Epistaxis Overview and Pathophysiology

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Questions and Answers

What is the most common source of epistaxis in individuals?

The Kiesselbach plexus (correct)

The anterior nasal cavity

The posterior nasal cavity

The inferior turbinate

Which type of epistaxis is usually more profuse and often arterial in nature?

Posterior bleed (correct)

Venous bleed

Capillary bleed

Anterior bleed

What is a potential complication associated with posterior epistaxis?

Nasal obstruction

Airway compromise (correct)

Recurrent nosebleeds

Sinus infection

Which statement best describes the clinical presentation of anterior epistaxis?

It involves a constant ooze of blood. Signup and view all the answers

Which arteries contribute to the vascular supply of the Kiesselbach plexus?

Both A and C Signup and view all the answers

What percentage of epistaxis cases typically occur anteriorly?

More than 90% Signup and view all the answers

Which of the following is a characteristic feature of venous bleeds in epistaxis?

A constant ooze of blood Signup and view all the answers

What is the primary reason most nosebleeds do not result in a medical report?

They are self-limiting. Signup and view all the answers

What is the preferred method to initially control epistaxis before seeking further treatment?

Pinching the nostrils together and maintaining an erect position Signup and view all the answers

Which of the following is NOT a common cause of epistaxis?

Foreign body in the throat Signup and view all the answers

What should be done if epistaxis is not controlled after 15 minutes of manual pressure?

Refer the patient to an ENT specialist Signup and view all the answers

Why should older adults be particularly monitored for epistaxis?

Epistaxis can indicate heart or coagulation problems Signup and view all the answers

Which of the following treatment options is recommended for an acute episode of epistaxis?

Oxymetazolone 0.05% applied directly to the bleeding site Signup and view all the answers

What is a crucial teaching point to prevent further episodes of epistaxis?

Avoid NSAID use Signup and view all the answers

What is the most common cause of nosebleeds?

Spontaneous rupture of blood vessels Signup and view all the answers

What indicates that epistaxis requires urgent referral to an ENT specialist?

Massive bleeding not controlled after manual pressure Signup and view all the answers

Which of the following should be avoided during recovery from epistaxis?

Sneezing with the mouth closed Signup and view all the answers

Which groups are most likely to experience epistaxis?

Young children and elderly individuals Signup and view all the answers

What is the purpose of a CBC in the context of substantial or recurring nosebleeds?

To check for bleeding time and platelet count Signup and view all the answers

Which local cause is NOT typically associated with epistaxis?

Inheritance of blood condition Signup and view all the answers

In what circumstance would a Type and Cross test be indicated for a nosebleed patient?

If significant blood loss is anticipated Signup and view all the answers

Study Notes

Epistaxis

Epistaxis is a common complaint and often benign
Most nosebleeds are self-limiting and spontaneous, some are recurrent
Epistaxis is divided into two categories: anterior bleeds and posterior bleeds
Anterior bleeds are more common (over 90%) and arise from Little’s area on the septum
Posterior bleeds arise in the back of the nasal cavity, are usually more profuse, and are often of arterial origin
Posterior bleeds present a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding

Pathophysiology

Bleeding typically occurs when nasal mucosa is eroded and vessels become exposed and break
The Kiesselbach plexus is located on the septum, where vessels from the internal carotid artery (ICA - anterior and posterior ethmoidal arteries) and the external carotid artery (ECA - sphenopalatine and branches of the internal maxillary arteries) converge
Anterior bleeds often have a capillary or venous origin and ooze, rather than the profuse pumping of blood observed with an arterial origin
Posterior bleeds likely originate from branches of the sphenopalatine artery

Contributing Factors

90% of epistaxis is due to spontaneous rupture of blood vessels in the Kiesselbach plexus
Systemic causes include arteriolosclerosis, hematological disorders, and hereditary hemorrhagic telangiectasias
Local causes include trauma, irritants (e.g., smoking), inflammation of the nasal mucosa, a septal defect, intranasal foreign bodies, paranasal tumors, medications like NSAIDS, anticoagulants, and antiplatelets
10% of nosebleeds are idiopathic
Epistaxis is more frequent in young children and elderly persons, and in males compared to females

Signs and Symptoms

Most epistaxis has no signs or symptoms other than external bleeding or blood dripping down the posterior nasopharynx

Diagnostic Testing

No laboratory studies are indicated for minor and nonrecurring nosebleeds
For substantial or recurring nosebleeds, CBC, including platelet count, bleeding time, prothrombin time, and partial thromboplastin time may be helpful
INR may be needed for patients on Coumadin
Type and Cross may be needed for patients anticipated to need a blood transfusion due to blood loss

Differential Diagnosis

Trauma
Inflammation due to rhinitis or infection
Vascular disorders
Clotting disorders and blood dyscrasias
Intranasal foreign bodies
Hereditary telangiectasia
Tumors

Treatment

Most episodes of epistaxis are mild and self-limited and resolve spontaneously
Control can be achieved by pinching the nostrils together for 5-10 minutes, keeping the patient in an erect position with the head tilted forward
Anterior bleeds not controlled by manual pressure may be controlled with two sprays of Oxymetazolone 0.05% applied directly to the bleeding site followed by 10-15 minutes of manual pressure
Nares may be packed, if necessary
Have suction available

When to Refer to ENT

Bleeding not controlled after 15 minutes of compression
Evidence of massive bleeding
Recurrent bleeding within the first hour
Second episode of epistaxis within 1 week
Uncontrolled bleeding from the posterior nasopharynx

Patient Teaching

Avoid NSAID use
Sneeze with the mouth open
Avoid hot and spicy foods
Do not pick at nose
Avoid hot showers

Considerations for the Geriatric Population

Patients older than 50 years often have more serious bleeding that requires medical attention
Anemia can be a complication of frequent or excessive bouts of epistaxis
Severe blood loss can exacerbate existing diseases
Assess older patients for dyspnea, chest pain/pressure, and syncope
Epistaxis in older adults can be a sign of arterial hypertension, cardiovascular disease, or a coagulation disorder

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Description

This quiz covers the common condition of epistaxis, commonly known as nosebleeds. It highlights the distinction between anterior and posterior bleeds, their origins, and relevant pathophysiology. Test your knowledge on the causes and management of this condition.