Internal Bleeding

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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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• Internal Bleeding Overview
• Internal Bleeding Causes
• Other Causes of Internal Bleeding
• Internal Bleeding Symptoms
• When to Seek Medical Care
• Exams and Tests
• Internal Bleeding Treatment
• Self-Care at Home
• Medical Treatment
• Surgery
• Next Steps
• Follow-up
• Prevention
• Outlook
• Synonyms and Keywords
• Author and Editor

Blood is meant to be circulated by the heart through blood vessels to supply the body's organs with oxygen and nutrients. These blood vessels include arteries, veins, and capillaries. When the integrity of the blood vessel wall is damaged, there is a clotting mechanism in place to repair the damage and minimize the amount of blood that leaves the injured blood vessel.

External bleeding is usually easy to recognize. A laceration of the skin bleeds, a person may cough or vomit blood, or a woman develops vaginal bleeding.

The symptoms of internal bleeding vary depending upon what part of the body is involved or what organ system is damaged. Symptoms may be dramatic, arise gradually, or the patient may have no initial complaints. For example, a patient may complain of total loss of vision in an eye if bleeding occurred within the globe; or a patient with a ruptured abdominal aortic aneurysm may be unconscious, in shock with no blood pressure, and a feeble pulse; occasionally small subdural hematomas are found in people getting a CT scan for other reasons and have no symptoms at all.

Some internal bleeding may cause significant pain and then gradually resolve spontaneously. For example, an ovarian cyst rupture is quite common and causes some blood to leak into the peritoneum (the space that contains the abdominal organs). Blood outside of blood vessels can be very irritating and the patient may complain of acute onset of pain. However, the treatment for most ruptured cysts is time and symptom control until the body absorbs the blood and the inflammation resolves.

The amount of bleeding and the location are associated with the presentation and outcome. A small amount of blood (1 or 2 ounces) in the skull can cause significant loss of brain function due to an increased build up of pressure, since it is like a solid box and doesn't have the ability to expand to accommodate extra volume. Should that same small amount of blood accumulate quickly in the pericardium (the sac that surrounds the heart) it might prevent the heart from adequately beating but should the internal bleeding take days or weeks to accumulate, the heart could adjust and continue to function.

When the internal bleeding begins to form a clot, it may be termed a hematoma.

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