鼻出血(英文)医学.pptxVIP

EPISTAXISRaza M. Jafri, FRCSAsst. Prof. Of OtolaryngologyHamdard University4/99Raza M. Jafri, FRCSdocraza@.pkREASONS FOR EXCESSIVE BLEEDINGVascularity of noseBoth external and internal carotids. Anastomsis between arteries and veins.Blood vessels run just under the mucosa-unprotected.Larger vessels on the turbinate run in bony canals- cannot contract.4/99Raza M. Jafri, FRCSdocraza@.pkLITTLES ( KIESSELBACHS) AREA1/2 inch from the caudal border of the septum antero-inferiorly.Vessels anastomosing are; Anterior ethmoid, greater palatine, and sphenopalatine, and septal branch of superior labial.Bleeding may be arterial or venous.4/99Raza M. Jafri, FRCSdocraza@.pkLateral WallFrank Netter. Ciba4/99Raza M. Jafri, FRCSdocraza@.pkBlood supply SeptumFrank Netter. Ciba4/99Raza M. Jafri, FRCSdocraza@.pkLittle’s areaConfluence of :Anterior Ethmoidal a.Greater Palatine a.Sphenopalatine a.Sup. Labial a.4/99Raza M. Jafri, FRCSdocraza@.pkCLASSIFICATION4/99Raza M. Jafri, FRCSdocraza@.pkI. According to siteAnteriorSuperior; Anterior ethmoid ( bleeding is from above ant. half of middle turbinate)Inferior; Greater palatine,Posterior; Sphenopalatine (Bleeding is from below anterior half of middle turbinate4/99Raza M. Jafri, FRCSdocraza@.pkII. PRIMARY SECONDARY4/99Raza M. Jafri, FRCSdocraza@.pkIII. According to EtiologyLocal Causes: [1] TraumaNose picking, fractures.4/99Raza M. Jafri, FRCSdocraza@.pkLOCAL CAUSES[2] Infections:Viral:Influenza, measlesDiphtheria, lupus vulgaris, leprosy, Parasites, maggots, fungal4/99Raza M. Jafri, FRCSdocraza@.pkLOCAL CAUSES [3] Idiopathic: Wegners granulomatosis, Osler-Weber-Rendaus syn., atrophic rhinitis4/99Raza M. Jafri, FRCSdocraza@.pkLOCAL CAUSES[4] Neoplasms: Of the nose, nasopharynx and sinuses.Carcinom of the NasopharynxAngiofibroma4/99Raza M. Jafri, FRCSdocraza@.pkLocal Causes[4] Miscellaneous: Septal spur, foreign bodies4/99Raza M. Jafri, FRCSdocraza@.pkGeneral CausesHypertension, CCF, mitral stenosis, Cirrhosis, coagulopathies, anemias, purpu