9 Types of Bruises and Everything You Should Know About

A contusion, commonly known as a bruise, manifests as a visible discoloration on the skin, resulting from subdermal hemorrhaging due to broken blood vessels. While often a consequence of physical trauma, bruises can also occur without injury. Characterized by the absence of external bleeding, bruises present a spectrum of shades—including black, purple, brown, blue, or yellow—depending on their age and severity. Although anyone can sustain a bruise, certain individuals may be more susceptible to bruising than others.

1. Hematoma

A hematoma typically develops as a result of an injury, leading to a collection of blood beneath the skin that may feel firm, uneven, or compressible. While hematomas may appear concerning due to their appearance and texture, they are generally not dangerous and do not lead to blood clots. The condition often resolves naturally within a span of one to four weeks without requiring significant medical intervention.

2. Purpura

Purpura refers to small, purple-colored lesions ranging from 4 to 10 mm across that manifest on the skin or mucous membranes, such as within the mouth and throat. These lesions result from the leakage of minute blood vessels, typically presenting as numerous pinpoint dots. Purpura may indicate an underlying medical issue, such as thrombocytopenia (a reduction in platelet count), and might arise from a variety of causes including congenital conditions, adverse drug reactions, or nutritional deficiencies.

3. Petechiae

Petechiae are minute hemorrhagic spots under the skin, closely resembling purpura but distinguished by their size, with petechiae being less than 4 mm in diameter. These small, flat spots are neither painful nor itchy, and unlike rashes, they do not change color when pressure is applied. Their occurrence can be attributed to a variety of factors including thrombocytopenia (a reduced platelet count), the use of certain medications, or more severe underlying conditions such as endocarditis, systemic infections, or leukemia. It is critical to accurately differentiate petechiae from common rashes for appropriate medical evaluation and treatment.

4. Senile Purpura

Age-related changes in the skin can lead to a condition known as senile purpura, characterized by bruising primarily on the hands and forearms of older adults. This occurs due to diminished skin density and increased fragility of blood vessels in the elderly. Such bruises manifest as dark purple patches that may arise without a clear cause and typically resolve within a week, although they can leave a lasting brownish stain on the skin.

5. Black Eye

A black eye typically results from facial trauma and is characterized by bruising around the eye. While most black eyes are relatively benign and heal on their own, they can occasionally indicate more severe injuries such as internal ocular damage, orbital fractures, or even cranial fractures. Prompt medical attention is warranted if additional symptoms like double vision, bilateral bruising (around both eyes), or epistaxis (nosebleeds) accompany the black eye, as these can be signs of a more critical condition.

6. Muscle Contusions

A muscle contusion refers to a bruise that affects the tissues and fibers of the muscle due to a direct impact, distinct from bruises that merely discolor the skin. It is a prevalent sports-related injury. Such trauma can lead to significant swelling and pain, resulting in restricted motion and diminished capacity to bear weight on the affected joint. In more severe cases, substantial hematomas may develop in the injured region.

7. Subcutaneous Bruises

Bruises can be categorized according to their location on the body. Subcutaneous bruises, those occurring just below the skin, typically begin as a red discoloration, transitioning through blue and purple shades, and eventually turning green or yellow as they heal. To mitigate such bruising, immediate application of ice to the affected area and keeping it elevated can be beneficial in reducing the severity and spread of bruising.

8. Intramuscular Bruises

Intramuscular bruises, commonly referred to as muscle contusions, are prevalent among male athletes engaged in highly physical sports such as rugby, football, soccer, and ice hockey. These injuries occur beneath the skin within the muscle tissue and are categorized by varying degrees of severity. While serious complications such as compartment syndrome or rhabdomyolysis are unusual, they are potential risks associated with severe bruising and should be monitored carefully.

9. Periosteal Bruises

Bone bruises, also known as periosteal bruises or microfractures, represent a type of injury where the bone tissue is damaged but not fully broken. Although these injuries are not as critical as fractures, they can cause significant discomfort and pain. Bone bruises can result from a variety of incidents such as vehicular accidents, sports-related traumas, falls, or sprains, leading to the accumulation of blood beneath the periosteum—a thin tissue layer enveloping the bone—or internal bleeding within the bone itself, contributing to swelling at the site of injury.

10. Who Is Prone to Bruising?

Bruising susceptibility varies among individuals due to factors such as genetics, diet, and coordination—affecting how frequently one might sustain minor injuries. Notably, women tend to bruise more easily than men, and the likelihood of bruising increases with age, as older adults have more fragile skin and vascular structures. Medical professionals are attentive to the occurrence of frequent bruising, which can be an important indicator of potential abuse, warranting special vigilance in the care of children and the elderly.

11. Medication

Certain pharmaceuticals may increase the likelihood of bruising. Commonly used over-the-counter medications such as aspirin, ibuprofen, and naproxen have been known to influence clotting times. This is also true for prescription blood thinners, including warfarin and heparin. Furthermore, specific antidepressants, steroids, and certain antibiotics may interfere with the clotting process. It is also important to note that the application of topical steroid creams may lead to skin thinning, which could result in a heightened risk of bruising.

For illustrative purposes, a visual representation of such medications and their effects can be found through various educational resources.

12. When to See a Doctor

Bruising is a natural response to injury, and in most cases, bruises heal independently without intervention. However, persistent or excessive bruising could indicate an underlying medical condition. Some symptoms to be aware of include more frequent bruising than usual or bruises that occur without any known cause. These symptoms can be associated with various health issues, such as thrombocytopenia (low platelet count), functional platelet disorders, or coagulation anomalies. If you are experiencing unusual bruising patterns, it is advisable to consult a healthcare professional for evaluation and appropriate management.

15 Symptoms of Urinary Tract Infection

Urinary tract infections (UTIs) can involve any part of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are more prevalent among women, with roughly 50% experiencing at least one UTI in their lifetime. The anatomical difference, notably the shorter length of the female urethra, contributes to this increased susceptibility, as it allows bacteria easier access to the urinary tract. However, with proper medical diagnosis, uncomplicated UTIs can be effectively treated with prescription medications, and the severity of the infection can often be assessed through its symptoms.

Burning Urination

A primary symptom of a urinary tract infection (UTI) is a burning sensation during urination. Urine flows through the ureters towards elimination. In some cases, E. coli, ordinarily found in the intestines, may migrate from the perianal region to the urinary tract, particularly during sexual activity or improper post-defecation hygiene. This is a pertinent reason for the recommendation that women maintain a front-to-back wiping technique to reduce the risk of contamination. Once the bacteria colonize the ureters, they provoke an inflammatory response. Consequently, the passage of urine over the inflamed tissue can result in discomfort and pain.

Frequent Urination

Individuals experiencing urinary tract infections (UTIs) often exhibit an increased frequency of urination. This is typically because the infection prevents the bladder from fully emptying. Frequent urination can also be caused by obstruction, inflammation, other infections, or additional health conditions. A prominent symptom of UTIs is an urgent, persistent need to urinate, even if the amount expelled is minimal. Patients may also encounter discomfort due to a burning sensation during urination.

Back Pain

A notable indication of a urinary tract infection (UTI) is a persistent lower back pain, often mistaken for muscle soreness. Such discomfort may not respond to common over-the-counter analgesics. If experiencing flank pain, it may suggest that the infection has extended to the kidneys—wherein targeted antibiotic therapy is typically required for relief. To alleviate symptoms temporarily, it is advisable to rest, stay hydrated, and limit physical activity.

Cloudy or Smelly Urine

A urinary tract infection (UTI) can alter the characteristics of the urine in those affected. Common changes include decreased urine output despite an increased urge to urinate. The appearance of the urine may also become cloudy and emit an unpleasant odor throughout the course of the infection. It's important to monitor these symptoms as they may indicate the presence of a UTI.

Blood in Urine

Occasionally, the excreted fluid may exhibit visible pus or a darker hue due to the presence of blood. The appearance of blood in urine can indicate a severe infection or other medical conditions affecting the urinary system. Such infections, if severe, have the potential to lead to complications including damage to the kidneys.

Genital Pain

Individuals may experience persistent pelvic and genital discomfort unrelated to urination, often described as a continuous, dull ache that cannot be overlooked. Initiating treatment is expected to alleviate this pain. Should there be no improvement within a two days of starting treatment, it is imperative to seek further evaluation from a healthcare provider. While discomfort can be a normal reaction to various conditions, enduring pain without a clear cause should be taken as a sign that medical assessment is warranted to identify and address any underlying issues.

Fever

An infection of the upper urinary tract often presents with fever and chills, symptoms common to many other conditions, which may complicate timely, accurate diagnosis. It is critical for patients experiencing these alongside other urinary tract infection (UTI) symptoms to comprehensively communicate their health status to their healthcare provider. This ensures accurate diagnosis and the formulation of an effective treatment strategy.

Nausea

When a urinary tract infection (UTI) progresses to the stage where kidney function is affected, individuals may experience persistent nausea, which can occur with or without food intake. This nausea may sometimes escalate to vomiting. Gradual consumption of bland foods might mitigate the worsening of nausea, but it is generally insufficient to completely alleviate the sensation.

Vomiting

While some individuals experiencing urinary tract infections (UTIs) may encounter nausea, leading to vomiting, persistent nausea despite treatment warrants further attention. This symptom could signal a more serious infection, potentially necessitating an alternative therapeutic approach to achieve complete recovery.

Discharge

Urinary tract infections may result in a discharge that varies from normal urethral secretions regarding appearance, texture, and odor, affecting both male and female patients. Typically, this discharge resolves after recovery; however, should it continue, further medical evaluation is advised. It is imperative for individuals presenting with abnormal discharge to undergo diagnostic testing to exclude other possible conditions, such as yeast infections or sexually transmitted diseases.

Pain During Intercourse

A urinary tract infection (UTI) often exacerbates the sensitivity of the urethra, as it can cause significant irritation and inflammation. This heightened sensitivity can make sexual intercourse particularly uncomfortable, as the urethra and surrounding tissues, susceptible to friction, can lead to increased discomfort or pain when inflamed. For women, this pain may be exacerbated due to pressure exerted on the bladder by the internal vaginal walls during sexual activity. Furthermore, sexual activity during a UTI episode may lead to the introduction of additional bacteria into the urethra, potentially aggravating the infection and increasing the level of pain experienced.

Leakage

During micturition, the central nervous system communicates with musculature surrounding the urinary tract, orchestrating bladder contractions and facilitating the expulsion of urine through the urethra. In the event that pathogenic bacteria infiltrate from the urethral entrance to the bladder, the resultant inflammation can lead to increased pressure within the bladder. This may precipitate involuntary urine leakage, independent of the regulatory cues typically issued by the body.

Fatigue

Experiencing persistent fatigue may be indicative of a urinary tract infection (UTI). This tiredness, which can occur in conjunction with other UTI symptoms, might stem from the body's immunological response as it combats the invasive bacteria. Such an ongoing defensive process can result in a general feeling of weariness and reduced energy levels.

Confusion

A urinary tract infection (UTI) has the potential to impair cognitive functions, particularly leading to confusion and challenges in concentration. In older individuals, these symptoms may be more severe and can indicate a progression of the infection to the kidneys. It's worth noting that elder adults may not exhibit traditional symptoms such as fever, and their inability to clearly communicate their discomfort can complicate the diagnosis of UTIs in this demographic. Therefore, if there is an onset of mental disorientation accompanied by typical UTI indicators, it is crucial to seek immediate medical consultation to address the condition effectively.

Feeling Cold or Shivering

An atypical and concerning symptom of a urinary tract infection (UTI) is experiencing chills or severe shivering despite being in a warm environment; these symptoms are referred to as rigors. Rigors may indicate that the UTI has evolved into a systemic infection. Prompt medical attention is critical if rigors are observed in conjunction with high fever, nausea, vomiting, low blood pressure, pain in the back or side (flank pain), rapid heart rate, increased breathing rate, changes in mental state, or an absence of urination for over 12 hours. These conditions may require immediate treatment to prevent any severe complications.

Insights Into Hepatitis E Infections

Hepatitis refers to liver inflammation, which can be attributed to various factors including infectious agents, excessive alcohol consumption, usage of certain medications, or autoimmune disorders. The condition is categorized into five primary types, designated as hepatitis A, B, C, D, and E, commonly abbreviated as HAV, HBV, HCV, HDV, and HEV. Hepatitis E is particularly prevalent in regions with limited access to clean drinking water and adequate sanitation, such as parts of Asia, Africa, the Middle East, Central America, and Mexico. In developed nations, HEV is relatively rare and diagnoses are typically associated with individuals who have recently visited endemic areas.

1. Definition of Hepatitis E

Hepatitis E, a condition caused by a single-stranded RNA virus, affects over 20 million individuals globally each year as per the World Health Organization. The primary mode of transmission is through the consumption of contaminated water. The virus propagates by entering the host's gastrointestinal tract and is excreted through feces. The illness typically resolves without medical intervention within two to six weeks, and most patients do not suffer severe complications, with a low mortality rate. Nevertheless, a small percentage of individuals may experience acute liver failure (ALF), a serious and potentially fatal condition.

2. The Unique Characteristics of HEV

Extensive research has determined that four specific genotypes of hepatitis E (HEV) are pathogenic in humans, each presenting unique epidemiological and clinical features distinct from other forms of hepatitis, with notable variations across geographical regions. Genotype 1 is commonly associated with large-scale outbreaks linked to water contamination or inadequate sanitation, prevalently in Asia and Africa. Genotype 2 appears sporadically, with cases documented in Mexico and West Africa. High-risk areas for HEV transmission include refugee camps and densely populated regions, especially following natural disasters. In contrast, genotype 4, often transmitted through contaminated food, is mainly found in China, Taiwan, Japan, and Europe, though it rarely leads to outbreaks. Developed countries report isolated incidents of genotype 3, which is also food-borne. This research underscores the need for region-specific surveillance and control measures to address the diverse transmission modes and risks associated with the different HEV genotypes.

3. Transmission of Hepatitis E

Hepatitis E virus (HEV) genotypes 1 and 2 are known to exclusively infect humans, generally transmitted via consumption of fecally contaminated water. These genotypes are often responsible for widespread acute hepatitis E outbreaks in developing regions, frequently associated with continuous exposure to infected groundwater. In contrast, genotypes 3 and 4 are linked to foodborne outbreaks in developing countries, while also causing occasional cases in more developed nations. Additionally, there is evidence of HEV transmission through blood transfusions in locales where the virus is commonly found within the population. Current research indicates that hepatitis E is not spread through needle sharing or sexual intercourse; however, there exists a potential risk of transmission through oral-anal contact.

4. Animal Transmission of Hepatitis E

Recent studies have established the presence of hepatitis E virus (HEV) genotypes 3 and 4 in wildlife such as boars and deer, as well as in commercial pork products. The research suggests that consumption of these meats, particularly when inadequately cooked, presents a risk for sporadic HEV transmission to humans. This risk is also observed among individuals who handle and process deer meat, with a certain proportion of hepatitis E cases attributed to such exposure. Additionally, occupational contact with domestic pigs has been associated with HEV infection, given the close genetic relationship between human and swine HEV strains. The potential for HEV transmission extends to shellfish and rodents in some regions. Furthermore, investigations have detected anti-HEV antibodies in multiple animal species including cows, horses, sheep, rabbits, and birds, highlighting a wide host range for the virus.

5. Symptoms of Hepatitis E

Patients presenting with hepatitis E typically exhibit symptomatology that parallels that observed in other hepatitis forms, including fever, malaise, and fatigue. Jaundice, marked by a yellow discoloration of the skin or sclera, is also common and signals liver distress. Other manifestations may include anorexia, nausea, vomiting, abdominal discomfort, and joint pain. Clinicians may note hepatomegaly with tenderness on physical examination. Additionally, hepatitis E can be indicated by dark urine and clay-colored stools. Notably, research from the American Society of Tropical Medicine and Hygiene indicates a 28 percent prevalence of anemia among pregnant women with hepatitis E.

6. Higher Risk Groups

In lower-income countries, individuals aged 15 to 44 are identified as being at an elevated risk of contracting hepatitis E. The danger is particularly acute for those already suffering from liver disorders, as they are prone to more severe complications. Medical professionals categorize pregnant women afflicted with hepatitis E as highly susceptible to fulminant hepatitis, a life-threatening condition characterized by reduced liver size. Research indicates that the mortality rate for pregnant women contracting hepatitis E is approximately 30%. Moreover, malnutrition may exacerbate the susceptibility to hepatitis E infection.

7. Incubation and Infectiousness

Hepatitis E typically manifests symptoms between 15 to 60 days following exposure, with the duration of symptoms ranging from one to six weeks, and in some instances, lasting up to ten weeks. Initial viral shedding through feces can occur from the early stages of infection and continue for three to four weeks. Persons infected with hepatitis E are considered contagious from when symptoms appear up to 30 days; however, the precise infectious periods have yet to be determined through research.

8. Diagnosis

Diagnosing hepatitis E can be particularly complex when a patient's history does not include travel to or residence in regions where the infection is prevalent, as its symptoms are similar to other forms of viral hepatitis. Clinicians may conduct serological assays to detect IgM antibodies specific to hepatitis E in the blood to aid in diagnosis. Additionally, reverse transcription-polymerase chain reaction (RT-PCR) is utilized for the detection of hepatitis E virus RNA in stool or blood specimens. Although the U.S. Food and Drug Administration (FDA) has not formally approved diagnostics for hepatitis E, serologic testing is available through commercial research laboratories. Research is actively underway to refine and establish reliable diagnostic methods for hepatitis E.

9. Increased Chronic HEV Infections Within Specific Populations

Recent data from the Centers for Disease Control and Prevention indicate a discernible uptick in the incidence of chronic hepatitis and chronic liver disease stemming from hepatitis E infections. Notably, these complications are predominantly seen in patients inflicted with genotype 3 who are also undergoing immunosuppressive therapy post-organ transplantation. Adjusting the immunosuppressive medication dosages has proven effective in resolving the infection. Furthermore, chronic hepatitis E virus (HEV) infections have been identified in individuals with hematological malignancies and those who are HIV-positive, with antiviral treatments demonstrating efficacy in eliminating the infections.

10. Prevention and Treatment

As of the most recent updates, the United States has not approved a vaccine for hepatitis E, although research and vaccine development efforts are underway internationally. In the absence of a vaccine, the primary method of prevention lies in maintaining excellent hygiene, with a focus on the accessibility to and use of clean, potable water. Travelers to regions with higher incidences of HEV should ensure their water is purified before consumption. Additionally, all individuals, irrespective of their geographic location, are advised to thoroughly cook pork and practice careful handling of deer meat to reduce the risk of transmission. Professionals in frequent contact with animals, such as veterinarians and butchers, are particularly encouraged to employ preventive measures to safeguard against hepatitis E infection.