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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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