EPISTAXIS: Causes and Management

Question 1

Epistaxis is ____________________.

• It can be _________ or ________
• It can vary from mild – severe bleeding.
• It can present as recurrent mild nose bleeding or as profuse severe bleeding.

Answer 1

bleeding from the nose

unilateral or bilateral.

Question 2

The most frequent site of nose bleeding is from the ___________ .

This lies in the ___________ part of the ___________.

Answer 2

Little’s area.

antero-inferior

nasal septum.

Question 3

Little’s area

This is the area of _________ of the various
branches of the blood vessels that supply the nasal cavity.
– The ________________ artery
– ________________ artery
– ________________ artery
– ________________ artery

Answer 3

anastomosis

The Anterior ethmoidal artery
– Sphenopalatine artery
– Greater palatine artery
– Superior Labial artery

Question 4

Little’s Area

• It is a highly vascular anastomosis and the
mucosa is (thin or thick?) ( ___________ plexus).

Answer 4

thin

Kiesselbach’s plexus

Question 5

The next common area of bleeding from the nose is at the (anterior or posterior?) end of the ___________. There is a venous plexus at this site (____________ area).

Answer 5

Posterior

Inferior turbinate

Woodruff’s

Question 6

CAUSES OF EPISTAXIS
• Classified as Local and Systemic Causes.

• Local Causes
– __________
– ___________

Answer 6

– Congenital
– Acquired

Question 7

CAUSES OF EPISTAXIS: LOCAL

•Congenital
–________________ syndrome ( _______________ )

Answer 7

Osler Weber Rendu

Telangiectasia

Question 8

CAUSES OF EPISTAXIS: LOCAL

Acquired Causes

• Trauma
– _____________ (Commonest)
– External _________
– _________ injuries
– _________ injury
– _________ body
– _________ trauma (Post – op)

Physiological
– ___________ or ___________
– Extremes of ______ and ______
– Extreme __________________

Answer 8

– Nose picking (Commonest)
– External blunt trauma
– Penetrating injuries
– Head injury
– Foreign body
– Surgical trauma (Post – op)

– Violent exertion or excitement
– Extremes of heat and cold
– Extreme alteration of pressure

Question 9

CAUSES OF EPISTAXIS: LOCAL

ACQUIRED

• Infection
– Acute ______
– ____________
– ____________
– ____________
– Diphtheria
– ____________ ____________
– ____________ diseases eg Tuberculosis, Wegener’s
granuloma, Syphilis and Lupus.
– _______ infections eg Rhinosporidosis

• Tumours
– Nasal _______
– Juvenile Angiofibroma
– Haemangioma
– Inverted papilloma
– Malignant tumours of the nose and paranasal sinuses

Answer 9

Rhinitis
Vestibulitis
– Sinusitis
– Adenoiditis
– Diphtheria
– Atrophic rhinitis
– Granulomatous diseases
– Fungal infections

Polyps

Question 10

CAUSES OF EPISTAXIS: SYSTEMIC

• ____________
• ____________ disorders eg ____________
• ________ diseases
• Uraemia
• _______ deficiency
• Scurvy
• Systemic infections measles, infectious
mononucleosis
• __________
• ____________ – ____________

Answer 10

Hypertension

Bleeding ; Haemophilia

Liver ; Vit K

Drugs ; Toxins – snake bites

Question 11

Last Cause of Epistaxis
• ___________

Answer 11

Idiopathic

Question 12

Management Of Recurrent Nasal
Bleeding

• Adequate ____________
• Comprehensive ____________
• ____________
• Definitive ____________

Answer 12

clinical history
Physical examination
Investigations
treatment

Question 13

Measures to stop the bleeding(recurrent nasal bleeding)
• ______ compress
• Nose ______
• Nasal ______
- Lubricated ______, Gloved finger pack
- ______ ______, ______ ______
• Chemical ______
– Silver nitrate
– Copper sulphate
– Trichloroacetic acid

Answer 13

• Cold compress
• Nose pinching
• Nasal packing
- Lubricated Gauze, Gloved finger pack
- Simpson’s Balloon, Foley’s catheter
• Chemical cauterisation

Question 14

Management of severe nasal
bleeding.
• The patient can be conscious or unconscious
• Resuscitation

ABCD rule
• A – Airway
– Maintain a clear airway by __________
– Conscious patient –_______ position with head _______________ and nose __________ to temporarily stop bleeding and ————- for breathing
– Unconscious –_________ in _______ position with head ____, tilt and insert an oro-pharyngeal airway.
• B – Breathing
• C – Circulation
• D – Definitive

Answer 14

proper positioning

Sitting; bent forwards ; pinched; mouth open

supine ; lateral; down

Question 15

DEFINITIVE TREATMENT
• This will depend on the identified cause.
• It may be medical treatment or surgical treatment.

• In cases of persistent severe epistaxis, there may be need for ____________ to stop the bleeding.

– Ligation of the ___________ Artery
– Ligation of the __________ Artery

Answer 15

Arterial Ligation

External Carotid; Maxillary