repeated nosebleeds
Introduction
Introduction Repeated epistaxis is a clinical symptom of cerebral hemorrhage. Nosebleed is one of the common clinical symptoms, mostly caused by nasal lesions, and can also be caused by systemic diseases. Occasionally, nasal bleeding due to nasal lesions. Most of the nosebleeds are unilateral, and can be bilateral; intermittent bleeding can also be repeated, and bleeding can be continued; the amount of bleeding varies, the blood is only in the nose, the severe can cause hemorrhagic shock; repeated bleeding can lead to anemia. Most bleeding can stop. There are many causes of nosebleeds, which can be caused by diseases of the nasal cavity itself, or by nasal or systemic diseases.
Cause
Cause
There are many causes of nosebleeds, which can be caused by diseases of the nasal cavity itself, or by nasal or systemic diseases.
Local cause
(1) Nasal injury: 1 Mechanical trauma: such as car accidents, falls, boxing injuries and nose digging, are common causes of nosebleeds. 2 Barometric injury: During high-altitude flight and diving, if the pressure difference between the inside and outside of the sinus suddenly changes too much, the mucosal blood vessels in the nasal cavity and sinus will expand and rupture. 3 radiotherapy injury: during the head and neck radiotherapy and after radiotherapy, nasal mucosa congestion and edema, or epithelial shedding, nose bleeding can also occur.
(2) Deviation of the nasal septum: occurs mostly in the vicinity of the epiphysis or bone spine (circular protrusion) or the convex surface of the nasal septum, where the mucous membrane is thin, and the flow of the air current changes here, so the mucous membrane becomes dry. The blood vessels rupture and bleed. Patients with perforation of the nasal septum may cause repeated episodes of hemorrhage due to mucosal dryness, erosion, and dryness of the perforated margin.
(3) nasal inflammation: 1 nasal non-specific inflammation: acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. may cause nosebleeds, the amount of bleeding is generally not much. 2 nasal specific infection: specific infections such as tuberculosis, lupus, syphilis, leprosy and diphtheria, due to mucosal erosion, ulcers, granulation, perforation of the nasal septum can cause nosebleeds.
(4) nasal cavity, sinus and nasopharynx tumors: the most prone to nasal bleeding is nasal septal hemangioma, nasopharyngeal angiofibroma, hemorrhagic nasal polyps and nasal sinus malignant tumors. A small amount of nosebleeds or blood in the sputum is one of the early major symptoms of malignant tumors.
(5) nasal foreign body: common in children, mostly unilateral nosebleeds, because the nasal foreign body remains in the nasal cavity for a long time, can cause nasal mucosal erosion bleeding. Animal nasal foreign bodies, such as leeches, can cause repeated massive nosebleeds.
Whole body cause
(1) Hemorrhagic diseases and blood diseases: 1 vascular wall structure and functional defect diseases: such as hereditary hemorrhagic telangiectasia, vitamin C deficiency, allergic purpura, drug-induced vascular purpura, infectious vascular purpura Vascular pseudohemophilia and the like. 2 the number of platelets or dysfunctional diseases: such as primary thrombocytopenic purpura, secondary thrombocytopenia caused by various causes. 3 coagulation factor disorders: such as various types of hemophilia, vitamin K deficiency and so on. 4 The blood's own anticoagulant effect is too strong: such as improper use of anticoagulant, anticoagulant substances such as anti-fibrinogen in the blood circulation, or excessive or accelerated fibrin dissolution, such as diffuse intravascular coagulation.
(2) Acute febrile infectious diseases: above, flu, hemorrhagic fever, scarlet fever, malaria, measles and typhoid. Due to hyperthermia, vascular toxic damage, nasal mucosa congestion, swelling and dryness, resulting in capillary rupture and bleeding. Under normal circumstances, the amount of bleeding is small, mostly occurs in the fever period, and the bleeding site is mostly located in the front of the nasal cavity.
(3) Cardiovascular diseases: 1 hypertension and arteriosclerosis: hypertension and arteriosclerosis are important causes of epigastric bleeding in middle-aged and elderly people. Arteriosclerosis is the pathological basis. Increased blood pressure, especially in constipation, excessive force or emotional agitation, can cause nasal blood vessels to rupture, causing nosebleeds. In addition, sneezing, coughing, violent nasal or nasal massage are also factors that are repeated and difficult to control. 2 increased venous pressure: emphysema, pulmonary heart disease, mitral stenosis, neck or mediastinal occupying lesions, etc., can cause superior vena cava hypertension, these patients' nasal and nasopharynx veins often anger and congestion When the patient has a severe cough or other incentives, the blood vessels can rupture and the bleeding site is located in the distribution area of the nasopharyngeal vein at the posterior nostril.
(4) Other systemic diseases: nose, pregnancy, premenopausal, menopause can cause nosebleeds, which may be related to increased capillary fragility. Patients with severe liver disease can cause nosebleeds due to liver clotting factor disorders. Uremic can also cause nosebleeds. Nose bleeding can be one of the early manifestations of rheumatic fever.
Examine
an examination
Related inspection
Nasopharyngeal MRI examination of otolaryngology CT examination
1. Detailed medical history and bleeding, confirm that bleeding originates from the nasal cavity or adjacent tissues, and excludes hemoptysis and hematemesis.
2. Determine the location of the bleeding, combined with the anterior endoscope, nasal endoscopy and / or CT, MRI examination to determine the location.
3. Blood routine examination is essential for patients with large bleeding and suspected blood disease. Coagulation is required in patients with anticoagulant drugs and suspected coagulation disorders.
4. Estimate the amount of bleeding, assess the current circulatory condition of the patient, whether there is hemorrhagic shock, and the necessary fashion must be consulted with the relevant department. According to the condition of each bleeding and the number of episodes, the patient's blood pressure, pulse, general conditions and laboratory tests to comprehensively determine the amount of bleeding. When the blood loss reaches 500ml, symptoms such as dizziness, thirst, fatigue, paleness, etc. may occur. When the blood loss reaches 500-1000ml, sweating, blood pressure drop, pulse speed and weakness may occur. If the systolic blood pressure is lower than 80mmHg, the blood is indicated. The capacity has been lost by about 1/4.
5. Investigate systemic diseases.
Diagnosis
Differential diagnosis
1, hemoptysis
After hemorrhage of the larynx, trachea, bronchus and lungs, the blood is excreted in the mouth, which is common in tuberculosis, bronchiectasis, lung cancer, lung abscess and pulmonary congestion caused by heart disease. Can be identified according to the patient's past medical history, physical signs and auxiliary examination.
2, hematemesis
Hematemesis is one of the main manifestations of upper gastrointestinal bleeding. When a large amount of hematemesis, blood can emerge from the mouth and nasal cavity, often accompanied by other symptoms of digestive tract diseases. The whole body examination can have positive signs and can be identified.
