variceal bleeding

Hemorrhage from dilated or variceal veins, usually understood to mean esophageal varices 2º to end-stage liver failure Management-surgical Surgical shunting, endoscopic sclerotherapy, esophageal variceal ligation, transjugular intrahepatic portosystemic stent-shunt–TIPS procedure Management-medical Vasopressin, nitroglycerin, somatostatin, β-blockers, long-acting nitrates. See Transjugular intrahepatic portosystemic stent-shunt–TIPS procedure.

bleeding

(bled'ing) 1. The emission of blood, as from an injured vessel.2. The process of emitting blood, as a hemorrhage or the operation of letting blood.

Normally, when blood is exposed to air, it changes to allow fibrin to form. This entangles the cells and forms a blood clot. See: coagulation, blood; coagulation factor; hemorrhage

arterial bleeding

Bleeding in spurts of bright red blood from an artery.

Emergency Care

Arterial bleeding may be controlled by applying pressure with the fingers at the nearest pressure point between it and the heart. The artery is located and digital pressure is applied above it until bleeding stops or until the artery is ligated or repaired. When a pressure point is ineffective in controlling arterial bleeding on an extremity, a tourniquet may be needed. See: table

breakthrough bleeding

Intermenstrual spotting or bleeding experienced by some women who are taking oral contraceptives.

clinically significant bleeding

Bleeding that causes hemodynamic instability (blood pressure less than 100 mm Hg or pulse more than 100 beats per min) or requires a transfusion of more than 2 units of blood in 24 hours.

dysfunctional uterine bleeding

Abbreviation: DUB
A diagnosis of exclusion in which there is abnormal bleeding from the uterus not caused by tumor, inflammation, or pregnancy. These causes of bleeding must be ruled out before DUB may be diagnosed. The condition may occur with ovulatory cycles, but most often occurs with anovulation. It is common in women with polycystic ovary syndrome. Endometrial hyperplasia followed by sloughing of the endometrium may occur in women with repeated anovulatory cycles.

Etiology

The absence of the luteal progesterone phase interferes with normal endometrial preparation for implantation or menstruation. Prolonged constant levels of estrogen stimulate uneven endometrial hypertrophy so that some areas slough and bleed before others, causing intermittent bleeding.

functional bleeding

1. Loss of blood from the uterus caused by an organic lesion, such as a cyst, fibroid, or malignant tumor.2. Metrorrhea.

gastrointestinal bleeding

Bleeding from anywhere in the gastrointestinal tract. Synonym: gastrointestinal hemorrhage

herald bleeding

Spontaneous hemorrhage from the gastrointestinal tract in a patient with an aortic bypass graft. The hemorrhage typically stops suddenly, only to recur massively days or weeks later. It is sometimes a clinical hallmark of bleeding from an aortoenteric fistula.

internal bleeding

Hemorrhage from an internal organ or site, esp. the gastrointestinal tract.

menstrual bleeding

See: menstruation

nasal bleeding

Epistaxis.

nuisance bleeding

Loss of a few drops of blood from minor cuts and scratches; or bruising of the skin after minor trauma. It is a potential complication of treatment with anticoagulant or antiplatelet drugs, and an occasional cause of drug discontinuation by treated patients.

occult bleeding

Inapparent bleeding, esp. that which occurs into the intestines and can be detected only by chemical tests of the feces. Synonym: Internal hemorrhage

uterine bleeding

Bleeding from the uterus. Physiological bleeding via the vagina occurs in normal menstruation. Abnormal forms include excessive menstrual flow (hypermenorrhea, menorrhagia) or too frequent menstruation (polymenorrhea). Nonmenstrual bleeding is called metrorrhagia. Pseudomenstrual or withdrawal bleeding may occur following estrogen therapy. Breakthrough bleeding is the term used for intermenstrual bleeding that sometimes occurs in women who take progestational agents such as birth control pills or receive estrogen-progesterone replacement therapy. amenorrhea; dysfunctional uterine bleeding; menstruation;

variceal bleeding

See: esophageal varix

venous bleeding

A continuous flow of dark red blood.

First Aid

Venous bleeding may be controlled by firm, continuous pressure applied directly to the bleeding site. If bleeding is from an area over soft tissues, a large, compress bandage should be held firmly against the site.

CAUTION!

A tourniquet should not be used. If the bleeding is over a bony area, as in the case of a ruptured varicose vein of the leg, pressure held firmly against the vein will provide immediate control of the blood loss. The patient should be taken to a health care provider as soon as possible if bleeding does not stop.

withdrawal bleeding

Uterine bleeding following discontinuation of treatment with cyclic hormone replacement therapy. It is caused by sloughing of the endometrium but is not technically considered menstruation because it is not associated with an ovulatory cycle.

Artery	Course	Bone Involved	Spot to Apply Pressure
For Wounds of the Face
Temporal	Upward ½ in (13 mm) in front of ear	Temporal bone	Against bony prominence immediately in front of ear or on temple
Facial	Upward across jaw diagonally	Lower part of lower maxilla	1 in (2.5 cm) in front of angle of lower jaw
For Wounds of the Upper Extremity
Axillary	Downward across outer side of armpit to inside of humerus	Head of humerus	High up in armpit against upper part of humerus
Brachial	Along inner side of humerus under edge of biceps muscle	Shaft of humerus	Against shaft of humerus by pulling aside and gripping biceps, pressing tips of fingers deep down against bone
For Wounds of the Lower Extremity
Femoral	Down thigh from pelvis to knee from a point midway between iliac spine and symphysis pubis to inner side of end of femur at knee joint	Brim of pelvis	Against brim of pelvis, midway between iliac spine and symphysis pubis
Posterior tibial	Downward to foot in hollow just behind prominence of inner ankle	Inner side of tibia, low down above ankle	For wounds in sole of foot, against tibia in center of hollow behind inner ankle