Parenchymal bleeding is bleeding in which blood is not released to the outside, but due to damage to internal organs or some of their pathologies expires into the internal cavities of the body (abdominal, pleural).
Types of bleeding
Bleeding is the outflow of blood from the vessels. Most often, it is caused by damage to them. This may be the result of an injury (which happens most often) or the consequences of pathological changes in the body. Such "melting" of vessels can be observed in tuberculosis, oncological conditions, ulcers of internal organs.
Bleeding is usually divided into external, when blood from a damaged vessel flows out through a wound or natural openings, and internal. In this case, blood accumulates in the cavities. The following types of external bleeding are distinguished:
- capillary - occur as a result of superficial damage, blood is released in small amounts, drop by drop;
- venous - occurs due to deeper damage (cut, stab wounds), while a largeamount of dark red blood;
- arterial - the cause is deep damage in which the wall of the arteries is damaged, while the blood is poured out in a pulsating stream and has a bright scarlet color;
- mixed bleeding can also occur with deep injuries, while both arteries and veins bleed simultaneously in the wound.
Internal bleeding
Internal bleeding can also be classified according to the localization of the process. With blows and injuries to the chest, bleeding may occur, in which blood is poured into the pleural cavity. In this case, she, accumulating there, compresses the lungs. Outwardly, this is manifested by difficulty breathing and increasing shortness of breath.
Bleeding in the abdominal cavity can be the result of diseases of the organs located in it, in women it can be an ectopic pregnancy, but most often the cause of internal bleeding in the abdominal cavity is blunt abdominal trauma, which is accompanied by a rupture of the liver or spleen. In this case, the bleeding is said to be parenchymal. In addition, with such bleeding, blood can not only pour into the abdominal cavity, but also accumulate in the thickness of the tissues, soaking them.
What is parenchyma
Parenchyma is a tissue that is the basis of many internal organs. Anatomically, it is formed depending on the task of the organ by epithelial, nervous, muscular, myeloid or lymphoid tissue. The parenchymal organs are the liver,spleen, kidneys, various glands and even the brain. A feature of these organs is that in each of them specialized structures are formed by the parenchyma, allowing the organ to perform its functions. In the liver, these are its lobules, in the kidneys - nephrons, in the spleen - follicles. In addition to the parenchyma, in the structure of such organs, a stroma is distinguished - a connective tissue base that performs supporting and trophic functions. When the smallest blood vessels (capillaries) supplying these organs are damaged, parenchymal bleeding occurs. Often, its presence is difficult to diagnose and therefore, by the time care begins, there may be a large amount of blood loss. That is why the timely diagnosis and stopping of parenchymal bleeding is a priority for the surgeon.
Causes of parenchymal bleeding
The first place among the reasons is unconditionally occupied by trauma. Regardless of what caused it - a traffic accident, a blow or a fall from a height - even a slight impact can be enough to start parenchymal bleeding. This is due to the fact that even a small tear of the organ capsule (and it is usually very delicate) is enough, as the blood vessels that feed the parenchyma and therefore are in large numbers here, are damaged and blood begins to pour into the body cavity.
In addition to injuries, the following pathologies can cause parenchymal bleeding:
- tumors, both malignant andbenign;
- infection (tuberculosis);
- pathology of parenchymal organs (hemangioma);
- parasitic lesions;
- pathology of the blood coagulation system.
Mechanism of blood loss
The result of bleeding in the body can be a hemorrhage (in this case, the outflowing blood impregnates the surrounding tissues) or a hematoma. Then a cavity filled with blood is formed in the tissue. With parenchymal bleeding, both of these options are possible. The danger lies in the fact that the vessels that feed the parenchyma do not collapse in their structure, which means that the bleeding will continue. Even if it is not intense, the symptoms of anemia will still increase, as a result, the organs and the brain will suffer from hypoxia. With significant blood loss, hemorrhagic shock develops - a serious condition in which blood pressure decreases significantly and signs of multiple organ failure progress.
Signs of parenchymal bleeding
Despite the obvious danger to the life of the patient, such bleeding is not always possible to identify immediately. It often happens that blood loss occurs for some time, with little or no effect on overall well-being. Parenchymal bleeding in the early stages can be suspected by general weakness, drowsiness, dizziness. The patient is thirsty, "flies" and darkening in the eyes, cold sweat. Possible fainting. The degree of blood loss can be judged by factors such as pulse, blood pressure andother objective signs.
With slight blood loss, a slight decrease in pressure and an increase in heart rate (up to 80–90 beats per minute) are possible. In some cases, it generally disappears without obvious signs, which creates an even greater danger, since parenchymal bleeding cannot stop on its own.
For moderate blood loss is characterized by an increase in heart rate to 100 beats per minute or more and a decrease in systolic pressure below 90 mm Hg. Art. there is also rapid breathing, pallor of the skin, cold clammy sweat, cold extremities, dry mouth, severe weakness, apathy, adynamia, mental retardation.
In case of severe blood loss, systolic pressure drops below 80 mm and pulse rate can exceed 110 beats per minute. Breathing is superficial, greatly accelerated, yawning, pathological drowsiness, tremor of the hands, a decrease in the amount of urine excreted, severe pallor, marbling of the skin, lethargy or confusion, excruciating thirst, cyanosis of the extremities, acrocyanosis.
Life-threatening bleeding
Massive internal bleeding is characterized by a decrease in pressure up to 60 and an increase in heart rate up to 140-160 beats per minute. Cheyne-Stokes breathing (respiratory movements first deepen and become more frequent, but at 5-7 breaths their intensity begins to decrease, after which there is a pause). Consciousness is confused or absent, delirium, the skin is sharply pale, sometimes with a grayish tint. Facial featuressharpened, eyes sunken.
Fatal blood loss (as a rule, it is a third of the volume, that is, 1.5–2 liters) is accompanied by the development of a coma. In this case, the pressure drops below 60 mm or is not detected at all, pulse contractions slow down to 2–10 beats, convulsions are observed, agonal breathing, the pupils are dilated, the skin is dry, “marble”. As a rule, such a condition is irreversible - agony inevitably sets in, and then death.
Parenchymal bleeding - first aid
Everyone knows very well that very often timely first aid can save a patient's life. Unfortunately, the same cannot be said for internal bleeding. Parenchymal bleeding cannot be stopped or reduced by improvised means, the most important thing that can be done for the victim is to deliver him to the surgical hospital as soon as possible, that is, call an ambulance.
To ensure that the patient's condition does not worsen, before she arrives, you can provide the following assistance for parenchymal bleeding:
- give the victim a horizontal position, with legs raised if hemorrhage in the abdominal cavity is possible, or a semi-sitting position if hemothorax is suspected;
- apply cold to the area of suspected bleeding.
Pay attention! Patients with symptoms of internal bleeding are strictly forbidden to warm the diseased area, provoke vomiting or do enemas and givemedicines that stimulate the heart.
Treatment
Today, the only way to stop parenchymal bleeding is surgery. As a rule, this happens during an emergency operation, before which they conduct laboratory tests that evaluate hematocrit, hemoglobin and red blood cells, do an ultrasound of the abdominal cavity, X-ray.
There are several ways to stop parenchymal bleeding. This is:
- organ resection;
- drying the stuffing box;
- electrocoagulation of vessels;
- vascular closure;
- feeder embolization;
- use of hemostatic sponges.
Along with stopping bleeding, the most important task is to compensate for blood loss, restore the volume of circulating fluid and improve microcirculation. For this purpose, transfusion of blood, plasma and blood substitutes is carried out, as well as the administration of a 5% glucose solution, saline.
