So this is what my fellow asked me today: Say, there is a patient whose hemoglobin is dropping, dropping, dropping and he has barely any significant signs or symptoms.. Besides the GI tract, where else can you have a significant bleed which can be hidden? There are three such places.
Guess before you read the answer! :D
1. Retroperitoneal bleeds can be a source of significant yet occult blood loss.
2. A hematoma in the thigh can be surreptitious.
3. A hematoma in the upper arm, especially in obese patients can be hard to find.
The brain and the lung are limited in space, so it's hard to have massive bleeds in these areas without having symptoms.
I thought it was kinda cool to know so I shared it with you guys. Keep these things in mind while evaluating a patient with occult blood loss, especially in patients with bleeding diathesis.
That's all!
-IkaN
Guess before you read the answer! :D
1. Retroperitoneal bleeds can be a source of significant yet occult blood loss.
2. A hematoma in the thigh can be surreptitious.
3. A hematoma in the upper arm, especially in obese patients can be hard to find.
The brain and the lung are limited in space, so it's hard to have massive bleeds in these areas without having symptoms.
I thought it was kinda cool to know so I shared it with you guys. Keep these things in mind while evaluating a patient with occult blood loss, especially in patients with bleeding diathesis.
That's all!
-IkaN
Can it not be a bleed into peritoneum from a uterine vessel after c-section..?
ReplyDeleteIt can be... But a bleed into the peritoneum will cause peritoneal irritation, leading to localized or generalized pain in the abdomen and/or tenderness/rigidity. So it isn't always "hidden" and after a drop in 1 or 2 g/dL of hemoglobin, you will definitely diagnose it.
DeleteIn retroperitoneal bleeds, however, the hemoglobin might drop 6-8 g/dL and you still can't find the source.
(PS: The list of differentials for peritoneal hemorrhage is huge.)
Here's the differentials for you, in case you were wondering! :D
DeleteGynecological:
Ectopic pregnancy
Ruptured ovarian cyst
Uterine leiomyoma/leiomyosarcoma
Ovarian granulosa cell tumor
Ruptured corpus leuteum cyst
Hyperemesis gravidarum
Endometriosis
Spontaneous uterine rupture
Splenic:
Chronic myelomonocytic leukemia
Infectious mononucleosis
Spontaneous splenic rupture
Iatrogentic
Spontaneous rupture of splenic vein
Torsion and rupture of wandering spleen
Hamartoma
Primary splenic angiosarcoma
Hepatic:
Peliosis hepaticus
Hepatic adenoma/adenomatosis
Hepatocellular carcinoma
Hemangioma
Primary hepatic angiosarcoma
Metastatic cancer
Amyloid
Focal nodular hyperplasia
Biliary Ruptured cholangiocarcinoma
Transhepatic rupture of gallbladder
Vascular:
Ruptured cystic artery pseudoaneurysm
Ruptured splenic artery aneurysm
Segmental mediolytic arteriopathy
Gastric:
Mixed cavernous-capillary hemangioma
GIST
Colonic:
Meckel’s diverticulitis
GIST
Pancreatic:
Ruptured pseudocyst
Miscellaneous:
Ruptured benign solitary fibrous tumor
Super bbb
ReplyDeleteThank you!
Delete