Introduction

• Epistaxis is a sign of disease not a diagnosis.
• Cause: coagulopathy or hemostatic problem, nasal tumor or infection, foreign body, trauma, hypertension, severe hyperglobulinemia, dental disease.
• Signs: bleeding from nose, may be associated with other respiratory signs, eg sneezing. stridor, sturtor.
• Diagnosis: laboratory tests, coagulation profiles, radiography, MRI, CT, rhinoscopy, biopsy.
• Treatment: manage underlying cause.
• Prognosis: variable depending on cause from good to guarded.

Pathogenesis

Predisposing factors

• Coagulopathy (inherited or acquired) Hemostatic disorder: primary inherited Hemostatic disorder: acquired.
• Access to toxins, eg rodenticides Anticoagulant rodenticide poisoning.

Pathophysiology

• Coagulopathy: may be defect in:
  • Primary hemostasis: involves platelet adhesion via vWF to the subendothelial collagen resulting in the formation of a platelet plug as well as reflex vasoconstriction of the blood vessel.
  • Secondary hemostasis: involves formation of fibrin by coagulation factors to stabilize the primary hemostatic platelet plug. Coagulation cascade is classically divided intointrinsicandextrinsicpathways with a finalcommonpathway.
• Invasion of blood vessels in nasal cavity in nasal diseases, eg Aspergillosis, neoplasia.
• Trauma of blood vessels in foreign body or trauma to the nose/face.
• Hypertension as cause of epistaxis uncommon.
• Hyperviscosity can result in vessel damage and epistaxis.

Timecourse

• Acute onset epistaxis - trauma, foreign body, coagulopathy.
• Chronic, intermittent - infectious disease (eg fungal), neoplasia.

Diagnosis

Treatment

Outcomes