EPISTAXIS

EPISTAXIS OR NOSE BLEEDING is a symptom and it is alarming for the patient and relatives.

Nose bleeding is very common due to the following reasons:

1) The nasal mucosa is very vascular.

2) There is very little protection to the blood vessels as they are only covered by delicate nasal mucosa.

WHAT ARE THE CAUSES OF EPISTAXIS OR NOSE BLEEDING?

The causes can be classified according to the:

A) Underlying pathology.

B) Site of Bleeding.

C) Age of the patient.

A) According to the underlying Pathology:

1) LOCAL CAUSES:

a) Trauma:

1) Accidental Trauma: It could be major or minor trauma with or without fractures of the nasal bone, the nasal mucosa is torned and nose bleeding may occur.

2) Excessive bleeding may occur following surgery on nose or paranasal sinuses.

3) Trauma due to foreign body which may be a sharp one or an impacted one may cause ulceration of the mucosa or formation of the granulation tissue which bleeds easily.

4) Chronic trauma : minor repeated trauma on the nasal mucosa may occur by habit of nose

picking. Removal of the scabs will cause ulceration of the nasal mucosa and bleeding starts.

b) Inflammatory causes:

1) Acute Inflammatory conditions like acute simple rhinitis, influenzal or Diphtheric rhinitis or acute sinusitis may cause nose bleeding.

2) In chronic inflammatory conditions like Syphilis Lupus, atrophic rhinitis there is ulceration and crusting which on separation causes bleeding.

c) Neoplasms:

Vascular benign tumours like Angioma or Fibroangioma will cause severe and spontaneous nose bleeding. The bleeding is from the dilated abnormal vessels of the tumour.

2) SYSTEMIC CAUSES:

a) congenital conditions;

Familial Telangiectisia: In this there are small cherry red spots occuring beneath the skin, mucosa of lips, nose, pharynx and gums. It starts in middle age and may be troublesome. The bleeding is a daily feature. It is probably due to some inherent weakness in the capillary wall.

b) Aquired conditions:

1) In acute inflammatory conditions of the body like Typhoid Fever, measles, rheumatic fever, the nasal mucosa is hyperaemic. There is super added secondary infection which causes bleeding.

2) Disorders of bleeding and Coagulation of blood:

3) Disorders of blood pressure:

4) Atmospheric Pressure Changes:

5) Deficiency Diseases:

6)Miscellaneous conditions : like menstruating more than once in a month.

In very hot seasons due to drying crusting and nose blowing.

B) ACCORDING TO THE SITE OF THE NOSE BLEEDING:

1) Anterior bleeding:

It is from the LITTLE AREA ON THE NASAL SEPTUM.

2) Superior bleeding.

It is from the Anterior Ethmodial Artery.

3) Posterior bleeding:

It is from the Sphenepalatine vessels, not easily seen. The blood goes into the Nasopharynx which is either swallowed or expelled out. It is often difficult to control and may be dangerous to life.

C) CAUSES ACCORDING TO AGE:

a) Children : Foreign bodies or little's area bleeding.

b) Adults: Little's area bleeding trauma.

c) Middle age : Hypertention.

d) Old age: Hypertension and Neoplasm.

WHAT ARE THE EFFECTS OF NOSE BLEEDING?

1) Due to massive bleeding patient may go into shock.

2) Due to repeated nose bleeding, Anaemia may develop.

WHAT IS THE MANAGEMENT OF NOSE BLEEDING?

1) IMMEDIATE TREATMENT ( FIRST AID TREATMENT ).

a) Patient to be reassured.

b) Patient should be probed up in bed or sitting up, head bent forwards so that blood does not go into the throat.

c) Pinch the nose firmly for 1-5 minutes and ask the patient to breath through mouth.

d) Apply ice on forehead , upper lip or nasal bridge to produce reflex vaso constriction.

Adrenaline packing in the nasal cavity.

2) HOSPITAL TREATMENT:

GENERAL PRINCIPLES:

a) Examine the nasal cavity with good light and nasal speculum to locate bleeding point. Remove or suck the bleed clots. Spray with 4% xylocaine.

b) Arrest the bleeding.

c) Replace the body fluids orally or parentally.

d) Prevent the recurrence of bleeding.

ARREST OF BLEEDING:

a) Cauterization.

b) Local Haemostatic agent.

c) Anterior nasal packing.

GENERAL TREATMENT CONSISTS OF :

a) Admission in the hospital.

b)Adequate sedation.

c) Antibiotic cover.

d) Maintanence of electrolyte balance and body fluids.

e) Replacement of blood loss.

f) General care.

MANAGEMENT IN SPECIAL CASES:

a) In head injuries, Control Bleeding, maintain clear air way, look after the head injury and give antibiotic cover.

b)Hypertensive nose bleeding, Control bleeding and give Anti hypertensive drugs.

c)Blood Dyscrasia: Fresh blood transfusion to be given plus other measures