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Causes of nosebleeds, first aid, diagnosis and treatment

Epistaxis - nosebleeds or nosebleeds?

It is not strange, but these two, similar in content phrases, display completely different concepts, united by a common name - epistaxis.

Nosebleeds occur in people of different ages. It can be spontaneous, or due to various external causes that have caused a violation of the integrity of multiple networks of capillaries that actively supply the mucous membrane of the nasal sinuses or nasopharynx. It is with this pathology that up to 10% of patients undergo treatment in outpatient otolaryngology departments.

Frequent manifestation of nosebleeds may be one of the symptoms of serious pathologies. Such cases in medicine are considered already as bleeding from the nose, which can provoke intracavitary vascular damage to the skull or nasal mucosa.

The respiratory system, esophagus or stomach may well be the source of pathology. In case of similar vascular disorders, blood flows out as a result of wicking through the natural openings (choans) connecting the oropharynx to the nasal cavity.



adult nasal bleeding

Nasal bleeding, in its manifestation are divided into several forms - light, medium and severe form. In addition, they differ in certain criteria:

– сосудистое поражение преддверия (переднее) или задних сосудов, кровоточивость из одной пазухи или двустороннее. According to the location - a vascular lesion of the vestibule (front) or posterior vessels, bleeding from one sinus or bilateral.

Bleeding from the anterior sections of the nasal cavity is caused by multiple branching of the vessels in the anterior zone of the Kisselbach plexus of both nostrils. It is the lesion of the anterior circulatory system of the nose that is the main cause of nosebleeds from one nostril.

Bleeding from the posterior part is caused by damage to the blood systems in the deep areas of the nose and is very dangerous. Blood loss can be unpredictable, stopping it and stopping it at home is almost impossible.

определяется длительность и кратковременность патологического процесса. According to the time indicator , the duration and short duration of the pathological process is determined.

The quantitative indicator is due to a profuse course (abundant), or insignificant (small amount, drops).

– редко возникающем (или однократным), многократно повторяющимся (рецидивирующим) и спонтанным (травмы или хирургические вмешательства). By the number of manifestations - rarely occurring (or once), repeatedly (recurrent) and spontaneous (trauma or surgical intervention). The danger of recurrent manifestations is due to the development of anemia.

– кровеносных капилляров, глубоких артериальных сосудов, либо венозной сети. According to the type of vascular lesion - blood capillaries, deep arterial vessels, or venous network.

Etiology of nasal bleeding

causes of nosebleeds

causes of nosebleeds, photo

Epitaxis is manifested in patients of any age due to various general causes and local causes, among which prevail:

  • drying of the mucous epithelium in a hot and unventilated room, which leads to capillary fragility. Usually sleep in such conditions causes the appearance of blood from the nose at night.
  • thinning and compaction of the intracavitary mucous membrane of the nasal sinuses during the development of specific atrophic rhinitis;
  • the presence of angiofibromas of the nasopharynx, tumor-like growths (hemangiomas) or polypous formations.

What can nasal bleeding tell in adults?

The causes of nasal bleeding in adults and children of a local nature are complemented by many pathologies.

They can cause physiological, traumatic and compensatory curvature of the cartilaginous septum of the nose, which causes changes in air flow in both nasal sinuses, provokes irritation and dryness in the maxillary sinuses, the development of long-term infectious processes, swelling and congestion, articular fragility.

Thermal, radiation and chemical burns cause necrosis of mucosal epithelium in the nasal cavity and damage to the capillary vascular walls.

The manifestation of unilateral or bilateral epistaxis is facilitated by operative manipulations and interventions (punctures, endoscopy, probing, piercing).

To the common reasons are added:

  1. Cardiovascular pathologies provoking increased permeability of the vascular walls. For example, various types of atherosclerosis, causing hardening of the arterial walls and the development of hypertension.
  2. Vascular anomalies in the cervical zone and head due to increased intravascular pressure provoked by disseminated intravascular hemostasis.
  3. Pathological conditions in hemorrhagic diathesis, manifested by increased vascular bleeding, due to the presence of pathologies associated with the process of blood coagulation disorders (coagulation).
  4. The sharp change in barrological pressure, characteristic of certain professions (divers, pilots, climbers).
  5. Pathology of the kidneys and liver disease. For example, cirrhosis, accompanied by high blood pressure and severe vascular fragility, and renal pathologies are often accompanied by uremic hemorrhage syndrome, manifesting epistaxis.
  6. Reception of the medicines interfering a normal hemostasis.
  7. Congenital anomalies - hemorrhagic angiomatosis or hemophilia.

In a perfectly healthy person, signs of epistaxis can occur with prolonged exposure to the nasopharynx of frosty and dry air, which causes dry mucous coating and vascular damage.

In the older generation, bleeding from the nose occurs more often due to age characteristics, when the vessels in the posterior section of the nasal sinuses lose their elastic properties and are damaged, causing posterior vascular hemorrhage.

With back bleeding, blood flows down the throat, and can be unnoticed and cause significant blood loss. In aged women, the cause of dystrophic changes in the mucous membrane of the endothelium and vessels is due to hypertensive crisis or the natural factor of menopause.

Causes of nosebleeds in children

Causes of nosebleeds in children

The mucous layer of the pediatric nasopharynx, gentle and easily traumatized, is supplied with blood by the largest vascular branch - the artery of the neck and head. The greatest predisposition to bleeding is observed in the vessels of the lower nasal passage.

In children, causal factors are in many ways similar to manifestations in adults, but they are also complemented by an external factor due to pathologies in the mucous epithelial layer due to the introduction of foreign stimuli - peas, pencils, buttons and many items that young children often put in their nose.

The registry of common causal factors includes:

  1. Infections that cause high fever, headache and nosebleeds caused by viral toxins (catarrhal viral infections or general intoxication with scarlet fever).
  2. Diseases that cause disruptions in coagulation processes, or congenital pathology of the hemostasis system.
  3. Sunstroke and overheating, or the influence of atmospheric pressure surges.
  4. Problems of intracranial and blood pressure. More often manifested in the pubertal period as a result of overloads (physical, emotional or sport-related). Blood goes nose, the pressure decreases. The advantage is that it comes out with its nose, and does not flow into the brain. This is how a peculiar defense of the organism is manifested, trying to stabilize the state at least for a while.
  5. Hormonal restructuring - the release of hormones in children at puberty is accompanied by a narrowing of the capillary vessels and an increase in blood pressure. Cyclic manifestations of nasal bleeding in girls are observed in the period of the formation of the menstrual "lunar" cycle.
  6. Avitominoz is an imbalance with vitamin “C”, manifested by vascular fragility and brittleness in spring, deficiency of vitamin “K” is the main cause of poor hemostasis, which is manifested by epistaxis.

Epistaksis during pregnancy

nasal bleeding during pregnancy, what to do?

Bleeding through the nose in the gestation period can cause various causes. Manifestations at the beginning of the 1st trimester are caused by the restructuring of the woman’s body.

Increased estrogen synthesis provokes an extensive accumulation of fluid in the intercellular space of the upper layer of the mucous epithelium and the blood overflow of the vascular network, which provokes an increased fragility and permeability of capillaries

Natural loads during pregnancy, and lying down causes increased sniffing. To alleviate the condition, the woman is forced to use vasodilators that dry the mucous membrane, damage blood vessels and cause signs of dry rhinitis. They usually manifest as bleeding in the morning, even with light blowing.

In subsequent trimesters - the 2nd and 3rd, epistaxis may be a consequence of beriberi followed by the development of pathological changes in the walls of the capillaries.

The presence of hypertension contributes to the pathology and provokes fetal hypoxia and problems with the development of the fetus. In the state of pregnancy, in order to ensure the nutrition of the fetus, blood circulation in the female body increases significantly, which increases the load on the heart and blood vessels.

Not abundant, rare manifestations of epistaxis do not cause a threat, but the appearance of blood from the nose every day, threatens to terminate the pregnancy and requires timely correction and medical assistance.

The main symptoms of nosebleeds

The vast majority of pathologies begin without prior symptoms. The characteristic symptoms include: vertigo (manifestation of dizziness), migraine attacks, tachycardia, hearing loss with tinnitus caused by impaired blood flow. They are accompanied by hypertension and strong weakness, they are a serious problem.

Certain symptoms correspond to various forms of pathology:

  • In the initial form of the pathological manifestations of symptoms manifested slight blood loss with signs of mild dizziness.
  • Mild weakness and tachycardia, tinnitus, signs of thirst and vertigo are noted.
  • The average severity of the manifestation is characterized by severe dizziness, shortness of breath, a fall in blood pressure and tachycardia, signs of cyanotic changes in the skin.
  • Severe form is manifested by hemorrhagic shock, severe lethargy, a fall in blood pressure, tachysystolic disorders, and fainting.

Severe bleeding with large blood loss may become recurrent in nature, occasionally repeating to cause mental disorders due to oxygen starvation.

First aid for nosebleeds

First aid for nosebleeds

First aid for nosebleeds will not cause difficulties if you clearly know how to do it correctly. It is necessary to firmly grasp - you cannot wait for an independent resolution of the problem. The situation may be aggravated by serious complications of the cardiovascular system, the manifestation of syncope and anemia.

To quickly stop the blood flow, you need to crouch, with your head thrown back slightly. Two fingers for 10-15 minutes to press the nose. During this time, the blood inside should clot and block the passage of the damaged vessel. Pay attention to mouth breathing is free.

It is possible to stop bleeding with the help of tamponade, having previously moistened the tampon with peroxide or apple vinegar. The swab is inserted into one nasal opening, or both. An ice or cold compress is applied to the nose bridge. For hours 2, 3, you should refrain from blowing your nose and breathing.

When bleeding from one nasal opening, for example, on the left side, you should raise your left hand above your head and vice versa, if on the right side.

Helping a child with nosebleeds is similar. But with the kids, you should take into account the psychological factor, because young children are usually very scared of this condition. It is necessary to distract him, calm him down and organize medical assistance as quickly as possible.

Diagnostic examination

diagnostics Often the manifestation of a single insignificant epistaxis is due to a traumatic cause. In this case, the rhinoscopic examination of the anterior zone of the Kisselbach plexus gives a complete picture of the source of bleeding.

If the source is in the deep zone of the nasal cavity, use the method of endoscopic examination (sensing).

To determine the generalizing characteristics of the lesion (hemodynamics), in the recurrent stage, blood tests are scheduled - coagulogram (clotting analysis), thromboelastogram, which allows to make a general assessment of the patient's condition by the result of hemoglobin and platelet parameters.

Biochemical and general analyzes, indicators of blood pressure, help to establish the background cause provoking epistaxis and make the correct medical therapy.

Methods for the treatment of nasal bleeding

Drug therapy is the main step in treatment. Due to the careful selection of appointments:

  1. Hemostatic agents - Epsilon, Abmen, are widely used calcium and hemostatic agents.
  2. Enhances the therapeutic effect of "Vikasol." His appointment is justified in case of background hepatic pathology.
  3. To strengthen the vascular walls are prescribed drugs that increase hemostatic functions - “Askorutin”, “Vipraksin”.
  4. Drugs that prevent blood clots - "Contrycal" or "Trasilol."
  5. Coagulation correctors and immunoglobulin preparations, which eliminate heavy bleeding.
  6. The complex therapy includes therapeutic agents that eliminate background pathologies that caused epistaxis.

All appointments, dosages and treatment regimen are purely individual for each patient.

В качестве местного лечения, для остановки носового кровотечения используют тампоны пропитанные плазмой или цитратной (стерилизованной) кровью, гемостатические кровоостанавливающие губки, фибринозные антисептические биологические тампоны. 1. As a local treatment, to stop nasal bleeding, use plasma swabs or citrated (sterilized) blood tampons, hemostatic hemostatic sponges, fibrinous antiseptic biological tampons.

При носовых кровотечениях из мелких сосудов используют различные методы прижигания – лазерное прижигание и электрокоагуляцию, криодеструкцию или ультразвуковую дезинтеграцию. 2. When nasal bleeding from small vessels using various methods of cauterization - laser cauterization and electrocoagulation, cryodestruction or ultrasonic disintegration.

Эффективное действие оказывают катетерная оксигенотерапия (вдыхание увлажненного кислорода), передняя или задняя тампонада – смоченные гемостатическим препаратом тампоны из длинных бинтов вставляются в полость носа для купирования выделений крови. 3. Catheter oxygen therapy (inhalation of humidified oxygen) has an effective effect; the anterior or posterior tamponade — tampons from long bandages moistened with a hemostatic preparation are inserted into the nasal cavity to relieve blood secretions.

As a surgical technique used:

Вестибулопластику – разрез слизистой оболочки с отслойкой и без нее, удаление подслизистого слоя с перегородки носа, выскабливание грануляционных разрастаний. 1. Vestibuloplasty - incision of the mucous membrane with and without detachment, removal of the submucosal layer from the nasal septum, scraping granulation growths.

При более серьезных патологиях – сосудистую перевязку, дермопластику, замену слизистой оболочки кожным заушным лоскутом. 2. For more serious pathologies - vascular ligation, dermoplasty, replacement of the mucous membrane of the skin of the ear for the ear.

Characteristics of possible complications

Large blood loss during epistaxis, can lead to an acute process of circulatory disorders (collapse) with a sharp violation of blood supply and acute hypoxia of tissues, organs and systems. Especially, it affects the brain, kidneys and heart tissue.

The progression of such a condition causes the patient to experience shock and loss of consciousness, which can result in death without medical intervention.


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