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Nasal bleeding – the expiration of blood from a nose cavity owing to violation of integrity of walls of blood vessels. Accompanies injuries and inflammatory diseases of a nose more often, it can be caused by diseases of vessels and systems of blood. It is characterized by the expiration of scarlet blood drops or a stream from nostrils, its running off on a back wall of a throat. Can be followed by noise in ears and dizziness. Plentiful recurrent nasal bleedings cause sharp falling HELL, increase of pulse, the general weakness, can pose a threat for life.

    Nasal bleeding

    Nasal bleeding – the expiration of blood from a nose cavity owing to violation of integrity of walls of blood vessels. Accompanies injuries and inflammatory diseases of a nose more often, it can be caused by diseases of vessels and systems of blood. It is characterized by the expiration of scarlet blood drops or a stream from nostrils, its running off on a back wall of a throat. Can be followed by noise in ears and dizziness. Plentiful recurrent nasal bleedings cause sharp falling HELL, increase of pulse, the general weakness, can pose a threat for life.

    Nasal bleeding - a widespread pathological state. Patients with nasal bleeding make about 10% of total number of the patients hospitalized in LOR-offices.

    Reasons of nasal bleedings

    Allocate the general and local reasons of nasal bleeding.

     Local reasons:

    • Injuries of a nose are the most common cause of bleeding. Except usual home, production and road accidents injuries of a mucous membrane of a nose at operations, hit of foreign matters and carrying out medical and diagnostic manipulations (nazogastralny sounding, a nazotrakhealny intubation, a kateterization and a puncture of nasal bosoms) concern to this group.
    • The pathological states which are followed polnokroviy a mucous membrane of a nose (sinusitis, rhinitises, adenoides).
    • Dystrophic processes in a mucous membrane of a nose (at the expressed curvature of a nasal partition, atrophic rhinitis).
    • Nose cavity tumors (specific granuloma, angioma, malignant tumor).

    General reasons:

    • Diseases of cardiovascular system (the symptomatic hypertension, hypertension, atherosclerosis, malformations which are followed by increase in arterial pressure).
    • Blood diseases, avitaminosis and hemorrhagic diathesis.
    • Temperature increase of a body at an overheat, sunstroke or an infectious disease.
    • Sharp difference of external pressure (at rise on big height at climbers and pilots, during bystry descent to depth at divers).
    • Violations of hormonal balance (at pregnancy, at teenage age).

    Classification of nasal bleedings

    Depending on in what department of a nasal cavity the blood loss source is localized, nasal bleedings subdivide on forward and back.

    Are a source of forward nasal bleedings in 90-95% of cases rich network of blood vessels of a so-called zone of Kisselbakh. In this zone a large number of the small vessels covered with the thin mucous membrane which is almost deprived of a submucous layer is located. Forward nasal bleedings very seldom happen the reason of massive blood loss, and, as a rule, do not threaten the patient's life. Often stop independently.

    Source of back nasal bleedings are rather large vessels of deep departments of a nasal cavity. Because of the big diameter of vessels back nasal bleeding often happens massive and can pose a threat for the patient's life. Such bleedings practically never stop independently.

    Blood loss at nasal bleeding is estimated as follows:

    • insignificant – several tens of milliliters;
    • easy – to 500 ml;
    • moderate severity – to 1000-1400 ml;
    • heavy – over 1400 ml.

    Symptoms of nasal bleeding

    Symptoms of nasal bleeding are subdivided into three groups:

    • symptoms of bleeding;
    • signs of sharp loss of blood;
    • symptoms of the main disease.

    At one patients nasal bleeding begins suddenly, at others dizziness, noise in ears, a headache, tickling or an itch in a nose can precede bleeding. A direct symptom of nasal bleeding is the expiration of blood from a nose cavity outside of or in a nasopharynx. In the latter case blood flows down in a rotoglotka where it is found at a faringskopiya.

    At insignificant blood loss pathological symptoms, as a rule, are not defined. Some patients can test dizziness from a type of blood. At easy blood loss patients show complaints to dizziness, noise in ears, thirst, the general weakness, heartbeat. In certain cases insignificant pallor of skin can be noted.

    Blood loss of moderate severity is followed by the expressed dizziness, falling of arterial pressure, akrotsianozy, tachycardia and short wind. At heavy blood loss hemorrhagic shock develops. The patient is slowed down, consciousness loss is possible. During survey reveal threadlike pulse, the expressed tachycardia, sharp falling HELL.

    Diagnostics and differential diagnostics

    For definition of localization of a source of nasal bleeding (forward or back bleeding) inspection of the patient, a faringoskopiya and a forward rinoskopiya is performed. In certain cases at pulmonary and gastric bleedings blood flows into a nose cavity, and feigns nasal bleeding. Primary differential diagnostics is based on data of external survey of the patient. At nasal bleedings blood dark red, at bleeding from lungs foams, has bright red color. The expiration of very dark blood similar to a coffee thick is characteristic of gastric bleeding. It is necessary to consider that the expressed nasal bleeding can be followed by bloody vomiting with dark blood. Swallowing the blood which is flowing down on a rotoglotka becomes the vomiting reason in this case.

    For assessment of blood loss and detection of the main disease which caused nasal bleeding additional researches are conducted. The volume of blood loss is estimated by results of the general blood test and a koagulogramma. Tactics of the general inspection is defined by symptoms of the main disease.

    Treatment of nasal bleedings

     At treatment of nasal bleeding it is necessary to stop as fast as possible a wound, to take measures for prevention of consequences of blood loss (or to compensate blood loss) and to hold the therapeutic events directed to fight against the main disease.

    At forward nasal bleeding in most cases to stop a wound, it is enough to put cold on area of a nose, for 10-15 minutes to press a nostril or to enter the wadded ball impregnated with haemo static means or weak solution of peroxide of hydrogen into a nasal cavity. Also the anemization mucous a nose is carried out by solution of adrenaline or ephedrine. If bleeding does not stop within 15 minutes,  the forward tamponada of one or both half of a nasal cavity is carried out.

    The forward tamponada of a nose often gives good effect and at back nasal bleedings. If back nasal bleeding did not manage to be stopped, carry out a back tamponada.

    At inefficiency of the listed actions and recurrent nasal bleedings expeditious treatment is carried out. The volume and tactics of intervention is defined by localization of a source of bleeding. If repeated nasal bleedings are localized in forward departments, the endoscopic coagulation, cryodestruction, introduction of skleroziruyushchy medicines and other actions directed to an obliteration of a gleam of small vessels of a zone of Kisselbakh is in certain cases applied.

    Nasal bleeding - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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