What disease does nosebleed indicate and what are the causes?

It can be said that most people have experienced nosebleeds. Some may occur occasionally due to dry air and the amount of nosebleed is small, while others may cause nosebleeds due to getting angry. This situation generally does not require treatment and will recover quickly without any harm to the body. However, nosebleeds can also have other reasons, such as trauma or some systemic diseases, so they should be paid special attention to. So, what disease does nosebleed indicate? What are the causes of nosebleeds?

There are many causes of epistaxis, which can be caused by diseases of the nasal cavity itself, or by diseases around the nasal cavity or systemic diseases.

1. Local causes

(1) Nasal injury

① Mechanical trauma such as car accidents, falls, boxing injuries and nose picking are common causes of epistaxis.

② Barotraumatic injury: During high-altitude flying or diving, if the air pressure difference inside and outside the sinuses changes too much suddenly, the blood vessels in the mucosa of the nasal cavity and sinuses will dilate, rupture and bleed.

③Radiotherapy injury During and after radiotherapy of the head and neck, the nasal mucosa becomes congested and edematous, or the epithelium falls off, and epistaxis may also occur.

(2) Nasal septum deviation

It often occurs near the bony ridge or spine (rectiform process) or the convex surface of the deviated nasal septum. The mucosa there is thinner and the direction of air flow changes here, so the mucosa becomes dry, causing blood vessels to rupture and bleed. Patients with nasal septum perforation may suffer from recurrent epistaxis due to dryness, erosion, and shedding of the mucosa at the edge of the perforation.

(3) Nasal inflammation

① Non-specific inflammation of the nose such as acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. can easily cause epistaxis, but the amount of bleeding is generally not much.

② Specific infections of the nose such as tuberculosis, lupus, syphilis, leprosy and diphtheria can cause epistaxis due to mucosal erosion, ulcers, granulation tissue and nasal septum perforation.

(4) Tumors of the nasal cavity, paranasal sinuses, and nasopharynx

Among them, the most likely to cause epistaxis are nasal septum hemangioma, nasopharyngeal angiofibroma, hemorrhagic nasal polyps and malignant tumors of the nasal cavity and paranasal sinuses. Minor nose bleeding or blood in the mucus is one of the main early symptoms of malignant tumors.

(5) Foreign body in the nasal cavity

It is common in children, mostly unilateral nasal bleeding, because foreign objects remain in the nasal cavity for a long time, which can cause erosion and bleeding of the nasal mucosa. Animal foreign bodies in the nasal cavity, such as leeches, can cause repeated heavy nosebleeds.

2. Systemic causes

(1) Bleeding diseases and blood diseases

① Diseases with defects in the structure and function of the vascular wall such as hereditary hemorrhagic telangiectasia, vitamin C deficiency, allergic purpura, drug-induced vascular purpura, infectious vascular purpura, von Willebrand disease, etc.

② Diseases with platelet quantity or function disorders such as idiopathic thrombocytopenic purpura, secondary thrombocytopenia caused by various reasons, etc.

③Coagulation factor disorders such as various types of hemophilia, vitamin K deficiency, etc.

④ The blood's own anticoagulant effect is too strong, such as improper use of anticoagulants, the presence of anticoagulant substances such as antifibrinogen in the blood circulation, or excessive or accelerated fibrinolysis, such as disseminated intravascular coagulation.

(2) Acute febrile infectious diseases

Such as cold, influenza, hemorrhagic fever, scarlet fever, malaria, measles and typhoid. It is mostly caused by high fever, toxic damage to blood vessels, congestion, swelling and dryness of the nasal mucosa, resulting in rupture and bleeding of capillaries. Generally, the amount of bleeding is small, mostly occurs during the fever period, and the bleeding site is mostly located in the front of the nasal cavity.

(3) Cardiovascular system diseases

① Hypertension and arteriosclerosis Hypertension and arteriosclerosis are important causes of nosebleeds in middle-aged and elderly people, and vascular sclerosis is its pathological basis. Increased blood pressure, especially when constipated, overexerting or emotionally excited, can rupture blood vessels in the nose and cause nosebleeds. In addition, sneezing, coughing hard, vigorous nasal breathing or nasal massage are also factors that cause nosebleeds to recur and become difficult to control.

② Increased venous pressure due to diseases such as emphysema, cor pulmonale, mitral valve stenosis, and space-occupying lesions in the neck or mediastinum can cause superior vena cava hypertension. The nasal cavity and nasopharyngeal veins of these patients are often distended and congested. When the patient coughs violently or due to other inducements, the blood vessels may rupture and bleed. The bleeding site is mostly located in the distribution area of ​​the nasopharyngeal vein at the posterior nostril.

(4) Other systemic diseases

Pregnancy, premenopause, and menopause can all cause epistaxis, which may be related to increased capillary fragility. Patients with severe liver disease may experience epistaxis due to impaired liver synthesis of coagulation factors. Uremia can also cause epistaxis. Epistaxis can be one of the early manifestations of rheumatic fever.