Post on 26-Feb-2018
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Dr Sari Wulan, SpTHT-KL
Department of Otorhinolaryngology - Head &
Neck Surgery!dayana !ni"er#ity $aculty of %edicine,
Sanglah eneral Ho#pital Denpa#ar
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'erdarahan(
- a etmoid anterior
- a etmoid po#terior
- a #fenopalatina
- ca) a fa#iali# - plek#u# Kie##el)ach anyaman pem)uluh
darah #eptum, letak #uperfi#ial, mudah
cedera*ena + nama arteri, )ermuara ke " optalmika
#inu# ka"erno#u# *ena tidak memiliki katup
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pi#ta.i#( from the reek /ord( epi 0on1 #ta2o 0to
fall in drop1 )leeding from the no#e
Se"erity of epi#ta.i#(
%ild, anterior )leeding that re#ol"e##pontaneou#ly Se"ere, po#terior )leeding /ith hypoten#ion,
anemia and air/ay compromi#e that lead to
death
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tiology(
Local(o Trauma( digital, fracture
o Na#al #pray
o 3nflammatory reactiono 4natomic deformitie#
o $oreign )odie#
o 3ntrana#al tumor#o 5hemical inhalant#
o Surgery
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Sy#temic(
o *a#cular di#order#o 6lood cell anomalie#
o 6lood cell malignancie#
o 4llergie#o %alnutrition
o 4lcohol
o Hyperten#iono Drug#
o 3nfection
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4nterior )leeding( )leeding from anterior part of#eptum 0Little7# area1 and anterior ethmoid
artery
Little area8 Kie#ell)ach ple.u# mo#t fre9uentarea of )leeding
'o#terior )leeding( )leeding from po#teriorethmoid artery, #phenopalatine artery
6leeding commonly #e"ere
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%anagement(
Stop the )leeding: identified )leeding point after
cleaning the na#al ca"ity
put lidocain & adrenalin gau2e for ; -
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o When )leeding #till profu#e packing na#al ca"ity/ith ri))on gau2e for ? day#
o When )leeding #till occur, packing /ith po#teriorpacking 0 6ello9 1
o When )leeding #till occur, ligation of arteryartery( - anterior ethmoidal artery
- po#terior ethmoidal artery
- internal ma.illary artery - #phenopalatine artery
- e.ternal carotid artery
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're"ention of complication 5omplication can occur(
- direct from )leeding( #hock
treatment( intra "enou# fluid drip ortran#fu#ion
- effect of gau2e packing( infection( middle
ear infection, #inu#iti#
treatment( oral anti)iotic
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're"ention for relap#e
pi#ta.i# only #ymptom, importance to detect
cau#e of epi#ta.i#
3f the di#ea#e treata)le, epi#ta.i# can not
relap#e
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