Nosebleeds
Introduction
Introduction to nosebleeds Epistasis (epistaxis), also known as epistaxis, is one of the common clinical symptoms, mostly caused by nasal lesions, but also caused by systemic diseases, occasionally due to nasal bleeding from the nasal cavity. Most of the nosebleeds are unilateral, and can be bilateral; intermittent bleeding can also be repeated, and bleeding can be continued; the amount of bleeding varies, the blood is only in the nose, the severe can cause hemorrhagic shock; repeated bleeding can lead to Anemia, most bleeding can stop. Bleeding can occur in any part of the nasal cavity, but it is most common in the anterior and posterior segment of the nasal septum. Sometimes there is jet or pulsating arteriolar hemorrhage. The posterior nasal hemorrhage often flows into the pharynx and spits out from the mouth. Generally speaking, local disease The nosebleeds caused are mostly limited to one side of the nasal cavity, and those caused by systemic diseases may alternate or simultaneously bleed on both sides of the nasal cavity. basic knowledge The proportion of illness: 90% Susceptible people: good in childhood Mode of infection: non-infectious Complications: aplastic anemia, megaloblastic anemia, anemia of chronic diseases
Cause
Cause of nosebleeds
Local trauma (30%):
1. trauma;
2. Pneumatic damage;
3. The nasal septum is deviated, and the nasal septum perforation often has symptoms of nasal discharge;
4. Inflammation: 1 non-specific inflammation: dry rhinitis, atrophic rhinitis, acute rhinitis, acute maxillary sinusitis, etc., often the cause of nosebleeds, 2 specific infections: nasal tuberculosis, nasal diphtheria, nasal syphilis, etc., due to mucosal ulceration, Easy to cause nosebleeds;
5. Tumor
6. Others: nasal foreign bodies, nasal leeches, can cause repeated massive bleeding, in the highland areas, due to low relative humidity, and more suffering from dry rhinitis, is an important cause of regional nosebleeds.
Systemic disease (30%):
1. Blood diseases: 1 abnormalities in platelet mass or quality, 2 abnormalities in blood coagulation mechanism;
2. Acute infectious disease;
3. Cardiovascular disease: 1 high arterial pressure: such as hypertension, atherosclerosis, nephritis, eclampsia with hypertension, etc. 2 increased venous pressure: such as mitral stenosis, large mass in the chest or mediastinum and neck, lung Emphysema, pulmonary edema and bronchial pneumonia;
4. Vitamin deficiency: When there is a deficiency of vitamin C, K, P and trace element calcium, nose bleeding is easy to occur;
5. Chemical drugs and drug poisoning: poisoning of phosphorus, mercury, arsenic, benzene, etc., can damage the function of the hematopoietic system and cause nasal discharge. Long-term use of salicylic acid drugs can cause thrombin deficiency and easy bleeding;
6. Endocrine disorders: compensatory menstruation, atrophic nosebleed often occurs in puberty, mostly due to decreased estrogen levels in the blood, caused by vasodilatation of the nasal mucosa;
7. Hereditary hemorrhagic telangiectasia, liver and kidney chronic diseases, and rheumatic fever can also be associated with nosebleeds.
Prevention
Nasal bleeding prevention
1. Keep the room quiet and clean, and the temperature should be appropriate. Keep the air fresh in the room, properly open the window and ventilate the air, and keep the temperature at 18~20 °C. Because the air is too dry, nasal bleeding can be induced, so the air humidity should be 60%.
2. The elderly should be slow when exercising on weekdays. Do not use force to nose, symptomatic and cough.
3. Diet should enter some digestible soft food, eat more fruits and vegetables, avoid spicy and stimulating diet, and keep the stool smooth, constipation can be given laxatives.
4. Patients with senile epistaxis are often accompanied by hypertension, coronary heart disease, bronchitis, etc. The primary disease should be regularly prevented, and the corresponding cause must be treated accordingly. Especially for patients with hypertension, blood pressure must be controlled to normal or as soon as possible. Close to normal levels, observe changes in the condition, and go to the hospital in time.
Complication
Nose bleeding complications Complications aplastic anemia megaloblastic anemia chronic disease anemia
Nose bleeding is difficult to control, whether it is fierce or severe bleeding, or long-lasting intractable bleeding, can cause serious damage to the body, the main impacts are: hemorrhagic anemia, acute hemorrhagic shock, cardiovascular system complications, cerebrovascular Accidents, suffocation, serious people can be life-threatening.
Symptom
Nasal bleeding symptoms Common symptoms Nasal anterior hemorrhage cough chocolate color Brachial artery bleeding Nasal bleeding Nasal mucosal ulcer Nostrils dry pain Digging Nostril Shock Anemia
Bleeding can occur in any part of the nasal cavity, but it is most common in the anterior and posterior segment of the nasal septum. Sometimes there is jet or pulsating arteriolar hemorrhage. The posterior nasal hemorrhage often flows into the pharynx and spits out from the mouth. Generally speaking, local disease The nosebleeds caused are mostly limited to one side of the nasal cavity, and those caused by systemic diseases may alternate or simultaneously bleed on both sides of the nasal cavity.
Examine
Check for nosebleeds
No bleeding can be found by anterior nasal examination, such as bleeding, after surgery, nasal or optical fiber nasopharyngoscopy, intranasal hemorrhage, blood often from the nasal passages or olfactory rupture, in addition to finding bleeding points, and making necessary Whole body examination (measure blood pressure, blood routine examination, bleeding time and clotting time measurement, capillary fragility test and platelet count, etc.), there must be a fashion consultation with the relevant departments to find the cause.
Diagnosis
Diagnosis of nosebleed
1. Detailed medical history and bleeding, confirm that bleeding originates from the nasal cavity or adjacent tissues, and excludes hemoptysis and hematemesis.
2. Determine the location of the bleeding, combined with the anterior endoscope, nasal endoscopy and / or CT, MRI examination to determine the location.
3. Blood routine examination is essential for patients with large bleeding and suspected blood disease. Coagulation is required in patients with anticoagulant drugs and suspected coagulation disorders.
