19Feb

Causes of nasal bleeding

Nasal bleeding is a manifestation of internal diseases or the effects of a traumatic factor, in which the integrity of the vessels of the nasal cavity is impaired. In most cases, the flow of blood from the nasal passages does not cause massive blood loss, may end on its own or after the provision of first aid. When blood coagulability is violated, damage to the vessels of the posterior parts of the nose, persistent increase in arterial pressure, the pathological process requires therapy in a medical institution.

Classification of

In ICD 10, nosebleeds are encoded R04.0 and refer to the section "Bleeding from the respiratory tract( R04)".Depending on the location of damaged vessels, the pathology is divided into several types.

Front nasal bleeding

occurs in 90% of cases of blood loss from the nasal passages. The source of the bleeding is the plexus of Kisselbach, which is located on the front of the nasal septum. It consists of a large accumulation of vessels, located under a thin layer of mucous membrane, and abundantly blood supply to the nasal cavity. This allows you to warm incoming air through the airways, clean it of dust and infectious agents, to perform the function of smell. Blood loss from the Kisselbach zone is easy to stop at the prehospital stage, in the absence of aggravating factors it does not endanger life. Most often, anterior bleeding occurs in children aged 3-10 years, which is associated with underdevelopment of the vascular plexus and looseness of the mucous layer of the nasal cavity.

Vascular plexus of nasal cavity
Location of the vascular plexus of Kisselbach in the nasal cavity of

Posterior nasal bleeding

Occurs from large arteries of the posterior part of the nose, are rare. Pathology is detected mainly in the elderly, which is associated with the development of arteriosclerosis of blood vessels, increased blood pressure in hypertensive disease, general wilting of the body. Against the backdrop of aggravating factors, heavy bleeding develops in areas difficult to visualize, which are difficult to self-manage. The pathological process requires the urgent provision of medical specialist care in a general surgical hospital or an ENT department.

In addition, nasal bleeding in adults is divided into primary, resulting from local processes, and secondary( symptomatic), which appear in the development of diseases of various body systems.

Causes of

Causes of nasal bleeding may be of a mechanical nature. Picking in the nose, trauma to the facial part of the skull, ingress of foreign objects( often occurs in younger children) leads to damage to blood vessels and the flow of blood through the nasal passages. The low humidity of the ambient air causes the mucous membrane to dry out and the fragility of the arterial vessels in the Kisselbach zone. In this case, a slight physical effect( sneezing, blowing) leads to a violation of the integrity of the arteries. Especially often this condition occurs during the winter heating season, when dry air accumulates in the apartment.

Causes of nasal bleeding due to the development of diseases include:

  • abnormal development of the vessels of the nasal cavity( hemangiomas);
  • chronic liver disease( hepatitis, cirrhosis);
  • pathology of the heart and blood vessels( valvular apparatus defects, arrhythmia);
  • bleeding disorder( hemorrhagic vasculitis, hemophilia);
  • rhinitis and sinusitis of bacterial, viral and mixed etiology( inflammation of the nasal mucosa and adjacent sinuses);
  • benign and malignant neoplasms of the nasal passages, polyps;
  • toxic increase in vascular wall permeability in infections( measles, influenza);
  • lack of vitamin K, ascorbic acid in the body;
  • hypertension, symptomatic hypertension;
  • syphilis, tuberculosis;
  • sunshine.
The cause of nasal bleeding in adults can be intense physical stress associated with straining( exercise, lifting weights, carrying loads).Stressful situation and intense excitement leads to a rapid pulse and an increase in the level of blood pressure, which can cause damage to the vessels of the nasal cavity and subsequent blood loss.
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How to stop blood from the nose?

Nasal bleeding in adolescents is associated with a period of puberty and imperfection of the endocrine system. Often there are blood loss in girls during the development of the menstrual cycle. In this case, the sex hormones affect not only the vessels of the endometrium, but also the interlacing of Kisselbach, which leads to the appearance of bleeding from the nasal cavity, which occur at night against the background of a menses. In boys during a period of intense growth, the discrepancy between physical development of the body and the functional capabilities of the cardiovascular system is manifested by nosebleeds. As adolescents grow up, these conditions pass independently.

Often there are nosebleeds during pregnancy in the first trimester of bearing a fetus, which is associated with hormonal restructuring of the female body. In this period, significantly increased the content of progesterone in the blood, which causes swelling and loosening of the nasal mucosa. Another cause of the pathological process may be a lack of calcium with intensive fetal growth. In the second trimester of pregnancy, the development of preeclampsia significantly increases blood pressure and causes severe nasal bleeding. Pathology causes a dangerous condition for the life of the mother and fetus, requires urgent hospitalization in the obstetrics ward.

Clinical picture

Usually the blood loss of their nose is easy to diagnose when blood flows from one nostril dropwise or in a jet. The appearance of a jet of blood from two nostrils is false during the development of heavy bleeding from the vessels of the left or right side of the nose. In this case, the blood flows through the nasopharynx into the adjacent nostril.

Endoscopy of the nasal cavity
Definition of bleeding localization with the help of endoscopic equipment

In rare cases, the causes of nasal bleeding in adults can lead to damage to the vessels of the posterior nasal cavity, which causes a latent loss of blood. At the same time it flows down the back wall of the pharynx, getting into the stomach and intestines, causes nausea, bloody vomiting, tar-like stool( "melena") and requires differential diagnosis with bleeding from the gastrointestinal tract.

Symptoms of nasal bleeding include:

  • leakage from one or two nostrils of non-foaming scarlet blood;
  • when blood gets into the digestive tract - vomiting with an admixture of clots, black feces;
  • headache;
  • dizziness, precancerous condition;
  • blushing of the skin, mucous membranes;
  • feeling of anxiety, restlessness;
  • increased heart rate, increased blood pressure;
  • increased respiration due to stress;
  • signs of hemorrhagic shock in case of significant blood loss( lowering of blood pressure, decreased diuresis, loss of consciousness, thread-like pulse).

Early diagnosis of blood loss from the vessels of the nose allows timely medical attention. In hospital conditions, the doctor examines the nasal passages with a special mirror or endoscope, establishes the localization of the pathological process, assigns laboratory methods of investigation to establish the cause of the condition and the degree of hemorrhage.

Providing first aid

What to do when a bleeding occurs from the nasal cavity, every person should know. Often, simple measures to stop bleeding help to minimize blood loss and conduct effective interventions without the involvement of medical personnel.

First aid for bleeding from the nasal cavity:

  • create a physical and psychological rest for the normalization of blood pressure and pulse, which helps stop the bleeding;
  • to seat the patient with a bowed head, to give a tray to collect leaking blood in his hands - this prevents her from getting into the stomach and allows to control the volume of blood loss;
  • to the occiput or bridge of the nose, attach an ice pack to narrow the vessels;
  • in the nasal passages should be placed cotton-gauze swabs moistened with adrenaline or hydrogen peroxide;
  • press the wing of the nose to the bone part of the septum to press the damaged vessel.
Stopping nasal bleeding
A simple method of stopping nasal bleeding

Blood spilled into the oral cavity must be spit into the tray. Otherwise, it flows into the stomach, causes nausea and vomiting with an admixture of clots. You can not blow your nose, talk, drink carbonated drinks, coffee, strong tea. After the termination of bleeding it is necessary to observe a mode of physical and mental rest. It is not recommended to use hard, hot, spicy food, which can cause a relapse of bleeding. You should take protein foods, soft vegetables and fruits, cold vitaminized drink( juice, decoction of dogrose).

In case of ineffectiveness of the medical measures carried out within a quarter of an hour, it is necessary to call an ambulance carriage or take the patient to the hospital by himself.

Medical intervention will also be required in the following cases:

  • profuse bleeding;
  • blood coagulation pathology, hypertensive disease, diabetes mellitus;
  • multiple bloody vomiting, stool darkening;
  • frequent episodes of nasal blood loss;
  • taking certain medications( aspirin, heparin);
  • signs of hemorrhagic shock.

It should be remembered that early provision of specialized medical care improves prognosis for recovery and can save a person's life.

Therapeutic tactics

In case of massive blood loss the patient is urgently delivered to the ENT department to provide medical care and treatment of the consequences of the pathological condition. In the absence of specialized facilities, the victim is referred to a surgical hospital. By examination, the doctor determines the localization of the damaged vessel and takes measures to stop blood loss.

Anterior tamponade of the nose
Anterior tamponade of the nasal cavity with bleeding from the Kisselbach zone

Treatment of nasal bleeding depends on the type of pathology and the cause of its occurrence.

  1. Front tamponade .It is carried out with damage to the integrity of the vessels of the plexus of Kisselbach. To do this, take a narrow long turunda from sterile gauze, with tweezers inject it into the nasal cavity, completely filling the internal space. Tamponing is left for a day, before use turunda can be treated with a solution of hydrogen peroxide, adrenaline to enhance the haemostatic effect.
  2. Rear tamponade .It is prescribed for bleeding from the back of the nasal cavity. The procedure requires the use of a special tampon, which is injected through the oral cavity for 2-3 days. The front sections of the nose are closed by the method of the front tamponade. Conducting manipulation causes painful sensations, therefore, requires the administration of painkillers and sedatives.
  3. Hypotensive therapy .It is carried out with bleeding caused by high blood pressure. It is planned to monitor the heart's performance against the background of taking Corinfar, Lasix with the subsequent appointment of treatment of hypertension.
  4. Replenishment of the volume of lost blood .Infusion therapy with isotonic solution, hemodez, polyglucin. In severe cases it is necessary to transfuse blood, blood substitutes, platelet mass.
  5. Hemostatic agents. Used to improve blood clotting, clot formation in the area of ​​vascular integrity, prevention of repeated episodes of hemorrhage. Assign Vikassol, ascorbic acid, calcium chloride, hemofobin.
  6. Local treatment of .Cauterization of the wall of the damaged vessel with silver nitrate, the introduction of a hemostatic sponge into the nasal cavity, the use of cryodestruction and galvanoacoustics.

In case of ineffectiveness of conservative therapy, surgical intervention on damaged vessels of the nasal cavity is prescribed. It is necessary to treat the concomitant disease that caused the pathological process.

Bleeding from the nose in most cases can be stopped after first aid. It does not pose a health hazard. The blood loss caused by severe internal diseases requires urgent hospitalization in a medical institution for complex treatment and prevention of hemorrhagic shock.