Nosebleed Other names epistaxis, bloody nose A three year old | FreeMedSite

Nosebleed
Other names epistaxis, bloody nose
A three year old with a minor nosebleed from falling and hitting his face on the floor.
Specialty Otorhinolaryngology
A nosebleed, also known as epistaxis ( /ˌɛpɪˈstæksɪs/ EP-ih-STAK-sis), is the common occurrence of bleeding from the nose. It is usually noticed when blood drains out through the nostrils.

There are two types: anterior (the most common), and posterior (less common, more likely to require medical attention). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.

Although the sight of large amounts of blood can be alarming and may warrant medical attention, nosebleeds are rarely fatal, accounting for only 4 of the 2.4 million deaths in the U.S. in 1999. About 60% of people have a nosebleed at some point in their life. About 10% of nosebleeds are serious. Nosebleeds appear to have a bimodal distribution, most commonly affecting those younger than 10 and older than 50.

Cause
Two children boxing, the one on the right having a nosebleed due to a punch to the face.
Nosebleeds can occur due to a variety of reasons. Some of the most common causes include trauma from nose picking, blunt trauma (such as a motor vehicle accident), or insertion of a foreign object (more likely in children). Relative humidity (including centrally heated buildings), respiratory tract infections, chronic sinusitis, rhinitis or environmental irritants can cause inflammation and thinning of the tissue in the nose, leading to a greater likelihood of bleeding from the nose.

Most causes of nose bleeding are self-limiting and do not require medical attention. However, If nosebleeds are recurrent or do not respond to home therapies, an underlying cause may need to be investigated. Some rarer causes of recurrent or prolonged epistaxis are categorized and listed below:

Coagulopathy:

Thrombocytopenia (thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura
Von Willebrand's disease
Hemophilia
Leukemia
HIV
Chronic liver disease—cirrhosis causes deficiency of factor II, VII, IX,& X
Inflammatory:

Granulomatosis with polyangiitis
Systemic lupus erythematosus
Medications/Drugs:

Anticoagulation (warfarin, heparin, etc)
Insufflated drugs (particularly cocaine)
Nasal sprays (particularly prolonged or improper use of nasal steroids)
Neoplastic:

Squamous cell carcinoma
Adenoid Cystic Carcinoma
Melanoma
Nasopharyngeal carcinoma
Nasopharyngeal angiofibroma
Traumatic:

Anatomical deformities (e.g. septal spurs)
Blunt trauma (usually a sharp blow to the face such as a punch, sometimes accompanying a nasal fracture)
Foreign bodies (such as fingers during nose-picking)
Digital trauma
Middle ear barotrauma (such as from descent in aircraft or ascent in scuba diving)
Nasal bone fracture
Septal fracture/perforation
Surgery (e.g. septoplasty and functional endoscopic sinus surgery)
Vascular Malformation:

Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu disease)
Angioma
Aneurysm of carotid artery