Epistaxis: not to be overlooked in bleeding in cirrhosis
Variceal bleeding is a life threatening complication of
cirrhosis, in which survival is closely related to failure to
achieve haemostasis. In a clinical review, Johal and colleagues (p 440) describe two patients in whom endoscopic treatment failed to control bleeding. A delay in the diagnosis of epistaxis as the primary cause of
the bleeding led to prolonged haemodynamic instability and further
decompensation. The authors say that in patients with haematemesis
without an identifiable cause at gastroscopy, the mouth and nasopharynx
should be examined carefully to exclude a bleeding point.
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- Lesson of the week: Epistaxis: an overlooked cause of massive haematemesis in cirrhosis
- Shawinder S Johal, Andrew S Austin, and Stephen D Ryder
BMJ 2003 326: 440-441.[Extract] [Full Text] [PDF]
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