Nosebleeds are a common disease of the ENT organs, which is the leakage of blood from the vessels of the nose as a result of injury, local disease, or against the background of a disease in the body.
Author:
- Gadzhiev Kamran Rafikovich
otolaryngologist, rhinosurgeon
3.38 (Voted by: 
What is nosebleed?
Nosebleeds are a common disease of the ENT organs, which is the leakage of blood from the vessels of the nose as a result of injury, local disease, or against the background of a disease in the body. It is considered an acute pathology and requires immediate emergency medical care. Lack of medical care leads to deterioration of a person's condition, even death. Therefore, underestimating this condition and considering it a short-term ailment is a common mistake of patients. There is a well-known fact in history when the leader of the Huns, Attila, did not capture the Roman Empire, dying in Western Europe from a nosebleed.
What is strictly forbidden to do
If your dog has a nosebleed, try to contact a veterinarian as soon as possible for a consultation or a home visit. When providing first aid, avoid the following:
- Use of sedatives. The effect of medications will blur the clinical picture and complicate diagnosis. Instead, use approving words and gentle strokes.
- Sudden movements. Moving an animal when injured must be very careful, as shaking or an accidental blow can worsen the condition.
- Pulling out foreign objects. Without proper skill, a stuck insect can be pushed even deeper, and a sharp sliver can damage the mucous membrane.
- Opening dried crusts in the nose. The formations that appear are necessary for safe wound healing.
- Inducing vomiting during loss of consciousness. The animal may choke on vomit.
If you have successfully stopped blood loss, do not rush to relax. Systemic diseases of a chronic nature can lead to relapses.
Causes of nosebleeds
To understand the causes of bleeding, you should know the anatomical structure of the nose and its functions. The nose and nasal cavity belong to the upper parts of the respiratory system. When we inhale, the air in the nose is cleaned, warmed and moistened. The vasomotor function is performed by the extensive vascular network located in it. When cold and dry air enters the nose, the vessels dilate and become full of blood, due to which the mucous membrane thickens and allows less air to pass through in order to warm and moisturize it. The opposite processes occur when warm, humidified air enters.
The vessels in the nasal cavity originate from the system of the external and internal carotid arteries. They are responsible for the blood supply to the anterior sections of the nasal septum. The weak point of the nasal vascular system is the anastomosis - the junction of capillaries from the external and internal carotid artery systems. There are two such places in the nasal cavity, and both of them are located in the area of the nasal septum. In the anterior sections it is the vascular bundle of Kisselbach (LocusKisselbahi), in the posterior sections it is the Woodruff bundle (plexusWoodruff). The vessels in the anastomotic area have a thin wall, covered on top with a thin mucous membrane of the nasal cavity. Therefore, minor injuries, increased pressure, dry cold air cause damage to these vessels.
A common cause of nosebleeds is injury. Such bleeding is called post-traumatic. But, in addition to traumatic ones, there are also iatrogenic causes. They represent nosebleeds after operations, manipulations in the nasal cavity (puncture, catheterization), installation of nasogastric or nasotracheal tubes during anesthesia or gastric lavage, endoscopic examination of the nasal cavity.
A deviated nasal septum, adenoid vegetations, aneurysms of the vessels of the nasal cavity, an oncological process or neoplasms in the nose are all risk factors.
Diseases of internal organs and diseases of the cardiovascular system can also cause nosebleeds. Most often it occurs in patients with hypertension with increased blood pressure. In case of incorrectly selected therapy and the patient does not comply with the doctor’s recommendations to stabilize the pressure, surges occur that lead to damage to blood vessels.
Cases of nosebleeds are common in patients taking anticoagulants (drugs that reduce blood clotting).
Ruptures of mucosal capillaries can also occur when:
- colds;
- taking narcotic drugs;
- frequent use of vasoconstrictor drugs;
- being in a dry and cold climate;
- overheating of the body (sunstroke);
- with vitamin deficiencies (vitamin C deficiency);
- with alcohol abuse;
- quickly diving into water or climbing a mountain.
Reasons why a dog has a nosebleed
To begin with, let's note that blood can flow out of a dog's nostrils in different ways: run copiously and non-stop, periodically drip, fly out when sneezing, and in some situations, blood clots are released from the nose. A relatively safe reason for bleeding from the nose can be considered injury. For example, when an animal hit its nose hard when colliding with a pole or was injured by a thorny stem of dry cattail. In these or similar situations, blood usually comes out of only one nostril. When bleeding is observed from both nostrils at once, the following ailments can be suspected:
Poisoning with poisons for rodents
– rodenticide poisons are aimed at stopping the production of vitamin K in the body of rats and mice, which leads to heavy blood loss and death of pests. If a dog accidentally swallows such a poison, then in addition to bleeding from the nose, throat, urethra and anus, there will be shortness of breath, cyanosis of the mucous membranes, severe thirst, bradycardia, diarrhea and vomiting, convulsions, apathy;
Blood parasitic diseases
(erlichiosis, trypanosomiasis, piroplasmosis, hemobartonellosis) – bites of certain insects (flies, horseflies, mosquitoes) and ticks often provoke the development of diseases that cause bleeding from the nose or gums. Blood may also be present in urine or stool. Other signs of the mentioned ailments are severe lethargy of the dog, pallor or yellowness of the mucous membranes, periodic temperature fluctuations, inflammation of the eyes, shortness of breath, tachycardia;
Von Willebrand disease
– sometimes a dog has a nosebleed due to the presence of this hereditary disease that causes poor blood clotting. Von Willebrand's disease is often diagnosed in Dobermans, Shelties, Poodles, German Shepherds, Airedale Terriers, and Rottweilers. With this disease, dogs experience severe blood loss after operations and injuries (bites, cuts, etc.). Sometimes there are spontaneous nasal and/or genitourinary bleeding;
Hemophilia
– another hereditary disease in which dogs experience nosebleeds, muscle swelling for no apparent reason (due to bleeding in the joints), subcutaneous hematomas, huge blood loss even after minor injuries, pain when urinating and blood in the urine;
Thrombocytopenia
– with many ailments (for example, leukemia, heartworms, inflammation of the spleen, vasculitis, etc.) a dangerous condition develops, characterized by low platelet formation, which leads to bleeding (including from the nose or gums several times a day ). Other signs of thrombocytopenia in dogs are apathy, pale mucous membranes, bloody diarrhea and/or urine, severe bleeding of wounds;
Arterial hypertension
– a similar problem in animals arises, for example, against the background of diabetes, obesity, and kidney disease. High blood pressure often causes nosebleeds. Other signs of hypertension are redness and pendulum movements of the eyes, decreased vision, shortness of breath, fainting, arrhythmia, and the appearance of blood in the urine.
Acute renal failure
– often the dog has a nose bleed due to kidney problems, caused, for example, by cardiovascular diseases, pancreatitis, diabetes. Signs of kidney problems are bleeding (including from the nose), severe thirst and poor appetite, lethargy, vomiting and diarrhea, decreased amount of urine, blood and/or pus in the urine, pallor/redness of mucous membranes, swelling;
Liver failure
– liver problems in dogs often develop against the background of viral diseases (leptospirosis, adenovirosis, etc.) or due to uncontrolled use of medications and for other reasons. More often than others, liver failure is diagnosed in Dalmatians, Labradors, spaniels, and Dobermans. Signs of liver problems - loss of appetite, weight loss, lethargy, gastrointestinal disorders, bleeding (from the nose, urethra, etc.), ascites and pain in the abdominal area, cramps, changes in the color of stool (discoloration) and urine (darkening);
Hyperthyroidism
– with hyperfunction of the pancreas, Labradors, Dobermans and Keeshonds suffer more often than others. Signs of such a disease are anxiety, nosebleeds, weight loss, increased heart rate, difficulty breathing, trembling, deterioration of coat condition, bulging eyes, weakness;
Oncological processes of the nasopharynx
– with cancer of the nasopharynx in dogs, blood occurs not only in the nasal discharge, but also in the saliva. Characteristic signs of such ailments are nasal congestion (breathing through the mouth), bad breath, decreased hearing, enlarged cervical lymph nodes, tachycardia, temperature fluctuations, weight loss, paralysis of muscles in the muzzle;
Foreign body in the nose
– if, say, a pointed part from a toy or a small bone gets into the dog’s nasal passage, there may also be blood from the nose, most often only from one nostril. With this problem, the nasal mucosa will become swollen, the dog will often sneeze and shake its head irritably, mucus will run out of the nose (with or without blood);
Secondary diseases of the nasopharynx
(rhinitis, sinusitis), developed against the background of infectious diseases (cryptococcosis, plague, etc.) - in such cases, dogs have profuse snot (sometimes with blood and/or pus), tearing, sneezing, swelling of the nasal mucosa, refusal to eat , wheezing, fever;
Heat/sunstroke
– if the dog was exposed to the scorching sun for a long time or was left in a closed car for a while, the nose may bleed due to overheating. Signs of such a problem are lethargy and drowsiness, rapid breathing, high temperature, rapid pulse, redness of the mucous membranes;
Vitamin K deficiency
– In very rare cases, a dog’s nose may bleed due to a deficiency of phylloquinone (the correct name for fat-soluble vitamin K), which is responsible for blood clotting. If there is a lack of vitamin K, a dog may experience not only nosebleeds, but also bleeding gums, subcutaneous and eye hemorrhages. Blood can also be observed in the urine, and in particularly difficult cases, in the feces.
Symptoms and classification of nosebleeds
Signs of a nosebleed are blood draining from the nostrils to the outside or down the back of the throat through the nasopharynx. Bleeding may be posterior or anterior. Anterior bleeding affects the Kisselbach capillary plexus, and posterior bleeding comes from large vessels and poses a great danger to the patient.
The main danger to life is the amount of blood lost. Normally, a healthy person has about 4-5 liters of blood in the body. With short-term bleeding, the volume of blood loss is up to 100 ml. This amount of blood loss does not greatly affect health, but depending on the type of nervous system, it can manifest as emotional excitement or fainting against the background of vegetative-vascular dystonia.
But if the volume of blood loss is more than 400-500 ml, then the patient develops weakness, dizziness, tinnitus, stars flashing before the eyes, the person becomes pale, the pulse quickens, and the blood pressure rises compensatory.
If the blood continues to flow and the volume of blood lost is up to 2-3 liters, then the patient shows signs of hemorrhagic shock. It becomes difficult to establish contact with the patient, shortness of breath increases, the skin turns pale, the extremities become cold, the hands, feet, and lips turn blue. Blood pressure decreases, the pulse is practically not palpable. The patient may lose consciousness.
First steps to help
If your dog has a nosebleed, calm down and think about what to do to stop it. Panic will not only not help, but will also make the situation worse.
Four-legged friends read the emotions of their owners well and can become seriously worried. An even greater jump in blood pressure will negate all your efforts, so take a break from analyzing the possible causes.
Lying position and cold on the bridge of the nose
Lay or sit your pet down with his head down. This position will prevent blood from refluxing into the throat and make breathing easier.
Apply ice, snow, a cold water bottle, or frozen meat wrapped in a thick cloth to the bridge of your nose. The cold will constrict the blood vessels and stop blood loss.
Help with poisoning
If you are sure that your pet has been poisoned by rat poison, induce vomiting with saline solution. In addition to washing, it is recommended to give activated carbon or another sorbent. After cleansing the stomach and intestines, be sure to contact a veterinary clinic. To neutralize the poison, you will need an injection of Vikasol.
Help with head injury
In case of injury, it is necessary to limit any movements of the animal as much as possible, placing it on its stomach. Make sure his head is on his front paws. Use cold and call a veterinarian. You will not be able to cope with internal bleeding on your own.
What to do if you have heatstroke
If he overheats, take your dog to a cool place and provide him with enough oxygen by opening the windows. Wet the fur or cover it with a damp cloth to reduce body temperature. In addition to a cold compress, offer your pet cool, but not ice-cold, water.
First aid for nosebleeds
- Call an ambulance or see an ENT doctor at the nearest clinic.
- Place the patient in a sitting position. Throwing your head back or lying down is undesirable. It is better to take a vertical position, placing a tray under your chin to determine the volume of lost blood.
- If the patient suffers from hypertension, measure blood pressure and take blood pressure-lowering medications prescribed by the doctor.
- Apply cold to the nose area and apply a cold towel to the collar area.
- Moisten cotton wool with 3% hydrogen peroxide and place it in the vestibule of the nose.
- Press the wing of the nose against the septum for 10-15 minutes.
Symptoms
Symptoms can be divided into obvious and hidden.
- Obvious symptoms can be observed, for example, with intestinal, gastric, pulmonary, etc. bleeding. In such cases, blood may be released when coughing, vomiting, in feces, or in urine. It is worth noting that these can be both drops and more serious volumes.
- Hidden symptoms appear with intracavitary bleeding. Characteristic signs are shortness of breath, pallor of the mucous membranes, increased abdominal volume, and a sudden onset of fatigue.
It is necessary to consult a veterinarian in the following cases (it does not matter whether it is full-fledged discharge or just inclusions):
- When your dog has stool, urine, or vomits blood
- When your nose bleeds
- There are hematomas (subcutaneous hemorrhages) on the body
- The dog has a very red eye or both eyes
- Pale mucous membranes
- Rapid breathing
- Fainting
- Weakness
Methods to stop nosebleeds
An ancient but effective method is anterior nasal tamponade. For tamponade, the doctor uses gauze turunda soaked in drugs. Using a nasal speculum and tweezers, the doctor establishes layers in the nasal cavity layer by layer from the vestibule of the nose to the nasopharynx and from the bottom to the upper sections. This method is effective, but has negative sides. Installing the turunda takes from 2-3 minutes to 10-15 minutes. The procedure is quite painful and difficult for patients to tolerate. Therefore, Merocell hemostatic tampons are used for anterior tamponade. These tampons are thin, so they are installed in the nasal cavity with minimal discomfort. After installation, the tampons are moistened with saline, under the influence of which they swell and fill the nasal cavity.
For posterior nosebleeds, when the source of bleeding is in the posterior sections of the nasal cavity and large vessels bleed, installation of a posterior tampon is indicated. The peculiarity of this method is that a special conductor is inserted through the nose, which is removed through the mouth. A tampon moistened with a hemostatic agent is tied to the end of the guidewire. The guidewire is pulled out of the nose and the tampon is inserted behind the soft palate into the nasopharynx, and then into the nasal cavity. The negative side of the method is the discomfort for the patient and the technical difficulty of performing it in an emotionally excited state.
An effective method of combating posterior and anterior nosebleeds, regardless of location, is the Epistop catheter. The catheter is a tube consisting of a system of three balloons. After installing the catheter in the nose, using warm water, the posterior balloon is inflated and compresses the vessels of the posterior localization. Then the middle-localized balloon is inflated, pinching the vessels in the area of the nasal turbinates and the middle nasal septum. And at the end, the anterior balloon expands, compressing the vessels in the area of the Kisselbach locus. The advantages of this method are that installation of such a catheter takes 1-3 minutes and the procedure is less painful for the patient.
Surgical methods to stop nosebleeds
In specialized institutions and clinics, if stopping posterior nasal bleeding using packing is ineffective, they resort to angiography (x-ray examination of blood vessels) and vascular embolization (cessation of blood flow through the vessel) of the nasal cavity under the control of an electron-optical converter. The listed methods are used in cases where the doctor is unable to identify the location of the bleeding. The reason for this is often bleeding from the deep parts of the nasal cavity.
In anterior nosebleeds, the source of bleeding is localized in the Kisselbach Locus region. And if the doctor has identified bleeding vessels, then the tactics to stop the bleeding are noticeably different from the listed methods.
Electrocoagulation
In almost all cases, in ENT practice, electrocoagulation is used to stop bleeding from the Kisselbach Locus. After preliminary local anesthesia, the bleeding vessels are cauterized with an electrocoagulator or Surgitron device. In our clinic, a similar procedure is performed under endoscope control. This allows for a good detailed examination of the nasal cavity, identifying damaged vessels and cauterizing them, minimizing the risk of relapse. But electrocoagulation has contraindications. An absolute contraindication would be an artificial ri driver. Electrocoagulation in this case can disable the pacemaker and lead to undesirable consequences for the patient, including cardiac arrest.
There are alternative methods to stop nosebleeds. Such as cauterizing bleeding vessels with preparations containing silver, or destroying vessels in the area of the Kisselbach locus using a sharp spoon called “abrasio”.
Often the cause of bleeding is a deviated nasal septum. By forming sharp protrusions, the deviated septum damages the nasal mucosa, thereby stimulating constant bleeding. In this case, the patient is indicated for surgical intervention. From local removal of a deviated section of the nasal septum (cristotomy) to complete correction of the nasal septum (septoplasty).
Food allergies
Unlike food intolerance, food allergies in dogs are several times less common. The disorder is characterized by an incorrect reaction of the immune system to microelements from food - cells identify them as foreign elements and attack. Then an allergic reaction occurs, which brings discomfort to the animal.
The first signs of an allergy are burning and rash on the skin. Severe itching occurs, bald patches appear at the site of the rash, and hair falls off. Harmful microflora soon enters the damaged areas, which will lead to the appearance of infected and bleeding wounds.
The main thing to remember when identifying a disease is that it is impossible to be completely cured. The veterinarian will prescribe a course of medication to eliminate the symptoms, and diet and dietary changes can also help. More often, allergens are found in foods containing protein - eggs, lamb, chicken and beef. It is advisable to exclude wheat, soybeans, and corn.
Rehabilitation period after surgery
Stopping nosebleeds is a kind of surgical intervention, which requires daily observation by an ENT doctor and postoperative rehabilitation. Patients who have had nasal tampons or hemostatic sponges installed receive hemostatic therapy after stopping the bleeding. If necessary, they are transfused with components of lost blood and undergo therapy aimed at lowering blood pressure. On average, a patient stays with a tampon in his nose for 3-7 days. After which the tampons are carefully removed, and the patient is under daily medical supervision for several days. During the rehabilitation period, it is important to continue taking medications that strengthen blood vessels, accelerate healing and moisturize the nasal mucosa.
Do I need to contact a veterinarian?
Excessive blood loss is fraught with serious consequences, so do not neglect the help of a veterinarian. Even a small leak can accompany a dangerous systemic disease, so do not make hasty conclusions until the diagnosis is established.
Diagnosis at home or in clinic
Before contacting the veterinary clinic, try to collect as much information as possible about what happened. Record all alarming symptoms, analyze the likelihood of injury and poisoning, and do not forget to take with you the instructions for all medications your pet takes.
Remember that one of the most alarming signs is paleness of the mucous membranes, which can lead to death from excessive blood loss. In such a situation, you should seek help even at night, without thinking about making an appointment in advance. Four-legged patients in serious condition are always accepted without a queue.
If you were unable to stop the bleeding, and your pet’s condition continues to worsen, do not waste time on the road and call a doctor directly to your home. If there is a serious threat to the dog’s life, they may be taken to the hospital.
Is it possible to avoid frequent nosebleeds?
There are external and internal factors that provoke nosebleeds. Therefore, to prevent this, you should avoid these factors or take measures to treat the triggering diseases.
External factors:
- frequent use of vasoconstrictor drugs,
- dry, cold or polluted air.
Internal factors:
- arterial hypertension,
- deviated nasal septum,
- neoplasms of the nasal cavity.
Diagnosis of internal bleeding
A complete medical history and professional examination/diagnosis of the animal is necessary for a quick and accurate diagnosis.
Diagnosis is made by instrumental methods, such as ultrasound (ultrasound) and x-rays. Ultrasound is used to determine the presence of tumors in the cavity or hematomas. A large volume of fluid in the cavity will not make visualization of the internal organs worse, but on an x-ray it will make visualization more difficult. If free fluid is detected in the chest or abdominal cavity, a number of additional studies are required to determine the nature of the fluid. The most common is puncture - taking fluid from the abdominal cavity for microscopic analysis. And thanks to a clinical blood test, the severity of blood loss can be determined.
In case of serious internal bleeding, emergency surgery is indicated.
After injuries, bleeding may occur, which will stop without the intervention of a veterinarian, resulting in the formation of a hematoma. If a hematoma occurs, it is necessary to monitor the condition of the animal, since the risk of renewed bleeding remains.
