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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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The presence of bruises may be seen in patients with platelet or coagulation disorders, or those who are being treated with an anticoagulant. Unexplained bruising may be a warning sign of child abuse, domestic abuse, or serious medical problems such as leukemia or meningoccocal infection. Unexplained bruising can also indicate internal bleeding or certain types of cancer. Long-term glucocorticoid therapy can cause easy bruising. Bruising present around the navel (belly button) with severe abdominal pain suggests acute pancreatitis. Connective tissue disorders such as Ehlers-Danlos syndrome may cause relatively easy or spontaneous bruising depending on the severity.
During an autopsy, bruises accompanying abrasions indicate the abrasions occurred while the individual was alive, as opposed to damage incurred post mortem.
Bruise shapes may correspond directly to the instrument of injury or be modified by additional factors. Bruises often become more prominent as time lapses, resulting in additional size and swelling, and may grow to a large size over the course of the hours after the injury that caused the bruise was inflicted. As stated above, bruising present in a different location than the site of impact is called "ecchymosis" and generally occurs when the tissue at the site of injury is loose, allowing blood to travel under the skin to another location due to gravity or other forces, such as in a black eye.
- Condition and type of tissue: In soft tissues, a larger area is bruised than would be in firmer tissue due to ease of blood to invade tissue.
- Age: elderly skin and other tissues are often thinner and less elastic and thus more prone to bruising.
- Gender: More bruising occurs in females due to increased subcutaneous fat.
- Skin tone: Discoloration caused by bruises is more prominent in lighter complexions.
- Diseases: Coagulation, platelet and blood vessel diseases or deficiencies can increase bruising due to more bleeding.
- Location: More extensive vascularity causes more bleeding. Areas such as the arms, knees, shins and the facial area are especially common bruise sites.
- Forces: Greater striking forces cause greater bruising.
- Genes: Despite having completely normal coagulation factors, natural redheads have been shown to bruise more, although this may just be due to greater visibility on commonly associated lighter complexion.
Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimeter in size or larger, and are therefore larger than petechiae ( less than 2 millimeters in diameter) or purpura (2 millimeters to 1 centimeter in diameter). Ecchymoses also have a more diffuse border than other purpura.
There are many causes of subcutaneous hematomas including ecchymoses. Coagulopathies such as Hemophilia A may cause ecchymosis formation in children. The medication betamethasone can have the adverse effect of causing echhymosis.
Presentation may be subtle; people with mild contusion may have no symptoms at all. However, pulmonary contusion is frequently associated with signs (objective indications) and symptoms (subjective states), including those indicative of the lung injury itself and of accompanying injuries. Because gas exchange is impaired, signs of low blood oxygen saturation, such as low concentrations of oxygen in arterial blood gas and cyanosis (bluish color of the skin and mucous membranes) are commonly associated. Dyspnea (painful breathing or difficulty breathing) is commonly seen, and tolerance for exercise may be lowered. Rapid breathing and a rapid heart rate are other signs. With more severe contusions, breath sounds heard through a stethoscope may be decreased, or rales (an abnormal crackling sound in the chest accompanying breathing) may be present. People with severe contusions may have bronchorrhea (the production of watery sputum). Wheezing and coughing are other signs. Coughing up blood or bloody sputum is present in up to half of cases. Cardiac output (the volume of blood pumped by the heart) may be reduced, and hypotension (low blood pressure) is frequently present. The area of the chest wall near the contusion may be tender or painful due to associated chest wall injury.
Signs and symptoms take time to develop, and as many as half of cases are asymptomatic at the initial presentation. The more severe the injury, the more quickly symptoms become apparent. In severe cases, symptoms may occur as quickly as three or four hours after the trauma. Hypoxemia (low oxygen concentration in the arterial blood) typically becomes progressively worse over 24–48 hours after injury. In general, pulmonary contusion tends to worsen slowly over a few days, but it may also cause rapid deterioration or death if untreated.
The symptoms of a cerebral contusion (bruising on the brain) depend on the severity of the injury, ranging from minor to severe. Individuals may experience a headache; confusion; sleepiness; dizziness; loss of consciousness; nausea and vomiting; seizures; and difficulty with coordination and movement. They may also have difficulty with memory, vision, speech, hearing, managing emotions, and thinking. Signs depend on the contusion's location in the brain.
A hickey, hickie or love bite in British English, is a bruise or bruise-like mark caused by the kissing or sucking of the skin, usually on the neck or arm. While biting might be part of giving a hickey, sucking is sufficient to burst small superficial blood vessels under the skin.
The origin of the word is from its earlier meaning of "pimple, skin lesion" (c. 1915); perhaps a sense extension and spelling variation from the earlier word meaning "small gadget, device; any unspecified object" which has a unknown origin (1909).
Hickeys typically last from 5 to 12 days and may be treated in the same way as other bruises. Ways to reduce the appearance of hickeys include icing recent hickeys to reduce swelling, rubbing them with a chilled spoon to remove the bruise, and applying a warm compress to older hickeys to dilate vessels and promote blood flow. They can be covered with a concealer or powder corresponding to the sufferer's skin tone, or a fake tan. Alternatively, articles of clothing such as scarves, snoods, turtle necks, or sleeves may be used to conceal hickeys.
Pulmonary contusion and laceration are injuries to the lung tissue. Pulmonary laceration, in which lung tissue is torn or cut, differs from pulmonary contusion in that the former involves disruption of the macroscopic architecture of the lung, while the latter does not. When lacerations fill with blood, the result is pulmonary hematoma, a collection of blood within the lung tissue. Contusion involves hemorrhage in the alveoli (tiny air-filled sacs responsible for absorbing oxygen), but a hematoma is a discrete clot of blood not interspersed with lung tissue. A collapsed lung can result when the pleural cavity (the space outside the lung) accumulates blood (hemothorax) or air (pneumothorax) or both (hemopneumothorax). These conditions do not inherently involve damage to the lung tissue itself, but they may be associated with it. Injuries to the chest wall are also distinct from but may be associated with lung injuries. Chest wall injuries include rib fractures and flail chest, in which multiple ribs are broken so that a segment of the ribcage is detached from the rest of the chest wall and moves independently.
Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called multiple petechial hemorrhages or multifocal hemorrhagic contusion. Caused by shearing injuries at the time of impact, these contusions occur especially at the junction between grey and white matter and in the upper brain stem, basal ganglia, thalamus and areas near the third ventricle. The hemorrhages can occur as the result of brain herniation, which can cause arteries to tear and bleed. A type of diffuse brain injury, multiple petechial hemorrhages are not always visible using current imaging techniques like CT and MRI scans. This may be the case even if the injury is quite severe, though these may show up days after the injury. Hemorrhages may be larger than in normal contusions if the injury is quite severe. This type of injury has a poor prognosis if the patient is comatose, even with no apparent causes for the coma.
Signs one may have a broken rib are:
- Pain on inhalation
- Swelling in chest area
- Bruise in chest area
- Increasing shortness of breath
- Coughing up blood (rib may have damaged lung)
Because children have more flexible chest walls than adults do, their ribs are more likely to bend than to break; therefore the presence of rib fractures in children is evidence of a significant amount of force and may indicate severe thoracic injuries such as pulmonary contusion. Rib fractures are also a sign of more serious injury in elderly people.
People tend to gain weight in lipedematous areas and lose it in non-lipedematous areas, though there are cases where weight loss has resulted in improvement of the condition. Obese lipedema patients who undergo bariatric surgery lose fat primarily from the waist up. While lipedema presents itself in various ways, diagnosis is possible as early as pre-puberty when inner thigh pads present and at any age when fat gathers and drapes at knees.
Symptoms of lipedema include disproportionately large, column-like legs, legs unusually large to the knees, disproportionate hips, stomach or buttocks. As lipedema progresses, patients become increasingly heavy in the lower body. The additional, expanding fat cells interfere with the pathways of lymphatic vessels, and patients can develop secondary lymphedema, a condition known as lipo-lymphedema. Many lipedema patients cannot tolerate the compression garments associated with conventional lymphedema treatment because the underlying lipedematous fat is very painful, and those patients therefore are at risk for the side effects of uncontrolled lymphedema, including recurring blood infections and fibrosis. If not kept in check through a healthy lifestyle, lipo-lymphedema can worsen, and patients will become progressively less mobile.
Rib fractures can occur with or without direct trauma during recreational activity. Cardiopulmonary resuscitation (CPR) has also been known to cause thoracic injury, including but not limited to rib and sternum fractures. They can also occur as a consequence of diseases such as cancer or rheumatoid arthritis. While for elderly individuals a fall can cause a rib fracture, in adults automobile accidents are a common event for such an injury.
Signs and symptoms include immediate pain, bruising and swelling, obvious weakness, spasms and a rapid decline in the hip / leg function, resulting in a decreased range of motion.
Lipedema is a disorder where there is enlargement of both legs due to deposits of fat under the skin. Typically it gets worse over time, pain may be present, and people bruise easily. In severe cases the trunk and upper body may be involved.
The cause is unknown but is believed to involve genetics and hormonal factors. It often runs in families. Risk factors include being overweight or obese. Other conditions that may present similarly include obesity, lipohypertrophy, chronic venous insufficiency, and lymphedema.
A number of treatments may be useful including physiotherapy and exercise. While surgery can remove fat tissue it can also damage lymphatic vessels. Treatment does not typically result in complete resolution. It is estimated to affect up to 11% of women. Onset is typically during puberty, pregnancy, or menopause.
Two of the symptoms of flail chest are chest pain and shortness of breath.
The characteristic paradoxical motion of the flail segment occurs due to pressure changes associated with respiration that the rib cage normally resists:
- During normal inspiration, the diaphragm contracts and intercostal muscles pull the rib cage out. Pressure in the thorax decreases below atmospheric pressure, and air rushes in through the trachea. The flail segment will be pulled in with the decrease in pressure while the rest of the rib cage expands.
- During normal expiration, the diaphragm and intercostal muscles relax increasing internal pressure, allowing the abdominal organs to push air upwards and out of the thorax. However, a flail segment will also be pushed out while the rest of the rib cage contracts.
The constant motion of the ribs in the flail segment at the site of the fracture is extremely painful, and, untreated, the sharp broken edges of the ribs are likely to eventually puncture the pleural sac and lung, possibly causing a pneumothorax. The concern about "mediastinal flutter" (the shift of the mediastinum with paradoxical diaphragm movement) does not appear to be merited. Pulmonary contusions are commonly associated with flail chest and that can lead to respiratory failure. This is due to the paradoxical motions of the chest wall from the fragments interrupting normal breathing and chest movement. Typical paradoxical motion is associated with stiff lungs, which requires extra work for normal breathing, and increased lung resistance, which makes air flow difficult. The respiratory failure from the flail chest requires mechanical ventilation and a longer stay in an intensive care unit. It is the damage to the lungs from the flail segment that is life-threatening.
A hip pointer is a contusion on the pelvis caused by a direct blow or a bad fall at an iliac crest and / or hip bone and a bruise of the abdominal muscles (transverse and oblique abdominal muscles). Surrounding structures such as the tensor fasciae latae and the greater trochanter may also be affected. The injury results from the crushing of soft tissue between a hard object and the iliac crest. Contact sports are a common cause of this type of injury, most often in football and hockey in general due to improper equipment and placement. The direct impact can cause an avulsion fracture where a portion of bone is removed by a muscle. The pain is due to the cluneal nerve that runs right along the iliac crest, which makes this a very debilitating injury. This pain can be felt when walking, laughing, coughing or even breathing deeply.
A hip pointer bruise usually causes bleeding into the hip abductor muscles, which move legs sideways, away from the midline of the body. This bleeding into muscle tissue creates swelling and makes leg movement painful. The hematoma that occurs can potentially build on the femoral nerve or lateral cutaneous of the femur. This injury usually lasts from one to six weeks, depending on the damage. In most cases, patients recover completely. A full assessment should be undertaken to rule out the possibility of damage to abdominal organs.
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath.
It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. The number of ribs that must be broken varies by differing definitions: some sources say at least two adjacent ribs are broken in at least two places, some require three or more ribs in two or more places. The flail segment moves in the opposite direction to the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called "paradoxical breathing" is painful and increases the work involved in breathing.
Flail chest is usually accompanied by a pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation. Often, it is the contusion, not the flail segment, that is the main cause of respiratory problems in people with both injuries.
Surgery to fix the fractures appears to result in better outcomes.
Erythema nodosum is characterised by nodules (rounded lumps) below the skin surface, usually on the shins. These subcutaneous nodules can appear anywhere on the body, but the most common sites are the shins, arms, thighs, and torso. Each nodule typically disappears after around two weeks, though new one may continue to form for up to six or eight weeks. A new nodule usually appears red and is hot and firm to touch. The redness starts to fade and it gradually becomes softer and smaller until it disappears. Each nodule usually heals completely without scarring over the course of about two weeks. Joint pain and inflammation sometimes continues for several weeks or months after the nodules appear.
Less common variants of erythema nodosum include:
- Ulcerating forms, seen in Crohn's disease
- Erythema contusiforme, when a subcutaneous hemorrhage (bleeding under the skin) occurs with a erythema nodosum lesion, causing the lesion to look like a contusion (bruise)
- Erythema nodosum migrans (also known as subacute nodular migratory panniculitis), a rare form of chronic erythema nodosum characterized by asymmetrical nodules that are mildly tender and migrate over time.
The first signs of erythema nodosum are often flu-like symptoms such as a fever, cough, malaise, and aching joints. Some people also experience stiffness or swelling in the joints and weight loss.
Metatarsalgia, literally metatarsal pain and colloquially known as a stone bruise, is any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals.
Metatarsalgia is most often localized to the first metatarsal head – the ball of the foot just behind the big toe. There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to "hypermobility of the first ray" – metatarsal bone and medial cuneiform bone behind it – both of which result in excess pressure being transmitted into the second metatarsal head.
Onychomadesis is a periodic idiopathic shedding of the nails beginning at the proximal end, possibly caused by the temporary arrest of the function of the nail matrix.One cause in children is hand foot and mouth disease. This generally resolves without complication.
Onychomadesis can also occur if the nail is damaged or suffers a loss of blood supply, i.e. due to a bruise. The nailbed turns black, and the nail drops off shortly afterwards. It takes around 6 to 12 months to regrow.
Because the brain swelling that produces these symptoms is often a slow process, these symptoms may not surface for days to weeks after the injury.
Common symptoms of a closed-head injury include:
- headache
- dizziness
- nausea
- slurred speech
- vomiting
Severe head injuries can lead to permanent vegetative states or death, therefore being able to recognize symptoms and get medical attention is very important. Symptoms of a severe closed-head injury include:
- coma
- seizures
- loss of consciousness
A blunt cardiac injury is an injury to the heart as the result of blunt trauma, typically to the anterior chest wall. It can result in a variety of specific injuries to the heart, the most common of which is a myocardial contusion, which is a term for a bruise (contusion) to the heart after an injury. Other injuries which can result include septal defects and valvular failures. The right ventricle is thought to be most commonly affected due to its anatomic location as the most anterior surface of the heart. Myocardial contusion is not a specific diagnosis and the extent of the injury can vary greatly. Usually, there are other chest injuries seen with a myocardial contusion such as rib fractures, pneumothorax, and heart valve injury. When a myocardial contusion is suspected, consideration must be given to any other chest injuries, which will likely be determined by clinical signs, tests, and imaging.
The signs and symptoms of a myocardial contusion can manifest in different ways in people which may also be masked by the other injuries. It is recommended that people with blunt chest trauma receive an electrocardiogram to determine if there are any irregularities with cardiac function. The presentation of an abnormal heart rhythm after sustaining a myocardial contusion can be delayed for up to 72 hours.
Eye injury and head trauma may also coincide with a black eye. Some common signs of a more serious injury may include:
- Double vision
- Loss of sight and/or fuzzy vision could occur
- Loss of consciousness
- Inability to move the eye or large swelling around the eye
- Blood or clear fluid from the nose or the ears
- Blood on the surface of the eye itself or cuts on the eye itself
- Persistent headache or migraine