CAUSES AND MANAGEMENT OF EPISTAXIS 1 VASCULAR ANATOMY 2 LITTLE’S AREA  Anteroinferior part of nasal septum.  Four arteries – anterior ethmoidal, septal  branch of superior labial, septal branch of sphenopalatine & greater palatine – Kiesselbach’s plexus 3 4 Retrocolumellar vein- vertically  downwards just behind columella, crosses the floor of nose, joins venous plexus on the lateral nasal wall 5 WOODRUFF’S PLEXUS  UNDER POSTERIOR END OF INFERIOR  TURBINATE. SPHENOPALATINE ARTERY  ANASTAMOSES WITH POSTERIOR PHARYNGEAL ARTERY. 6 CAUSES LOCAL  Infective–rhinitis, sinusitis, diphtheria,  rhinosporidiosis, tuberculosis, syphillis. Inflammatory –atrophic rhinitis  Trauma –finger nail, injuries, surgeries.  Foreign bodies –non living & living.  7 Neoplastic–  haemangioma, papilloma, carcinoma or sarcoma. DNS & septal spur.  High altitude  Nasopharynx–adenoids, juvenile  angiofibroma, tumors 8 SYSTEMIC BLEEDING DISORDERS  COAGULOPATHIES –  haemophilia, christmas desease, , Vit K deficiency, Liver desease  PLATELET DISORDERS  Thrombocytopenia  Platelet dysfunction  – BLOOD VESSEL DISORDER  scurvy, heriditory haemorrhagic telangectasia 9 CONTD. . - Cardiovascular  Hypertension, mitral stenosis, arteriosclerosis - DRUGS  salicylates, anticoagulant therapy . Mediastinal compression  IDIOPATHIC  10