Haemorrhage/bleeding variceal

Blood from the haemorrhoidal venous plexus passes via the azygous superior rectal vein into the inferior mesenteric vein and thereafter into the portal vein. By contrast, the paired middle rectal vein and inferior rectal vein discharge their blood via the iliac vein into the inferior vena cava. In portal hypertension, anorectal varices are found in the region of the rectum, the anal canal and the external anal region. Haemorrhoids are distended and dislocated cavernous bodies in the rectum, which have no connection to the portal venous system. Although haemorrhoids and anorectal varices are two different clinical pictures, it is quite possible for them to occur simultaneously. The frequency of anorectal varices (40-80%) is dependent upon the extent and duration of portal hypertension. The bleeding tendency is low (7-14%). However, there have also been reports of massive haemorrhages. (21,45,55,66,83,105,156) (s. tab. 14.10)... 

The basic treatment of bleeding oesophageal varices is carried out under intensive care conditions. It essentially corresponds to the procedures for upper gastrointestinal haemorrhage, (s. pp 350, 351) The therapy has three main objectives ... 

There are a number of causes including (I.) well-known hepatotoxic factors (e.g. superimposed viral infection, alcohol consumption, hepatotoxic drugs, intoxication) and (2.) endogenous factors (e.g. sepsis, variceal bleeding, gastrointestinal haemorrhage, diarrhoea, hypoxia). Acute liver failure is frequently the result of a chain of damaging events, like a vicious circle. 

Oesophageal varices have traditionally been managed by sclerotherapy. This therapy has proved efficient in controlling active haemorrhage but has no influence on the reduced life expectancy of these patients. The sclerosing agent is injected in repeated 1 to 2-ml aliquots in and around the varicose vein. Sclerotherapy controls the bleeding in up to 90%. 

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