Internal Bleeding: Hospital Detection Techniques And Procedures

Internal bleeding is a medical emergency that requires immediate attention. It occurs when there is bleeding inside the body that is not visible externally. Hospitals employ various methods to detect and locate internal bleeding, including physical examinations, medical history reviews, and diagnostic imaging tests such as X-rays, CT scans, ultrasounds, and MRIs. Laboratory tests, such as complete blood counts and coagulation studies, also help assess overall blood health and clotting abilities. In cases of suspected gastrointestinal bleeding, procedures like endoscopy or colonoscopy may be performed. The treatment approach depends on the severity and location of the bleeding, with severe cases requiring urgent surgery or fluid replacement through intravenous fluids.

Physical examination

The physical examination aims to identify the source of bleeding, which can be challenging due to the various potential causes. Internal bleeding can occur anywhere inside the body, including organs, tissues, and cavities. Common causes include trauma, such as accidents, falls, or physical injuries, resulting in ruptured blood vessels. Less obvious causes include gastrointestinal conditions, medication side effects, medical procedures, and organ rupture.

During the physical examination, doctors will assess the patient's vital signs, such as blood pressure and heart rate, to determine the severity of the bleeding. They will also check for external signs of internal bleeding, such as bruising or bleeding from body orifices. This examination helps doctors decide on the best course of treatment, which may include surgery or observation.

In some cases, doctors may perform a digital rectal exam as part of the physical examination, especially when gastrointestinal bleeding is suspected. They may also recommend laboratory tests, such as complete blood counts and coagulation studies, to assess blood cell counts, clotting factors, and overall blood health. These tests help identify any underlying conditions contributing to the internal bleeding.

The physical examination is just one aspect of diagnosing internal bleeding. Doctors may also utilize imaging tests, such as X-rays, CT scans, ultrasounds, and MRIs, to visualize internal structures and detect abnormalities. Early identification and treatment of internal bleeding are critical to reducing the risk of complications and improving the chances of a full recovery.

Imaging tests

X-rays are commonly used to visualise bones and detect any internal injuries or bleeding. Computed tomography (CT) scans, a more advanced form of X-ray technology, provide detailed images of bones, tissues, and blood vessels. CT scans are often used in cases of severe trauma to perform a full-body scan, known as a pan-scan, to identify any internal injuries or bleeding. CT angiography (CTA) is a specialised CT scan that uses dye and X-rays to visualise blood flow and detect bleeding in specific vessels.

Magnetic resonance imaging (MRI) scans are another powerful tool used to diagnose internal bleeding. They utilise magnetic fields and radio waves to generate detailed images of the body's interior, helping doctors identify the source and extent of bleeding.

Ultrasounds are also employed to visualise internal organs and detect bleeding. This non-invasive technique uses sound waves to create images, providing valuable information about the presence and severity of internal bleeding.

In cases of gastrointestinal (GI) bleeding, endoscopy plays a crucial role in diagnosis and treatment. Doctors use a thin, flexible tube called an endoscope, equipped with a light and camera, to examine the GI tract. This allows them to visualise the oesophagus, stomach, duodenum, rectum, and colon, identifying the source of bleeding. Capsule endoscopy is a specific type of endoscopy where a tiny camera is swallowed in a capsule form, capturing images as it moves through the small intestine.

Angiography is a specialised imaging test that focuses on individual blood vessels. By using dye and X-rays, doctors can carefully examine the blood flow and identify any bleeding or blockages in specific vessels. This technique is often used after an initial diagnosis to further investigate the extent and cause of bleeding.

These imaging tests provide doctors with valuable information to locate and assess internal bleeding, enabling them to make informed decisions about treatment options, such as surgery or medication, to stabilise the patient and prevent severe complications.

Laboratory tests

Liver function tests are another type of laboratory test that may be used to evaluate liver function, as liver disease can increase the risk of bleeding. Kidney function tests are also employed to assess kidney health and identify any bleeding-related issues in these organs. These tests are especially useful when there is a suspicion of bleeding related to kidney or liver disease or injury.

In cases of suspected gastrointestinal bleeding, doctors may perform endoscopic procedures such as upper endoscopy or colonoscopy. These procedures allow doctors to visualise the digestive tract and identify the source of bleeding in the gastrointestinal tract.

Additionally, blood and urine tests may also be used to help diagnose and confirm hemorrhages. These tests can provide valuable information about the presence and severity of internal bleeding, helping doctors make informed decisions about treatment options.

Endoscopy or colonoscopy

If a patient presents with symptoms of internal bleeding, such as shortness of breath, lightheadedness, pain, or low blood pressure, a doctor will first inquire about their medical history and conduct a physical examination. If gastrointestinal bleeding is suspected, an endoscopic procedure such as an upper endoscopy or colonoscopy may be performed to visualise the digestive tract and identify the source of the bleeding.

Endoscopy and colonoscopy are both procedures that use a thin, flexible tube with a light and camera at the end to examine the inside of the body. During an upper endoscopy, the tube is passed down the throat to examine the oesophagus, stomach, and upper intestines. This procedure is particularly effective in cases of suspected upper gastrointestinal bleeding, with the most common causes being peptic ulcers and acute gastric mucosal lesions.

Colonoscopy, on the other hand, is used to examine the large intestine and is often performed after bowel preparation to distinguish the cause of lower gastrointestinal bleeding. It is considered effective in treating bleeding with hemostasis. The timing of a colonoscopy is a matter of some debate, with some studies suggesting that urgent colonoscopy within 8 to 24 hours of observing lower gastrointestinal bleeding can increase the detection rate of recent bleeding, while others find no significant difference in outcomes between early and delayed colonoscopy.

In addition to endoscopy and colonoscopy, doctors may also employ various imaging tests, such as X-rays, CT scans, ultrasounds, MRIs, and angiography, to visualise internal structures and detect abnormalities or signs of internal bleeding. These tests are crucial in pinpointing the source of the bleeding and guiding treatment options, which may include fluid replacement with intravenous (IV) fluids to stabilise the patient.

Surgery

The treatment approach for internal bleeding depends on its location, severity, and underlying cause. Surgical procedures are typically a last resort when other methods, such as fluid replacement or medication, have been deemed insufficient or inappropriate for the specific case.

Some surgical procedures used to treat internal bleeding include:

• Laparotomy: This is an abdominal surgery performed to access the internal organs and stop the bleeding.
• Embolization: This procedure involves blocking blood vessels to prevent further bleeding.
• Endoscopy: A flexible tube with a camera is inserted into the body to visualize and address the source of bleeding.
• Fasciotomy: In cases of internal bleeding into the thigh, a surgeon may cut deeply into the thigh to relieve pressure and gain access to stop the bleeding.
• Repairing damaged blood vessels: Surgeons may repair torn or crushed blood vessels caused by trauma to stop the bleeding.
• Removing ruptured organs: If an organ, such as the spleen or liver, has been perforated or lacerated, it may need to be removed to control the bleeding.
• Cauterization: This technique involves sealing the source of bleeding through heat or chemical means.

It is important to note that the decision to perform surgery is made based on the specific circumstances of each case, and hospitals will always prioritise the patient's safety and stability.

Frequently asked questions