospital is required.
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