Gastrointestinal Bleeding
Gastrointestinal Bleeding or GI bleeding refers to bleeding from any part of the gastrointestinal tract, from the mouth and esophagus to the stomach or intestines.
Gastrointestinal bleeding can occur due to infection or medications that damage tissues leading to bleeding. GI bleeding needs to be monitored carefully and attended to. Upper Gastrointestinal bleeding can result from gastritis or peptic ulcers. Lower GI bleeding is often due to diverticulitis, polyps, anal fissures or hemorrhoids.
Acute GI bleeding manifests in bloody bowel movements and vomiting of blood. There is fatigue and weakness. The patient suffering GI bleeding may suffer pain in the abdomen. A person suffering from gastrointestinal bleeding experience thirst, low blood pressure and dizziness. The patient may notice black tarry stools.
Laboratory tests, endoscopy and rectal examinations may be needed to determine the source of the gastrointestinal bleeding. Excessive bleeding can lead to anemia. In severe cases, it can lead to shock and may need hospitalization for further treatment. There might be need for blood transfusion. Upper GI bleeding can be treated with injection of chemicals. Medicines are then prescribed to prevent the bleeding from recurring. If polyps or hemorrhoids are the cause for gastrointestinal bleeding, they are surgically removed.
Pelvic Fracture
Fractures of the pelvis account only for about 0.3-6% of all fractures. A pelvic fracture can simply be described as a break in one or more bones comprising the pelvis. Pelvic fracture is a serious condition and requires immediate medical intervention.
The worst pelvic fractures are caused by high-speed accidents such as car accidents or motorcycle accidents or falls from high places, which have major impact on the body. The greater the force, the more severe the fracture. Depending upon the direction and degree of the force, these injuries can be life threatening.
Other injuries such as broken bones or damage to liver, kidneys or other organs.
Pelvic fracture also occurs in people with osteoporosis.
Pelvic fracture occurs among teens, involved in sports and athletic activities such as football, hockey, skiing and long distance running. These fractures occur with sudden muscle contractions.
Pelvic fracture is usually caused by falls in elderly people, especially when getting out of a bathtub or descending stairs.
Symptoms of pelvic fracture include severe pain in the groin, hip or lower back area. The pain is bound to worsen when moving the legs. There may be pain in the abdomen and numbness and tingling sensation in the groin or legs. Bleeding from the vagina, urethra or rectum is often noticed with pelvic fractures. There may be difficulty in urinating and difficulty in walking or standing.
Types of Pelvic fractures
Stable or unstable pelvic fractures: In stable pelvic fracture, there is minimal hemorrhage. The break occurs in one point in the pelvic ring. In unstable pelvic fracture, the pelvis becomes unstable. The break occurs in two or more break points in the pelvic ring. There occurs moderate to severe hemorrhage.
Open or closed pelvic fractures: If open skin wound occurs during the fracture in the lower abdomen, it is called open pelvic fracture. If no skin wounds occur, then it is closed pelvic fracture.
Diagnostic tests such as x-rays, CT scans are used to diagnose pelvic fractures. MRI allow a detailed picture of the pelvic area. Abdominal ultrasound is used to find internal bleeding and other injuries within the abdomen. Urethrography may be conducted to check injuries in urethra by means of an injected dye. Arteriography, in which dye is injected in the arteries to check for internal bleeding within the pelvis, is sometimes used.
Treatment to the pelvic fracture depends upon the severity of the injury caused. A pelvic fracture is a serious injury. In some cases, it may be complicated with injuries in other parts of the body and severe shock as well. Sometimes severe internal and external bleeding and damage to the internal organs could occur. In these situations, immediate attempt is made by the emergency doctor to stop internal and external bleeding caused by the injury. In case of minor fracture, the treatment would merely consist of bed rest and painkillers.
Most of the times, surgery is undertaken to repair the pelvic fracture. Healing after surgery can take anywhere between few weeks to several months. Thus a lengthy rehabilitation becomes necessary after an extensive pelvic surgery. Basilar skull fracture
If there is a fracture or break in the cranial or skull bones, it is called a skull fracture. When the base of the skull is involved in a head injury, it is a basilar skull fracture or basal skull fracture. It is also known as depressed skull fracture and linear skull fracture. This linear fracture is rare and occurs in only 4% of patients with severe head injury. Falls, injuries caused by penetrating external objects like knives, hammers or axe or gunshot wounds may result in skull fractures. It can also occur when the skull hits a solid object with considerable force. Basilar skull fracture can be called a linear fracture at the base of the skull. Usually, dural tear is associated with this type of fracture. This fracture occurs at specific points on the skull base. While analyzing skull fractures, it is seen that 19-221% of all skull fractures happen to be basilar skull fractures.
There may be a traumatic brain injury when the skull is fractured. The area of the brain injured and the severity of injury is diagnosed by examining the fracture. If bacteria enter inside the skull through this fracture of the skull, it will lead to infection. Sudden blow to the back of the head can also result in a basilar skull fracture.
After a head injury, if there is a leak of a clear fluid from the nose or ears, it indicates that the clear fluid is cerebrospinal fluid (CSF) that surrounds the brain. CSF drains out through the ears or nose, when the skull is fractured and the Meninges or the covering of the brain is torn. The typical nasal drainage due to allergies, cold or crying is different from this drainage of CSF. It is also an indication of a fracture of the frontal bone or the base of the skull i.e. sphenoid or temporal bone or of the ethmoid bones (bones that support the nose and sinuses).
If bleeding from the ears or nose is not due to a cut or a direct blow, it may be an indication of a fracture of the base of the skull. Determine the cause of the bleeding by washing the blood thoroughly and see if the bleeding is from a cut or not. Ascertain the source of bleeding from the ear. It is an indication of a skull fracture if a nose bleed does not stop with home treatment. If bruising or dislocation develops within 24 hours after a head injury, it also indicates a basilar skull fracture. Often bleeding within the skull may occur with a basilar skull fracture. This condition may lead to infection.
Battle's sign-bruising behind one ear.
Raccoon eyes-bruising around both eyes.
Abnormalities pertaining to vision.
Weakness of facial muscles.
Problems in hearing.
Difficulties in smelling.
Nasal drip due to leaking of cerebral spinal fluid.
Diagnosis is made with laboratory check of the clear dripping fluid for the presence of CSF. A CT scan of the head with the focus on bones can reveal the extent of damage to the bones. CSF otorrhea and bruising over the mastoids commonly known as 'battle sign' is an indication of a fracture of the petrous temporal bone. Rhinorrhea and bruising around the eyes (raccoon eyes) are noticed with anterior cranial fossa fractures. Depending on an associated intracranial pathologic condition, the Glasgow Coma Score and loss of consciousness may differ from patient to patient. Temporary deafness is a possibility but it resolves in about three weeks. Hemotympanum and mucosal edema in the middle ear fossa cause this temporary hearing loss. Basilar skull fractures sometimes leads to meningitis in some patients. If the bones around the foramen magnum are broken, there is a risk of damage to the blood vessels and nerves exiting the hole.
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