epistaxis

Re: epistaxis

Evelyn Barbour-Hill — Fri, 01 Apr 2011 22:59:04 GMT

[quote user="shp21uk"]

Glad the bleeding's finally stopped. For future reference, sometimes in desperation sedation with a CRI of Domitor and packing the nose can often lower the BP enough to let clotting happen.

For this dog-def x-ray and have a look around while sedated for any obvious FB and I would do a BMBT and possibly clotting panel as well (obviously depends on finances). Whatever it is it's not going to go away. Warn the owners may need rhinoscopy for definitive diagnosis though.

Helen

[/quote]

You might warn the owners that if nothing more is done the next haemorrhage might be worse..............

I'm not criticising anyone else, but I don't think packing the nose is a very good idea except maybe as a last resort. There's a pretty obvious risk of making the problem worse - ramming a foreign body further in, mashing up a tumour, or simply traumatising conchae that were previously unaffected. Also, if the site of haemorrhage is rather caudal, you may simply divert the blood flow into the pharynx instead.

One thought - if the patient is sedated enough to lie still, chilling the nose with external ice can help.

Re: epistaxis

Zita Okarina — Wed, 30 Mar 2011 14:52:17 GMT

No sign of bleeding disorder from elsewhere of the body . no petechia. no melaena. no haematuria. everything was fine but nose.

well, thank you for all the input :)

Re: epistaxis

HMC — Tue, 29 Mar 2011 15:15:42 GMT

Any evidence of a bleeding disorder anywhere else on the body? petechia on the gums? melaena? haematuria?

I would do xrays, as suggested too.

Re: epistaxis

shp21uk — Tue, 29 Mar 2011 14:34:14 GMT

Glad the bleeding's finally stopped. For future reference, sometimes in desperation sedation with a CRI of Domitor and packing the nose can often lower the BP enough to let clotting happen.

Helen

Re: epistaxis

Alex Gough — Mon, 21 Mar 2011 15:14:03 GMT

[quote user="Evelyn Barbour-Hill"]

Aspergillosis (not very likely from the history, but possible.)

[/quote]

We see a lot of aspergillus cases (have been through a real run lately), and they can present with unilateral epistaxis, so I wouldn't rule it out.

Alex

Re: epistaxis

Bob Russell — Mon, 21 Mar 2011 15:03:17 GMT

[quote user="Julie Innes"]

I would definitely do an xray anyway, to try to find a reason for the bleeding. While he is sedated you can also get a good look around.

[/quote]

Absolutely - do X-ray. Many of the possible causes will not have gone away even though the symptoms have.

The next bleed could be worse!

Re: epistaxis

Julie Innes — Sun, 20 Mar 2011 14:53:47 GMT

I would definitely do an xray anyway, to try to find a reason for the bleeding. While he is sedated you can also get a good look around.

Re: epistaxis

Zita Okarina — Sun, 20 Mar 2011 03:38:11 GMT

Thank you SO much for the input. Today, this morning I came to his cage, and found no blood at all. And I realized after I slowed down the speed of drips, then he seems better. We will do X-ray if he came back in a worse condition.

Re: epistaxis

Utlendigur — Sun, 20 Mar 2011 00:17:52 GMT

Couple of other differentials

Vacsular anomaly

Hypertension - ok unlikely in a 5yrs old dog but may be worth checking

If not a coagulopathy then xrays (and a good look around pharynx, nares etc) are a good next bet - plus the premed (if acp or similar) may lower the BP a bit an let it clot Having had yet another Fri evening stick injury, any history of chewing sticks etc?

Re: epistaxis

Evelyn Barbour-Hill — Sat, 19 Mar 2011 23:28:05 GMT

It really would be good to radiograph. I feel you've got to try and find the cause of the haemorrhage. You may even see some pretty obvious changes on the radiograph which could give you a near-enough diagnosis.

Likely differentials, in no particular order:

Coagulopathy of one kind or another.

Aspergillosis (not very likely from the history, but possible.)

Foreign body.

Neoplasia.

Is there anything abnormal visible per os?

And I almost forgot: it's worth looking up the nostril with an auriscope. You can get quite far in. Possibly all you will see is blood, but it's easy enough to try.

Re: epistaxis

Gillian Mostyn — Sat, 19 Mar 2011 17:42:23 GMT

Do a buccal mucosal bleeding time - see if there is any indication of a coagulopathy.

Also, have you radiographed to check for any indication of neoplasia up there.....?????

Re: epistaxis

Mark Hedberg — Sat, 19 Mar 2011 16:52:14 GMT

Have you done hematology? What's the platelet count?

Re: epistaxis

Michael Woodhouse — Sat, 19 Mar 2011 15:19:47 GMT

Cab you do any clotting tests? Do you believe the dog is coagulopathic or has a nasal problem. Suppose you could sedate the dog and pack the nose with gauze bandage for 48 hours in desperation?

Re: epistaxis

Zita Okarina — Sat, 19 Mar 2011 15:16:22 GMT

no endoscopy :(

Re: epistaxis

Michael Woodhouse — Sat, 19 Mar 2011 15:09:55 GMT

Is referral for endoscopy and option? Steady on the fluids as you dilute clotting factors.