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.

EPISTAXIS

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.

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

1. CBC (anemia, thrombocytopenia)
2. Chemistry panel (liver disease, renal disease)
3. Rumpel–Leede test (thrombocytopenia)
4. Liver function test (cirrhosis)
5. Prothrombin time (liver disease, vitamin K deficiency, drug effects)
6. Partial thromboplastin time (DIC, hemophilia)
7. X-rays of the sinuses (neoplasm)
8. Nasopharyngoscopy (polyps, neoplasm)
9. Circulation time (CHF)
10. Arterial blood gas analysis (lung disease)
11. Platelet count (thrombocytopenia)
12. Bleeding time (thrombocytopenia, vascular purpura)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Nosebleeds: Introduction (review 260 causes)
• Next Book Extract About Nosebleeds: HEMOPTYSIS (Differential Diagnosis in Primary Care)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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