2. Define epistaxis.
Bleeding from inside the
nose, either anterior nasal or
posterior nasal.
Epi : from above
Staxis : drop by drop drip of fluid.
3. Epistaxis is a sign, NOT a disease
It should never be treated as a
harmless event.
4. Anatomical considerations
Nasal cavity: mucosa and turbinates
are very vascular
Receives blood supply from branches
of both internal and external carotid
arteries.
Network of arteries : Kiesselbach’s
plexus, woodruff’s plexus
9. Little’s area
Situated over the anteroinferior part of
nasal septum, just above the vestibule
Caudal part of the nasal septum which
has a rich submucosal arterial
network(Kiesselbach’s plexus) by septal
branches of
- anterior ethmoidal
- sphenopalatine
- superior labial
- greater palatine
10. Prone for
drying (effect
of inspired air )
and
microtrauma
by nose
picking
Commonest
site for
epistaxis in
children
11. Question 2
The following is true regarding little’s area of
the nose, except:
A) Situated over the anteroinferior part of the
lateral wall of the nose
B) Has a rich submucosal vascular plexus
named Kiesselbach’s plexus
C) Bleeding from Retrocolumellar vein is one
of the differential diagnoses of little’s area
epistaxis
D) The kiesselbach’s plexus is formed by the
septal branches of anterior
ethmoidal, sphenopalatine, greater
palatine, and superior labial arteries
12. Answer :
A.
Little’s area is situated over the
anteroinferior part of the nasal septum
13. Retrocolumella vein
This vein runs vertically downwards
behind the columella.
It crosses the floor of nose & joins venous
plexus on the lateral wall of nose.
Common site of venous bleeding in young
people
14. Question 3
Which statement is true about
Retrocolumellar vein?
A. This vein runs vertically downwards below
the columella.
B. It crosses the floor of nose & joins venous
plexus on the nasal septum.
C. It crosses the floor of nose & joins venous
plexus on the lateral wall of nose.
D. It crosses the roof of nose & joins venous
plexus on the lateral wall of nose.
E. Common site of venous bleeding in old
people.
16. Woodruff’s Area
Vascular area situated over the
posterior end of inferior turbinate
Sphenopalatine artery anastomoses
with posterior pharyngeal artery
Posterior epistaxis occur
17. Question 4
Which statement is true about Woodruff’s
area?
A. Site for anterior epistaxis
B. Greaterpalatine artery anastomoses with
posterior pharyngeal artery here
C. Vascular area situated under posterior
end of inferior turbinate
D. Vascular area situated above posterior
end of inferior turbinate
E. Vascular area situated under posterior
end of middle turbinate
Answer : C
18. Sites of epistaxis
Little’s Area (90%)
Above the level of middle turbinate
Below the level of middle turbinate
Posterior part of nasal cavity
Diffuse. ie : septum & lateral wall
Nasopharynx
19. Question 5
Which is the commonest site of
epixtaxis?
A. Above the level of middle turbinate
B. Below the level of middle turbinate
C. Posterior part of nasal cavity
D. Little's area
20. Answer
D, 90% of the epistaxis site is from
little’s area.
21. Epistaxis
Anterior epistaxis Posterior
epistaxis
Blood flows out from the Blood flows back into
front of nose with the the throat. Patient may
patient is in sitting swallow it and have
position. “coffee-coloured”
vomitus.
** may misdiagnosed as
haematemesis
22. Differences between anterior and
posterior epistaxis
Anterior epistaxis Posterior epistaxis
Incidence more Less
site Little’s area or anterior Posterosuperior part of
part of lateral wall nasal cavity; difficult to
localise the bleeding
point
age Children and young adult >40 years
cause Trauma Spontaneous; often due
to hypertension or
arteriosclerosis
Bleeding Mild bleeding, can be Severe bleeding;
controlled by local requires hospitalisation
pressure or anterior nasal and postnasal pack
pack
23. Question 6
Which of these statements are true?
A. Anterior epistaxis is usually caused by
hypertension
B. Posterior epistaxis is more common
C. Anterior epistaxis does not usually
occurs in children and young adults
D. Anterior epistaxis bleeding is usually
mild
24. Answer
D, posterior epistaxis is more
severe, usually requires
hospitalisation and postnasal
pack;while anterior epistaxis is usually
mild bleeding.
33. What is the commonest cause of
epistaxis?
A. Idiopathic
B. Deviated nasal septum
C. Fracture to the base of skull
D. Hypertension
E. Finger nail trauma
