Causes of nasal bleeding, first aid, diagnosis

Epistaxis - nasal bleeding or nosebleed?

As it is not strange, but these two, similar in content phrases, display completely different concepts, united by a common name - epistaxis.

Nasal bleeding occurs in people of different age categories. It can be spontaneous, or due to various external causes that have caused a disruption in the integrity of multiple capillary nets that actively supply the mucous layer of the nasal sinuses or nasopharynx. It is with this pathology that up to 10% of patients undergo treatment in out-patient departments of otolaryngology.

Frequent manifestation of nasal bleeding may be one of the symptoms of serious pathologies. Such cases in medicine are already considered as bleeding from the nose, which can trigger intracavitary vascular lesions of the skull or nasal mucosa.

The respiratory system, esophagus or stomach may well be a source of pathology. With similar vascular disorders, the blood flows outward as a result of flowing through the natural openings( the choana) that connect the oropharynx with the nasal cavity.

Forms of manifestation

Nasal bleeding, in its manifestation, is divided into several forms- Light, medium and heavy form. In addition, they differ by certain criteria:

At the location of - vascular lesion of the anterior( front) or posterior vessels, bleeding from one sinus or bilateral.

Bleeding from the anterior sections of the nasal cavity is caused by multiple branching of the vessels in the anterior zone of the Kisselbach plexus of both nostrils. It is the defeat of the anterior circulatory system of the nose - the main cause of nasal bleeding from one nostril.

Bleeding from the back is due to damage to the circulatory system in the deep zones of the nose and is very dangerous. The blood loss can be unpredictable, stopping it and stopping at home is almost impossible.

According to the time index , the duration and short duration of the pathological process is determined.

Quantitative indicator is due to profuse current( abundant), or insignificant( small amount, drops).

By the number of manifestations of - rarely occurring( or once), repeatedly recurring( spontaneous) and spontaneous( trauma or surgical interventions).The risk of recurrent manifestations is caused by the development of anemia.

According to the type of vascular lesion of - blood capillaries, deep arterial vessels, or venous network.

Etiology of nasal bleeding

Epitaxial manifestation in patients of any age is due to various common causes and local causes, among which prevail:

• the drying of the mucous epithelium in a hot and unventilated room, leading to capillary embrittlement. Usually a dream in such conditions causes the appearance of blood from the nose at night
• thinning and thickening of the intracavitary mucosa of the nasal sinuses during the development of a specific atrophic rhinitis;
• presence of angiofibroma of the nasopharynx, tumor-like growths( hemangiomas) or polypposic lesions.

What can noseaches bleed to adults?

Causes of nasal bleeding in adults and children of a local nature are supplemented by many pathologies.

They can be caused by physiological, traumatic and compensatory distortions of the cartilaginous septum of the nose, which causes changes in the air flow in both nasal sinuses, provokes in them and in the maxillary sinuses irritations and dryness, the development of long-term infectious processes, puffiness and stuffiness, joint fragility.

Thermal, radiation and chemical burns cause necrosis of the epithelium of the mucosa in the nasal cavity and damage to the capillary vascular walls.

One-sided or bilateral epistaxis is facilitated by operative manipulations and interventions( puncture, endoscopy, probing, piercing installation).

To the general reasons are added:

1. Cardiovascular pathologies provoking increased permeability of the vascular walls. For example, various types of atherosclerosis, causing sclerosing arterial walls and the development of hypertension.
2. Vascular anomalies in the neck and head caused by increased intravascular pressure provoked by disseminated syndrome of intravascular hemostasis.
3. Pathological conditions in hemorrhagic diathesis, manifested by increased vascular bleeding due to the presence of pathologies associated with the process of blood clotting( coagulation).
4. A drastic change in the barrological pressure inherent in certain occupations( among divers, airmen, climbers).Pathology of kidney and liver disease. For example, cirrhosis, accompanied by high blood pressure and severe vascular brittleness, and kidney pathologies often accompany the syndrome of uremic bleeding, manifested by epistaxis.
5. Admission of drugs interfering with normal hemostasis.
6. Congenital anomalies - hemorrhagic angiomatosis or hemophilia.

In a perfectly healthy person, signs of an epistaxis can manifest with prolonged exposure to the nasopharynx of frost and dry air, causing dryness of the mucous coating and vascular damage.

In the older generation, bleeding from the nose occurs more often, due to age features, when the vessels in the posterior nasal sinuses lose their elastic properties, are damaged, causing a posterior vascular hemorrhage.

With back bleeding, blood drains into the throat, and can be unnoticed and provoke considerable blood loss. In women aged, the cause of dystrophic changes in the mucosal endothelium and vessels is due to hypertensive crisis or the natural factor of menopause.

Causes of nasal bleeding in children

The delicate and easily traumatized mucous layer of the infant's nasopharynx is supplied with blood by the largest vascular branch - the artery of the neck and head. The greatest predisposition to bleeding is noted in the vessels of the lower nasal passage.

In children, the causative factors are similar in many respects to the manifestation in adults, but are also supplemented by an external factor caused by pathologies in the mucous epithelial layer due to the introduction of foreign stimuli - peas, pencils, buttons and many objects that young children often put in their noses.

The register of common causative factors includes:

1. Infections causing heat, causing headache and nasal bleeding( catarrhal viral infections or general intoxication with scarlet fever) caused by viral toxins.
2. Diseases that cause malfunctions in coagulation processes, or congenital pathology of the hemostasis system.
3. Solar impact and overheating, or the effect of atmospheric pressure jumps.
4. Problems of intracranial and arterial pressure. Most often appear in the puberty period as a result of overloads( physical, emotional or related to sports).The blood goes with the nose, the pressure goes down. The plus is that it comes out with a nose, and does not pour into the brain. This is how the body protects itself, trying at least temporarily to stabilize the condition.
5. Hormonal restructuring - the release of hormones in children at puberty age is accompanied by a narrowing of the capillary vessels and an increase in blood pressure. Cyclic manifestations of nasal bleeding in girls are noted in the period of the formation of the menstrual "lunar" cycle.
6. Avitominosis - an imbalance with vitamin "C", manifested by vascular brittleness and brittleness in the spring, vitamin K deficiency is the main cause of poor hemostasis, which is manifested by epistaxis.

Epistaxis during pregnancy

Nose bleeding in the gestation period can cause a variety of reasons. Manifestations at the beginning of the first trimester are caused by the restructuring of the woman's body.

Increased synthesis of estrogen provokes a large accumulation of fluid in the intercellular space of the upper layer of the mucosal epithelium and blood clotting of the vascular network, which causes increased fragility and permeability of the

capillaries. Natural loads during pregnancy and lying position cause rapid sniffing. To ease the condition, a woman is forced to use vasodilator drugs that dry the mucous membrane, damage the vessels and cause signs of dry rhinitis. Usually, they show bleeding in the morning, even with a slight barking.

In the subsequent trimesters - the 2nd and 3rd, the epistaxis can be a consequence of avitaminosis followed by the development of pathological changes in the walls of the capillaries.

The presence of hypertension promotes pathology and provokes fetal hypoxia and problems with fetal development. In a state of pregnancy, to ensure a healthy diet, blood circulation in the female body increases significantly, which increases the burden on the heart and blood vessels.

Not abundant, rare manifestations of epistaxis do not cause a threat, but the appearance of blood from the nose every day, threatens the termination of pregnancy and requires timely correction and medical care.

The main symptomatology of nasal bleeding

The vast majority of pathologies begin without previous symptoms. Characteristic symptoms include: vertigo( manifestations of dizziness), migraine attacks, tachycardia, hearing impairment with tinnitus caused by blood flow disturbance. Passing, accompanied by hypertension and severe weakness, pose a serious problem.

To various forms of pathology, there is a certain symptomatology:

• In the initial form of pathological manifestations, the symptomatology is manifested by a minor blood loss with signs of light dizziness.
• In mild form, weakness and tachycardia, tinnitus, signs of thirst and vertigo are noted.
• The average severity of the manifestation is characterized by severe dizziness, shortness of breath, a drop in blood pressure and tachycardia, signs of a cyanotic change in the skin.
• The severe form is manifested by hemorrhagic shock, pronounced inhibition, falling AD, tahisystolic impairment, syncope.

Severe form of bleeding with large blood loss, can become recurrent, periodically repeating to cause mental disorders due to oxygen starvation.

First aid for nasal bleeding

First aid for nosebleeds will not cause difficulties if you clearly know how to do it correctly. It is necessary to firmly assimilate - it is impossible to wait for an independent resolution of the problem. Serious complications from the cardiovascular system, manifestation of fainting and anemia can aggravate the situation.

For quick stopping of blood, it is necessary to sit down, slightly throwing back his head. With two fingers, press the nose for 10-15 minutes. During this time, the blood inside should curtail and block the passage of the damaged vessel. Pay attention to the breath of the mouth was free.

You can stop bleeding with a tamponade, after moistening the tampon with peroxide or apple cider vinegar. The tampon is inserted into one nasal opening, or both. An icy or cold compress is applied to the region of the nose. During the hours 2, 3, you should refrain from blowing your nose and nose.

When bleeding from one nasal aperture, for example, from the left side, it is necessary to raise the left arm above the head and vice versa, if on the right side.

Helping a child with nosebleeds is similar. But with the kids should take into account the psychological factor, because young children are usually very frightened of this state. It is necessary to distract him, calm him and organize medical assistance as quickly as possible.

Diagnostic examination

Often the manifestation of a single minor epistaxis is due to a traumatic cause. In this case, a rhinoscopic examination of the anterior zone of the Kisselbakh plexus gives a complete picture of the source of bleeding.

If the source is in the deep zone of the nasal cavity, the method of endoscopic examination( probing) is used.

To determine the general characteristic of the lesion( hemodynamics), in the recurrent stage, a blood test - a coagulogram( coagulation assay), a thromboellastogram, is made, which allows to make an overall assessment of the patient's condition based on the hemoglobin and platelet parameters.

Biochemical and general analyzes, blood pressure indicators, help establish the background cause provoking epistaxis and make the right treatment.

Methods of treatment of nasal bleeding

Drug therapy is the main stage in treatment. Due to careful selection of prescriptions:

1. Hemostatic drugs - "Epsilon", "Abmen", calcium and haemostatic agents are widely used.
2. Strengthens the therapeutic effect of "Vikasol".Its appointment is justified with background hepatic pathology.
3. For the strengthening of the vascular walls are prescribed drugs that increase hemostatic functions - "Ascorutin", "Vipraxin".
4. Drugs that prevent thrombosis - "Kontrikal" or "Trasilol".
5. Coagulation correctors and immunoglobulin preparations that eliminate excessive bleeding.
6. Complex therapy includes therapeutic agents that eliminate background pathologies that caused epistaxis.

All prescriptions, dosages and treatment regimens are strictly individual for each patient.

1. As a topical treatment, tampons impregnated with plasma or citrated( sterilized) blood, hemostatic hemostatic sponges, fibrinous antiseptic biological tampons are used to stop nasal bleeding.

2. With nasal bleeding from small vessels, various methods of cauterization are used - laser cauterization and electrocoagulation, cryodestruction or ultrasonic disintegration.

3. Effective effect is provided by catheter oxygen therapy( inhalation of moistened oxygen), anterior or posterior tamponade - tampons moistened with haemostatic preparation from long bandages are inserted into the nasal cavity to stop the discharge of blood.

is used as surgical methods:

1. Vestibuloplasty is a section of the mucosa with and without detachment, removal of the submucosa from the septum of the nose, scraping of the granulation growths.

2. For more serious pathologies - vascular dressing, dermoplasty, replacement of the mucous membrane with a dermal ear flap.

Description of possible complications

Large blood loss in case of epistaxis can lead to an acute process of circulatory disturbance( collapse) with a sharp disruption of blood supply and acute hypoxia of tissues, organs and systems. Especially, it affects the brain, kidneys and heart tissues.

Progression of this condition causes the patient a shock and loss of consciousness that without medical intervention can result in death.