Hemorrhage (Blood Loss in Surgery)
Definition
Hemorrhage is the escape of blood from blood vessels.
Occurs either by:
- Rupture of the vessel wall (e.g. trauma, aneurysm)
- Unruptured vessel wall with bleeding due to pressure erosion (e.g. tumor, foreign body)
Classification of Hemorrhage
By Direction:
External: Visible bleeding from a wound or natural orifice
Internal:
- Into hollow organs (e.g. hematuria, melena )
- Into body cavities (e.g. hemothorax, hemoperitoneum, hemopericardium )
- Into tissues (e.g. hematoma)
By Etiology:
Rupture: Spontaneous break in a vessel
Erosion: Gradual wear by infection, tumor, or ulcer
By Type of Vessel:
Arterial – bright red, pulsatile
Venous – darker, steady flow
Capillary – oozing
Parenchymatous – diffuse bleeding from organ tissue (e.g. liver, spleen)
By Timing:
Primary – occurs immediately during or after trauma/surgery
Secondary – occurs after 48 hours, often due to infection, slipped ligature
Postoperative Hemorrhage:
Due to technical mistakes (slipped ligature, poor hemostasis)
Or progressive disease (infection, erosion)
Clinical Signs of Hemorrhage
General:
- Tachycardia
- Hypotension
- Cold, clammy skin
- Pallor
- Weakness, syncope
- Anemia (later)
Local:
Based on location of bleeding (e.g. hematuria → urinary tract, melena → GI tract)