A nosebleed , also known as epistaxis ( EP - STAK -sis ), is a common occurrence of bleeding from the nose. Usually seen when blood flows out through the nostrils.
There are two types: anterior (most common), and posterior (less common, more likely to require medical attention). Sometimes in more severe cases, blood can appear nasolacrimal duct and out of the eye. Fresh blood and frozen blood can also flow into the stomach and cause nausea and vomiting.
Although the vision of large amounts of blood can be alarming and may require medical attention, nosebleeds are rarely fatal, accounting for only 4 out of 2.4 million deaths in the US in 1999. About 60% of people experience nosebleeds at some point in life. About 10% serious nosebleeds.
Video Nosebleed
Cause
The cause of nosebleeds can generally be divided into two categories, local and general factors, although a large number of nosebleeds occur for no apparent reason.
Local factors
- Blunt trauma (usually a sharp blow to the face like a punch, sometimes accompanied by a fracture of the nose)
- Foreign body (like a finger when lifting the nose)
- Inflammatory reactions (such as acute respiratory infections, chronic sinusitis, rhinitis or environmental irritation)
Other possible factors
- Anatomical abnormalities ( eg. septal spurs or hereditary haemorrhagal telangiectasia)
- Insufflated drugs (especially cocaine)
- Intranasal tumors ( eg. nasopharyngeal carcinoma or nasopharyngeal angiofibroma
- Low relative humidity from inhaled air (especially during winter). The evidence for this support is weak.
- Nasal kanula O 2 (tends to dry the nasal mucosa)
- Nose sprays (especially old or incorrect use of nasal steroids)
- Middle ear of barotrauma (such as from descending on a plane or climbing in scuba diving)
- Surgery ( eg. septoplasty and functional endoscopic sinus surgery)
Systemic factors
Most common factors
- Infectious diseases ( for example. common cold)
- Hypertension
Other possible factors
- Alcohol (due to vasodilation)
- Anemia
- Blood discrimination
- Connective tissue disease
- Drugs - aspirin, fexofenadine, warfarin, clopidogrel, prasugrel, isotretinoin, desmopressin and others
- Envenomation by mambas, taipans, kraits, and death adders
- Chronic liver disease - cirrhosis causes factor deficiency II, VII, IX, & amp; X
- Heart failure (due to increased venous pressure)
- hematologic malignancies (such as leukemia)
- Idiopathic thrombocytopenic purpura
- Pregnancy (rare, due to hypertension and hormonal changes)
- Vascular disorders
- Vitamin C and vitamin K deficiency
- Von Willebrand's Disease
- Hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), a rare disease affecting the family
- Mediastinum compression by tumor (increased venous pressure)
- Hemophilia
- Thrombotic thrombocytopenic purpura
Maps Nosebleed
Pathophysiology
Nosebleeds occur due to rupture of blood vessels in the peripheral nose mucosa. Broken may be spontaneous or triggered by trauma. Nosebleeds are reported in up to 60% of the population with a peak incidence in those under the age of ten and over the age of 50 years and seem to occur in men more than women. Increased blood pressure (eg due to general hypertension) tends to increase the duration of spontaneous epistaxis. Anticoagulant medications and blood clotting disorders may increase and prolong bleeding. Spontaneous epistaxis is more common in older people because the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. Parents are also more susceptible to prolonged nose bleeding because their blood vessels are less able to constrict and control bleeding.
The majority of nasal bleeding occurs in the anterior (front) nose of the nasal septum. This area is rich in blood vessels (Kiesselbach plexus). This area is also known as Little area. Bleeding further behind the nose is known as posterior bleeding and is usually due to bleeding from Woodruff's plexus, the venous plexus located in the posterior part of the inferior meatus. Posterior bleeding is often prolonged and difficult to control. They can be attributed to bleeding from both nostrils and with greater blood flow into the mouth.
Sometimes blood flow from other sources of bleeding passes through the nasal cavity and out of the nostrils. Thus the blood comes from the nose but not the true nosebleed, that is, it does not really come from the nasal cavity. Such bleeding is called pseudoepistaxis ( pseudo epistaxis ). Examples include blood coughing through the airways and ending in the nasal cavity, then dripping out.
Treatment
Blood flow usually stops when a blood clot, which may be driven by direct pressure is applied by pinching the soft meat portion of the nose. This applies pressure to the Little's area (Kiesselbach's area), the source of the majority of nasal bleeding, and promotes freezing. Pressure must be firm and applied for at least five minutes and up to 20 minutes; tilting the head forward helps reduce the possibility of nausea and airway obstruction. Swallowing excess blood can irritate the stomach and cause vomiting.
Drugs
Local applications of vasoconstrictive agents have been shown to reduce bleeding time in benign epistaxis cases. Oxymetazoline or phenylephrine drugs are widely available in free-sold nasal sprays for the treatment of allergic rhinitis, and they can be used for this purpose.
Procedures
If these simple steps do not work then medical intervention may be needed to stop the bleeding. The use of silver nitrate to burn blood vessels is common but not very useful for those who have mild bleeding. It's also often painful even when freezing is used.
There are two types of nasal packing, anterior nasal packing and posterior nasal packing. There are several types of anterior nasal packets. Some use gauze and others use balloons. Posterior packaging can be done by using a Foley catheter, blow up the balloon while in the back of the throat, and apply traction. Gauze or Merocel packing bands can also be used. There are also some recyclable packaging materials, such as surgicel that functions as a package but are not removed and dissolved after a few days. Packaging is generally left for two to five days.
Ongoing bleeding despite good nasal packing is a surgical emergency and can be treated with nasal cavity endoscopy evaluation under general anesthesia to identify elusive bleeding points or to directly bind blood vessels supplying the nose. These blood vessels include sphenopalatina, anterior and posterior ethmoidal arteries. Less commonly the upper jaw or branch of the external carotid artery may be ligated. Bleeding can also be stopped by intra-arterial embolization using a catheter placed in the groin and lifting the aorta to the bleeding vessel by an interventional radiologist. There is no difference in yield between embolization and ligation as a treatment option, but embolization is much more expensive. Advanced bleeding may be an indication of more serious baseline conditions.
More
The local cooling utility of the head and neck is controversial. Some countries that apply ice to the nose or forehead are useless. Others feel that it can increase vasoconstriction of the nasal blood vessels and is thus useful.
Prevention
Application of topical antibiotic ointment to the nasal mucosa has been shown to be an effective treatment for recurrent epistaxis. One study found it was equally effective with nasal cautery in the prevention of recurrent epistaxis in people without active bleeding at the time of treatment - both having a success rate of about 50 percent.
Society and culture
In the visual language of Japanese comics (manga) and animation (anime), suddenly, a violent nosebleed shows that the bloody person is sexually aroused. In Western fiction, nosebleeds often signify intense mental focus or effort, especially during the use of psychic powers.
In American and Canadian use, "nosebleed" or "nosebleed" is a common hose for seating at the highest and furthest sporting event or spectator of the event. Reference refers to a tendency for nose bleeding at high altitudes, usually due to lower barometric pressure.
The oral history of the Native American Sioux tribe includes references to women who experience nosebleeds as a result of lovers' music games, implying sexual arousal.
In Finnish, "begging for nosebleeds" is generally used in the abstract sense to describe self-destructive behavior, such as ignoring safety procedures or intentionally upsetting the stronger parties.
In Filipino slang, for "nosebleed" is having a serious difficulty speaking in English with an eloquent or genuine English speaker. It can also refer to anxiety caused by a stressful event such as an examination or job interview.
In Dutch, "pretending to nosebleed" is a saying that means pretending not to know anything about something, when it actually involved somehow.
Etymology
The word epistaxis comes from the Greek: ???????? epistazo , "bleed from nose" from ??? epi , "above, above" and ????? stazo , "to drip [from the nostrils]".
References
External links
- National Library of Medicine - Explains the causes, solutions, and prevention of nosebleeds
Source of the article : Wikipedia
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