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Medical Term:

EPISTAXIS

Common Name:

Nosebleeds
Description: Epistaxis is bleeding from the nostril, nasal cavity or from the nasopharynx (back part of the nose). 

Most common site of bleeding is from the  Little's area (Kiesselbach's plexus) which is located in the front part of the nasal septum and contains many blood vessels. 

Second most common site is the anterior end of the inferior nasal turbinate. Less commonly the bleeding originates from the posterior nasal cavity or the nasopharynx, usually under the posterior half of the inferior turbinate or the roof of the nasal cavity. 

Causes: In most cases the cause is unknown. The other causes of epistaxis are as follows:  

Localized infections- vestibulitis and sinusitis and dried mucus membranes in the nose.

Injury- repeated injury from picking the nose, blunt injury or fracture of the nose.

Narrowing of the arteries (arteriosclerosis)

High blood pressure.

Disorders causing tendency to bleed: Aplastic anemia; Leukemia;  Low platelet count;  Liver disease;  Hereditary blood disorders such as hemophilia;  and hereditary hemorrhagic telangiectasia.

 

Prevention: Liberal application of petroleum jelly (Vaseline) to nostril to prevent drying and picking. Increasing humidity in the house at night may also help by reducing the dryness in the nostril. Keeping fingernails short to prevent injury to the nose.
Signs & Symptoms

Usually bleeding from the nose. However, cases of posterior bleed may have no symptoms or may present with hemoptysis (coughing up blood), nausea, hematemesis ( vomiting blood), or black stools.

Risk Factors

Same as mentioned under causes.

Diagnosis & Treatment
Epistaxis is a symptom or a sign, not a disease. Less than 10% are caused by a tumor or a bleeding disorder.
General Measures:
Bleeding is usually controlled by pinching the sides of the nose together for 5 to 10 minutes. If this does not stop the bleeding , a doctor looks for the source of bleeding. Bleeding can be temporarily stopped by applying pressure inside the nose with a piece of cotton wool , saturated with a drug that causes blood vessels to contract, such as epinephrine, and a local anesthetic, such as lidocaine. Once the bleeding has stopped, and the site is numb , the physician can seal (cauterize) the bleeding source with silver nitrate or electrocautery (a device that uses electrical current to produce heat). If the patient has a  history of a bleeding disorder , the bleeding source is not cauterized because it may start to bleed again. In such a case, the physician gently presses gauze saturated with petroleum jelly, against the bleeding source. After the bleeding stops , the cause of the bleeding is identified and treated .
In case of a posterior bleed, which usually occurs in people with arteriosclerosis and high blood pressure, the bleeding source is further back and therefore more difficult to stop. In these cases , the nasal cavity is packed with gauze and left in place for 4 days. An antibiotic is also prescribed to prevent an infection of the sinuses and the middle ear.

Newer method of treating posterior bleeds is using the balloon systems, instead of the traditional nasal packing.

Intractable bleeding will require arterial ligation  (closing off the arterial supply to the area).
People with hereditary telangiectasia ( a disease in which blood vessels are malformed) have a tendency to severe nosebleeds resulting in severe, persistent anemia that is not easily corrected with iron supplements. A skin graft on to the nasal septum reduces the number of nosebleeds and then the anemia can be corrected.
Medications:
Iron supplements in patients with considerable blood loss.
Antibiotics for patients with nasal packing that is left in for  a few days ,to prevent sinusitis or a middle ear infection.
Vasoconstrictor-such as phenylepherine 0.25%, epinepherin 1:1000 or 4% cocaine.
Activity:

Bed rest with head at 45 to 90 degrees.

Diet:
No alcohol or hot liquids.
Possible Complications :
Sinusitis
 Septal hematoma ( large blood clot) or abscess  from excessive trauma during packing.
Septal perforation from excessive cauterization.
External nasal deformity as a result of tissue damage ,from excessive pressure ,from the packing in a posterior nosebleed.
Vasovagal episode during packing ( fainting)
Prognosis
Good results with proper treatment.
Other

  'Nothing Specified'.

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