鼻出血(英文)

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1、EPISTAXISGlenPorter,MDFrancisB.Quinn,MDUTMB-GalvestonGalveston,TexasIntroductionandHistory5-10%ofthepopulationexperienceanepisodeofepistaxiseachyear.10%ofthosewillseeaphysician.1%ofthoseseekingmedicalcarewillneedaspecialist.Mythology:brownpaper,nails

2、,scissors,scarletthreads,“leadthathasnevertouchedtheground”Aconditionwithalonghistory—HippocratestoHenryGoodyear.Anatomy/PhysiologyofEpistaxisAnatomyNasalcavityVascularsupplyPhysiologyVascularnatureMucosaWhybleedingfromthenose?Vascularorgansecondaryt

3、oincredibleheating/humidificationrequirementsVasculaturerunsjustundermucosa(notsquamous)ArterialtovenousanastamosesICAandECAbloodflowAnatomyoftheLateralNasalWallSPF-classI(35%)-classII(56%)-classIII(9%)ExternalCarotidArtery-Sphenopalatineartery-Great

4、erpalatineartery-Ascendingpharyngealartery-Posteriornasalartery-SuperiorLabialarteryInternalCarotidArtery-AnteriorEthmoidartery-PosteriorEthmoidarteryPterygopalatineVasculature--InternalmaxillaryarteryAnatomyoftheNasalCavityandVasculatureSphenopalati

5、neAAEthmoidAAGreaterPalatineAKesselbach’sPlexus/Little’sArea:-AnteriorEthmoid(Opth)-SuperiorLabialA(Facial)-SphenopalatineA(IMAX)-GreaterPalatine(IMAX)Woodruff’sPlexus:-Pharyngeal&Post.NasalAAofSphenopalatineA(IMAX)Anteriorvs.PosteriorMaxillarysinuso

6、stiumAnterior:younger,usuallyseptalvs.anteriorethmoid,mostcommon(>90%),typicallylessseverePosterior:olderpopulation,usuallyfromWoodruff’splexus,moreserious.EtiologyLocalfactorsVascularInfectious/InflammatoryTrauma(mostcommon)IatrogenicNeoplasmDessica

7、tionForeignBodies/otherEtiologySystemicfactorsVascularInfection/InflammationCoagulopathyLocalFactors--VascularICAAneurysmsextraduralcavernoussinusLocalFactors-Infection/InflammationRhinitis/SinusitisAllergicBacterialFungalViralLocalFactors-TraumaNose

8、pickingNoseblowing/sneezingNasalfractureNasogastric/nasotrachealintubationTraumatosinuses,orbits,middleear,baseofskullBarotraumaNasalFracturewithSeptalHematomaLocalFactors-IatrogenicnasalinjuryFunctionalendoscopicsinussurgeryRhinoplastyNasalreconstru