anatomy Heme/Onc Flashcards
Where does the brachiocephalic become the subclavian (aka bifurcates)?
At the sternal clavicualar joint
The vertebral arteries go on to supply what structure of the brain? Where does it branch off?
The basilar artery supports the posterior circulation of the brain in the circle of willis known as the posterior communicating branches. It branches off the subclavian
Where does the internal thoracic artery branch off?
The subclavian also gives off the thyrocervical and costcervical trunks, and they go on to supply the intercostal muscles.
Where does the dorsal scapular artery branch off?
The subclavian
Where does the ophthalmic artery branch off?
The internal carotid then continues to go upwards to supply the circle of willis and form the middle cerebral artery
What arteries supply the heart?
Ascending aorta and the coronary arteries
Which artery runs anterior to the thorax?
Internal thoracic
What is the order of the branches of the external carotid artery that supply the face?
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
What is the fun mnemonic to remember the branches of the external carotid?
Some Antomists Like Freaking Out Poor Medical Students
What are the parietal (somatic) branches of the thoracic aorta? Where do they branch off?
Intercostal and superior phrenic
These surround the organs
They branch off of the thoracic (descending) aorta
What are the visceral branches of the thoracic aorta? Where do they branch off?
Bronchial, Esophageal, Mediastinal, and Pericardial. These are the branches that supply the organs
What are the branches of the subclavian?
Costocervical trunk, thyrocervical trunk, internal thoracic, vertebral, dorsal scapular artery
What artery branches off of the thyrocervical trunk?
The suprascapular artery supplies a lot of the chest, shoulder, a lot of the bones and muscle there
When the subclavian becomes the axillary, what branches does the axillary give off?
The thoracoacrominal artery, Subscapular artery, posterior circumflex humeral artery, anterior circumflex humeral artery, posterior intercostal arteries and anterior intercostal artery
The lateral thoracic artery supplies the lateral border of the rib cage and the intercostal arteries. Where does it originate?
Thoracoacrominal artery
Why do we worry about the circumflex arteries?
The posterior and anterior humeral arteries wrap around the humerus and provide blood to the upper arm. We worry about them very much during fractures because of the bleeding that can occur
As soon as the axillary artery becomes the brachial artery at the inferior border of the teres major muscle, it begins to branch, and there is a deep artery that runs a bit more posterior and lateral to the brachial artery, which continues down to supply what?
Makes the radial artery and ulnar artery of the forearm. The radial and ulnar arteries then feed into the superficial palmer arch that anastomoses to supply the digital arteries of the hand.
There is an artery that lies in between the radial and ulnar arteries. What is its name?
Common interosseous artery
What are the branches of the abdominal aorta?
Visceral branches
- Celiac trunk: Supplies the liver, gallbladder, spleen, stomach, esophagus, duodenum
- Superior and inferior mesenterics: Supplies the small intestine and the colon
- Suprarenal: Adrenal glands
- Renal: Kidneys
- Gondal: testes or ovaries
Parietal branches
- Inferior phrenic: Supplies inferior diaphragm
- Lumbars: Posterior abdominal wall
- Median sacral: supplies the Sacrum and Coccyx
R. common iliac: Pelvis, R. lower limb, Arteries of the R. Lower limb
L. common iliac: Pelvis, L. lower limb, Arteries of the L. lower limb
Why is the superior mesenteric artery (SMA) clinically significant?
Perfuses the midgut and SMA syndrome can occur where occlusion occurs in the artery and cause SEVERE abdominal pain. They will develop mesenteric ischemia
Why is the median sacral artery clinically significant?
When people come in with hip fractures, the median sacral artery can bleed or become occluded
What are the branches of the celiac trunk?
The common hepatic artery branches to the right to supply the gallbladder and the liver.
The splenic artery and the left gastric artery
The abdominal aorta bifurcates into the right and left common iliac arteries. How does the common iliac artery then branch off?
The internal and external iliac.
The internal iliac artery has what branches?
Superior and inferior gluteal arteries. Obturator artery. Pudendal artery for more pelvic blood supply
What does the obturator artery supply?
The muscles of the thigh and are part of the pelvis too
The external iliac artery travels more distally to get downward to the leg and become the femoral artery at what location?
The inguinal ligament
What arteries come off of the femoral artery?
The deep femoral artery of the thigh is what we palpate when we palpate the femoral artery. Then the deep artery also has a lateral circumflex femoral artery and a medial circumflex femoral artery
The femoral artery becomes the popliteal artery where?
In the popliteal fossa
The popliteal artery branches into which arteries?
Anterior tibial and posterior tibial
The anterior tibial branches into what structures?
the dorsalis pedis artery (pulse point, DP). arcuate artery, and dorsal metatarsal arteries (so top of the foot)
The posterior tibial artery gives off what arteries?
Fibular artery, and helps give some medial and lateral plantar arteries of the foot
What two structures merge to become the superior vena cava?
The left and the right brachiocephalic
What two structures merge to become the brachiocephalic?
Right internal jugular and right subclavian
What is the azygous system?
It drains the thoracic wall and empties into the SVC. Some of the lumbar veins drain here as well.
What are the functions of vertebral veins?
They drain the deoxygenated blood from the head
What are tributaries of the internal jugular vein?
“I Find Large Purple Spiders Most Obnoxious”
Inferior petrosal sinus (ophthalmic)
Facial Vein (superficial temporal vein)
Lingual vein
Pharyngeal veins
Superior thyroid vein
Middle thyroid vein
Ophthalmic vein
What are the sinuses of the brain?
What are the major branches of the axillary vein?
The basilic (anterior and medial), the brachial (in between, a little bit posterior), and the cephalic (anterior and lateral)
What is the median cubital vein?
The vein that connects the basilic and cephalic veins. This is where a lot of blood draws are performed. This continues to run and form the ulnar and radial veins, which eventually anastomose in the hand to form the deep venous palmer arch
Name the veins
Why is the hepatic portal system significant?
It functions as a filtration of the blood and drains the gut to the liver. When patients have cirrhosis of the liver, this clogs and backs up. This is how ascites can happen. Copudum adusae can happen, which is a swelling of the veins in the abdomen. Esophageal varices, hemorrhoids
What do the hepatic veins supply?
The liver
Where does the external iliac become the femoral vein?
The inguinal ligament
The femoral vein becomes this vein that runs more medially.
The great saphenous vein is clinically significant because we typically use it for coronary artery bypass grafting (CABG)
When does the thoracic aorta become the abdominal aorta?
After it passes through the diaphragm at T12
What are the two leg pulses commonly palpated during a cardio exam?
Dorsalis pedis and posterior tibial
Where does the IVC pass through the diaphragm to return blood to the heart?
T8 (vena cava has 8 letters)
What are the veins that drain directly into the IVC?
The 3 hepatic veins that drain the liver, the renal veins, the lumbar veins, the RIGHT gonadal vein (the left is connected to the left renal vein)
Which gonadal vein has a higher cause of experiencing compression?
The left gondal vein means that varicose seals are more likely to occur on the left testy or ovary compared to the right
What is the term for veins that accompany arteries?
Vena comitantes
Is the great saphenous on the medial or lateral side?
Medial because you always wanna protect it
The term “common” suggests what?
There is a splitting or bifurcation
Describe the structures missing
- The brachiocephlic artery supplies the right subclavian and right common carotid artery
- The common carotid artery supplies the internal and external carotid arteries
- The subclavian artery supplies the vertebral and axillary arteries
- The vertebral artery: These arteries from the left and right side of the neck move upward to merge to become the basilar artery of the brain, which will then branch to supply the cerebellum, the brain stem, and the occipital lobe (posterior portion of the brain)
- The left internal common carotid: These arteries from the left and right side of the neck move upward and become a part of the anterior cerebral artery and middle cerebral artery to make up the anterior portion of the circle of willis.
- The left external common carotid Has 3 branches
- Facial: comes off the external. It is a very distinct artery as it has a very tortuous, curly route as it comes up deep to the mandible and emerges superfifically on the side of our face; a pulse can be palpated here
- Maxillary: courses deep to the mandible and supplies muscle in this region and some structures near the oral and nasal cavities
- Superficial Temporal: lateral portion of the head
Which vessel (s) supply the middle meningeal artery? What is the significance of the middle meningeal artery?
The maxillary artery that ascends on the lateral aspect of the head to supply the meninges. The medial meningeal artery will run between the skull and the dura mater, which can be easily damaged with a blow to the side of the head in the pteryion leading to possible epidural hemorrhage or hematoma with rupture to the vessel
Describe these structures
What is the unique name for structures labeled #1 and #2 that durian blood from the brain?
- The majority of veins follow the same naming structure as the arteries. The big exception is that to drain the brain itself, we are going to have unique structures, named intracranial dural venous sinuses. They will line the inner aspect of our skull. Responsible for filtering and draining the blood back from the vein itself. Within the skull, the dural venomous sinuses are all going to funnel back towards the jugular foramen at the formation of the internal jugular vein.
- The internal jugular vein drains the majority of blood from our brain
- The External Jugular vein drains the superficial aspects of the posterior neck and the jaw. The internal and external jugular veins sandwich the sternocleomastoid muscle. Has 3 branches
- The retromandibular vein that drains the side of the head and some deeper structures of the face
- Facial: drains into the INTERNAL jugular vein
- Superficial temporal vein: contributes its drainage into the retromandibular. - Subclavian
What is a unique feature of the veins of the head and neck?
They are valveless, meaning they are not only going to have the one-way direction of flow. This is important because this is going to be based on pressure. So if you have pressure in one region, you can actually take another route to drain the veins.
What are the two dominant routes of blood to the brain?
The internal carotid artery is located more anteriorly, and the vertebral artery is located more posterioly. The brain is HIGHLY metabolic
The right and left internal carotid arteries travel upward to the brain to supply the Circle of Willis and provide blood supply to what parts of the brain?
The carotid arteries turn more medially in the bone and the base of the skull, and the internal carotid artery enters its base as the carotid canal. This is going to be located within the temporal bone, then it will course medially and horizontally and then ascend up into the skull superior to the foramen lacerum. The carotids will take a turn in the skull itself, and it happens in the cavernous sinus. The internal carotid artery still has not branched as it is coming up through the space, and it curves back on itself where it is now going to join with the circle of willis (ther anteriocerebral circle)
The right and left vertebral arteries travel upward to the brain to merge to become the ______ and provide blood supply to ____?
The basilar artery
Vertebral artery predominantly supplies blood to the cerebellum and the posterior aspect of our brain. While the internal carotid artery is going to supply the temporal lobes laterally, as well as frontal lobes anteriorly, and the parietal lobes superiorly
What is the vein responsible for draining deoxygenated blood from the brain toward the heart?
Internal jugular vein
Which vessel is responsible for connecting the anterior and posterior sources of the blood supply to the brain?
Posterior communicating artery
What vessel courses deep to the mandible and gives off branches to the oral and nasal cavities?
Maxillary artery
The internal carotid supplies what portion of the brain?
The frontal lobe
The dural venous sinuses are formed between the meningeal layer of the dura mater and what other structure?
Periosteal layer
What vessel is a branch of the internal carotid artery?
Middle cerebral artery
Venous blood draining through the dural venous sinuses eventually exits the skull through which passageway?
Jugular foramen
Which venous sinus structure is unpaired?
Straight sinus
Identify the borders of the right subclavian as it travels to become the axillary and brachial artery:
The right subclavian originates off of the brachiocephalic trunk. So, the right subclavian is shorter than the left. The right subclavian doesn’t change names until it hits the lateral border of the first rib, where it becomes the axillary artery. The name doesn’t change again until it hits the inferior border of the teres major muscle, where it becomes the brachial artery.
The radial and ulnar arteries anastomose to become what?
The radial (lateral) and ulnar (medial) arteries are branches of the brachial artery. The superficial palmer arterial arch that supplies the structures of the hand
What is the name for the bony area where the brachial artery splits into the radial and ulnar arteries?
Cubital fossa
The ulnar artery travels distally to the palm of our hand through what bony structure?
The hypothernar eminence and forms the dominant contribution to the superficial palmer arterial arch
The radial artery travels dorsally through what bony structure?
the posterior aspect of the thumb, this area is known as the anatomical snuff box where it can has branches to the carpal bones. The radial artery supplies the thumb (first digit) and the pointer finger (second digit). It forms the dominant contributionto the deep palmer arterial arch.
What is the name for the complex network of veins present on the back part of the hand?
Dorsal venous network
What are the names of the two veins found on the medial and radial parts of the forearm?
These are superficial veins that don’t parallel the deeper arteries. Along the medial aspect of the forearm, BASILIC vein. Along the lateral aspect of the forearm is the CEPHALIC.
(starts along the thumb)
Describe the structures
What is a great site for blood draws?
Median cubital fossa
Describe the cephalic vein
Course laterally up in a groove known as the deltopectoral groove. Located between the deltoid muscle and the pectoralis major muscle, can be really prominent in people who have relatively little body fat.
Describe the superficial veins
These veins are the only ones that contain valves and when the muscle is contracted and gets more superficial on that fat or deep fascia, it can actually assist in unidirectional flow of blood back to the heart. Muscle assistance in pumping blood back to the heart, this is why you use a stress ball when you give blood
What does the term veine commatantas?
Veins sandwich arteries all over the body. 2 deep veins for every single deep artery
The union of the radial and ulnar veins forms which blood vessel?
Brachial vein
Which blood vessel is found with the radial nerve in the spiral groove of the humerus?
Deep brachial artery
What abdominal arteries are unpaired?
- Celiac trunk: derived from the foregut
- Superior mesenteric artery: supplies lots of the abdomen, especially the parts that derive from the midgut. Duodenum, pancreas, ⅔ of large intestine, jejunum and ileum, SI, ascending colon and ⅔ of transverse colon
- Inferior mesenteric artery: supplies the rest of the large intestine, last ⅓ of transverse colon, all of descending and sigmoid colon, and superior ⅓ of the rectum
What are the paired abdominal arteries?
- Renal arteries: asymmetrical, because the left is shorter than the right, due to the displacement of the aorta, liver mostly, so right kidney, suprarenal gonadal arteries are also associated w/ the renal arteries. The suprarenal arteries sometime branch of the renal arteries, but sometimes they branch off the abdominal aorta.
- Inferior phrenic artery: supports and supplies the inferior diaphragm. Can sometimes give off superior suprarenal branches
- Gonadal arteries: branch off the abdominal aorta, just inferior to the renal arteries. These arteries are typically really long due to the embryologic descent of the gonads. (testes or ovaries)
- Lumbar arteries: provide segmental blood supply for the lumber vertebrae and the body wall in this region. NUMEROUS and highly varied
- Iliac arteries: the abdominal aorta bifurcates into the common iliac artery of each leg. From here, the blood will continue down into the pelvis and lower limb
What are the three branches of the celiac trunk and what do they supply?
- Splenic artery: supplies spleen and tail of the pancreas
- Common hepatic artery: supplies liver, gallbladder, adn the head of the pancreas, parts of the duodenum, and the greater curvature of the stomach
- Left gastric artery: lesser curvature of the stomach
What veins coverage to become the IVC and what veins drain nto the IVC?
The IVC is formed by the blood supply draining the lower limb and pelvis will then receive further blood from other regions of the body: gonadal veins= on the right side, it drains directly into IVC. On the left, will drain into the renal vein, because gonadly veins= branches off the left renal vein, because it has a longer branch off the abdominal aorta.
Describe the structures
What system does not drain directly into the IVC?
GI blood DOES NOT directly drain into the IVC, because it must go through the hepatic portal vein
What is the purpose and location of the hepatic portal vein?
The vast majority of abdominal organs, send their blood directly to the liver through a portal system. The venous drainage of these organs, are converged through 3 major pathways:
1. Superior mesenteric vein: draining blood from parts of the duodenum, all of the jejunum and ileum, the cecum, the ascending colon and ⅔ of the transverse colon
2. Inferior mesenteric vein: draining blood from the rest of the transverse colon, all of the descending and sigmoid colon and parts of the rectum.
3. Splenic vein: joins superior and inferior mesenteric vein in the spleen and surrounding areas and converges these 3 into a single vessel called the hepatic portal vein, which ensures that all the blood within these structures is bypassing systemic circulation and stocking the liver, so it can filter the nutrient rich blood, before sending it into systemic circulation. Large fats cannot be filtered this way.
At what vertebral level does the aorta pass through the diaphragm?
T12
Arterial blood supply from the branches of the celiac trunk, supplies what organ?
liver
Arterial blood supply from the branches of the superior mesenteric artery supplies what organs?
jejunum
Arterial blood supply from the branches of the inferior mesenteric artery supplies what organs?
sigmoid colon
At what level does the abdominal aorta bifurcate into the common iliac arteries?
L4
The splenic and superior mesenteric veins combine to form what?
The hepatic portal vein
At what vertebral level does the IVC pass through the diaphragm?
T8
The external iliac artery will pass where?
Deep to the inguinal ligament. The inguinal ligament separates the abdominal and pelvic cavities anteriorly
What is the major supply of blood in the thigh?
femoral
What is the longest vein in the human body?
The great saphenous and has no accompanying artery
Where does the IVC bifurcates?
L5
Describe these structures
Describe these structures
Which side (anterior or posterior) provides more blood supply to tissues?
posterior
What are the four types of arterial pulses we can palpate for?
Dorsalis pedis, posterior tibial pulse, popliteal pulse, and femoral pulse
Describe the general location of the dorsalis pedis pulse?
Between the extensor hallucis longus tendon and the second digit (toe). Find the muscle w/ foot dorsiflexed, place two fingers in the depression and have them relax the foot to evaluate pulse.
Describe the general location of the posterior tibial pulse
Between the posterior surface of the medial malleoulus and the medial border of the calcaneal tendon (aka achilles). Optimally palpated when the foot is inverted in order to relax the flexor retinaculum as the posterior tibial artery passes deep to this ligament.
Describe the general location of the popliteal pulse?
Inferior part of the popliteal fossa with the patient prone and knee flexed to relax the popliteal fascia and the hamstrings. Easy in a lean individual
Describe the general location of the femoral pulse?
Inferior to the midpoint of the inguinal ligament
What is the name of the femoral artery after it passes through the adducter hiatus?
Popliteal artery
The dorsalis pedis is a continuation of which artery?
Anterior tibial artery
What vessel is a superficial vein that arises anterior to the medial malleollus from the medial aspect of the dorsal venous network?
Great Saphenous Vein
The anterior popliteal vein drains into which blood vessel?
Popliteal vein
