Anatomy Flashcards
The upper limb is divided into which regions?
- axilla
- arm or brachium
- elbow / cubital fossa
- forearm
- wrist
- hand
The lower limb is divided into which regions?
- inguinal region / groin
- thigh
- knee / popliteal fossa
- leg
- ankle
- foot
What are the two types of fascia?
Superficial and deep
Describe the superficial fascia
- subcutaneous tissue
- varies in depth
- loose connective tissue and fat
- includes superficial blood vessels, cutaneous nerves, lymphatics and sweat glands
- there can be variation between people and between different areas of the body eg. gluteal region and the hand region
Describe the deep fascia
- covers most of the body deep to the skin and superficial fascia
- relatively tough and sheet like
- dense connective tissue
- usually white, sometimes glistening appearance
- named according to the location it is found in
- divides limbs into compartments
- present throughout most of the body but not all
Name an example where deep fascia is absent /hard to find or see
In the face
Name the sections of deep fascia in the upper limbs
- pectoral fascia
- deltoid fascia
- brachial fascia
- antebrachial fascia
Name the sections of deep fascia in the lower limbs
- fascia lata (thigh)
- iliotibial tract
- crural fascia (leg)
Describe the features of the iliotibial tract (or iliotibial band)
- lateral area of the thigh
- thickened band of fascia lata
- joins to the tibia inferiorly and the ilium superiorly
Describe the roles of deep fascia
- invests muscles
- forms intermuscular septa
- forms compartments
- aids in venous return
What is investing?
When the deep fascia not only covers the outer aspect of the limb but extends internally to cover deep structures
Describe investing in the lower limb
Deep fascia invests the muscles not only individually but also by way of a thickened sheet known as intramuscular septa. This forms a fascial compartment - muscle in the compartment have similar actions and the same neural supply
What are the benefits of compartments within the fascia?
- can help with the spread of infection or tumours
- can help to prevent overstretching
- forms part of the muscular skeletal pump
- occurs in both the lower and upper limbs
Describe the route of the arterial supply of the upper limbs starting with the subclavian artery
- subclavian artery passes under the clavicle
- then becomes the axillary artery
- then the brachial artery
- then the deep brachial artery
- within the cubital fossa the brachial artery then bifurcates to give two branches; the radial artery and the ulnar artery
- these then branch into deep and superficial palmar arches
- then the metacarpal and digital arteries
How many digital arteries are there per digit?
4
Describe the route of arterial supply of the lower limb starting with the external iliac artery
- external iliac artery
- then deep femoral artery
- then femoral artery
- then popliteal artery
- within the popliteal fossa the popliteal artery bifurcates to give two branches; anterior tibial artery and the posterior tibial artery
- then dorsalis pedis artery
- medial and lateral plantar arteries
- arcuate artery and deep plantar arch
- metatarsal and digital arteries
What is the chief arterial supply to the lower limb?
Femoral artery
What is the arterial supply of the thigh?
- deep femoral artery by way of perforator branches (usually 3 or 4)
Which artery essentially supplies the dorsal arch?
Arcuate artery
Digital arteries are what type of artery?
End arteries
How would you limit blood loss from an artery?
By applying pressure proximal to the site of injury
Where is the carotid artery found?
At the level of the upper border of the thyroid cartilage, posterior to the sternocleidomastoid muscle
Where is the femoral artery found?
Inferior the the inguinal ligament
Where is the dorsalis pedis artery found?
Medial to the tendon of the extensor hallicus longus muscle
Describe superficial veins
- run in superficial fascia
- smaller, thinner
- highly variable; vein pattern analysis can be used for identification
- drain into deep veins
Describe deep veins
- run deep to the deep fascia
- larger, thicker
- more predictable
- often occur in neurovascular bundles
- pierce the deep fascia
Describe the cephalic vein
- arises from dorsal venous network
- travels the lateral aspect of the limb
- travels through the deltopectoral groove
- pierces deep fascia to drain into the axillary vein
Describe the basilic vein
- arises from the dorsal venous network
- travels the medial aspect of the limb
- drains into the brachial vein
What are the three most common variants of superficial veins in the cubital fossa?
- median cephalic vein
- median vein of the forearm (20%)
- median basilic vein
What percentage of people will have no connecting veins in the cubital fossa?
80%
Describe the great saphenous vein
- arises from the dorsal venous arch
- travels the medial aspect of the limb
- drains into femoral vein; femoral triangle
Where is the great saphenous vein found?
- immediately anterior to medial arelous
- 4 fingers width from the medial aspect of the platella
The great saphenous vein travels with what?
The saphenous nerve (somatic sensory nerve)
Describe the small saphenous vein
- arises from dorsal venous arch, the lateral aspect
- travels the posterior midline of the leg
- drains into popliteal vein, posterior to the knee
Describe the drainage of veins of the lower limbs starting with the planter arch
- planter arch
- drains to posterior and anterior tibial vein
- drains into fibular vein
- drains into popliteal vein
- drains into femoral vein
- drains into external iliac vein
- drains into common iliac vein
- finally drains into the IVC
Describe the drainage of the upper limbs starting with the superficial and deep palmer venous arches
- superficial and deep palmer venous arches
- drains to radial and ulnar vein
- drains to brachial vein
- drains to axillary vein
- drains to subclavian vein
- drains axillary vein
- drains to subclavian vein (internal jugular also drains to subclavian vein)
- drains to brachiocephalic vein
- finally, drains to SVC
Are deep veins usually bilateral or unilateral?
Bilateral or more. Except from IVC and SVC
How does venous blood normally flow from superficial into deep veins?
Through perforating veins.
Enter at an oblique angle
Describe the features of venous valves
- ensure unidirectional blood flow against gravity
- incompetent valves result in reverse flow into superficial veins
- become weak and dilated - varicose veins
Describe the action of the musculovenous pump
- as the muscle contracts, deep fascia helps to increase the pressure in the compartment so perforating veins compressed preventing backflow
- pushes blood back towards the heart
Describe the action of the arterial venous pump
- accompanying veins (vena comitantes) surrounded with artery in vascular sheath, veins are flattened so helps blood to flow back to the heart
The lymphatics of the upper limb generally follow what?
The veins
Describe superficial lymphatics of the upper limb
- arise from plexuses in fingers and hand
- follow cephalic and basilic veins
Describe deep lymphatics of the upper limb
- follow deep veins of upper limbs
- drain into lateral axillary axillary nodes
Where does axillary nodes drain?
Generally drain into the subclavian lymphatics
Which lymph nodes will the cephalic vein mainly drain into?
Mainly pass into apical axillary lymph nodes
Which lymph nodes will the basilic veins drain into?
They drain into the cubital nodes and then into lateral axillary lymph nodes
The lymphatics of the lower limb generally follow what?
The veins
The superficial lymphatics of the lower limbs follow which veins?
The saphenous veins - great and small
The deep lymphatics of the lower limbs follow which veins?
The deep veins of the lower limbs
Describe the lymphatics of the great saphenous vein
- tend to pass to superficial inguinal lymph nodes
- then to iliac or deep inguinal nodes
Describe the lymphatics of the small saphenous vein
- pass to the popliteal fossa nodes first
- then to deep inguinal nodes
- then to external iliac nodes
Where do the external iliac lymph nodes drain to?
The common iliac nodes and enter the lumbar lymphatics
Where do the deep lymphatics of the lower limb drain to?
- usually first towards popliteal lymph nodes
- then deep inguinal nodes
- then external iliac nodes
Define ischaemia
Inadequate oxygenation of cells / tissues / organs due to an interruption to blood supply (arterial or venous)
Name reasons for reduced arterial perfusion pressure
- left ventricular failure
- arterial bleed (injury)
- arterial rupture (aneurysm)
- occlusion of lumen (atherosclerosis, PVD)
- arterial spasm
- external compression of arterial supply (tumour, compartment syndrome, inflammation)
What is the most common site of venous ulceration?
Gator area
Describe venous ulceration
- venous pressure increases
- damages blood vessels in the skin
- skin becomes inflamed, dry and itchy
- cannot heal well due to poor blood supply
- begins to break down
The gator area is the territory of which veins?
The small and great saphenous veins
If a thrombus breaks away to the lungs, depending on the diameter is can occlude what?
- segmental artery
- lobar artery
- pulmonary artery
- pulmonary trunk
What type of embolus can arrests the circulation of the lungs?
Saddle embolus - pulmonary trunk
