# Bruise? Hematoma? What the heck is this? **URL:** \ **Category:** Factual Questions\ **Created:** [March 16, 2003, 7:24pm UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822 "2003-03-16T19:24:38Z")\ **Posts on this page:** 9\ **Page:** 1
**Author:** ![Eats\_Crayons](https://avatars.discourse-cdn.com/v4/letter/e/278dde/32.png) [@Eats\_Crayons](https://boards.straightdope.com/u/Eats_Crayons)\ **Post date:** [March 16, 2003, 7:24pm UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/1 "2003-03-16T19:24:38Z")
Okay, so I think it’s some form of bruise, but there is no swelling. Our 74-yr-old (longtime alcoholic, and I mean _Alcoholic_ with a capital “A”) was staggering home from the pub, slipped on the ice and — according to witness reports — sorted of flipped and landed like a ragdoll on his back. Incredibly, the only injuries he suffered were to his hands from rapping them on the ground as he struggled like a turtle on his back, and a very nasty gash on his forehead — he’d smacked himself in the face with his cane. (He was so floppy-drunk he didn’t even try to catch himself and so didn’t get any injuries that you’d have expected - a sober 74-yr-old would’ve broken a wrist or something.) I’m curious about the ecchymosis in his hands. Even a very firm handshake will cause what looks like horrendous purple bruising. The entire back of his hand is a very _deep_ purple, but there is no pain or swelling. What the heck is this? (Alhough his cane split open his brow and left a line of cuts down his face, there’s no bruising on his face or anywhere else.) My recently departed granny also used to bruise very easily, but this doesn’t look the same. Is it simply the aging skin (and presumably ultra-thinned alcoholic blood?) A telltale sign of liver damage? I’m quite curious. And no, he will not be going to a doctor. :rolleyes: The only way we would ever be able to get him to a doctor or a hospital would be if he was unconcious and unable to fight back. He emphatically refuses medical treatment of any kind. He bled like a stuck pig for three hours until someone finally reached me to go patch him up. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [March 16, 2003, 8:21pm UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/2 "2003-03-16T20:21:53Z")
If an individual has cirrhosis of the liver, the clotting factors responsible for stopping bleeding are generally quite depleted. Therefore normal activities which result in microtrauma which platelets and other factors seal up before they result in anything now cause more severe bruising. If the individual is unwilling to seek medical attention and/or stop drinking, little can be done. While the addition of vitamin K to the diet may help somewhat, there is more going wrong than nutritional supplement will fix. ---
**Author:** ![Eats\_Crayons](https://avatars.discourse-cdn.com/v4/letter/e/278dde/32.png) [@Eats\_Crayons](https://boards.straightdope.com/u/Eats_Crayons)\ **Post date:** [March 16, 2003, 8:44pm UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/3 "2003-03-16T20:44:55Z")
Thanks **Qadgop**. I’m thoroughly convinced for a few reasons that he is already suffering from chronic liver damage. Unfortunately, he refuses to believe that he’s an alcoholic (though it took four hours for him to even _start_ sobering up the other night) and thinks that “you have no problems _until_ you go to the doctor.” :rolleyes: How do you tell the difference between purpura senilis (like my teetotaller granny) and the bruising caused by liver damage? He has other symptoms that very strongly suggest cirrhosis, so that’s not even in debate — I’m just curious to know. Is it determined only on the basis of history (alcoholic vs. non-drinker) or is the appearance of the bruising different as well? I know there is nothing that can be done about our 74-yr-old, sadly. We can’t badger him into giving up his vices. They are the activities he enjoys most in life right now (and palying chess). So as long as he is not in pain, we’re satisfied that he’s happy, though technically dying slowly. All we do is think up sneaky reasons to make sure he gets more Vitamin B to help cut down on the alcohol cravings. (Not that it’s helping much). ---
**Author:** ![C\_K\_Dexter\_Haven](https://avatars.discourse-cdn.com/v4/letter/c/b2d939/32.png) [@C\_K\_Dexter\_Haven](https://boards.straightdope.com/u/C_K_Dexter_Haven)\ **Post date:** [March 16, 2003, 8:47pm UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/4 "2003-03-16T20:47:05Z")
If you’re not going to a doctor, please remember that any responses that you receive online are (at best) well-intentioned suggestions. People can spout generalizations – like, cirrhosis may impede clotting, or broken bones might hurt, or skin cancer often looks like bruises. But these are worthless generalizations. Even if we have doctors commenting here, they can’t SEE the bruises you’re talking about, so all they can do is describe generalized situations. I know, I know, this is obvious and you’re aware of it, but we gotta remind you anyway. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [March 16, 2003, 9:04pm UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/5 "2003-03-16T21:04:51Z")
There’s probably no good way to differentiate Purpura Senilis from the purpura due to coagulopathy without doing blood studies and biopsies. And there’s probably no need to differentiate so finely either. PS is due to fragile blood vessels, generally due to the changes of age. Clotting factors will probably be normal. A 74 year old alcoholic could well have both fragile vessels and severely abnormal clotting factors. And unfortunately vitamin b will NOT cut down an alcoholic’s desire to drink. No medication known will do this. Although some drugs can re-direct their cravings, such as benzodiazepines, opiates or stimulants. NOTE: I do not recommend substituting one addiction for another. Spouting more generalizations, QtM, MD ---
**Author:** ![Eats\_Crayons](https://avatars.discourse-cdn.com/v4/letter/e/278dde/32.png) [@Eats\_Crayons](https://boards.straightdope.com/u/Eats_Crayons)\ **Post date:** [March 17, 2003, 12:49am UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/6 "2003-03-17T00:49:28Z")
> [@](#): > > \*Originally posted by C K Dexter Haven \* > \*\*If you’re not going to a doctor, please remember that any responses that you receive online are (at best) well-intentioned suggestions. People can spout generalizations – like, cirrhosis may impede clotting, or broken bones might hurt, or skin cancer often looks like bruises. But these are worthless generalizations. Even if we have doctors commenting here, they can’t SEE the bruises you’re talking about, so all they can do is describe generalized situations. \*\* Understood \*\*C K \*\*, but please remember too, that I’m not asking for any diagnosis of any kind. Nor am I looking for treatment options, because he would absolutley refuse anything that would interfere with his drinking and smoking. The old curmudgeon is not long for this world – that is not in dispute. Neither is the fact that he has chronic liver damage. He has been drinking since he was a _child_. In any case, whether it’s cirrhosis, or diabetes, or cancer, it doesn’t make any difference in his case. It’s going to go untreated until he dies. No arguing or reasoning with him, I’m afraid (and his mind is still sharp so we can’t even exercise “power of attorney for care”). My questions are more for general knowledge because I’m curious about what I’m seeing. E.g. I wonder why Mr. 74’s bruises appear so different than my granny’s did. Is it only because she was a Spaniard and her skin was darker, or because purpura senilis actually looks different to the naked eye? That kind of stuff. **Qadgop** Really? I’ve read so much 12-stepper stuff that recommends lotsa B complex vitamins to help “reduce the cravings”, though I’ve been a bit skeptical (read it in non-scientific sources). Doesn’t one of the B vitamins help you sober up faster? ---
**Author:** ![Eats\_Crayons](https://avatars.discourse-cdn.com/v4/letter/e/278dde/32.png) [@Eats\_Crayons](https://boards.straightdope.com/u/Eats_Crayons)\ **Post date:** [March 17, 2003, 1:21am UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/7 "2003-03-17T01:21:08Z")
Er,… to clarify – the 12-step literature I’ve read was in the time when my father was dying of an alcoholism/smoking-related cancer. Though my gene pool may make me a more likely candidate for becoming an alcoholic, I tend to prefer juice and mineral water. I’m not currently in a 12 step program myself. (And alsas, my father joined AA a little too late. He died sober, but the damage to his body was irreversable.) ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [March 17, 2003, 1:29am UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/8 "2003-03-17T01:29:14Z")
Nope. Nothing sobers one up any faster than time. Or dialysis. The early AA’ers were big on healthy diets and vitamin therapy, mainly to help ward off Wernicke-Korsakov’s syndrome (a nasty complication of malnutrition involving vitamin deficiency), and later to enhance embracing a _sober lifestyle_, but it won’t do squat to make a person drink less or get undrunk faster. Otherwise, there’s nothing out there better than the 12 steps for keeping an abstinent alcoholic sober. ---
**Author:** ![Eats\_Crayons](https://avatars.discourse-cdn.com/v4/letter/e/278dde/32.png) [@Eats\_Crayons](https://boards.straightdope.com/u/Eats_Crayons)\ **Post date:** [March 17, 2003, 4:51am UTC](https://boards.straightdope.com/t/bruise-hematoma-what-the-heck-is-this/161822/9 "2003-03-17T04:51:01Z")
I googled WK syndrome, but the site had Big Words like “bilateral lateral rectus palsies”… got the general idea though. Brain damage from thiamine deficiency. Another related thing I’m wondering about re: the ecchymosis. How is it that even though he whacked himself in the face with the cane hard enough to split his brow, cut his nose and cheek – there’s not a single bruise on his face? Does it affect the extremities (hands and arms) more obviously or was he just “lucky”? BTW I think my curiosity is pretty much satisfied. To think, it all started with me wondering why they were calling them “blood weals.”