hemorrhages

Hemorrhages are events in which blood escapes from the circulatory system due to rupture or disruption of vessels. They can be external, visible as bleeding on the skin or mucous membranes, or internal, occurring within body tissues, cavities, or organs.

Common cutaneous manifestations include petechiae, purpura, and ecchymosis; hematoma denotes a localized collection of blood outside vessels within tissue.

Internal hemorrhages may involve the brain (intracranial hemorrhage), the lungs (pulmonary hemorrhage with hemoptysis), the gastrointestinal tract (upper or lower GI bleeding with hematemesis, melena, or hematochezia), or the urinary tract (hematuria).

Causes include trauma and surgery; coagulopathies such as platelet disorders, clotting factor deficiencies, or liver disease; use of anticoagulants or antiplatelet drugs; vascular disorders; hypertension; infections or malignancies.

Pathophysiology involves disruption of vessel wall integrity, reduced platelet number or function, or impaired coagulation cascades, allowing blood to escape and form a hematoma or bleed into a body cavity.

Diagnosis relies on history and physical examination, complete blood count, coagulation tests (PT/INR, aPTT), platelet count, and targeted imaging or endoscopy to locate internal bleeding.

Management focuses on stopping the bleed and treating the underlying cause: local compression or pressure, surgical or endovascular control when needed, reversal of anticoagulation, transfusion of blood products, and supportive care.

Prognosis varies widely; intracranial hemorrhage or massive internal bleeds carry higher risk, while small superficial bleeds may resolve with minimal intervention.