1.

epistaxis

1. Epidemiology
• number event epistaxis in population general around 60%,
with less from 10% search help medical, Distribution age is
bimodal, with summit on child small (2-10 year) and individual
age more (50-80 year). epistaxis rarely on baby that without
disease coagulopathy or pathology nasal (atresia koanal,
neoplasms). traumalocal (scrape nose) often happen on
toddler to children, prevalence epistaxis tend more high on
man (51%) of the female (49%).
2. Etiology
1. Local
a) Trauma
Bleeding could happen because trauma light as scrape nose,
impact light, sneezing or release snot too hard, or as result
trauma more great as hit o'clock, fall down or accident then
traffic, traumabecause often scrape nose could cause ulceration
and bleeding in mucous part anterior septum.
b) Infection
epistaxis could happen on infection nose and sine paranasal as
rhinitis or sinusitis. inflammation will cause enhancement
permeability vessel blood local so that ease occurrence bleeding
in nose,
c) neoplasms
epistaxis that related with neoplasms usually a little and
intermittent, Hemongioma, carcinoma, and angiofibroma could
cause epistaxis weight, Because on tumor happen growth cell
abnormal and formation vessel blood that new
(neovascularization) which is fragile so that ease occurrence
bleeding,
d) abnormality congenital
abnormality congenital that often cause epistaxis is bleeding
telangiectasia heriditer (Hereditary hemorrhagic telangiectasia/
Osler's disease).
e) Causes other including object foreign and perforation septum.
Perforation septum rice or abnormality septum could into
predisposing bleeding nose,
f) Influence environment
For example stay in area that very high, pressure air low or
environment the air very dry,
g) Deviation septum
Deviation septum is something circumstances Where happen
switchover position from septum rice from located that be in line
medially body, apart that could cause turbulence air that could
cause formation crusting, vessel blood experience rupture even
by trauma very light as rubbing nose,
2. systemic
a) abnormality blood as thrombocytopenia, hemophilia and leukemia,
ITP, dyscrasias blood,
b) Drugs
Drugs as therapy anticoagulants, aspirin and phenylbutazone could
also predispose epistaxis recur, Aspirinhave effect antiplatelet that is
with menginhibisi production thromboxane, which on circumstances
normal will binding molecules platelet for make something blockage
on Wall vessel blood that broken, Aspirincould cause process freezing
blood into more long so that could happen bleeding, By because ,
aspirin could cause epistaxis,
c) Disease cardiovascular
Hypertension and abnormality vessel blood, as on atherosclerosis,
nephritis chronicle, cirrhosis hepatic, syphilis, diabetes mellitus could
cause epistaxis, epistaxis result hypertension usually great, often
relapse and prognosis no good
1. Hypertension
epistaxis often happen on pressure blood high because fragility vessel
blood that in cause by disease hypertension that chronic came to pass
contraction vessel blood continue constantly that
result easy outbreak vessel blood that thin,
2. arteriosclerosis
On arteriosclerosis happen stiffness vessel blood, If happen
circumstances pressure blood increase, vessel blood no can
compensate with vasodilation, cause rupture from vessel blood,
3. Cirrhosis hepatic
On cirrhosis hepatic function synthesis proteins and vitamins needed
for freezing blood disturbed so that easy occurrence bleeding, so that
epistaxis can happen on patient cirrhosis hepatic,
4. Diabetes mellitus
Wall vessel blood into more thick but weak so that easy happen
bleeding, so that epistaxis could happen on patient diabetes
mellitus,

c) alcoholism, Smoke
Alcohol and smoke could cause cell blood red clot so that cause
occurrence blockage on vessel blood, casethis cause occurrence
hypoxia and Dead cell. apart that case this cause enhancement
pressure intravascular that could result outbreak vessel blood so
that could happen epistaxis,
3. pathogenesis and pathophysiology
1) epistaxis anterior could originated from plexus kiesselbach,
constitute source bleeding most often found children and
juvenile, Could too originated from artery ethmoid anteriorly.
Bleeding could Stop own (spontaneous) and could controlled
with action simple
2) epistaxis posterior, originated from artery sphenopalatine and
artery ethmoid posterior. Bleeding tend more weight and rarely
Stop own, so that could cause anemia, hypovolemia and shock,
Often found on patient with disease cardiovascular
4. Manifestation clinical
Patient often declare that bleeding originated from part front
and back nose, On epistaxis anterior sign and symptom in clinical
clear visible, while on epistaxis posterior could asymptomatic or
in stealthy as nausea, hematemesis, Anemia, hemoptysis, or
melena,
5. Diagnosis
1. History
On part this important for ditanyana about history occurrence
epistaxis, history disease ago, amount volume blood that
disappear, time and frequency episode previous, disease
comorbidity; hypertension, Diabetes, disease artery coronary,
fibrillation atrium and more, therapy drug anticoagulants (as
aspirin, drug this constitute resistor function platelet and could
cause elongation or bleeding) history operation or trauma,
alcohol, and history use drugs more,
2. Examination physical
Rate circumstances general and sign vital in order to for look
signs hypovolemia, including skin pale, Diaphoresis, skin cold, or
tachycardia, apart that do examination rhinoscopy anterior and
posterior. Tools that be required for examination is lamp head,
speculum nose and tool suckers and tweezers bayonet, cotton,
fabric kassa, For examination that adequate patient must placed
in position and height that ease examiner work, Must enough
corresponding for observed or explore side in nose, Could use
rinoskopi anterior and posterior.
3. Examination support
a) Chest X-sine Computed tomography (CT) or magnetic
resonance imaging (MRI) usually no indicated for examination
epistaxis except suspected presence tumor or infection as cause
from epistaxis mentioned
b) endoscopy nose for look or get rid of possibility disease more,
c) screening to coagulopathy
Test test that right including time prothrombin serum, time
thromboplastin Partial, amount platelet and time bleeding,
6. Governance
Three principle main in overcome epistaxis that is : stop
bleeding, prevent complication and prevent recurrence epistaxis,
If there is shock, repair past kedaan general patient,
1. epistaxis anterior
a. cautery : cautery in chemistry could do with use solution silver
nitrate 20-30%, source bleeding be oiled with solution
mentioned to arise crusting that
colored yellowish result occurrence necrosis superficial,
b. tampon anterior:use cotton or fabric kassa that be given
vaseline or unguent antibiotik.Tampon this maintained for 3-4
day and to patient be given antibiotics spectrum large,
2. epistaxis posterior
a. posterior tampon:The principle tampon could close koana and
fixed in nasopharyngeal for avoid flow blood to nasopharyngeal,
Then do installation anterior tampon.
b. tamponballoon
c. ligation artery : handling the most effective for every type
bleeding is with ligating vessel blood that rupture on part
proximal source bleeding with soon, But reality difficult for
identified source bleeding that right on epistaxis that weight or
persistent, There is some approach ligation artery that supply
blood to mucous nose
7. complication
Could happen directly result epistaxis own or result business
overcome, result installation anterior tampon could arise
sinusitis (because ostium sine choke), Water eye that bloody
(Bloody tears) because blood flow in retrograde through duct
nasolacrimal and septicemia, result installation posterior tampon
could arise otitis media, haemotympanum, and lacerations
palate mole and corner seedling when yarn that issued through
mouth too tight withdrawn, As result bleeding great could
happen shock and anemia. Pressure blood that down sudden
could inflict ischemia brain, insufficiency coronary and infarction
myocardial and finally Dead, Must soon do administration
infusion or transfusions blood,
8. Prognosis
99% case epistaxis anterior could Stop own, On patient with
bleeding which is old and great, there some source bleeding, or
bleeding recur show that possibility happen bleeding result
abnormality systemic as hypertension, anticoagulants, or
coagulopathy so that have prognosis bad,