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Bruising

Dec 05, 20232 min read

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🌱來自: snippets

Bruising

Easy bruising for how long

  • Ask about present complain: how long how freqeutnly has easy brusing occurred? Is it ecchymoses or purpura? How extensive are bruises? Are they located in areas subject to trauma (limbs) or pressure (waist band)? Do petechiae occur? Are bruises painful? How long to resolution? How many currently?
  • Associated symptoms: gum bleeding? prolonged bleeding after skin trauma, dental extraction, childbirth, or surgery? Epistaxis? Menorrhagia? Joint or soft tissue hematoma, hematemesis, melaena, hemoptysis, or hematuria? Is there a history of poor wound healing?
  • Family history:
  • Drug history: aspirin or anticoagulant therapy? medication or supplements
  • Systemic enquiry: hemorrhagic tedency such as hepatic, renal failure, malabsorption, leukemia, connective tissue disorder, or amyloid
  • PE: senile purpura, True purpura is easily D/D from erythema and telangiectasis by pressuer. Splenomegaly or lymphadenpathy in leukemia, s/s of hepatic failure, telangiectasia in Osler-Rendu-Weber syndrome or hyperextensible joints and apper-thin scars in Ehlers-Danlos syndrome. @ Check coagulatory function (CBC-DC, PB SMEAR, APTT/PT, TT/fibrinogen/bleeding time) and basic lab and CXR. @ D/D -Common diagnosis: simple easy bruising; trauma; senile purpura -Hemostatic defects: thrombocytopenia; plt function defects; coagulopathy (rarely) -Vascular defects: corticosteroid excess; collagen disease; uremia; dkysproteinemia; anaphylactoid purpura; Ehlers-Danlos syndrome; scurvey; vasculitis

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