of the inferior members.
The notion of venous
of the inferior members expresses the set of hemodinámicas disturbances at sanguineous level that appears when an operation of the venous
takes place badly. This pathology, predominantly feminine (2 / 3 women in front of 1 / 3 men) is very frequent, since it reaches approximately to 40 % of the population of the developed countries.
Frequently it is pronounced with the appearance of discreet edema in the inferior members, accompanied by
sensation of slowness of legs. Also it can appear by
venous éstasis that can go of the simple varicosidad (arborescencia of very small
and blue intradérmicas veins) to the complex variz.
The complications of the venous
can be of type:
: varicose trombosis or periplexia,
angiodérmica and varicose ulcer.
1. The veins.
The veins are tubular structures that the return assures the blood to the heart. Like all the conductive
, they are protected by cells of endotelio,
they are different from other
in which they have, of
form, you fold internal that corresponds to valves. These valves facilitate the circulation from the the most elevated most inferior zone to, preventing than the blood flows back towards the feet. The
to valvular allows the vein to fight against the hydrostatic pressure and the force of the gravity. The wall of
thickness smaller twice than the one of the artery.
It is formed by
weave specialized in the containment and made up of:
• elastic Fibers,
• Fibers of colágeno and
2. The venous
of the inferior members contains two networks schematically:
venous network and
superficial venous network.
Deep the venous network is the one that surrounds to the arteries. It is surrounded by the
mass. This network drains 90 % of the venous blood of the inferior members.
The superficial venous network is visible under the skin, is bad prote'ge'e and outside the
. She does not assure the return the blood more than in 10 %, and is the cause of several venous
of the inferior members. This network is compound essentially of internal and external safenas veins. The superficial venous network is united to the deep veins by the armor - piercing veins that are in
to drain the blood of the surface towards the deepest zones.
3. The venous circulation.
The venous circulation is governed by two types of mechanisms: the called mechanisms passive and, by the active opposition, mechanisms.
The passive mechanisms.
The return of the venous blood is determined by the pressure differential between the periphery and the heart (right auricle) The venous pressure depends on several factors:
It is the impulse of the
blood that entails the mobilization of the venous blood. The
is bound to the venous
by the capillaries. When the degree of opening of the hair arterioles increases, the venous pressure increases vice versa and.
The hydrostatic pressure.
The passage of "knocked down"
, where the hydrostatic pressure is the same one in all the sides, to "the raised"
imposes to the veins of the inferior members great variations of pressure. The process is limited by two factors:
• the colágeno of the venous weave, that assures
structure to him maintenance,
• the capacity of the valves to close
, and that divide the blood column. If it appears an excessive pressure, the valves end up losing their functionality. Before an
to valvular, the process also worsens by the creation of
compensating superior pressure in the immediately inferior part to the damaged valve.
This pressure is related to the contraction of muscles of the inferior members that, when compressing the deep veins, impel the blood towards the heart. The gradient of pressure between the surface and the depth explains the passage of the blood of the superficial veins towards the deep veins.
The venous aspiration.
The aspiration of the venous blood must to the conjunction of two processes:
• the contraction of the right ventricle that creates
in the right auricle,
• the intratorácica negative pressure.
The active mechanisms.
The veins are not only
set of túbulos in
to lead the blood towards the
cavities. Also are walls equipped with contractibilidad. The venous weave contains active elements: smooth
fibers that allow the vein to reduce or to increase their caliber. These fibers are compound of smooth
cells regulated by adrenérgicas completions. These completions
noradrenaline that causes, by activation of the receivers,
contraction of the smooth
. Noradrenaline at venous level is
vasoconstrictor. Other transmitters can affect to the vasomotilidad inhibiting or stimulating the liberation of this noradrenaline by the
The serotonin, histamina, angiotensina II and prostaglandins
and F2 have
vasoconstrictor effect. It agrees to consider that during
too important venous contraction, takes place an exudation of
at hair level due to the compensating vasodilatación of the arterioles. The prostaglandins present A1, A2, E2 and I2 in the inflammation, have an inhibiting effect on the venous smooth
and therefore, they cause
The organization of the venous
functional point of view, an adaptation model to fight against the force of the gravity. At the same time, he is one of the great weak points, since this complex and multifactorial regulation can be unbalanced easily.
We are going to see the different mechanisms that cause the appearance of the venous
adopted by the human being makes undergo considerable pressures to the venous network of the inferior members. He is undeniable that remaining of immovable foot and during long time favors and aggravates the venous insufficiency. It is stated very frequently in people who work during all the day of foot.
On the other hand, some studies have returned to bring to light the relation between long permanence On guard seated and the presence from
. In the third - world countries and East, it is stated that the varicosidad is rare. The western ones sleep an average of 8 hours, 8 hours of foot work or seated and 8 hours seated in
sofa relax. Therefore, during 16 hours it is in
that does not favor the correct venous circulation. The
also relax 8 hours
walking, cycling or seated in the
, he is to say that the
are 16 hours On guard favorable. Therefore, the
doubled chair, legs, seems to favor the appearance of venous
To walk improvement the operation of the venous
of the inferior members. The frequent
better sanguineous drainage and in addition, they
network of collateral veins apt to suplementar
deficient containment. To make physical exercise of continued form is
protective factor of the venous
; on the contrary, the sedentarismo is an aggravating factor.
Thus, with the changes of temperature vasomotores phenomena are observed venous level. These variations of section of the vein must to the thermal sensitivity of the
completions of smooth the
cells. The cold causes
vasocontricción by increase of the affinity of noradrenaline by its receivers.
By an inverse process, during the exhibition to the heat,
vasodilatación takes place. The heating by the
, sobrewarmed up means,
solar exhibition or too important thermal amplitude favor the sanguineous éstasis and the installation of the venous
. The sensation of heavy legs, edema and the
are agravated by the heat. The frequency of functional
of the venous insufficiency is much greater in
The statistics are clear:
in front of affects to two women
man. As it is obvious east done is in narrow relation with the hormonal phenomena. The estrogens or, more concretely, the variation of their levels can affect the venous wall, which explains that the puberty, the
and the premenopause are responsible for an accentuation of the venous distension. In addition, the way of feminine life, normally more sedentary, often associated to
work, makes that the woman reunites enough more unfavorable elements, propitious to
It seems to be that the hereditary factor also can influence in the appearance of venous
. He is dificil to attribute ésto to the inheritance in case single, since, often, individuals of
have nutritional habits and similar hygiene of life. If one were inheritance, the races and the ethnic groups would be due to mark to significant differences between.
Surveys epidemiologists have tried to demonstrate this, therefore
study made by Brizzio in an India community of
native town of
, demonstrates affirmative results in that sense. In the group of pure Indians, no had
. In the group of racially mixed Indians most presented / displayed pictures of venous
. In this
case, the mestization
been the person in
of the appearance of the varicose
It is possible to be spoken of
weakness of the conjuntivo weave or rather question is hereditary degenerations of endotelio? La is open still today.
At the moment one knows that after
insufficiency, the alterations produced at level of the venous weave can have to the action of free radicals. Let us remember that the free radicals are unstable molecules that have
free electron and that tend to become stabilized, mainly after numerous physiological oxidativas reactions.
The free radicals act on lipids causing their oxidation. The oxidativa alteration of nutritional lipids is well - known for
long time: it causes
modification of the scent and the
similar phenomenon takes place on lipids of the alive organisms, mainly on which they constitute biological membranes. The free radicals are the
great number of structural and functional
of cellular membranes. At level of the endoteliales cells, these
are translated, at
of the permeability, people in
of the plasmática flight (edema
) Later, the action repels on the valves, with increase of the fragility and destruction in case of elevation of the venous pressure.
cells of the venous wall, can present / display morphologic and physiological
produced by the free radicals giving rise to an abnormal conjuntivo weave, that does not assure its mechanical properties correctly. The oxidation of lipids of membranes also can have consequences in other structures that are not the cellular membrane. Thus, the lipids of oxidized membranes form peroxides, being known the malonil - dialdehído one (M.
. carrier of two free radicals, is able to act on protéicas molecules and to modify their structures. It
the property to establish
cross - sectional bridge between proteins. This bridge affects so much to the
. as to colágeno and elastina fibers, being able to alter its functional characteristics. Thus, the different weaves implied in the venous return are disorganized of progressive form by the free radicals.
After this review, we see with greater thoroughness three clinical forms susceptible to be dealt with
The hemorroides are pathological expansions of the anorrectal venous network. According to the affected veins, 3 locations are distinguished:
• Hemorroides internal.
• Hemorroides external.
• Hemorroides marginal.
The anorrectales veins constitute an anastomosis carry - digs. The hemorroidal pathology very is extended. Its frequency is explained by an anatomical particularitity: the
carries does not contain valves at level of the anorrectales veins.
In addition, these venous walls are frequently subject to inflammatory phenomena of the mucosa due to the great microbial load of the average fecal.
predisponentes factors of the hemorroidal pathology are:
• Any increase of the intra - abdominal pressure:
• nutritional Excess, in individual eaten strongly condimentadas, spirit, strong
of transit that can cause continuous traumatismos of the venous walls: constipation or diarrea.
• Certain sports as it is the case of:
equitación, cycling, motociclismo.
• Long trips by car.
Also it is necessary to consider that, sometimes, the hemorroides also can be symptomatic manifestations of underlying pathologies like:
• pelvic Lesiones that forms an obstacle:
- sigmoidal, utero -
When the expansion of the anal venous network is
, the hemorroides are generally asintomáticas. On the contrary, when this expansion is accentuated, the hemorroides are painful (congestivos accesses) and including complicated.
The complications of the hemorroidal
• local Hemorrhage.
• Prolapse of the varicose package.
• hemorroidal Polyp.
The treatment of the hemorroides only can be medicinal or
- surgical (
or surgery) In this chapter we will treat only the medical treatments.
1. Rules higieno -
He is interesting to follow some
measures simple to prevent the hemorroidales accesses:
• Eliminar the predisponentes foods, to suppress spices, the
• Luchar against the constipation or the diarrea.
• Prohibir the irritating laxatives.
• local Hygiene with nonirritating soap.
• Aportar fiber to the diet, to avoid the constipation.
2. Local treatments.
Numerous preparations of local use exist, under form of pomadas for the hemorroidal access. These treatments are considered sólamente like helping.
In the acute hemorroidal crisis we will essentially use plants with vitaminic
and raninos, as it is the case of the
tree of Indians and
Grapevine, already described in this volume.
Plants adapted for this
tree of Indians.