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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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The diagnosis for internal bleeding begins with the health care practitioner taking a history and performing a physical examination on the patient. The situation and the source of the bleeding will focus the testing strategy on the part of the body that may be involved with the bleeding. Sometimes the direction of diagnosis is self evident; a motor vehicle crash victim who complains of abdominal pain will have attention directed to the abdomen. Sometimes it is less evident. A confused patient may have issues with bleeding in the brain, or may be so anemic (decreased red blood cell count) from blood loss elsewhere, that the brain is not getting enough oxygen and nutrients to function properly.

Blood tests may include a complete blood count (CBC) or hemogram to access for anemia and abnormal platelet count. INR (international normalized ratio) and PTT (partial thromboplastin time, a blood test that measures how long it takes for blood to clot) are blood clotting studies that may be measured to screen for abnormal clotting function. Depending upon the situation, the hospital blood banking system may be alerted to begin the process of crossmatching blood products for potential transfusion.

Diagnostic tests such as X-rays, Doppler ultrasound, and CT scan may be used depending upon the underlying medical problem associated with internal bleeding.

Computerized tomography (CT scan) is the primary tool used in emergency situations to access for bleeding or swelling in the brain. In a small fraction of patients who have bleeding from a ruptured cerebral aneurysm (a blood vessel that leaks in the brain), the CT will initially be normal and a lumbar puncture may be performed to help make the diagnosis.

CT scan is also one of the tests that can be performed to access for bleeding within the abdomen and chest. It is especially helpful in trauma to look for bleeding from the solid organs of the abdomen like the liver, spleen, and kidney. It is ideal for evaluating the retroperitoneal space for bleeding and can also evaluate fractures of the pelvis and spine.

In cases of potential bleeding from a major blood vessel, CT angiography may be considered to look for a specific blood vessel that is bleeding.

Ultrasound may be used to look for sources of bleeding, most often where there is an obstetric or gynecologic source of bleeding.

Endoscopy, colonoscopy, and anoscopy are used to look for sources of bleeding in the gastrointestinal tract. Using a flexible scope with an attached camera, a gastroenterologist may look into the stomach and intestine, rectum, and colon to find the source of bleeding. Using the same instrument, cautery (electricity used to coagulate or burn a blood vessel) can stop the bleeding if the source is found.

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