ppt epistaksis

7/30/2019 PPT EPISTAKSIS

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EPISTAXIS


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bleeding from inside the nose

common and seen in all age groups

often presents as an emergency

is a sign which caused by other underline

disease / constitutional cause


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Nasal SeptumInternal Carotid System

Ant. ethmoidal artery

Post. ethmoidal artery

External Carotid System

Sphenopalatine artery

Greater palatine artery

Sup. Labial artery


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Lateral WallInternal Carotid System

Ant. ethmoidal artery

Post. ethmoidal artery

External Carotid System

Sphenopalatine artery

Greater palatine artery

Br. of maxillary artery

Br. of facial artery


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Littles Area situated in anteroinferior part of nasal

septum

Form by 4 arteries ant. ethmoidal, septal brof sup. labial, Septal br of sphenopalatineand greater palatine (anastomosed)Kiesselbachsplexus

Retrocolumellar Vein runs vertically downwards just behind

columella joins venous plexus on thelateral nasal wall


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Nose

1. Trauma. Digital trauma, intranasal surgery,violent sneeze2. Infection. Viral rhinitis, nasal diphteria, and all

crust-forming disease3. Foreign bodies

4. Neoplasms of nose and paranasal sinuses5. Atmospheric Changes. High altitudes, sudden

decompression6. Deviated nasal septumNasopharynx1. Adenoiditis2. Juvenile Angiofibroma3. Malignant tumors


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1. CV system.

2. Dis. of Blood and Blood Vessels

3. Liver Disease

4. Kidney Disease

5. Drugs6. Mediastinal Compression

7. Acute General Infection

8. Hormonal vicarious mens., pregnancy

*80 % is idiopathic


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1. Littles Area (90 % cases)

2. Above the level of middle turbinate(ICS)

3. Below the level of middle turbinate (Br. of SP)

4. Posterior part of nasal cavity

5. Diffuse. (general sys. inf., blood dyscrasias)


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1. Anterior Epistaxis.

Blood flows out from the front of nose withthe patient in sitting position.

2. Posterior Epistaxis

Mainly the blood flows back into the throat


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Difference between anterior and posterior epistaxisAnt. Epistaxis Post. Epistaxis

Incidence More common Less common

Site Littles area Posterosuperior part of

nasal cavity

Age Child- young adult > 40 yr

Cause Mostly trauma Spontaneous

Bleeding Mild, easy to control Severe, requireshospitalisation


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1. Onset

2. Duration and frequency of bleeding3. Amount of blood loss

4. Side of nose which has bleeding

5. Type of bleeding6. Family history

7. History of drug intake

8. History of known medical ailment


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1. Physic Examination. Vital sign and

rhinoscope2. Lab. test.

3. Radiology. Nasal and paranasal sinuses X-Rays, Blood and liver test, and biopsy.


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1. First Aid Trotter method

2. Anterior Nasal Packing3. Posterior Nasal Packing

4. Cauterisation Silver Nitrat

5. Embolisation - absorbable gelatin spongefor persistant epistaxis

6. Ligation of Vessels


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1. Patient sit up with a back rest. Record blood

loss2. Mild sedative should be given

3. Keep check on vital signs

4. Maintain hemodynamics.5. Antibiotiscs may be given

6. Intermittent oxygen may be required

7. Find the underlying disease


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Benign tumour

Aetiology : Idiopathic, thought to betestosterone dependent

Arise from the posterior part of nasal cavityand then grow into the nasal cavity,nasopharynx and into the pterygopalatinefossa.

the vessel are just endothelium-lined with

no muscle coat. Tend to be severe bleeding and cant be

control by adrenaline


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Clinical Features

1. exclusively seen in males in age group of10-20 yr

2. epistaxis and anaemic

3.

denasal speech caused by obstruction4. mass in the nasopharynx


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Investigations

1. Soft tissue lateral film of nasopharynx2. X-Rays of paranasal sinuses and base of

skull

3.

CT- Scan4. MRI

5. Carotid Angiography to show extension ofthe tumour and its vascularity.

Diagnosis can be done by biopsy, but AVOIDED


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Treatment

1. Surgical Excision. Vary depend on the tumourorigin and extension :

Transpalatine

Transpalatine + sublabial (Sardanas approach)

Extended lateral rhinotomy

Extended Denkers approach

Intracranial-extracranial

Infratemporal fossa


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multifactorial disease

most common in China Aetiology is unknown. The factor thought to be

are: Genetic chinese

Viral Epstein-Barr virus

Environment air pollution, smoking, salted fish,smoke


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Clinical Features:

mostly seen in 5th

to 7th

decades peoplesmales are 3 times more prone than femalesNasal obstruction, nasal disharge, denasal speech andEPISTAXISConductive hearing loss, serous or suppurative otitis

media, tinnitus and dizzinesssquint and diplopia, ophthalmoplegia, facial pain andreduced corneal reflex, jugular foramen sindromecervical nodal metastasesdistant metastases involve bone, lung, liver and other site


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Diagnosis

nasopharyngoscope (most important) Skull x-rays, CT-Scans, MRI with gadolinium and biopsy

Treatment

Irradiation Systemic chemotherapy is used as palliation

ppt epistaksis

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