Bruising – Excluding NAI

Bruising in the elderly is a common presentation. This chart on A4Medicine can be helpful in data gathering and plan further investigations based on clinical suspicion. The clinician should consider Vitamin C deficiency as an easily treatable cause of bruising.Perio-orbital bruising can be a presentation of Nueroblastoma in children and should alert the clinician to examine the child further. A list of possible first line investigations is also available. Senile purpura is a common cause of bruising in the elderly.

Common problem Bruise - haematoma which forms due to bleeding under intact skin in s/c tissue due to vascular damage or injury Damage that causes bleeding can be○ trauma external to vessel○ internal to the vessel○ vessel itself Colour changesRed discoloration → purple → brownish yellow Usually disappears within 2-3 weeks A detailed history often provides sufficient information Bruising is reported ↑ frequently by women than men

History-What does the patient mean Circumstances -spontaneous or following trauma ? dental procedures Age of manifestation General overall health○ past medical history○ past surgical history- all operations , dental extractions etc Type of bleeding ie epistaxis , menorrhagia or hematomas Any petechiae or purple patches ( purpura ) with bruises Nutritional status Alcohol...