Epistaxis

Ng Xiang Wei 08/273673/KU/12915

Identitas Pasien
Nama Jenis kelamin Umur Alamat :S : Perempuan : 24 tahun : Purworejo

Keluhan Utama
Hidung kiri keluar darah

Riwayat Penyakit Sekarang

Pagi tadi pasien mengeluh hidung kiri keluar darah setelah pasien bersin. Darah kurang dari satu sendok teh dan bercampur dengan lendir. Sekarang pendarahan sudah berhenti.

Riwayat Penyakit Dahulu

Sering batuk pilek, alergi debu dan dingin (+), trauma (-), penyakit darah (-)

Epistaxis
Bleeding inside the nose Sign of local or constitutional cause

Blood supply of the nose

Littles Area
Anterior inferior part of nasal septum 4 arteries: anterior ethmoidal, septal branch of superior labial, septal branchof sphenopalatine and greater palatine anastomose Kiesselbachs plexus Subject to drying effect of inspiratory current and finger nail trauma Usual site for epistaxis in children and yound adults

Retrocolumellar vein
Common site of venous bleeding in young people Vein runs vertically downwards just behind columella, cross the floor of nose and join venous plexus on lateral nasal wall

Woodruffs Area
Under posterior end of turbinate where sphenopalatine artery anastomoses with posterior pharyngeal artery Site of posterior epistaxis

Causes
Local General Idiopathic

Local
Nose 1. Trauma 2. Infections 3. Foreign bodies 4. Neoplasms of nose and paranasal sinuses 5. Atmospheric changes 6. Deviated nasal septum Nasopharynx 1. Adenoiditis 2. Juveinile angiofibroma 3. Malignant tumors

General
1. 2. 3. 4. 5. 6. 7. 8. Cardiovascular Disease of blood Liver disease Kidney disease Drugs Mediastinal compression Acute general infection Vicarious menstruation

Sites of Epistaxis
1. Littles area: 90% 2. Above level of middle turbinate on septum 3. Below the level of middle turbinate on septum 4. Posterior part of nasal cavity 5. Diffuse (both septum and lateral nasal wall) 6. Nasopharynx

Classification
Anterior epistaxis Blood flows out from front of nose in sitting position Posterior epistaxis Blood flows back into throat, coffee colored vomitus

1. 2. 3. 4. 5. 6. 7.

Mode of onset Duration and frequency of bleeding Amount of blood loss Side of nose where bleeding occurs Bleeding is anterior or posterior type Bleeding tendency in patient Medical history (HT, leukaemia, mitral valve disease, cirrhosis, nephritis) 8. Drug intake (analgesics, anticoagulants, etc)

First Aid
Pinching nose with thumb and index finger for 5 mins Trotters method Cold compress

Management
1. In active bleeding, clear blood clot in nose by suction and localise bleeding site. 2. In minor bleeds from accessible sites, may use cauterisation. 3. If bleeding is profuse and/or site of bleeding difficult to localise anterior nose packing. 4. Pack can be removed after 24 hours. If it has to be kept for 2-3 days, give systemic antibiotics. 5. Posterior nasal packing for posterior bleeding.

Cauterisation
Silver nitrate Electrocautery Endoscopic cautery (posterior bleeding)

Anterior Nasal Packing

Posterior Nasal Packing

Epistaxis balloon