Download - PPT EPISTAKSIS
-
7/30/2019 PPT EPISTAKSIS
1/22
EPISTAXIS
-
7/30/2019 PPT EPISTAKSIS
2/22
bleeding from inside the nose
common and seen in all age groups
often presents as an emergency
is a sign which caused by other underline
disease / constitutional cause
-
7/30/2019 PPT EPISTAKSIS
3/22
Nasal SeptumInternal Carotid System
Ant. ethmoidal artery
Post. ethmoidal artery
External Carotid System
Sphenopalatine artery
Greater palatine artery
Sup. Labial artery
-
7/30/2019 PPT EPISTAKSIS
4/22
Lateral WallInternal Carotid System
Ant. ethmoidal artery
Post. ethmoidal artery
External Carotid System
Sphenopalatine artery
Greater palatine artery
Br. of maxillary artery
Br. of facial artery
-
7/30/2019 PPT EPISTAKSIS
5/22
Littles Area situated in anteroinferior part of nasal
septum
Form by 4 arteries ant. ethmoidal, septal brof sup. labial, Septal br of sphenopalatineand greater palatine (anastomosed)Kiesselbachsplexus
Retrocolumellar Vein runs vertically downwards just behind
columella joins venous plexus on thelateral nasal wall
-
7/30/2019 PPT EPISTAKSIS
6/22
-
7/30/2019 PPT EPISTAKSIS
7/22
Nose
1. Trauma. Digital trauma, intranasal surgery,violent sneeze2. Infection. Viral rhinitis, nasal diphteria, and all
crust-forming disease3. Foreign bodies
4. Neoplasms of nose and paranasal sinuses5. Atmospheric Changes. High altitudes, sudden
decompression6. Deviated nasal septumNasopharynx1. Adenoiditis2. Juvenile Angiofibroma3. Malignant tumors
-
7/30/2019 PPT EPISTAKSIS
8/22
1. CV system.
2. Dis. of Blood and Blood Vessels
3. Liver Disease
4. Kidney Disease
5. Drugs6. Mediastinal Compression
7. Acute General Infection
8. Hormonal vicarious mens., pregnancy
*80 % is idiopathic
-
7/30/2019 PPT EPISTAKSIS
9/22
1. Littles Area (90 % cases)
2. Above the level of middle turbinate(ICS)
3. Below the level of middle turbinate (Br. of SP)
4. Posterior part of nasal cavity
5. Diffuse. (general sys. inf., blood dyscrasias)
-
7/30/2019 PPT EPISTAKSIS
10/22
1. Anterior Epistaxis.
Blood flows out from the front of nose withthe patient in sitting position.
2. Posterior Epistaxis
Mainly the blood flows back into the throat
-
7/30/2019 PPT EPISTAKSIS
11/22
Difference between anterior and posterior epistaxisAnt. Epistaxis Post. Epistaxis
Incidence More common Less common
Site Littles area Posterosuperior part of
nasal cavity
Age Child- young adult > 40 yr
Cause Mostly trauma Spontaneous
Bleeding Mild, easy to control Severe, requireshospitalisation
-
7/30/2019 PPT EPISTAKSIS
12/22
1. Onset
2. Duration and frequency of bleeding3. Amount of blood loss
4. Side of nose which has bleeding
5. Type of bleeding6. Family history
7. History of drug intake
8. History of known medical ailment
-
7/30/2019 PPT EPISTAKSIS
13/22
1. Physic Examination. Vital sign and
rhinoscope2. Lab. test.
3. Radiology. Nasal and paranasal sinuses X-Rays, Blood and liver test, and biopsy.
-
7/30/2019 PPT EPISTAKSIS
14/22
1. First Aid Trotter method
2. Anterior Nasal Packing3. Posterior Nasal Packing
4. Cauterisation Silver Nitrat
5. Embolisation - absorbable gelatin spongefor persistant epistaxis
6. Ligation of Vessels
-
7/30/2019 PPT EPISTAKSIS
15/22
1. Patient sit up with a back rest. Record blood
loss2. Mild sedative should be given
3. Keep check on vital signs
4. Maintain hemodynamics.5. Antibiotiscs may be given
6. Intermittent oxygen may be required
7. Find the underlying disease
-
7/30/2019 PPT EPISTAKSIS
16/22
Benign tumour
Aetiology : Idiopathic, thought to betestosterone dependent
Arise from the posterior part of nasal cavityand then grow into the nasal cavity,nasopharynx and into the pterygopalatinefossa.
the vessel are just endothelium-lined with
no muscle coat. Tend to be severe bleeding and cant be
control by adrenaline
-
7/30/2019 PPT EPISTAKSIS
17/22
Clinical Features
1. exclusively seen in males in age group of10-20 yr
2. epistaxis and anaemic
3.
denasal speech caused by obstruction4. mass in the nasopharynx
-
7/30/2019 PPT EPISTAKSIS
18/22
Investigations
1. Soft tissue lateral film of nasopharynx2. X-Rays of paranasal sinuses and base of
skull
3.
CT- Scan4. MRI
5. Carotid Angiography to show extension ofthe tumour and its vascularity.
Diagnosis can be done by biopsy, but AVOIDED
-
7/30/2019 PPT EPISTAKSIS
19/22
Treatment
1. Surgical Excision. Vary depend on the tumourorigin and extension :
Transpalatine
Transpalatine + sublabial (Sardanas approach)
Extended lateral rhinotomy
Extended Denkers approach
Intracranial-extracranial
Infratemporal fossa
-
7/30/2019 PPT EPISTAKSIS
20/22
multifactorial disease
most common in China Aetiology is unknown. The factor thought to be
are: Genetic chinese
Viral Epstein-Barr virus
Environment air pollution, smoking, salted fish,smoke
-
7/30/2019 PPT EPISTAKSIS
21/22
Clinical Features:
mostly seen in 5th
to 7th
decades peoplesmales are 3 times more prone than femalesNasal obstruction, nasal disharge, denasal speech andEPISTAXISConductive hearing loss, serous or suppurative otitis
media, tinnitus and dizzinesssquint and diplopia, ophthalmoplegia, facial pain andreduced corneal reflex, jugular foramen sindromecervical nodal metastasesdistant metastases involve bone, lung, liver and other site
-
7/30/2019 PPT EPISTAKSIS
22/22
Diagnosis
nasopharyngoscope (most important) Skull x-rays, CT-Scans, MRI with gadolinium and biopsy
Treatment
Irradiation Systemic chemotherapy is used as palliation