| General
Illness Information |
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 |
|
|
|
|