Nosebleeds
Introduction
Introduction 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, or bilateral, intermittent bleeding, and continuous bleeding, the amount of bleeding is not the same, lighter only blood in the nose, severe cases can cause hemorrhagic shock, repeated bleeding can lead to Anemia, most bleeding can stop.
Cause
Cause
(1) Nasal injury
1 Mechanical trauma such as car accidents, falls, boxing injuries and nose digging are common causes of nasal discharge.
2 Atmospheric injury In the process of flying at high altitude and during diving, if the pressure difference between the inside and outside of the sinus suddenly changes too much, the mucosal blood vessels in the nasal cavity and sinus will expand and rupture and bleed.
3 radiotherapy injury during head and neck radiotherapy and after radiotherapy, nasal mucosa congestion and edema, or epithelial shedding, nasal discharge can also occur.
(2) The deviation of the nasal septum occurs mostly in the vicinity of the epiphysis or the bone spine (the rectangular protrusion) or the convex surface of the nasal septum. The mucosa is thinner and the flow of the air current changes here, so the mucous membrane becomes dry. Blood vessel rupture and bleeding. Patients with perforation of the nasal septum may cause repeated nasal discharge due to dryness, erosion, and dryness of the mucosa at the perforation edge.
(3) nasal inflammation
1 nasal non-specific inflammation acute rhinosinusitis, dry rhinitis, atrophic rhinitis and other prone to nasal discharge, the amount of bleeding is generally not much.
2 nasal specific infections such as tuberculosis, lupus, syphilis, leprosy and diphtheria, due to mucosal erosion, ulcers, granulation, perforation of the nasal septum can cause nasal discharge.
(4) Nasal cavity, sinus and nasopharynx tumors, among which the most prone to nasal discharge are nasal septal hemangioma, nasopharyngeal angiofibroma, hemorrhagic nasal polyps and nasal sinus malignant tumors. A small amount of nosebleeds or blood in the sputum is one of the early major symptoms of malignant tumors.
(5) nasal foreign body is common in children, mostly unilateral nasal bleeding, because the nasal foreign body remains in the nasal cavity for a long time, can cause nasal mucosal erosion bleeding. Animal nasal foreign bodies, such as leeches, can cause repeated massive nosebleeds.
Examine
an examination
(1) Suspension of early bleeding or who have undergone hemostasis
1. First ask the history of the history of colds and trauma. There is no history of repeated epistaxis in the past. For children with unilateral nosebleeds, nasal foreign bodies should be considered. For middle-aged and elderly patients, ask if there is a history of hypertension or arteriosclerosis.
2. To detect the cause of blood, the nasal cavity and nasopharynx should be examined in detail. If necessary, X-ray film, CT scan, nasal and sinus endoscopy should be performed. For those with high fever, the necessary blood and bacteriological examinations should be performed to exclude blood diseases and acute infectious diseases.
(2) Those who continue to bleed and have more bleeding
1. Hemostasis should be stopped first (posterior and posterior nostril filling).
2. Estimated bleeding volume: If the estimated bleeding volume reaches 500-1000ml, the blood volume should be replenished in time to prevent shock.
3. Determine the source of blood supply: if necessary, surgically ligature the corresponding blood vessels.
Diagnosis
Differential diagnosis
Hemoptysis
After hemorrhage of the larynx, trachea, bronchus and lungs, the blood is excreted in the mouth, which is common in tuberculosis, bronchiectasis, lung cancer, lung abscess and pulmonary congestion caused by heart disease. Can be identified according to the patient's past medical history, physical signs and auxiliary examination.
2. Hematemesis
Hematemesis is one of the main manifestations of upper gastrointestinal bleeding. When a large amount of hematemesis, blood can emerge from the mouth and nasal cavity, often accompanied by other symptoms of digestive tract diseases. The whole body examination can have positive signs and can be identified.
