The diagnosis of internal bleeding begins with a thorough history taken by the health care practitioner. This is followed by a physical examination, concentrating on the area of the body where the internal bleeding may have occurred. For example, if there is concern about bleeding in the brain, the physical examination will focus on the neurologic system, or if it is intra-abdominal bleeding, the exam will be directed toward the abdomen.
Blood tests may be performed to check for a low red blood cell count, or anemia. However, if the bleeding occurs rapidly, the initial hemoglobin reading or red blood cell count may be normal.
The suspicion of internal bleeding will often require an imaging test to look for the bleeding source.
- If there is concern that there is gastrointestinal bleeding, a gastroenterologist may use fiberoptic scopes to look into the esophagus and stomach (endoscopy) or into the colon (colonoscopy) to identify the source. If the source is found, the physician may be able to stop the bleeding using electricity to cauterize or burn the blood vessel that is bleeding.
- Computerized tomography is the most common test to look for bleeding in the brain. It is also able to identify brain swelling and fractures of the skull.
- Ultrasound may be used to look for blood in the abdomen. While it has its place in the management of trauma, ultrasound is especially useful in evaluating obstetric and gynecologic problems such as bleeding from an ovarian cyst or an ectopic or tubal pregnancy.
- CT also is an effective tool in looking for intra-abdominal and retroperitoneal bleeding. It can evaluate the potential injury site, the severity of organ damage, and whether the bleeding is contained within an organ (such as the liver, kidney, or spleen) or whether the bleeding has spilled into the peritoneum. It is also a helpful test in assessing pelvic fractures.
- If the source of bleeding is thought to be due to a damaged artery, angiography may be used to evaluate the arterial blood flow.
In some situations in which the patient is critically ill from internal bleeding, the decision may be made to undergo emergency surgery to find and repair the bleeding site. This may occur in trauma victims with abdominal or chest injuries who have unstable vital signs (decreased level of consciousness, low blood pressure, and other signs of shock) and are at risk for bleeding to death if they wait for diagnostic tests.
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