[医药卫生]鼻出血.ppt

EPISTAXIS Glen Porter, MD Francis B. Quinn, MD UTMB-Galveston Galveston, Texas Introduction and History 5-10% of the population experience an episode of epistaxis each year. 10% of those will see a physician. 1% of those seeking medical care will need a specialist. Mythology: brown paper, nails, scissors, scarlet threads,“lead that has never touched the ground” A condition with a long history—Hippocrates to Henry Goodyear. Anatomy/Physiology of Epistaxis Anatomy Nasal cavity Vascular supply Physiology Vascular nature Mucosa Why bleeding from the nose ? Vascular organ secondary to incredible heating/humidification requirements Vasculature runs just under mucosa (not squamous) Arterial to venous anastamoses ICA and ECA blood flow Anterior vs. Posterior Maxillary sinus ostium Anterior: younger, usually septal vs. anterior ethmoid, most common (90%), typically less severe Posterior: older population, usually from Woodruff’s plexus, more serious. Etiology Local factors Vascular Infectious/Inflammatory Trauma (most common) Iatrogenic Neoplasm Dessication Foreign Bodies/other Etiology Systemic factors Vascular Infection/Inflammation Coagulopathy Local Factors -- Vascular ICA Aneurysms extradural cavernous sinus Local Factors - Infection/Inflammation Rhinitis/Sinusitis Allergic Bacterial Fungal Viral Local Factors - Trauma Nose picking Nose blowing/sneezing Nasal fracture Nasogastric/nasotracheal intubation Trauma to sinuses, orbits, middle ear, base of skull Barotrauma Local Factors - Iatrogenic nasal injury Functional endoscopic sinus surgery Rhinoplasty Nasal reconstruction Local Factors - Neoplasm Juvenile nasopharyngeal angiofibroma Inverted papilloma SCCA Adenocarcinoma Melanoma Esthesioneuroblastoma Lymphoma Local Factors –  Dessication Cold, dry air—more common in wintertime Dry heat—Phoenix and Death valley Nasal oxygen Anatomic abnormalities Atrophic rhinitis Local Factors - Other Self-inflicted (pedi) vs. traumatic foreig