hematomas

Bleeding is the loss of blood. It can be external, or outside the body, like when you get a cut or wound. It can also be internal, or inside the body, like when you have an injury to an internal organ. Some bleeding, such as gastrointestinal bleeding, coughing up blood, or vaginal bleeding, can be a symptom of a disease.

Normally, when you are injured and start bleeding, a blood clot forms to stop the bleeding quickly. Afterwards, the clot dissolves naturally. To be able to make a clot, your blood needs blood proteins called clotting factors and a type of blood cell called platelets. Some people have a problem with clotting, due to another medical condition or an inherited disease. There are two types of problems:

• Your blood may not form clots normally, known as a bleeding disorder. This happens when your body does not make enough platelets or clotting factors, or they don't work the way they should.
• Your blood may make too many clots, or the clots may not dissolve properly

Sometimes bleeding can cause other problems. A bruise is bleeding under the skin. Some strokes are caused by bleeding in the brain. Severe bleeding may require first aid or a trip to the emergency room.

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

Symptoms of a TBI can be mild, moderate, or severe. Concussions are a type of mild TBI. The effects of a concussion can sometimes be serious, but most people completely recover in time. More severe TBI can lead to serious physical and psychological symptoms, coma, and even death.

The main causes of TBI depend on the type of head injury:

• Some of the common causes of a closed head injury include
  • Falls. This is the most common cause in adults age 65 and older.
  • Motor vehicle crashes. This is the most common cause in young adults.
  • Sports injuries
  • Being struck by an object
  • Child abuse. This is the most common cause in children under age 4.
  • Blast injuries due to explosions
• Some of the common causes of a penetrating injury include
  • Being hit by a bullet or shrapnel
  • Being hit by a weapon such as a hammer, knife, or baseball bat
  • A head injury that causes a bone fragment to penetrate the skull

Some accidents such as explosions, natural disasters, or other extreme events can cause both closed and penetrating TBI in the same person.

Certain groups are at higher risk of TBI:

• Men are more likely to get a TBI than women. They are also more likely to have serious TBI.
• Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI

The symptoms of TBI depend on the type of injury and how serious the brain damage is.

The symptoms of mild TBI can include:

• A brief loss of consciousness in some cases. However, many people with mild TBI remain conscious after the injury.
• Headache
• Confusion
• Lightheadedness
• Dizziness
• Blurred vision or tired eyes
• Ringing in the ears
• Bad taste in the mouth
• Fatigue or lethargy
• A change in sleep patterns
• Behavioral or mood changes
• Trouble with memory, concentration, attention, or thinking

If you have a moderate or severe TBI, you may have those same symptoms. You may also have other symptoms such as:

• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Not being able to wake up from sleep
• Larger than normal pupil (dark center) of one or both eyes. This is called dilation of the pupil.
• Slurred speech
• Weakness or numbness in the arms and legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible. To make a diagnosis, your health care provider:

• Will ask about your symptoms and the details of your injury
• Will do a neurologic exam
• May do imaging tests, such as a CT scan or MRI
• May use a tool such as the Glasgow coma scale to determine how severe the TBI is. This scale measures your ability to open your eyes, speak, and move.
• May do neuropsychological tests to check how your brain is functioning

The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury.

For mild TBI, the main treatment is rest. If you have a headache, you can try taking over-the-counter pain relievers. It is important to follow your health care provider's instructions for complete rest and a gradual return to your normal activities. If you start doing too much too soon, it may take longer to recover. Contact your provider if your symptoms are not getting better or if you have new symptoms.

For moderate to severe TBI, the first thing health care providers will do is stabilize you to prevent further injury. They will manage your blood pressure, check the pressure inside your skull, and make sure that there is enough blood and oxygen getting to your brain.

Once you are stable, the treatments may include:

• Surgery to reduce additional damage to your brain, for example to
  • Remove hematomas (clotted blood)
  • Get rid of damaged or dead brain tissue
  • Repair skull fractures
  • Relieve pressure in the skull
• Medicines to treat the symptoms of TBI and to lower some of the risks associated with it, such as
  • Anti-anxiety medication to lessen feelings of nervousness and fear
  • Anticoagulants to prevent blood clots
  • Anticonvulsants to prevent seizures
  • Antidepressants to treat symptoms of depression and mood instability
  • Muscle relaxants to reduce muscle spasms
  • Stimulants to increase alertness and attention
• Rehabilitation therapies, which can include therapies for physical, emotional, and cognitive difficulties:
  • Physical therapy, to build physical strength, coordination, and flexibility
  • Occupational therapy, to help you learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
  • Speech therapy, to help you to with speech and other communication skills and treat swallowing disorders
  • Psychological counseling, to help you learn coping skills, work on relationships, and improve your emotional well-being
  • Vocational counseling, which focuses on your ability to return to work and deal with workplace challenges
  • Cognitive therapy, to improve your memory, attention, perception, learning, planning, and judgment

Some people with TBI may have permanent disabilities. A TBI can also put you at risk for other health problems such as anxiety, depression, and post-traumatic stress disorder. Treating these problems can improve your quality of life.

There are steps you can take to prevent head injuries and TBIs:

• Always wear your seatbelt and use car seats and booster seats for children
• Never drive under the influence of drugs or alcohol
• Wear a properly fitting helmet when riding a bicycle, skateboarding, and playing sports like hockey and football
• Prevent falls by
  • Making your house safer. For example, you can install railings on the stairs and grab bars in the tub, get rid of tripping hazards, and use window guards and stair safety gates for young children.
  • Improving your balance and strength with regular physical activity

Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body. Your nerves take in information from your senses and send it to the brain to be processed. Your brain and nerves also communicate to help you move and to control your body's functions.

When the brain is healthy, it works quickly and automatically. But when you have a brain disease, it may affect how well you can function and do your daily activities. Some common brain diseases include:

• Brain tumors, which can press on nerves and affect brain function.
• Degenerative nerve diseases, which can affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Types include Alzheimer's disease and Parkinson's disease.
• Encephalitis (inflammation in the brain), which can lead to problems such as vision loss, weakness, and paralysis.
• Genetic brain disorders, which are caused by changes in genes (also called variants or mutations). These disorders can affect the development and function of the brain.
• Strokes, which can cause a loss of brain cells and can affect your ability to think clearly.
• Traumatic brain injuries (TBIs), which can affect brain function. They may range from mild to severe. The effects of a TBI may be temporary or permanent.

The symptoms of brain diseases vary widely, depending on the specific problem. In some cases, damage is permanent. In other cases, treatments such as surgery, medicines, or therapies such as physical, occupational, and speech therapies, may cure the disease or improve the symptoms.

A bruise is a mark on your skin caused by blood trapped under the surface. It happens when an injury crushes small blood vessels but does not break the skin. Those vessels break open and leak blood under the skin.

Bruises are often painful and swollen. You can get skin, muscle and bone bruises. Bone bruises are the most serious.

It can take months for a bruise to fade, but most last about two weeks. They start off a reddish color, and then turn bluish-purple and greenish-yellow before returning to normal. To reduce bruising, ice the injured area and elevate it above your heart. See your health care provider if you seem to bruise for no reason, or if the bruise appears to be infected.

Hemophilia is a rare bleeding disorder in which the blood does not clot properly. This can lead to problems with bleeding too much after an injury or surgery. You can also have sudden bleeding inside your body, such as in your joints, muscles, and organs.

Your blood contains many proteins called clotting factors that can help form clots to stop bleeding. People with hemophilia have low levels of one of these factors, usually either factor VIII (8) or factor IX (9). How severe the hemophilia is depends on the amount of factor in the blood. The lower the amount of the factor, the more likely it is that bleeding could happen and might lead to serious health problems.

There are several different types of hemophilia. The most common are:

• Hemophilia A (classic hemophilia), which is caused by a lack or decrease of clotting factor VIII (8)
• Hemophilia B (Christmas disease), which is caused by a lack or decrease of clotting factor IX (9)

Most types of hemophilia are inherited. They are caused by change in one of the genes (also called a mutation) that provides instructions for making the clotting factor proteins. The change may mean that the clotting proteins don't work properly or that they are missing altogether.

These genes are on the X chromosome. You may have one or two X chromosomes:

• People who are born male have one X chromosome (from the mother) and one Y chromosome (from the father). They can get hemophilia if their one X chromosome has the gene change.
• People who are born female have two X chromosomes, one from the father and one from the mother. They usually only get hemophilia if:
  • Both X chromosomes have the gene change OR
  • One X chromosome has the gene change and the other X chromosome is missing or inactive.

  People who are born female who have the gene change on one X chromosome are a "carrier" of hemophilia. Sometimes they may have some symptoms of hemophilia. They can pass the gene change on to their children.

Hemophilia that is not inherited is called acquired hemophilia. It is rare. It happens when your body makes specialized proteins called autoantibodies that attack and disable a clotting factor. This can happen because of pregnancy, immune system disorders, cancer, or allergic reactions to certain medicines. Sometimes the cause is unknown.

Hemophilia is much more common in people who were born male since they can get it with a change to the gene on one X chromosome. People who have a family history of hemophilia are also at higher risk.

The signs and symptoms of hemophilia are:

• Bleeding into the joints. This can cause swelling and pain or tightness in the joints. It often affects the knees, elbows, and ankles.
• Bleeding into the skin (which is bruising).
• Bleeding into the muscle and soft tissue, which can cause a build-up of blood in the area (called a hematoma).
• Bleeding of the mouth and gums, including bleeding that is hard to stop after you lose a tooth.
• Bleeding after circumcision.
• Bleeding after having shots, such as vaccinations.
• Bleeding in the head of an infant after a difficult delivery.
• Blood in the urine or stool.
• Frequent and hard-to-stop nosebleeds.

In some cases, severe hemophilia may cause bleeding in the brain. This may cause brain damage and can be life-threatening.

To find out if you have hemophilia, your health care provider will:

• Ask about your medical history, including your symptoms and other health conditions you may have.
• Ask about your family history, to find out if you have relatives who have or had hemophilia.
• Do a physical exam to look for signs of hemophilia, such as bruising.
• Do certain blood tests to show if your blood is clotting properly. If it does not, then you will have clotting factor tests to diagnose the cause of the bleeding disorder. These blood tests would show the type of hemophilia and the severity.

There is genetic testing for the factor VIII (8) and factor IX (9) genes. This testing may be used in people who have a family history of hemophilia to:

• Identify people who are carriers before they make decisions about pregnancy
• Test a fetus for hemophilia during pregnancy
• Test a newborn for hemophilia

The best way to treat hemophilia is to replace the missing clotting factor so that your blood can clot properly. This is usually done by injecting replacement clotting factor into a vein. The replacement clotting factor may be made from donated human blood. Or it may be made in a lab; this kind is called a recombinant clotting factor.

Replacement clotting factor can help treat a bleeding episode. In more severe cases of hemophilia, you might get the factor on a regular basis to prevent bleeding. You can learn how to inject the factor so that you can do it yourself at home.

There are other medicines to treat hemophilia. They may work by releasing factor VIII (8) from where it is stored in the body tissues, replacing the function of factor VIII (8), or preventing clots from breaking down.

If bleeding has damaged your joints, physical therapy may help them function better.

Good quality medical care from healthcare professionals who know a lot about the disorder can help prevent some serious problems. Often the best choice for care is to visit a hemophilia treatment center (HTC).

Centers for Disease Control and Prevention

Your toenails and fingernails protect the tissues of your toes and fingers. They are made up of layers of a hardened protein called keratin, which is also in your hair and skin. The health of your nails can be a clue to your overall health. Healthy nails are usually smooth and consistent in color. Specific types of nail discoloration and changes in growth rate can be signs of lung, heart, kidney, and liver diseases, as well as diabetes and anemia. White spots and vertical ridges are harmless.

Nail problems that sometimes require treatment include:

• Bacterial and fungal infections
• Ingrown nails
• Tumors
• Warts

Keeping your nails clean, dry, and trimmed can help you avoid some problems. Do not remove the cuticle, which can cause infection.

Your nose is important to your health. It filters the air you breathe, removing dust, germs, and irritants. It warms and moistens the air to keep your lungs and tubes that lead to them from drying out. Your nose also contains the nerve cells that help your sense of smell. When there is a problem with your nose, your whole body can suffer. For example, the stuffy nose of the common cold can make it hard for you to breathe, sleep, or get comfortable.

Many problems besides the common cold can affect the nose. They include:

• Deviated septum - a shifting of the wall that divides the nasal cavity into halves
• Nasal polyps - soft growths that develop on the lining of your nose or sinuses
• Nosebleeds
• Rhinitis - inflammation of the nose and sinuses sometimes caused by allergies. The main symptom is a runny nose.
• Nasal fractures, also known as a broken nose