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A - MSRA ENT [6] > [1] Epistaxis > Flashcards

[1] Epistaxis Flashcards

1
Q

What is epistaxis more commonly known as?

A

A nosebleed

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2
Q

What is epistaxis?

A

Bleeding from the nasal cavity and/or nasopharynx

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3
Q

What sort of age distribution does epistaxis have?

A

Bimodal

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4
Q

When are nosebleeds most common?

A

In the young and the old

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5
Q

Why does the nasal cavity bleed profusely?

A

The mucosa has a rich blood supply that can easily be ruptured

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6
Q

What is blood supply rupture associated with?

A

Trauma or can be spontaneous

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7
Q

What are the two types of nosebleeds?

A
  • Anterior

- Posterior

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8
Q

Which type of nosebleed is most common?

A

Anterior

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9
Q

What area of the nasal cavity to anterior nosebleeds start in?

A

Little’s area

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10
Q

What is found within Little’s area?

A

Kiesselbach’s plexus

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11
Q

What is Kiesselbach’s plexus?

A

A richly vascular area

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12
Q

Bleeding from what causes posterior nosebleeds?

A

Woodruff’s plexus

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13
Q

What is Woodruff’s plexus?

A

A venous plexus

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14
Q

Where is Woodruff’s plexus found?

A

In the posterior part of the inferior meatus

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15
Q

How are posterior nosebleeds different from anterior nosebleeds in presentation?

A
  • Prolonged
  • Both nostrils
  • More blood in the mouth
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16
Q

Which type of nosebleed is more difficult to control?

A

Posterior

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17
Q

What are the most common causes of nose bleeding?

A
  • Nose picking
  • Blunt trauma
  • Insertion of foreign body
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18
Q

When is bleeding more likely?

A

When there is inflammation and thinning of the nasal tissues

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19
Q

What factors can cause thinning and inflammation?

A
  • Relative humidity
  • Respiratory tract infection
  • Chronic sinusitis
  • Rhinitis
  • Environmental irritants
  • Nasal oxygen
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20
Q

When should investigation of epistaxis causes be considered?

A

When they are recurrent and do not respond to home therapies

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21
Q

What are the categories of rare underlying causes of epistaxis?

A
  • Coagulopathy
  • Inflammatory
  • Medications/drugs
  • Neoplasia
  • Trauma
  • Vascular malformation
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22
Q

What coagulopathies can cause epistaxis?

A
  • Thrombocytopenia
  • Leukaemia
  • Haemophilia
  • HIV
  • Chronic liver disease
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23
Q

What inflammatory causes lead to epistaxis?

A
  • Granulomatosis with polyangiitis

- SLE

24
Q

What medication can cause nosebleeds?

A

Anticoagulation

25
Q

What other drugs can cause nosebleeds?

A

Insufflation (sniffed) drugs

26
Q

What insufflation drug can particularly cause epistaxis?

A

Cocaine

27
Q

What neoplastic conditions can cause epistaxis?

A
  • Squamous cell carcinoma

- Nasopharyngeal angiofibroma

28
Q

What are the rarer traumatic causes of epistaxis?

A
  • Anatomical deformities e.g. septal spurs

- Nasal bone fracture

29
Q

What vascular malformations can cause epistaxis?

A
  • Hereditary haemorrhagic telangiectasis

- Aneurysm of carotid artery

30
Q

Where can blood commonly come out from in epistaxis?

A

One or both nostrils

31
Q

Where may blood travel in more severe cases?

A

Thought the nasolacrimal duct and come out of the eye

32
Q

What worrying symptoms can nose bleed cause?

A

Nausea, vomiting and apparent haematemesis

33
Q

How can nose bleed cause apparent haematemesis?

A

Back flow of blood into the stomach causing vomiting

34
Q

How is epistaxis typically diagnosed?

A

Clinically

35
Q

In nosebleeds requiring investigations, what may be useful?

A
  • FBC
  • Coagulation
  • Urea and creatinine
  • LFT
  • Nasal endoscopy and nasopharnygoscopy
  • Other specific investigations
36
Q

What are the differentials for epistaxis?

A
  • Haemoptysis

- Haematemesis

37
Q

How are most cases of epistaxis managed?

A

Self-limiting with home management

38
Q

How can nose bleeds be managed at home?

A
  • Sit or stand upright
  • Pinch nose just above nostrils for 10 - 15 minutes
  • Lean forwards
  • Breath through mouth
  • Ice pack on top of the nose
39
Q

How can a patient who is hospitalised with epistaxis be treated?

A
  • Anterior septal pressure

- Liberal topical vasoconstrictor

40
Q

What is an example of a topical vasoconstrictor?

A

Oxymetazoline 0.05%

41
Q

What is rare in epistaxis?

A

Haemodynamic compromise

42
Q

What is needed if haemodynamic compromise occurs in epistaxis?

A
  • Urgent fluid resuscitation

- Possible blood transfusion

43
Q

What happens if there is persistent bleeding despite initial treatment?

A
  1. Chemical cauterisation
  2. Packing
  3. Endoscopic evaluation and ligation or intra-arterial embolisation
  4. Open surgical ligation
44
Q

What is chemical cauterisation?

A

Using silver nitrate to burn and seal off the bleeding

45
Q

What is usually applied before chemical cauterisation?

A

Topical anaesthetic

46
Q

What type of bleeds is chemical cauterisation best for?

A

Mild easily visible bleeds

47
Q

What is nasal packing often accompanied with?

A

Antibiotics and analgesia

48
Q

What are the types of nasal packing?

A
  • Anterior packing

- Posterior packing

49
Q

What are the types of anterior packing?

A
  • Traditional packing

- Expanding nasal sponges

50
Q

What is traditional anterior nasal packing?

A

Horizontal layering of 12mm cotton gauze saturated with petroleum jelly or antibiotic ointment

51
Q

Why are expanding nasal sponges more convenient?

A

Easier to position

52
Q

What are the difficulties with posterior nasal packing?

A
  • Greater patient discomfort

- Consider IV analgesia and anti-emetics

53
Q

How is endoscopic evaluation and ligation performed?

A

Under GA

54
Q

How is intra-arterial embolisation performed?

A

Using a catheter inserted in the groin and passed up the aorta to the vessel

55
Q

What are the potential complications of epistaxis?

A
  • Sinusitis
  • Septal haematoma/perforation
  • Mucosal pressure necrosis
  • Vasovagal episode
  • Aspiration

A - MSRA ENT [6] (22 decks)

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