《鼻出血英》PPT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,sciss

2、ors,scarletthreads,“leadthathasnevertouchedtheground”Aconditionwithalonghistory—HippocratestoHenryGoodyear.Anatomy/PhysiologyofEpistaxisAnatomyNasalcavityVascularsupplyPhysiologyVascularnatureMucosaWhybleedingfromthenose?Vascularorgansecondarytoincredibleheating/hum

3、idificationrequirementsVasculaturerunsjustundermucosa(notsquamous)ArterialtovenousanastamosesICAandECAbloodflowAnatomyoftheLateralNasalWallSPF-classI(35%)-classII(56%)-classIII(9%)Sphenopalatineforamen(SPF)ClassClass1:theopeningoftheSPFispurelyintothesuperiormeatusC

4、lass2:theSPFspanstheethmoidalcrest(i.eopenstobothsuperiorandmiddlemeatiClass3:therearetwoseparateopeningintothesuperiorandmiddlemeatiExternalCarotidArtery-Sphenopalatineartery-Greaterpalatineartery-Ascendingpharyngealartery-Posteriornasalartery-SuperiorLabialarteryI

5、nternalCarotidArtery-AnteriorEthmoidartery-PosteriorEthmoidarteryPterygopalatineVasculature--InternalmaxillaryarteryAnatomyoftheNasalCavityandVasculatureSphenopalatineAAEthmoidAAGreaterPalatineAKesselbach’sPlexus/Little’sArea:-AnteriorEthmoid(Opth)-SuperiorLabialA(F

6、acial)-SphenopalatineA(IMAX)-GreaterPalatine(IMAX)Woodruff’sPlexus:-Pharyngeal&Post.NasalAAofSphenopalatineA(IMAX)Anteriorvs.PosteriorMaxillarysinusostiumAnterior:younger,usuallyseptalvs.anteriorethmoid,mostcommon(>90%),typicallylessseverePosterior:olderpopulation,u

7、suallyfromWoodruff’splexus,moreserious.EtiologyLocalfactorsVascularInfectious/InflammatoryTrauma(mostcommon)IatrogenicNeoplasmDessicationForeignBodies/otherEtiologySystemicfactorsVascularInfection/InflammationCoagulopathyLocalFactors--VascularICAAneurysmsextraduralc

8、avernoussinusLocalFactors-Infection/InflammationRhinitis/SinusitisAllergicBacterialFungalViralLocalFactors-TraumaNosepickingNoseblowing/sn