epistaxis

Question 1

what is epistaxis?

Answer 1

nose bleed

Question 2

what are the local causes of epistaxis?

Answer 2

idiopathic
trauma
foreign bodies
inflammation
tumour

Question 3

what are the systemic causes of nose bleeds?

Answer 3

drugs e.g. warfarin, aspirin
clotting abnormalities
liver disease
haemophilia
leukaemia
thrombocytopenia
arteriosclerosis
hereditary haemorrhage telangiectasia
systemic inflammatory conditions
Werner’s granulomatosis
hypertension - causes prolonged bleeding but not primary cause of epistaxis

Question 4

the nose is a vascular organ secondary to what requirements?

Answer 4

heating/humidification

Question 5

the nose gains a blood supply from…?

Answer 5

a number of vessels, originating from both the internal and external carotid artery

Question 6

what is the most common site of bleeding in epistaxis?

Answer 6

little’s area on the anterior septum, where a number of vessels anastomose

Question 7

which vessels anastomose at ‘little’s area’ on the anterior septum?

Answer 7

anterior ethmoid
posterior ethmoid
sphenopalatine
great palatine
superior labial

Question 8

where does an anterior epistaxis originates from ?

Answer 8

KIESSELBACH’S PLEXUS

(littles area)

Question 9

where does a posterior epistaxis originate?

Answer 9

IN POSTERIOR SEPTUM
- SPHENOPALATINE ARTERY (branch of maxillary artery)

Question 10

what does GAPSS stand for?

Answer 10

Greater palatine, anterior and posterior ethmoidal, sphenopalatine, superior labial arteries

Question 11

how to treat epistaxis overall?

Answer 11

a stepwise approach starting with the easiest to most extreme management

Question 12

what is the 1st step in treating a nose bleed?

Answer 12

first aid measures:
pinching the fleshy anterior part of the nose

leaning forward

spitting out into a bowl

ice pack compression

Question 13

what management is done on arrival to secondary care?

Answer 13

resuscitation if necessary

arrest/slow flow (e.g. ice, topical vasoconstrictor)

anterior rhinoscopy/nasal endoscopy to investigate source of bleeding

Question 14

how long should direct compression be given for?

Answer 14

10-15 min

Question 15

what direct therapy should be given if there is an identifiable anterior bleeding point?

Answer 15

silver nitrate cautery

Question 16

what are some examples of indirect therapy to compress difficult to identify bleeding points (likely posterior) or heavy bleeding points?

Answer 16

nasal packs (e.g. rapid rhino) or Foley catheters

Question 17

what is the final stage of management for epistaxis if gotten to the most extreme?

Answer 17

surgery - sphenopalatine artery ligation (endoscopic)

Question 18

what autosomal dominant inherited disorder can cause recurrent nose bleeds?

Answer 18

hereditary haemorrhagic telangiectasia, presents with visible telangiectasis, arteriovenous malformations and recurrent nose bleeds

Question 19

what is the long term management for HHT (hereditary haemorrhagic telangiectasia) ?

Answer 19

iron replacement therapy