Epistaxis Flashcards
What are the blood supply areas associated with epistaxis?
Anterior ethmoidal artery
Kiesselbach’s plexus
Superior labial artery
Greater palatine artery
Posterior ethmoidal artery
Sphenopalatine artery
Woodruff’s plexus
What areas does the anterior ethmoidal artery supply?
The anterior ethmoidal artery supplies the anterior third of the lateral nasal wall and adjacent septum.
Which areas are supplied by the posterior ethmoidal artery?
The posterior ethmoidal artery supplies the superior turbinate, posterior superior lateral nasal wall, and septum.
Where does the sphenopalatine artery arise from, and what does it supply?
The sphenopalatine artery arises from the internal maxillary artery. It enters the nose just posterior to the posteroinferior tip of the middle turbinate. A medial branch supplies much of the septum, while a lateral branch supplies the inferior and middle turbinates.
What are the classifications of epistaxis based on location?
Anterior epistaxis: commonly associated with Kiesselbach’s plexus, accounting for 80% of total cases and often seen in children and young adults. It can be idiopathic or result from trauma (nose picking!).
Posterior epistaxis: associated with Woodruff’s plexus, accounting for 20% of total cases and usually seen in adults older than 50 years, especially males. It can be caused by hypertension or tumors.
What are the common causes of epistaxis?
Idiopathic (unknown cause): accounts for 90% of cases
Secondary causes:
1/Local causes: hereditary hemorrhagic telangiectasia, trauma (accidental or iatrogenic), inflammatory conditions (acute or chronic), neoplastic conditions (benign or malignant), septal deviations or perforations, and nasal steroid use leading to dryness.
2’General causes:
cardiovascular diseases (hypertension and congestive heart failure), liver and renal failure, blood diseases (hemophilia, thrombocytopenic purpura, and leukemia), vitamin K or C deficiency, fevers (rheumatic and typhoid), certain drugs (anticoagulants and antiplatelets), and nasal endometriosis (possible but not well-established).
What are the common presentations of epistaxis?
Bleeding: can be unilateral or bilateral, anterior or posterior
Recurrent attacks: may present with pseudo hematemesis or pseudo hemoptysis (coughing up blood)
What are the important aspects of the examination for epistaxis?
General examination: check vital signs (pulse, blood pressure, temperature), observe for color changes and signs of irritability, assess skin for bruises or petechiae.
Local examination: perform anterior/posterior rhinoscopy, endoscopy, and oropharyngeal examination to determine the site, cause, and severity of bleeding.
What investigations are recommended for epistaxis?
ystemic investigations after controlling bleeding: complete blood count (CBC), coagulation profile, liver and kidney function tests.
Local investigations: CT scan of the nose, paranasal sinus, and nasopharynx; MRI and MRA if needed; biopsy in certain cases.
How can bleeding in epistaxis be controlled?
Mild to moderate bleeding:
1 Position the patient appropriately.
Apply compression to the nose for clotting time (5-10 minutes).
2 Use ice compresses to vasoconstrict.
3 Use cotton packing with vasoconstrictive drops (e.g., pseudoephedrine or adrenaline).
4 Consider cauterization (chemical: silver nitrate 2% solution or chromic acid crystals; electric: bipolar cautery is less traumatic than monopolar cautery).
5 Utilize anterior nasal packing with Vaseline gauze, inflatable balloons, or Merocel sponges for 2-3 days (may need to be repeated) with prophylactic antibiotics to prevent infection and exacerbation of bleeding.
What measures should be taken for severe epistaxis?
1 /Begin anti-shock measures immediately.
2/ Consider posterior nasal packing, which can involve a combination of anterior and posterior packs using Vaseline gauze, inflatable balloons, Foley catheter, or arterial ligation.
3 ‘Angiography and selective embolization may be required.
What are the possible management options for epistaxis complications?
1/ Lateral endoscopic procedures: raising a mucosal flap posterior to the natural ostium of the maxillary sinus to expose the terminal branches of the sphenopalatine artery, followed by direct cauterization or clippage withmicrovascular clips.
2/ Surgical procedures: septoplasty, turbinectomy, arterial ligation, embolization, or ethmoid artery ligation.
3/Rarely, surgical intervention with external carotid artery ligation may be necessary for intractable epistaxis.
