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Questions and Answers
What is generally true about anterior epistaxis compared to posterior epistaxis?
What is generally true about anterior epistaxis compared to posterior epistaxis?
Which of the following is NOT a local cause of epistaxis?
Which of the following is NOT a local cause of epistaxis?
What makes posterior epistaxis less alarming despite potentially significant bleeding?
What makes posterior epistaxis less alarming despite potentially significant bleeding?
Which of the following is a systemic cause of epistaxis?
Which of the following is a systemic cause of epistaxis?
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What is a potential non-infectious inflammatory cause of nosebleeds?
What is a potential non-infectious inflammatory cause of nosebleeds?
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What percentage of epistaxis episodes are classified as anterior?
What percentage of epistaxis episodes are classified as anterior?
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Which anatomical area is primarily associated with the occurrence of anterior epistaxis?
Which anatomical area is primarily associated with the occurrence of anterior epistaxis?
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Which age groups have the highest incidence of epistaxis?
Which age groups have the highest incidence of epistaxis?
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Which factor is least likely to contribute to spontaneous epistaxis?
Which factor is least likely to contribute to spontaneous epistaxis?
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What vascular structure is primarily involved in posterior nasal cavity bleeding?
What vascular structure is primarily involved in posterior nasal cavity bleeding?
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Which factor is NOT associated with prolongation of epistaxis?
Which factor is NOT associated with prolongation of epistaxis?
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What is typically the nature of epistaxis episodes in most cases?
What is typically the nature of epistaxis episodes in most cases?
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During which season does the incidence of epistaxis notably increase?
During which season does the incidence of epistaxis notably increase?
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Which of the following is a systemic cause of nasal bleeding?
Which of the following is a systemic cause of nasal bleeding?
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What is a potential complication from internal carotid artery issues regarding nasal bleeding?
What is a potential complication from internal carotid artery issues regarding nasal bleeding?
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Which investigation is NOT typically a part of the laboratory workup for epistaxis?
Which investigation is NOT typically a part of the laboratory workup for epistaxis?
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What should be the initial step in treating anterior epistaxis?
What should be the initial step in treating anterior epistaxis?
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Which medication is most likely to contribute to nasal mucosal irritation causing epistaxis?
Which medication is most likely to contribute to nasal mucosal irritation causing epistaxis?
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In the context of coagulopathies causing epistaxis, which condition is characterized by decreased platelet count?
In the context of coagulopathies causing epistaxis, which condition is characterized by decreased platelet count?
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What is the role of imaging such as CT scan in the evaluation of epistaxis?
What is the role of imaging such as CT scan in the evaluation of epistaxis?
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Which of the following conditions would most likely lead to increased systemic venous pressure as a cause of epistaxis?
Which of the following conditions would most likely lead to increased systemic venous pressure as a cause of epistaxis?
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Flashcards
Anterior Epistaxis
Anterior Epistaxis
Bleeding from the front part of the nose, usually seen in younger people, often caused by dry nasal mucosa.
Posterior Epistaxis
Posterior Epistaxis
Bleeding from the back part of the nose, more common in older adults, often associated with high blood pressure.
Local causes of Epistaxis
Local causes of Epistaxis
Nose picking, blowing, sneezing, trauma (like a fracture), foreign objects, nasal intubation, or nasal surgery can all cause nose bleeds.
Inflammatory & Neoplastic causes of Epistaxis
Inflammatory & Neoplastic causes of Epistaxis
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Dessication as a cause of Epistaxis
Dessication as a cause of Epistaxis
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What is epistaxis?
What is epistaxis?
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What is the age distribution of epistaxis patients?
What is the age distribution of epistaxis patients?
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Where does epistaxis usually originate from?
Where does epistaxis usually originate from?
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What factors can worsen epistaxis?
What factors can worsen epistaxis?
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What is the main cause of epistaxis?
What is the main cause of epistaxis?
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Where does lateral nasal wall bleeding usually occur?
Where does lateral nasal wall bleeding usually occur?
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What are the two types of epistaxis?
What are the two types of epistaxis?
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What is the percentage of epistaxis cases originating from the posterior nasal cavity?
What is the percentage of epistaxis cases originating from the posterior nasal cavity?
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Atrophic Rhinitis
Atrophic Rhinitis
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Vascular Epistaxis
Vascular Epistaxis
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Arteriovenous Malformation
Arteriovenous Malformation
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Septal Deviation
Septal Deviation
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Thrombocytopenia
Thrombocytopenia
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Hemophilia
Hemophilia
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Von Willebrand Disease
Von Willebrand Disease
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Applying Pressure to the Anterior Nose
Applying Pressure to the Anterior Nose
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Study Notes
Epistaxis
- Epistaxis is defined as bleeding from the nostril, nasal cavity, or nasopharynx.
- Bleeding stems from the rupture of small blood vessels within the nose, or from any cause.
- It's one of the most common ENT emergencies.
- Bleeding is often self-limiting, but can be serious and life-threatening, requiring prompt intervention.
- Epistaxis primarily originates from the lateral nasal wall or the septum.
- Lateral nasal wall bleeding typically occurs near the sphenopalatine artery.
- 90-95% of epistaxis episodes are anterior.
- The posterior nasal cavity is the source in roughly 5-10% of cases.
Epidemiology
- Age distribution is bimodal, with most cases occurring in the 2-10 and 50-70 year age groups.
- Incidence increases in winter.
- True prevalence is unknown as most episodes are self-limiting and unreported.
Applied Anatomy
- The nasal cavity is divided into anterior and posterior nasal cavities.
- The most frequent bleeding site is the plexus of vessels at the anteroinferior aspect of the nasal septum within the anterior nasal cavity.
- This area (Kiesselbach's plexus, also known as Little's area) is a common source of bleeding.
Pathophysiology
- Epistaxis results from different predisposing factors.
- Rupture of a blood vessel within the richly perfused nasal mucosa.
- Rupture can be spontaneous or caused by trauma, systemic or local factors.
- Increased blood pressure (like hypertension) prolongs spontaneous epistaxis.
- Anticoagulant medication and blood clotting disorders promote and prolong bleeding.
- Elder individuals are more susceptible to prolonged nosebleeds due to decreased blood vessel constriction function.
Anterior vs Posterior Epistaxis
- Anterior:*
- More common in younger individuals.
- Often due to nasal dryness.
- Usually readily visible bleeding, but generally less severe and easily controlled.
- Posterior:*
- More common in older individuals.
- Hypertension is a frequent contributing factor.
- Significant posterior bleeding that may not be readily observable because blood is swallowed.
- More challenging to control.
Etiology
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Idiopathic: Unknown cause
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Local:
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Trauma (nose picking, nose blowing, sneezing, nasal bone fracture, foreign bodies, nasal intubation, surgical procedure)
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Inflammatory (infectious: Rhinitis/Rhinosinusitis [Bacteria, Viruses and/or Fungi]; Tuberculosis [Lupus vulgaris]; Syphilis [syphilitic ulcer of the nose]; Non-infectious: Pyogenic granuloma, allergic rhinitis)
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Neoplasms (Benign: Juvenile nasopharyngeal angiofibroma, Haemangioma, Inverted papilloma; Malignant: Nasopharyngeal carcinoma, Sinonasal cancers)
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Dessication (dry air, especially in winter; nasal oxygen administration; atrophic rhinitis)
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Vascular (vascular malformations [arteriovenous malformations], internal carotid artery aneurysms [rupture/post-traumatic pseudoaneurysm])
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Anatomical anomalies (septal deviation, septal perforation, septal varices, septal spurs)
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Chemical irritants (cocaine, heroin, tobacco)
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Medications (antihistamines, nasal corticosteroids)
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Systemic:
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Vascular (Hereditary hemorrhagic telangiectasia [Osler-Rendu-Weber Syndrome])
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Cardiovascular (Mitral stenosis, Coarctation of the aorta due to elevated systemic venous pressure)
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Coagulopathies (decreased platelet count [thrombocytopenia], idiopathic thrombocytopenic purpura; platelet dysfunction; systemic disease [uremia], drug-induced [anticoagulants, NSAIDs, antiplatelet drugs])
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Clotting factor deficiencies (Hemophilia A, Hemophilia B, Von Willebrand's disease)
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Hematologic malignancies (ALL, AML/CML, Aplastic anemia)
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CKD Uremia
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Liver failure
Diagnostic Evaluation
- Medical history
- Physical examination
Investigations
- Laboratory Work Up: Complete Blood Count (including platelet count); Bleeding indices (PT, PTT, INR, thrombin time, bleeding time); Liver function tests (ASAT, ALAT); Renal function tests (serum creatinine, urea); Peripheral blood smear (to assess for hematological malignancies)
- Bone marrow aspiration/trephine biopsy: To diagnose leukemia or aplastic anemia.
- Clotting factors assays: To identify clotting factor deficiencies.
- Biopsies: To analyze nasal tumors (inverted papilloma, pyogenic granulomas, lupus vulgaris, JNA).
- Imaging Work Up: X-ray of paranasal sinuses; CT scan of paranasal sinuses
Treatment
- Conservative: First aid measures (squeezing the nose, leaning forward); Cauterization; Nasal packing (anterior or posterior).
- Surgical: Arterial ligation; Embolization
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Description
This quiz covers the essentials of epistaxis, including its definition, common causes, and anatomy related to nasal bleeding. Learn about the epidemiology and management of this common ENT emergency. Perfect for medical students and healthcare professionals.
