Epistaxis

Also Known As

Nose bleed

Description

Nose bleeds in horses are known as "epistaxis." When a horse begins bleeding from the nostrils, key questions include the age of the horse, the exercise tolerance of the horse, the volume and frequency of the blood loss, and the character of the epistaxis.

Many of the causes of epistaxis are mild and self-limiting, but others such as guttural pouch mycosis and progressive ethmoid hematoma, a benign, well-encapsulated mass in the paranasal sinuses, can have serious or fatal consequences.

A horse's nasal passages are richly supplied with blood vessels and the throat, lower airways or lungs may be injured to a degree that blood vessels are damaged causing epistaxis.

Symptoms

  • Bleeding from one or both nostrils

Causes

Causes of epistaxis include trauma, complications of pneumonia, pulmonary abscess, pulmonary infarction, exercise-induced pulmonary hemorrhage, foreign bodies in the nostrils, neoplasia, sinusitis, nasal polyps, systemic diseases, ethmoid hematoma and guttural pouch mycosis as well as other diseases and conditions.

Bleeding that occurs shortly after racing or vigorous exercise is strongly suggestive of exercise induced pulmonary hemorrhage (EIPH).

A mucopurulent nasal discharge with blood staining is associated with ethmoid hematoma, whereas guttural pouch mycosis is likely to cause bright red blood to drain through the nostrils. Major bleeds often follow intermittent minor bleeds. .

In some cases of epistaxis, abnormal respiratory noise will be evident especially in the case of hematomas or other conditions where airflow is reduced or absent on the affected side.

Prevention

Given the variety of causes of epistaxis, prevention is nearly impossible except through good horse and stable management to reduce the number of injuries that might cause nose bleeds and prompt diagnosis to determine the cause when nose bleeds occur.

Since many diseases and conditions can lead to epistaxis, careful attention to the condition of the horse and any incidents of epistaxis that occur will help prevent serious or life-threatening situations.

Treatment

Treatment of epistaxis is related directly to the cause of the bleeding. In some cases, where the bleeding is a one-time or an intermittent occurrence lasting no more than 15 minutes, no treatment may be necessary. In on-going or obviously serious cases of epistaxis, a veterinarian should examine the horse thoroughly including nasal passages, the guttural pouches, and the nasopharynx. .

A thorough endoscopic examination of the airways and lungs along with a collection of blood for hematology and biochemical profiles, along with skull radiography where advised by a veterinarian, will help diagnose the problem so that effective treatment may begin.

In any case, a horse with epistaxis should be kept as calm as possible. Since horses breathe through their noses, the nostrils should never be packed. A cold, wet towel or ice pack may be held just below the horse's eyes.

In cases where polyps or hematomas are causing the epistaxis, surgery or other methods may be recommended by a veterinarian to treat the condition.

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