Bleeding from the blood vessels of nose. The commonest little area located at the upper 1/3 of nasal septum, the area is highly vulnerable as 4 arteries anastomos superficially, just under the mucous layer, and comprising the Kiesselbach’s Plexus. The arteries are –
- Anterior ethmoidal artery
- Greater palatine artery
- Spheno palatine artery
- Superficial labial artery
Spheno palatine artery is also known as artery of epistaxis. Slight nasal injury either external or internal causes bleeding from this area. The area also play a roll as a life saving function that is whenever there is high pressure in systemic circulation, that time the Spheno palatine artery rupture and causing profuse bleeding or haemorrhage, and prevent Intracranial Haemorrhage.
EPISTAXIS ( eh-puh-stak-suhs) comes from the Greek word “EPISTAZEIN” ( EPI – Upon, STAZEIN – to drip) Which means Bleeding From Nose.
TYPE
- Anterior Epistaxis
- Posterior Epistaxis
CAUSES
LOCAL CAUSES:
- Digital Rubbing or manipulation
- Nose picking
- Traumatic
Physical
Chemical inhalation of toxic chemicals
- Chronic Nasal cannula use
- DNS
CONGENITAL:
- Haemophilia
- Osler’s Syndrome – weakness of blood vessels
INFLAMMATORY:
- Rhinitis
- Sinusitis
- Nasal TB
- Malaria
- Diphtheria
- Kala azar
- Measles
- Typhoid
CIRCULATORY:
- Hypertension
- Enlarged adenoids
- Mitral Stenosis
- Vascular Malformations
- Alcoholism
NEOPLASTIC:
- Leukaemia
- Hodgkin’s Lymphoma
- CA of nose
- Nasal Polyp
- Haemangioma
ENDOCRINE:
- Vicarious menstruation
DEFICIENCY:
- Vitamin C, K deficiency
TOXIC:
- Uraemia
- Septicaemia
ENVIRONMENTAL:
- Allergies
- Dry area
DRUG INDUCED:
- Anticoagulant – warfarin
- Clopidogrel
- Topical nasal steroid spray
- NSAIDs – Aspirin, Naproxen, ibuprofen
- Cocaine
INVESTIGATION
- CT scan
- CBC, Prothrombin time(PT), Partial thromboplastin time (PTT)
- X-Ray of nose
- Review vicarious menstrual history
- Review of present illness
- Review systemic symptoms like HTN etc
- Review past history pregnancy, HIV etc.
- Review drug history like Nonsteroidal anti-inflammatory drugs etc
- Review any trauma present or not, inhalation toxic chemical or not
- Manual Compression of nose
- Application of ice over the nasal breech
- Ballooning inside the nasal cavity
- Anterior and posterior Nasal packing
- Ligation of bleeding vessels under local anaesthesia
- Ressection of nasal septum followed of ligation of bleeding vessels
- The above treatment is associated with antihypertensive, supplements of Vit C, K
- Application of Vasoconstriction with sedative
