The symptoms of internal bleeding depend upon where the bleeding is located, how much bleeding has occurred, and what structures and functions in the body are affected. Blood outside the circulatory system (the heart and blood vessels) is very irritating to tissues, causing inflammation and pain. Examples of some internal bleeding situations include:
Intracranial bleeding from trauma or from a leaking aneurysm often causes pain but may also present with altered mental function. Neurological exam results range from a near-normal exam to confusion to coma. Symptoms of stroke, including weakness, slurred speech, and loss of vision, may also be associated with intracerebral bleeding. The signs and symptoms depend upon where and how much blood there is in the brain. If the bleeding continues, symptoms become progressive and easier to recognize.
Intra-abdominal bleeding may be hidden and present only with pain, but if there is enough blood loss, the patient may complain of weakness, lightheadedness, shortness of breath, and other symptoms of shock and decreased blood pressure. Once again, the symptoms depend upon where in the abdomen the bleeding occurs.
- If there is gastrointestinal bleeding, the patient may vomit bright red blood, or if it has been in the stomach for a period of time, the vomit may look like coffee grounds. Bowel movements may be bloody or they may be black and tarry, again depending upon the location of the bleeding in the gastrointestinal tract.
- If the internal bleeding causes blood to spill into the peritoneum, there can be a significant amount of pain with any movement, and the abdomen can become tense and feel rigid to touch.
- Sometimes intra-abdominal blood will track toward the skin and can be appreciated on physical examination. Cullen's sign is the term used to refer to the appearance of bruising surrounding the umbilicus. Grey-Turner sign is bruising in the flanks.
Blood seen in the urine may be due to internal bleeding at any site within the urinary tract, from the kidney to the bladder. Often bladder infections are associated with blood in the urine but other causes need to be considered based upon the particular symptoms as well as the patient's age and medical history, especially males who may have had prostate surgery. Men and women who have had radiation therapy may develop inflammation of the bladder wall which can cause a significant amount of bleeding.
Bleeding may occur deep within muscles after injury, and rarely, compartment syndrome may occur. Should so much bleeding occur that the pressure build-up within the muscle is greater than the patient's blood pressure, blood cannot get to the muscle cells, and they begin to die. Symptoms include intense pain, difficulty moving the joints below the injury, and loss of sensation. Most commonly this is seen in the shin and forearm and may or may not be associated with a broken bone.
Bleeding may also occur into joints, causing significant pain and loss of range of motion. This most frequently is seen in patients who are on anticoagulation medications. An injury may or may not be needed to cause the bleeding.
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