Diseases of respiratory system
EPISTAXIS (NOSE BLEED)
Definition
 - Epistaxis means bleeding from the
nostrils regardless of origin of the
hemorrhage.
 - hemoptysis means coughing of
blood with hemorrhage usually
originating from the lungs.
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Etiology
a- Epistaxis occurs commonly in the horses
and may be due to lesions in nasal cavity,
nasopharynx, guttural pouch or lungs.
b- Hemorrhage lesions of nasal cavity,
nasopharynx and guttural pouch usually
cause unilateral epistaxis, while blood
originating from the lungs is discharged
from both nostrils and not the mouth
because of the long soft palate.
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N.B.
Blood originating from the
lungs is not foamy as was
previously thought because
the horizontal position of the
major bronchi allows blood to
flow out freely without being
coughed-up and made foam.
Froth is usually the result of
pulmonary edema in which
case it is very fine pink stable
froth
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c- The commonest cause of epistaxis
A) Local causes
1- External trauma.
2- Foreign bodies in nasal cavities.
3- Neoplasms (erosion of m.m. of nasal cavity).
4- Mycotic ulceration of B.V. in the wall of guttural
pouch around the guttural pouch.
5- Encapsulated hematoma in nasal cavity.
6- Hemorrhage polyps of m.m. of nasal cavity or
paranasal sinuses.
7- Erosion of the nasal mucosa in glanders.
8- Internal trauma due to passage of nasal tube or
endoscope.
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B) Systemic causes:
1- Congestive heart failure (mild
epistaxis).
2- Purpura hemorrhagica.
3- Thrombocytopenia (generalized
bleeding).
C)- Idiopathic
in exercise-induced epistaxis in race
horses (bleeders).
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Unilateral epistaxis
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Diagnosis
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I- History
II- Clinical signs.
III) Exam of nasal cavities :
1- Visually with the aid of strong pointed
source of light through external nares.
2- with the use of flexible fiberoptic
endoscope will permit thorough exam of
the nasal cavities, nasopharynx, guttural
pouch larynx, trachea and major bronchi.
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Blood visualized by endoscopy of the trachea in a
horse with exercise-induced pulmonary
hemorrhage.
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Treatment
a- Treat the cause, if it is known.
b- when the cause is obscure, treat symptomatically as follow:
1- Cold packs over the nose and forehead.
2- Tampon or gauze soaked in adrenaline inserted in zigzag
manner into affected nostril (but not in both nostrils).
3- vasoconstrictor drugs e.g. thrombin solution spray on
bleeding surface immediately, or diacynon injection.
4- Calcium preparations e.g. calcium gluconate 20% 500 ml.
S/C or slow I/V.
5- Vitamin – K injection ( synkavit = synthetic – vitamin – K )
6- Blood transfusion in severe cases.
7- Hematinics e.g. iron preparations (iron dextran or ferrous
sulphate)
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N.B:

Avoid injection of adrenaline as it
increasing bleeding by rising of blood
pressure.
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QUESTIONS
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