HAEMORRHAGE

Presented by
Dr.A.S.M Ariful Islam
Assistant professor & Head
Dept. of Oral & Maxillofacial surgery
Update Dental College & Hospital
Definition-
Haemorrhage means escape of blood
from closed cardiovascular system.
 Classification:
O Depending on the nature of the vessel
involved-
1. Arterial
2. Venous
3. capillary
. • Bright red
Arterial

• Emitted as spurting jet

• Can lead to severe blood loss
• Often hard to control

venous

• Darker red
• Steady and copious flow
• Color becomes further darker with oxygen desaturation
• Usually easy to control
 capillary
• Bright red
• Rapid and oozing
• Blood lose becomes serious if continues for hours
• Generally minor and easy to control
 Depending on the timing of haemorrhage-

1. Primary
2. Reactionary
3. Secondary
 primary
 Occurs at the time of surgery
 Causes is injury to vessels
 May be arterial,venous or capillary
 More common in surgery on malignancies

Reactionary
 Bleeding with in 24 hours(usually 4-6 hours) of surgery
 Causes is slipping of ligature,dislogement of clot or
cessation of reflex vasospasm
 Bleed starts when there is a rise in the arterial and
venous pressure.
 secondary
• Occurs after 7-14 days of surgery
• Cause in sloughing of vessels due to infection,pressure
necrosis or malignancy
• 1st a warning stain followed by a sudden severe bleed
• Common after hemorrhoids surgery,GI surgery &
amputations.
  Depending on the duration of
haemorrhage
O Acute hemorrhage-
occurs suddenly. eg. oesophagel variceal bleeding due
to portal HTN.
O Chronic hemorrhage-
occurs for a long time duration. eg. Bleeding in GIT
due to H.pylori .
 Depending on the nature of
bleeding
O External haemorrhage/revealed:
-external or visible bleeding-soft tissue injuries
-bleeding from the limb vessels,wound or nose etc.
O Internal haemorrhage:
-internal or invisible bleeding-blunt or
penetrating trauma
-may remain concealed as in ruptured spleen or
liver.
-concealed haemorrhage may become revealed as
in haemetemesis or melaena in peptic ulcer bleed.
 Depending upon type of intervention

O Surgical haemorrhage:
is the result of injury and amenable to surgical
control or from angioembolism.

O Non – surgical haemorrhage:

is general ooze from all raw surface due to
coagulopathy, it can not be stopped by surgical mean,require
correction coagulation abnormalities.
 Clinical evaluation of a bleeding
patient-
O Careful evalution of the patients with coordinated
history and physical examination provides valuable
clues as to wheather the bleeding abnormality resides
in:
1. The vessle wall
2. Platelets
3. In the process of coagulation
o Laboratory test should suppliment and not supersede a
careful review of history and physical examination.
The history should include the following
questions-
1. Is there any personal or family history of a bleeding
tendency?
2. Has the patient undergone surgery or dental extraction
previously?
3. Is there any history of hematuria,gastrointestinal
haemorrhage,easy bruising,hemarthrosis,menorrhagia or
epistaxis?
4. Is there any history of cancer or collagen vascular disease?
5. What medication is the patient taking or has taken recently?
6. Is the patient on any special diet?

A careful physical examination should note any-

adenopathy,splenomegaly,hepatomegaly