Diseases of respiratory system EPISTAXIS NOSE BLEED Definition

Diseases of respiratory system EPISTAXIS (NOSE BLEED) Definition n - Epistaxis means bleeding from the nostrils regardless of origin of the hemorrhage. n - hemoptysis means coughing of blood with hemorrhage usually originating from the lungs. 1

Etiology a- Epistaxis occurs commonly in the horses and may be due to lesions in nasal cavity, nasopharynx, guttural pouch or lungs. b- Hemorrhage lesions of nasal cavity, nasopharynx and guttural pouch usually cause unilateral epistaxis, while blood originating from the lungs is discharged from both nostrils and not the mouth because of the long soft palate. 2

N. B. Blood originating from the lungs is not foamy as was previously thought because the horizontal position of the major bronchi allows blood to flow out freely without being coughed-up and made foam. Froth is usually the result of pulmonary edema in which case it is very fine pink stable froth 3

c- The commonest cause of epistaxis A) Local causes 1 - External trauma. 2 - Foreign bodies in nasal cavities. 3 - Neoplasms (erosion of m. m. of nasal cavity). 4 - Mycotic ulceration of B. V. in the wall of guttural pouch around the guttural pouch. 5 - Encapsulated hematoma in nasal cavity. 6 - Hemorrhage polyps of m. m. of nasal cavity or paranasal sinuses. 7 - Erosion of the nasal mucosa in glanders. 8 - Internal trauma due to passage of nasal tube or endoscope. 4

B) Systemic causes: 1 - Congestive heart failure (mild epistaxis). 2 - Purpura hemorrhagica. 3 - Thrombocytopenia (generalized bleeding). C)- Idiopathic in exercise-induced epistaxis in race horses (bleeders). 5

Unilateral epistaxis 6

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Diagnosis n n n I- History II- Clinical signs. III) Exam of nasal cavities : 1 - Visually with the aid of strong pointed source of light through external nares. 2 - with the use of flexible fiberoptic endoscope will permit thorough exam of the nasal cavities, nasopharynx, guttural pouch larynx, trachea and major bronchi. 9

Blood visualized by endoscopy of the trachea in a horse with exercise-induced pulmonary hemorrhage. 10

Treatment a- Treat the cause, if it is known. b- when the cause is obscure, treat symptomatically as follow: 1 - Cold packs over the nose and forehead. 2 - Tampon or gauze soaked in adrenaline inserted in zigzag manner into affected nostril (but not in both nostrils). 3 - vasoconstrictor drugs e. g. thrombin solution spray on bleeding surface immediately, or diacynon injection. 4 - Calcium preparations e. g. calcium gluconate 20% 500 ml. S/C or slow I/V. 5 - Vitamin – K injection ( synkavit = synthetic – vitamin – K ) 6 - Blood transfusion in severe cases. 7 - Hematinics e. g. iron preparations (iron dextran or ferrous sulphate) 11

N. B: n Avoid injection of adrenaline as it increasing bleeding by rising of blood pressure. 12

QUESTIONS 13