nosebleed
Introduction
Introduction Nasal sputum is one of the common clinical symptoms, commonly known as nosebleeds. It can be caused by nasal diseases or by systemic diseases. Mostly unilateral, in a few cases, bilateral nasal bleeding can occur. The amount of bleeding varies, the light is only the blood in the sputum, the severe one can cause hemorrhagic shock, repeated nasal bleeding can lead to anemia. Blood from the Qingdao out of the nose, called the nose. It is a common condition. Mainly due to the lungs, stomach, liver heat and heat, forced blood, so that the blood overflows the clear road, from the nostrils out of the nose, there are also a small number of kidney deficiency or qi deficiency. The snot is also known as sputum. When the amount of nasal discharge is large, it is also called nasal sinus or nasal sputum.
Cause
Cause
There are many causes of nasal discharge, which may be caused by diseases of the nasal cavity itself, or by nasal or systemic diseases.
Local cause
(1) Nasal injury:
1 Mechanical trauma: such as car accidents, falls, boxing injuries and nose digging, are common causes of nasal discharge. 2 Barometric injury: During high-altitude flight and 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. 3 radiotherapy injury: during the head and neck radiotherapy and after radiotherapy, nasal mucosa congestion and edema, or epithelial shedding, can also appear nose.
(2) Deviation of the nasal septum: occurs mostly in the vicinity of the epiphysis or bone spine (circular protrusion) or the convex surface of the nasal septum, where the mucous membrane is thin, and the flow of the air current changes here, so the mucous membrane becomes dry. The blood vessels rupture and bleed. Patients with perforation of the nasal septum may cause repeated nasal discharge due to dry mucosa, erosion, and dryness of the perforated margin.
(3) nasal inflammation: 1 nasal non-specific inflammation: acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. easily cause nasal discharge, the amount of bleeding is generally not much. 2 nasal specific infection: 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: the most prone to nasal discharge is 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: 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.
2. Systemic causes
(1) Hemorrhagic diseases and blood diseases: 1 vascular wall structure and functional defect diseases: such as hereditary hemorrhagic telangiectasia, vitamin C deficiency, allergic purpura, drug-induced vascular purpura, infectious vascular purpura Vascular pseudohemophilia and the like. 2 the number of platelets or dysfunctional diseases: such as primary thrombocytopenic purpura, secondary thrombocytopenia caused by various causes. 3 coagulation factor disorders: such as various types of hemophilia, vitamin K deficiency and so on. 4 The blood's own anticoagulant effect is too strong: such as improper use of anticoagulant, anticoagulant substances such as anti-fibrinogen in the blood circulation, or excessive or accelerated fibrin dissolution, such as diffuse intravascular coagulation.
(2) Acute febrile infectious diseases: above, flu, hemorrhagic fever, scarlet fever, malaria, measles and typhoid. Due to hyperthermia, vascular toxic damage, nasal mucosa congestion, swelling and dryness, resulting in capillary rupture and bleeding. Under normal circumstances, the amount of bleeding is small, mostly occurs in the fever period, and the bleeding site is mostly located in the front of the nasal cavity.
(3) cardiovascular diseases: 1 hypertension and arteriosclerosis: hypertension and arteriosclerosis are important causes of epigastric bleeding in middle-aged and elderly people, and arteriosclerosis is the pathological basis. Increased blood pressure, especially in constipation, excessive force or emotional agitation, can cause nasal blood vessels to rupture, causing nosebleeds. In addition, sneezing, coughing, violent nasal or nasal massage are also factors that are repeated and difficult to control. 2 increased venous pressure: emphysema, pulmonary heart disease, mitral stenosis, neck or mediastinal lesions and other diseases, can cause superior vena cava hypertension, these patients' nasal and nasopharynx veins often anger and congestion When the patient has a severe cough or other incentives, the blood vessels can rupture and the bleeding site is located in the distribution area of the nasopharyngeal vein at the posterior nostril.
(4) Other systemic diseases: pregnancy, premenopausal, menopause can cause nasal discharge, which may be related to increased capillary fragility. Severe liver disease patients can cause nasal discharge due to liver clotting factor disorder. Uremic can also cause snoring. The snot can be one of the early manifestations of rheumatic fever.
Examine
an examination
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 bleeding site, combined with anterior endoscopy, endoscopic or CT, MRI examination to determine the bleeding site.
3. Blood routine examination is essential for patients with large blood loss and suspected blood disease. Coagulation is required in patients with anticoagulant drugs and suspected coagulation disorders.
4. Estimate the amount of bleeding, assess the current circulatory condition of the patient, whether there is hemorrhagic shock, and the necessary fashion must be consulted with the relevant department. According to the condition of each bleeding and the number of episodes, the patient's blood pressure, pulse, general conditions and laboratory tests to comprehensively determine the amount of bleeding. When the blood loss reaches 500ml, symptoms such as dizziness, thirst, fatigue, and paleness may occur. When the blood loss reaches 500 to 1000 ml, sweating, blood pressure drop, pulse rate and weakness may occur. If the systolic pressure is lower than 80 mmHg, it indicates that the blood volume has lost about 1/4.
5. Investigate systemic diseases.
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.
