Epistaxis ๐๐ฉธ : ENT Lectures
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Epistaxis ๐๐ฉธ :
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Definition : Epistaxis refers to bleeding from the nose, a common condition that can range from minor to severe. It often arises from the nasal mucosa due to its rich vascular supply, primarily in the anterior and posterior parts of the nasal cavity.
Types of Epistaxis :
1) Anterior Epistaxis: Originates from the anterior nasal septum, particularly the Kiesselbach's plexus (Little's area). Most common and usually less severe.
2) Posterior Epistaxis:Originates from the posterior nasal cavity or nasopharynx, often involving branches of the sphenopalatine artery.
Less common but more severe and challenging to control.
Etiology :
Local Causes:
Trauma (nose picking, facial injury)
Dry air or nasal mucosa drying
Foreign body insertion
Nasal infections (rhinitis, sinusitis)
Allergies
Nasal tumors or polyps
Systemic Causes:
Hypertension
Coagulopathies (e.g., hemophilia, platelet disorders)
Use of anticoagulants (e.g., aspirin, warfarin)
Liver disease affecting coagulation
Environmental Factors:
Dry climates, high altitudes, or winter season
Exposure to chemical irritants or smoke
Pathophysiology :
Vascular Fragility:
The nasal mucosa contains a dense network of blood vessels that can easily rupture due to minor trauma or inflammation.
Increased Bleeding Tendency:
Conditions that impair clotting mechanisms or increase blood pressure can lead to persistent or recurrent bleeding episodes.
Clinical Features :
Symptoms:
Bleeding from one or both nostrils
Blood dripping into the throat if posterior (may cause coughing or vomiting of blood)
May be associated with nasal obstruction or a sensation of fullness in the nose.
Signs of Severe Epistaxis:
Persistent or recurrent bleeding
Signs of hypovolemia (dizziness, fainting, pallor, rapid pulse)
Diagnosis :
Clinical Examination:
Visual inspection with nasal speculum and light to identify the bleeding site.
Assessment of Severity:
Check blood pressure, heart rate, and signs of hypovolemia.
Laboratory Tests:
Complete blood count (CBC), coagulation profile, and blood grouping in severe cases.
Management :
Initial First Aid:
Sit the patient upright, leaning forward slightly to prevent blood from entering the throat.
Pinch the soft part of the nose for 10-15 minutes.
Apply a cold compress to the bridge of the nose or the back of the neck to reduce blood flow.
Medical Management:
Topical Vasoconstrictors: e.g., oxymetazoline, to constrict blood vessels and reduce bleeding.
Cauterization: Chemical (silver nitrate) or electrical cautery for visible bleeding points.
Nasal Packing: Anterior or posterior nasal packing with gauze, nasal sponges, or balloon catheters.
Surgical Management:
Ligation or Embolization: Of offending vessels, especially for severe posterior bleeds.
Systemic Treatments:
Control of underlying conditions (e.g., hypertension, anticoagulant reversal).
Complications
Recurrent Bleeding: Due to inadequate treatment or failure to address the underlying cause.
Hypovolemia/Shock: From severe or uncontrolled bleeding.
Infection: Secondary to nasal packing.
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