EPISTAXIS

Ask the following questions:

1. Is there hypertension? The patient with hypertension could have either essential or symptomatic hypertension. Be sure to recheck the blood pressure, as other health professionals may miss the auscultatory gap. Next, treat the hypertension and examine the patient for symptomatic hypertension later.
2. Is the bleeding from Little's area or is it farther up the nasal passageway? Ninety percent of epistaxis results from bleeding in Little's area, and this area is most easily controlled. Bleeding from this area is usually not a serious problem. However, when the bleeding is from the posterior nasal areas, one must always consider the possibility of carcinoma.
3. Is there a history or are there clinical signs of a coagulation disorder? There may be a history of hemophilia or leukemia. There may be splenomegaly. There may be bleeding sites elsewhere to indicate that there is a systemic disorder associated with the epistaxis. One can easily perform a Rumpel-Leede test to determine if there is a platelet deficiency or dysfunction.

DIAGNOSTIC WORKUP

The diagnostic workup of epistaxis should include a coagulation profile with prothrombin time, partial thromboplastin time (PTT), bleeding time, platelet count, Rumpel-Leede test, and CBC. If these tests suggest a coagulation disorder, referral to a hematologist can be done for further diagnostic workup.

A nasal smear should be done for eosinophils to determine if the patient has chronic allergic rhinitis.

When a carcinoma of the nasal pharynx or sinuses is suspected, x-rays of the paranasal sinuses can be done as well as nasopharyngoscopy. A CT scan of the sinuses is also of value in difficult diagnostic problems.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Nosebleeds: Introduction (review 260 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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