鼻出血（英文）课件

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1、EPISTAXISGlenPorter,MDFrancisB.Quinn,MDUTMB-GalvestonGalveston,Texas---吴彦桥主持讲解IntroductionandHistory5-10%ofthepopulationexperienceanepisodeofepistaxiseachyear.10%ofthosewillseeaphysician.1%ofthoseseekingmedicalcarewillneedaspecialist.Mythology:brownpaper,nails,scissors,scarlet

2、threads,“leadthathasnevertouchedtheground”Aconditionwithalonghistory—HippocratestoHenryGoodyear.Anatomy/PhysiologyofEpistaxisAnatomyNasalcavityVascularsupplyPhysiologyVascularnatureMucosaWhybleedingfromthenose?Vascularorgansecondarytoincredibleheating/humidificationrequirement

3、sVasculaturerunsjustundermucosa(notsquamous)ArterialtovenousanastamosesICAandECAbloodflowAnatomyoftheLateralNasalWallSPF-classI(35%)-classII(56%)-classIII(9%)Sphenopalatineforamen(SPF)ClassClass1:theopeningoftheSPFispurelyintothesuperiormeatusClass2:theSPFspanstheethmoidalcres

4、t(i.eopenstobothsuperiorandmiddlemeatiClass3:therearetwoseparateopeningintothesuperiorandmiddlemeatiExternalCarotidArtery-Sphenopalatineartery-Greaterpalatineartery-Ascendingpharyngealartery-Posteriornasalartery-SuperiorLabialarteryInternalCarotidArtery-AnteriorEthmoidartery-P

5、osteriorEthmoidarteryPterygopalatineVasculature--InternalmaxillaryarteryAnatomyoftheNasalCavityandVasculatureSphenopalatineAAEthmoidAAGreaterPalatineAKesselbach’sPlexus/Little’sArea:-AnteriorEthmoid(Opth)-SuperiorLabialA(Facial)-SphenopalatineA(IMAX)-GreaterPalatine(IMAX)Woodr

6、uff’sPlexus:-Pharyngeal&Post.NasalAAofSphenopalatineA(IMAX)Anteriorvs.PosteriorMaxillarysinusostiumAnterior:younger,usuallyseptalvs.anteriorethmoid,mostcommon(>90%),typicallylessseverePosterior:olderpopulation,usuallyfromWoodruff’splexus,moreserious.EtiologyLocalfactorsVascula

7、rInfectious/InflammatoryTrauma(mostcommon)IatrogenicNeoplasmDessicationForeignBodies/otherEtiologySystemicfactorsVascularInfection/InflammationCoagulopathyLocalFactors--VascularICAAneurysmsextraduralcavernoussinusLocalFactors-Infection/InflammationRhinitis/SinusitisAllergicBac

8、terialFungalViralLocalFactors-TraumaNosepickingNoseblowing/sn