Bruises, or contusions, are common injuries resulting from trauma to soft tissues and blood vessels under the skin. They are characterized by pain, swelling, and discoloration.
Causes:
- Trauma: Blunt force trauma is the most common cause, leading to ruptured blood vessels under the skin.
- Medical Conditions: Certain conditions like bleeding disorders (e.g., hemophilia) or illnesses causing platelet dysfunction can lead to easy bruising.
- Medications: Blood thinners (anticoagulants) and antiplatelet agents can increase the likelihood of bruising.
- Age-Related Changes: Thinner skin and weakened blood vessels in elderly individuals can result in more frequent bruising.
- Vitamin Deficiencies: Especially vitamin C deficiency.
Diagnosis:
- Clinical Evaluation: Typically, the history of the injury and physical examination are sufficient for diagnosis.
- Blood Tests: If a bleeding disorder or other underlying condition is suspected (e.g., FBC, INR, aPTT).
- Imaging Tests: Rarely needed, but may be considered in cases of severe trauma to rule out deeper tissue damage or fractures.
Differential Diagnosis:
- Hematoma: A larger collection of blood outside of a blood vessel, often more raised than a bruise.
- Deep Vein Thrombosis (DVT): A blood clot in a deep vein, usually in the leg, can initially appear similar to a bruise.
- Vasculitis: Inflammation of the blood vessels, which can cause skin discoloration.
- Abuse or Non-Accidental Injury: Especially in children or vulnerable adults.
- Spontaneous Bleeding: Due to blood disorders or other systemic illnesses.
Management:
- Rest and Protection: Avoid further injury to the affected area.
- Cold Compress: Apply ice wrapped in a cloth to reduce swelling and pain immediately after injury.
- Elevation: Elevate the bruised area, if possible, to reduce swelling.
- Pain Relief: Over-the-counter pain relievers like acetaminophen; avoid NSAIDs as they may worsen bleeding.
- Warm Compress: Applying heat after 48 hours to increase blood flow and aid healing.
When to Seek Medical Attention:
- If bruises appear spontaneously without known trauma.
- If bruising is frequent or excessive.
- If bruising is accompanied by severe pain or swelling.
- If there are signs of infection, such as redness, warmth, or pus.
- If there are concerns about blood disorders or if taking blood-thinning medications.
Prevention:
- Protective gear during sports or activities.
- Careful handling of individuals with known bleeding tendencies.
- Regular review of medications that may contribute to easy bruising.
Follow-Up:
In cases of unusual, frequent, or unexplained bruising, or if there are concerns about an underlying condition, further evaluation and long-term follow-up may be necessary.