ISSN 2398-2950      

Epistaxis

ffelis

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  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  Secondary hemostasis 01  Secondary hemostasis 02 : involves formation of fibrin by coagulation factors to stabilize the primary hemostatic platelet plug. Coagulation cascade is classically divided into intrinsic and extrinsic pathways with a final common pathway.
  • 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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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Haney S M, Beaver L, Turrel J et al (2009) Survival analysis of 97 cats with nasal lymphoma: a multi-institutional retrospective study (1986-2006). JVIM 23 (2), 287-294 PubMed.
  • Smith W, Day T & Mackin A (2005) Diagnosing Bleeding Disorders. Comp Contin Educ Pract Vet 27 (11), 828-843 VetMedResource.
  • Henderson S M, Bradley K, Day M J et al (2004) Investigation of nasal disease in the cat - a retrospective study of 77 cases. J Feline Med Surg (4), 245-257 PubMed.

Other sources of information

  • Quimby J, Lappin M R & Rosenthal M (2010) Feline focus - update on feline upper respiratory diseases: introduction and diagnostics. Compendium January 2010 (Vol 32, No 1).
  • Northrup N, Geiger T (2004) Clinical aproach to Patients with Epistaxis. Compendium January 2004, Vol 26, No 1.

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