Epistaxis is defined as acute hemorrhage from the nostril, nasal cavity, or nasopharynx. Pathophysiology Epistaxis is classified on bleeding site as anterior or posterior. Approximately 90% of nosebleeds can be visualized in the anterior portion of the nasal cavity. Massive epistaxis may be confused with hemoptysis or hematemesis. Blood dripping from the posterior nasopharynx confirms a nasal source. Anterior hemorrhage is common & originates from the nasal septum. A common source of anterior epistaxis is the Kiesselbach plexus, an anastomotic network of vessels on the anterior portion of the nasal septum, also referred to as Little's area. It receives blood supply from both the internal and external carotid arteries. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior hemorrhage originates from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx. Frequency The lifelong incidence of epistaxis in the general population is about 60%, with less than 10% seeking medical attention. Mortality/Morbidity Mortality is rare and is usually due to complications from hypovolemia, with severe hemorrhage or underlying disease states. Increased morbidity is associated with nasal packing. Posterior packing can potentially cause airway compromise and respiratory depression. Packing in any location may lead to infection.
The following are some of the symptoms of Epistaxis: Duration, severity of the hemorrhage, and the side of initial bleeding are the markers for the diagnosis and treatment Underlying illnesses and other causes can be : • Hypertension • Hepatic • other systemic disease • family history • easy bruising • prolonged bleeding after minor surgical procedures Recurrent episodes of epistaxis, even if self-limited, should raise suspicion for significant nasal pathology. Use of medications, especially aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, heparin, ticlopidine, and dipyridamole should be documented, as these not only predispose to epistaxis but make treatment more difficult. Causes Most cases do not have an easily identifiable cause. • Local trauma (ie, nose picking) is the most common cause, followed by facial trauma • foreign bodies • nasal or sinus infections • prolonged inhalation of dry air • A disturbance of normal nasal airflow (deviated nasal septum) • Iatrogenic causes: nasogastric and nasotracheal intubation. • Topical nasal drugs : antihistamines and corticosteroids • Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI). • Oral anticoagulants and coagulopathy due • Splenomegaly • Thrombocytopenia • platelet disorders • liver disease • renal failure • chronic alcohol use • AIDS-related conditions. • von Willebrand disease • hemophilia A, and hemophilia B • Vascular fragility from long-standing disease. • dry climates • Cold weather Vascular abnormalities that contribute to epistaxis may include the following: • Sclerotic vessels • Hereditary hemorrhagic telangiectasia • Arteriovenous malformation • Neoplasm • Aneurysms • Septal perforation, deviation • Endometriosis
It is as per the underlying cause. But since its an acute phenomena the primary management is necessary followed by diagnosing a cause and then planning a treatment management.