Kuliah S1 FK UNDIP Modul 4.1 Epistaksis

Summary

This lecture focuses on common nasal and sinus issues, including foreign objects in the nose and nosebleeds (epistaxis). The discussion highlights the causes of nasal problems, from congenital conditions and allergies to infections and tumors. It emphasizes the importance of identifying key symptoms, such as congestion, snoring, and unilateral nasal discharge, which guide the differential diagnosis. The presentation also explains the diagnostic process, covering physical examinations, such as anterior rhinoscopy, and advanced techniques like endoscopy and imaging. Special attention is given to diagnosing and managing epistaxis, with a distinction between anterior and posterior types, and their respective treatments.

Takeaways

• 😀 Understanding the anatomy of the nose and paranasal sinuses is crucial for diagnosing nasal conditions.
• 😀 Common nasal symptoms include sneezing, runny nose, congestion, foul smells, nasal bleeding, and snoring.
• 😀 The primary causes of nasal symptoms include congenital abnormalities, allergies, infections, tumors, trauma, and foreign objects.
• 😀 Foreign bodies in the nose are most common in children and can be difficult to diagnose because children often do not report them.
• 😀 Foreign bodies can be organic (e.g., insects, seeds) or inorganic (e.g., plastic, beads, paper), with organic objects sometimes causing a noticeable smell.
• 😀 Diagnosis of foreign bodies involves physical examination, including anterior rhinoscopy and potentially endoscopy or X-ray for foreign objects.
• 😀 Epistaxis (nosebleeds) can be classified into anterior and posterior, with different causes and treatments for each.
• 😀 Anterior epistaxis is often caused by trauma or irritation, with bleeding from the anterior part of the nose's blood vessels, and is usually less severe.
• 😀 Posterior epistaxis, which involves larger blood vessels, can result in significant bleeding that may require medical intervention such as nasal packing.
• 😀 Systemic factors like hypertension and metabolic disorders can contribute to more severe epistaxis, especially in older adults.
• 😀 Diagnosing posterior epistaxis often requires advanced techniques like nasoendoscopy due to the location of the bleeding point.

Q & A

What are the common symptoms that may indicate a nasal or sinus issue?

Common symptoms include sneezing, a runny nose, nasal congestion, a blocked or stuffy nose, loss of smell, nosebleeds, nasal voice, or noisy breathing (snoring).

What are the main etiologies considered when diagnosing nasal and sinus issues?

The six main etiologies to consider are congenital abnormalities, allergies, infections, tumors, trauma, and foreign objects.

Why is diagnosing foreign objects in the nose challenging, especially in children?

Children often do not immediately report inserting foreign objects into their noses. This, combined with their inability to recognize or explain symptoms, makes diagnosis more difficult.

What are the two categories of foreign objects found in the nasal cavity?

The two categories are organic foreign objects (such as insects or seeds) and inorganic foreign objects (such as plastic materials, beads, or stones).

What are some typical signs of a foreign object in the nose based on anamnesis?

Typical signs include unilateral nasal blockage, foul odor, and unilateral nasal discharge. Children may also report discomfort or describe sensations of movement within their nose, especially when the foreign object is an insect.

How is a foreign object in the nose diagnosed during physical examination?

For objects near the anterior nasal area, they can often be seen directly. For deeper objects, anterior rhinoscopy using a nasal speculum and headlight, or endoscopy, may be required for better visualization.

What is epistaxis, and how is it classified?

Epistaxis is bleeding from the nose. It is classified into anterior and posterior epistaxis, depending on the location of the bleeding site within the nasal cavity.

What are the main causes of epistaxis?

The causes can be categorized into local factors (e.g., trauma, picking the nose) and systemic factors (e.g., hypertension, blood disorders, and vascular diseases).

How does the bleeding in anterior epistaxis differ from posterior epistaxis?

Anterior epistaxis is typically caused by smaller arteries and results in light, intermittent bleeding that usually stops on its own. Posterior epistaxis, however, is often more severe, with heavy bleeding that may flow into the throat, requiring medical intervention.

What diagnostic methods are used for posterior epistaxis when bleeding cannot be easily seen during physical examination?

For posterior epistaxis, additional diagnostic methods such as nasal endoscopy or nasopharyngoscopy may be needed to locate the bleeding point, as the source is often deeper within the nasal cavity or nasopharynx.