ISSN 2398-2969      

Epistaxis

icanis

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

General

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

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mylonakis M E et al (2008) A retrospective study of 61 cases of spontaneous canine epistaxis (1998 to 2001). JSAP 49 (4), 191-196 PubMed.

Other sources of information

  • Northrup N, Geiger T (2004)Clinical aproach to Patients with Epistaxis.Compendium January 2004, vol 26, No 1.

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