3 hemorrhage

HemodynamicsHemodynamicsHEMORRHAGEHEMORRHAGE

Dr.CSBR.Prasad, M.D.

HEMORRHAGEHEMORRHAGE• Hemorrhage - extravasation of blood due to rupture of BV• Capillary bleeding: Chronic congestion Hemorrhagic diatheses • Rupture of a large artery or vein - due to: Vascular injury Trauma Atherosclerosis Inflammatory Neoplastic erosion of the vessel wall

Manifestations – depends on size, Manifestations – depends on size, extent, and location of bleeding. extent, and location of bleeding.

• Hematoma (accumulation of blood within tissue )• Petechiae (1 - 2 mm hemorrhages into skin,

mucous membranes, or serosal surfaces )• Purpura (≥3 mm) • Ecchymoses (>1 - 2 cm) subcutaneous

hematomas • Large accumulations of blood in one or another of

the body cavities - hemothorax, hemopericardium, hemoperitoneum, or hemarthrosis

A - Punctate petechial hemorrhages of the colonic mucosa

B - Intracerebral hemorrhage

Consequences of thrombocytopenia

Petechial hemorrhages (pinpoint hemorrhages) seen on the epicardium

of the heart

Hemopericardium – Hemopericardium –

Cardiac tamponadeCardiac tamponade

Aortic tear with hemorrhages

Lacerated Liver – [Peritoneal hemorrhages]

Ecchymoses

Hematoma

Adrenal hemorrhageAdrenal hemorrhage

Raccoon Raccoon eyeseyes

HematomaHematoma

HematomaHematoma

Purpura - HSP

Subconjunctival hemorrhage

Subdural Subdural

hematomahematoma

Subdural hematomaSubdural hematoma

Subgaleal hemorrhageSubgaleal hemorrhage

Subgaleal Subgaleal hemorrhagehemorrhage

Clinical significance of hemorrhage Clinical significance of hemorrhage

Depends on the volume and rate of bleeding & blood loss: • Rapid loss of up to 20% of the blood volume or slow losses of even >20%

• Losses >20% may result in hemorrhagic (hypovolemic) shock

• The site of hemorrhage is also important: Trivial bleeding in the subcutaneous tissues – innocuous Trivial bleeding in the brain – may cause death

• External loss Vs Internal loss: Chronic or recurrent external blood loss – Loss of iron and IDA Hemorrhage into body cavities or tissues – No iron deficiency

No adverse effects

E N DE N Dgoto goto Hemostasis & Thrombosis