Epistaxis pathophysiology

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Editor in Chief:: C. Michael Gibson, M.S., M.D.. Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D.

Overview

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury harder to repair. In some patients rapture of nasal blood vessels is spontaneous.

Pathophysiology

Different causes tear vessels of nose plexuses and motive epistaxis:

• Epistaxis results from to tears in the nasal mucosal lining, which contains many small blood vessels. It can be started by trauma, nasal picking, coagulopathies, tumors or spontaneous.
• There is not enough evidence that hypertension is a risk factor for epistaxis. The role of lowering blood pressure to control and prevent epistaxis remains controversial.
• Anterior epistaxis is more common, and source of this bleeding is usually Kiesselbach's plexus.
• Posterior bleeding is less common and harder to stop, and source of this bleeding is usually Woodruff's plexus. Bleeding from this plexus may cause aspiration and show bleeding with coughing and hemoptysis as it can generate a greater flow of blood which can compromise the airways by leaking into the posterior pharynx.

Location of the Kiesselbach's and Woodruff's plexus