EPISTAXIS
The differential diagnostic approach to epistaxis is anatomic and
histologic. Table 27 breaks the nasal passages into anatomic
and histologic components and cross-indexes them with the various
etiologies.
By far, the most common cause of epistaxis is trauma from nose
picking. Many people are particularly vulnerable to this because of the
closeness of Kiesselbach plexus of veins and capillaries to the surface of
the septal mucosa. This cause can quickly be ruled out by nasoscopic
examination of the anterior portion of the septum. This same area may be
inflamed or ulcerated by various infections, particularly syphilis,
tuberculosis, leprosy, and mucormycosis. Carcinomas in this area are
uncommon, but the Schmincke tumor of the nasopharynx should not be
forgotten; more important are allergic polyps, which usually do not bleed
unless traumatized. Wegener midline granulomatosis is an autoimmune disease
that may present with a bloody or nonbloody nasal discharge. It usually
involves the sinuses, however, and must be differentiated from mucormycosis.
EPISTAXIS
|
| V
| I
| N
| D |
|
| Vascular
| Inflammatory
| Neoplasm
| Deficiency |
|
| | | | |
|
Anterior Septal Mucosa
| | Rhinitis Syphilis Leprosy Mucormycosis Tuberculosis
| Carcinoma (rarely) |
Sinuses
| | Tuberculosis Mucormycosis Viral sinusitis
| Polyp Carcinoma |
Nasopharynx
| | | Schmincke tumor Adenoid |
Veins and Capillaries
| Venous obstruction from emphysema, asthma, and congestive heart failure
| | Hemangioma |
Arteries
| Hypertension |
Blood
| | | Leukemia Polycythemia
| Aplastic anemia |
|
Other systemic diseases are prominent causes of epistaxis. Back pressure
from obstructed veins in emphysema, asthma, and right heart failure must be
considered. Arterial hypertension, from whatever etiology, is a common cause
from middle age onward. Rheumatic fever and blood dyscrasias round out the
picture.
Other miscellaneous causes of epistaxis are skull fracture and menopause. In
most cases, adequate examination of the nasal septum discloses the
diagnosis, and coagulation or nasal packing will suffice in treatment. The
blood pressure should always be checked and, in recurrent cases,
nasopharyngoscopy, coagulation studies, and a search for systemic disease
must be made.
Other Useful Tests
-
CBC (anemia, thrombocytopenia)
-
Chemistry panel (liver disease, renal disease)
-
Rumpel–Leede test (thrombocytopenia)
-
Liver function test (cirrhosis)
-
Prothrombin time (liver disease, vitamin K deficiency, drug
effects)
-
Partial thromboplastin time (disseminated intravascular coagulation
[DIC], hemophilia)
-
X-rays of the sinuses (neoplasm)
-
Nasopharyngoscopy (polyps, neoplasm)
-
Circulation time (CHF)
-4pc
EPISTAXIS
|
| I
| C
| A | T | E |
| Intoxication | Collagen or
| Allergic and
| Trauma | Endocrine |
|
| Congenital
| Autoimmune
| | |
|
|
| | Midline granuloma and polyps Rhinitis
| Nose-picking Foreign body
| Menopause Menstruation |
| |
| |
| |
|
| | Midline granuloma and polyps Sinusitis | | |
| |
|
| | Rheumatic fever
| Skull fracture Foreign body | |
|
| Kiesselbach plexus Telangiectasis | | | |
| |
|
| | |
Heparin and warfarin therapy
| Hemophilia and other coagulation defects
| Thrombocytopenia |
|
-
Arterial blood gas analysis (lung disease)
-
Platelet count (thrombocytopenia)
-
Bleeding time (thrombocytopenia, vascular purpura)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Nosebleeds
Read excerpts from these other book chapters related to Nosebleeds:
Medical Books Excerpts
- EPISTAXIS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- HEMOPTYSIS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- EPISTAXIS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Epistaxis
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Hemoptysis
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Epistaxis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Epistaxis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hemoptysis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hemoptysis
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Nosebleed
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Hemoptysis
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Epistaxis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Hemoptysis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Epistaxis
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Hemoptysis
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Epistaxis
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- EPISTAXIS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Nosebleeds
» Next page: HEMOPTYSIS (Differential Diagnosis in Primary Care)
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