1 / 26

Epistaxis

Epistaxis. Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine. Arterial supply of the septum. Kiesselbach’s Plexus/Little’s Area: -Anterior Ethmoid (ICA) -Superior Labial A (Facial) -Sphenopalatine A (IMAX) -Greater Palatine (IMAX ) Woodruff’s Plexus:

hanrahan
Download Presentation

Epistaxis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Epistaxis Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine

  2. Arterial supply of the septum

  3. Kiesselbach’s Plexus/Little’s Area: -Anterior Ethmoid (ICA) -Superior Labial A (Facial) -Sphenopalatine A (IMAX) -Greater Palatine (IMAX) Woodruff’s Plexus: - Sphenopalatine A (Pharyngeal & Post. Nasal branches) (IMAX) -Posterior ethmoid (ICA)

  4. Classification: • Anterior epistaxis (90%) • Bleeding from Little’s area. • Controlled by an anterior pack • Younger patients • Posterior epistaxis (10%) • Occurs in the area of Woodruff’s plexus • Older patients • Epistaxis not controlled by anterior nasal packing.

  5. Local Factors - Inflammation Etiology: • URI • allergic rhinitis • Sinusitis Increased vascularity and greater friability of vessels in inflamed mucosa

  6. -Trauma • Nose picking • Nose blowing/sneezing • Nasal fracture • Nasogastric/nasotracheal intubation • Trauma to sinuses, orbits, middle ear, base of skull • Barotrauma

  7. -Iatrogenic nasal injury • Functional endoscopic sinus surgery • Septoplasty or Rhinoplasty • Nasal reconstruction

  8. -Neoplasm • Juvenile angiofibroma • Inverted papilloma • SCCA • Adenocarcinoma • Melanoma • Lymphoma

  9. -Others: • Cold, dry air—more common in wintertime • Dry heat. • Anatomic abnormalities (ie: nasal septal deformity - turbulent flow (dry mucosa leading to crusting) • Atrophic rhinitis

  10. foreign bodies • Intranasal parasites • Septal perforation • Chemical (cocaine, nasal sprays, ammonia)

  11. Systemic factors • Vascular. • Infection/Inflammation. • Coagulopathy.

  12. :- Vascular • Hypertension • Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) • subepidermal vessels lacking elastic tissue in capillary wall and deficiency of smooth muscle

  13. – Infection/Inflammation • Tuberculosis • Syphillis • Wegener’s Granulomatosis • Periarteritis nodosa • SLE

  14. – Coagulopathies • Primary coagulopathies (hemophilia, von Willebrand’s disease, thrombocytopenia and polycythemia vera). • Secondary coagulopathies (uremia, alcoholism, chronic liver disease, leukemia, myeloma, aplastic anemia, idiopathic thrombocytopenis purpura or hypovitaminosis). • Iatrogenic coagulopathies (heparin)

  15. Etiology and Age • Children - foreign body, nose picking • Adults - trauma, idiopathic • Middle age - tumors • Old age - hypertension

  16. Management: • Initial Management: • ABC’s. • Vital signs—need IV. • Medical history/Medications. • Labs. • Physical exam – • Rhinoscopy

  17. Exam and treatment options

  18. Non-surgical treatments • Topical decongestants/vc. • Cautery (AgNo3) • Nasal packing. • Control of hypertension • Correction of: coagulopathies/thrombocytopenia

  19. Nasal packing: • Anterior nasal packs • Traditional • Recent modifications • Posterior nasal packs • Traditional • Recent modifications

  20. Packing

  21. Posterior Packs – Admission • Elderly and those with other chronic diseases may need to be admitted to the ICU • Continuous cardiopulmonary monitoring • Antibiotics • Oxygen supplementation may be needed • Mild sedation/analgesia • IVF

  22. Discharge instructions • Humidity/emolients • Nasal saline sprays • Avoidance of nose picking/blowing • Sneeze with mouth open • Avoid straining • Avoid hot/spicy food

  23. Indications for surgery: • Continued bleeding despite nasal packing • Nasal anomaly interfering withpacking • Patient refuse/intolerance of packing • Posterior bleeding with failed non surgical treatment after >72hrs

  24. :Surgical treatment • Transmaxillary IMA ligation • Transnasal Sphenopalatine ligation • External carotid artery ligation • Anterior/Posterior Ethmoidal A. ligation Last one

  25. The end www.zahrawi.ly

More Related