epistaxis
DESCRIPTION
ENTTRANSCRIPT
![Page 1: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/1.jpg)
EPISTAXIS
BLOOD SUPPLY OF THE NOSE
![Page 2: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/2.jpg)
![Page 3: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/3.jpg)
![Page 4: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/4.jpg)
![Page 5: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/5.jpg)
Epistaxis
1. Introduction2. Definition3. Epidemiology4. Aetiology5. Pathogenesis6. Clinical features
or presentations
MGT
DISCUSS
Etiopathogenesis
Symptoms
Signs
![Page 6: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/6.jpg)
7. Investigations8. Diagnosis9. Treatment
MGT OF EPISTAXIS1. Introduction2. Definition3. Hx 4. Symptoms
Signs5. Investigations6. Diagnosis7. Treatment
Pathogenesis
Etiology
Clinical features
![Page 7: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/7.jpg)
LOCAL CAUSES
1. Idiopathic80 – 90%
2. Traumaa. Abraisions, # Nose, PNS, Base of Skull (CSF
Rhino)b. Picking of Nose in childhood & old-agec. FBs, Rhinolithsd. Burnse. Aitrogenic – Nasal surgery
Little’s Area
Retrocolumnar veins
RXN Epistaxis
2 Epitaxis
![Page 8: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/8.jpg)
3. Inflammatory
a. Allergy
b. Non-Allergic
Infective
Specific
2. None infective
Bacterial
1. Infective Viral
Fungal
Wagner’s Granulomas Midline (Lethal) Gran.
Vasomotor Rhinits
Specific
Non-specific
TBC, Syphylis, Lepnsy, Sarcoidosis, Lypus Vulgaris, Mucorales Species
![Page 9: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/9.jpg)
(Rhinoentomorphtomycosis), Atrophic
Rhinitis
Rhinoscleroma (K. Rhinoscleromatis –
cental, Eastern Europe, Central &South America)
characterized by:
1. Large foam cells (mikulitz cells) containing bacilli in vacoule
2. Russel bodies i.e. plasma cells with eosinophic staining cytoplasm and prominent nuclei.
![Page 10: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/10.jpg)
Rhinoscleroma 3 types
NON – SPECIFIC: (1) Organism for common cold viral
i. Influenzaii. Picorna virus
• Coxsackie virus• Reo virus• Echo virus• Rhino virus/(commonest cause)3. RSV4. Parainfuenza5. Adenino virus
Atrophic
Tumefactive
Cicatrizing stage
![Page 11: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/11.jpg)
2. Organisms for Bacteria
Pneunomia, a/c, ch. Rhinitis/sinusitis
4. Neoplastic
Benign Intermed Malignant• Haemangioma Inverted NPC• Angiofibroma Papilloma Lymphomas
Rhabdomy-
sarcoma
Stewarts/Lethal midline
granuloma
Melanoma
Benigns tumoursMalignant
Nose
Sinuses
Nasopharynx
![Page 12: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/12.jpg)
5. Environmental:• High attitude• Alc – Drying
6. Vicarious Menstruation
A. Systemic Causes: Dx of Blood & Blood Vessels
i. HBP, venous pressure inii. Leukaemiaiii. Sickle cell anaemiaiv. Vit C & K deficienciesv. Osler Rendu weber dx (familial Hge
Telangectasia (Autosamal Recessive)
Lowers Atmospheric pressure
Dry effect
Cardiac Disorders
SVC, bleeding via Retrocolumella vein
Pulm, Disorder
![Page 13: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/13.jpg)
B. Platelets defects:
i. Thrombocytopenic purpura (Aut. recessive)
ii. Thrombocytopeina
C. Coagulation Defects:i. Haemophiliacs = lack of viiiii. Xmas dx = lack of ixiii. Vit C, iv Vit K = deficiency =>
lack of ii vii ix xv. Von willebrands dx
2. Liver dx =>
PancytopeniaAgranulocytopenia
NoFunction
insufficiency
![Page 14: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/14.jpg)
3. Kidney dx via uraemic synd.4. Anticoagulant Therapies e.g. Heparin/warfarin
Areas of Bleeding1. a. Little’s area – kiesselbach’s plexus
75 – 90%, single bld vessel/leish of vessels from the floor upwards or mucocutenous junc. Also bleeding polypus i.e. inflammatory granuloma of septum arising from little’s area.
b. - other parts of septum include a septal spur
![Page 15: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/15.jpg)
2. Inferior turbinate & Nasal floor.
3. Above middle Turb from AEV in HBP.
4. Middle meatus – rare site but bleed from polypoid swelling must always suspicious of Neoplasm.
5. Sinuses
Blood vessels involved:
1. Ant. Ethmoidal PLEXUSES INVOLVED
2. Post Ethmoidal K!ESSELBACH’S
3. Greater palantine WOODRUFF’S
4. Sphenopalantine ECA
5. Superior labial
6. Ascending pharyngeal
Ethmoidal
Max Antrum
ICA
![Page 16: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/16.jpg)
Clinical Features
1. Common Aldoscents & old
2. Mild – severe epistaxis
3. Ant. or post
Treatment
1.a Trotter’s positioning
- Head forward & flexed
- Breath through the mouth
1.b Pinch the Nostrils press. Compresses from outside for septal bleeds
False
Melena
HemetamesisHemophysis
![Page 17: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/17.jpg)
2. Ice or cold pack- Bridge of Nose- Roof of mouth
3. Packing of the Nose & NasophynxAnterior packs
a. Gauze Adrenaline packb. Gauze Imp. BIPPc. Finger glove
- guaze BIPP/Genticin & Liquid Paraffin
Post packs
![Page 18: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/18.jpg)
d. Inflatable Bag or soft Nasal splint
Post Nasal Packa. Rectangular gauze packb. Foley’s catheter
4. Cauterizationa. Chemical b. Electrical – Electrocautery
But you may anaesthetize the area with xylocaine,cocaine or GA for children.
AgNo3 – 15 – 25%Chronic AcidTrichloroacetic Acid 50%
![Page 19: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/19.jpg)
5. EUA: Failure of the above, to enable
a. Better ID of bleeding pt.
b. Better Ant. & Post Nasal packs.
6. Arterial Ligation or Clipping:
a. Ext. carotid Artery distal to Lingual ART
b. Max Artery at the pteriygomaxillay fossa via
Transantral Approach
c. Ethmoidal Arteries via Ext. frontoethmoidectomy
7. Embolization: Embolization of max. art. Is via femoral Artey – a catheter is threaded under ultrasonic guidance to the max. Art. & Gel foam used to embolize the bleed pt.
![Page 20: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/20.jpg)
8. Cryosurgery9. Drugs:
1. Sedatives & Bed Rest
2. Systemic A/Bs prevent infection when packing is retained > 24hrs
3. Vit C & K in large doses + cal.
4. Injection of Haemostatics e.g. Aminocaproic acid in bleeding due to ed fribrinolysis.
5. Special Situations:a. Infusion of cryo-ppts in clotting abnormalitiesb. Plasma-frozenc. Blood - whole
![Page 21: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/21.jpg)
6. Hereditary Haemorrhagic Telangiectasia
a. Oestrogen Therapy
- induces metaplasia of the Nasal
mucosal memb. in bleeding
b. Septodermaplasty – replacing the mucous membrane of the Nose with split skin Graft.
![Page 22: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/22.jpg)
(c) Radiation – if bleeding areas of FHT persist,
(d) Laser therapy:- argon laser can be used to Rx FHT in Nose & URT.
10. Treat Primary Lesion.
INVESTIGATIONS: 1. Hb, WBCT
Platelets, RBC, counts
TD
ESR, Film
![Page 23: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/23.jpg)
2. Clotting Profile: clotting time, bleeding time, Prothrombin Index, PTTK,
3. Estimation of Antihaemophiliac Globulin (AHG)
4. Gp & CM Blood
5. Retroviral Tests
6. Genotype
7. LFT
8. S/U/E/CR
![Page 24: EPISTAXIS](https://reader033.vdocument.in/reader033/viewer/2022061111/54548fcfb1af9f86048b45fb/html5/thumbnails/24.jpg)
9. Urinalysis
10. X-Rays:a. Paranasal sinusesb. Post Nasal spacec. SMVd. CXR – PA
11. CT Scans
12. MRI
13. EUA & Biopsy of Tumours for Histology.
Dr. I.J. OKORAFORConsultant ENT SurgeonUNTH, ENUGU