Hemorrhage
Written by Rhiana Devadasan
38) Hemorrhage - definition, classification, pathophysiology, clinical features, treatment.
Etymology (origin of the word):
hemorrhagia = bleeding
The prefix "hemo" = blood. The suffix "rrhagia" = to burst forth.
Hemorrhage = the extravasation (escape/leakage of fluid) of blood from a ruptured blood vessel. Importance: hemorrhages are one of the main causes of death after trauma or diseases complicated with hemorrhage.
CLASSIFICATION
According to the type of vessel...
- Arterial haemorrhage
- Strong, pulsating, light red colour.
- Intensive at the proximal site & weak distally (but in shock, it is weak from both sides of vessel).
- Vertical vessel cut = strong. Diagonal cut = weak.
- Venous haemorrhage
- Like a pool, slow and continuous.
- Dark blue colour (due to CO₂)
- Can be pulsating (but rarely) due to transformed pulsations nearby.
- Stronger bleeding distally
- Capillary haemorrhage
- Slow, drop-like, red in colour
- Whole surface bleeds
- Usually stops spontaneously
- SUBTYPE: PARENCHYMAL HEMORRHAGE
- more dangerous than capillary hemorrhage
- (life-threatening, especially in hemorrhagic diathesis, hemophilia, etc.)
According to the site...
- Internal
- A loss of blood that occurs from the vascular system into a body cavity or space.
- e.g. hemoperitoneum, hemothorax, hemoarthrosis
- Not visible.
- External
- A loss of blood that occurs from the vascular system & leaves the body through a natural opening (e.g. mouth, nose, ears, urethra, anus, etc.) or a break through the skin.
- e.g. epistaxis (nosebleed), hemoptysis (coughing up blood - lungs), hematemesis (vomiting blood - stomach), melena (bloody stools - GI bleeding), hematuria (blood in urine), metrorrhagia (uterus), rectorrhagia (rectal bleeding).
- Visible.
According to amount/size...
- Gross (Obvious)
- Occult (Hidden)
According to the pathogenic cause...
- Hemorrhagia per rhexim Bleeding by bursting out e.g. trauma, disease, esophageal varices
- Hemorrhagia per diabrosim Bleeding after erosion e.g. bleeding peptic ulcer
- Hemorrhagia per diapedisim Bleeding by diapedesis (migration of blood cells out of capillary walls) e.g. due to higher permeability of BVs in stasis, diathesis (predisposition) & vascular diseases
According to the timing...
- Primary
- Occurs immediately after the lesion/surgery
- Most common in surgery on malignancies
- Reactionary
- Bleeding within 24 hours (usually 4-6 hrs) of surgery
- Causes = slipping of ligature, dislodgement of clot or cessation of reflex vasospasm
- Bleed starts when there is a rise in the arterial or venous pressure
- Secondary
- Occurs 7-14 days after time of injury/surgery
- Causes = tehcnical (surgical), sloughing/trauma of vessels due to infection, septic or tumor necrosis or malignancy
- Common after haemorrhoid surgery, GI surgery and amputations
According to the duration...