Anatomy of Limbs: Fascia, Arterial, venous and lymph supplies, venous ulceration Flashcards
1
Q
What is another name for superficial fascia and where does it lie?
A
- Subcutaneous tissue
- underneath the dermis
2
Q
What are the anatomical names for the back of the knee and the back of the elbow?
A
- back of knee: popliteal fascia
- back of elbow: cubital fascia
3
Q
What 2 components is the superficial fascia composed of?
A
- loose connective tissue
- fat
4
Q
What 4 components does the superficial fascia contain?
A
- superificial blood vessels
- cutaneous nerves
- lymphatics
- sweat glands
5
Q
What is deep fascia and what does it look like?
A
- dense connective tissue underneath the superficial fascia
- looks white and shiny
6
Q
How is the deep fascia arranged in the limbs?
A
It lies underneath the skin and superficial fascia in the circumference of the limb and also invests into muscles compartmentalising them
7
Q
What are the 2 physiological reasons behind deep fascia compartmentalising muscles?
A
- helps contain spread of infection/tumours
- prevents belly of muscle from expanding too much when they contract thus helping venous return
8
Q
What 2 components do muscles that are compartmentalised by deep fascia share?
A
- nerve supply
- carry out similar actions
9
Q
Label this diagram.
A
10
Q
Label this diagram.
A
11
Q
What does the brachial artery bifurcate into at the cubital fossa?
A
- radial artery
- ulnar artery
12
Q
Describe the blood supply to the arm.
A
- Subclavian artery becomes the
- axillary artery which becomes the
- brachial artery which becomes the
- deep brachial artery which bifurcates into
- ulnar and radial arteries which become the
- deep & superficial palmar arches
- metacarpal and digital arteries
13
Q
What is important to note about the subclavian artery in terms of its route into the arm?
A
It passes under the clavicle
14
Q
Describe the blood supply to the lower limb.
A
- external iliac artery passes under the inguinal ligament and branches into
- deep femoral artery which branches out into
- perforators
- and the femoral artery which continues inferiorly to become the
- popliteal artery posterior to the popliteal fossa which then bifurcates into the
- anterior tibial artery and posterior tibial artery which then become the
- dorsalis pedis artery (direct continuation of anterior tibial artery)
- medial and lateral plantar arteries (bifurcations of posterior tibial artery)
- arcuate artery and deep plantar arch which become the metatarsal and digital arteries
15
Q
What is another name for the deep femoral artery?
A
profunda femoris artery (profound, deep)
16
Q
What are arterial perforators in the lower limb?
A
arteries that extend from deep femoral artery
17
Q
What pulse points should you be able to palpate in neck, upper limb and lower limb?
A
- neck: bifurcation of common carotid artery
- upper limb: brachial artery, radial artery
- lower: femoral artery, popliteal artery, posterior tibial artery, dorsalis pedis artery
18
Q
Describe the anatomical location of the bifurcation of the common carotid artery.
A
anterior to sternocleidomastoid muscle at level of upper border of thyroid cartilage
19
Q
What are the two types of veins in the limbs?
A
- superficial veins
- deep veins
20
Q
Describe superficial veins in terms of location, size and where they drain into.
A
- location: in superficial fascia and are highly variable in different bodies as to where they sit
- size: small, thin veins
- drain into: deep fascia by piercing through the deep fascia
21
Q
Describe deep veins in terms of location, size and what do they often occur in?
A
- location: run deep to deep fascia and lie in much more predictable patterns
- size: larger and thicker than superficial veins
- occur in neurovascular bundles
22
Q
What are the two superficial veins in the upper limb and from what do they both arise?
A
- cephalic vein and basilic vein
- both arise from the dorsal venous network
23
Q
Which superficial upper limb vein travels superiorly laterally and which travels superiorly medially?
A
- cephalic travels laterally (CL-> CuLater)
- basilic vein travels medially (ByeMan)
24
Q
Where does the cephalic vein of the arm drain into?
A
runs through deltopectoral groove then pierces deep fascia into deltopectoral triangle to join axillary vein
25
Where does the basilic vein of the arm drain into?
pierces through deep fascia at about mid-arm level above elbow and into the brachial vein
26
What is the name of the vein that some people have the joins the basilic and cephalic vein and what is this vein often used for?
- median cubital vein
- often used for venepuncture
27
What are 4 common variants of superficial veins in cubital fossa?
- median cephalic vein
- median basilic vein
- median vein of forearm
- no connecting vein i.e. no median cubital vein
28
What are the two main superficial veins in the lower limbs and from where do they both arise?
- great saphenous vein
- small saphenous vein
- both arise from dorsal venous arch however great arises from medial aspect and small arises from lateral aspect
29
Where does the great saphenous vein lie in relation to the medial malleolus?
immediately anterior to it
30
Where does the great saphenous vein lie in relation to the medial aspect of the patella?
approx. 1 hands breath medial to the medial aspect of patella
31
What nerve does the great saphenous vein run with?
saphenous nerve
32
What happens to the size of the great saphenous vein as it runs proximally?
It enlarges due to other veins joining it along the way
33
Which superficial vein in the lower limb runs medially up the leg and which runs along the posterior midline?
- great saphenous: medially
- small saphenous: posterior midline
34
Where does the great saphenous vein drain into?
drains into femoral vein in the region of the femoral triangle that is just distal to the midpoint of the inguinal ligament
35
Where does the small saphenous vein drain into?
Drains into the popliteal vein posterior to the knee
36
Label this diagram.
37
Describe deep venous drainage of upper limb.
-superficial and deep palmer venous arches into ulnar and radial veins into brachial vein into axillary vein into axillary vein into subclavian vein which meets with internal jugular to form the brachiocephalic vein which then drains into the superior vena cava
38
Describe the deep venous drainage of the lower limb.
Drains from planter arch (deep veins) into posterior and anterior tibial veins and the fibular vein, which drains into the popliteal vein into femoral vein and tributary from deep femoral vein joins with femoral to form external iliac vein into common iliac vein and then drains into Inferior vena cava
39
Through what types of veins does blood flow form superficial veins into deep veins and what 2 aspects of these prevent blood flowing backwards?
- Perforating veins
- have valves and flow down into deep veins at oblique angle
40
What prevents backflow from deep veins into sueprficial veins?
valves in perforating veins + oblique angle mean that when muscle contracts perforating veins are squished and blood can't flow back up them
41
What can incompetent valves result in?
varicose veins: weak and damaged veins
42
What are vena comitantes and what is the purpose of them?
veins that accompany deep arteries (veins often travel in groups), AKA accompanying veins
-purpose is to use pulsation of artery as they travel with artery enclosed in a vascular sheath and then get flattened as artery pulses
43
What do lymph vessels in the limbs generally follow?
veins
44
From what do superficial lymphatics in the upper limb arise and what do they follow?
- plexuses in fingers and hands
- follow cephalic and basilic veins
45
What nodes do superficial lymphatics that follow the cephalic veins drain into?
apical axillary nodes
46
What nodes do superficial lymphatics that follow the basilic veins drain into?
first drain into cubital nodes and then into lateral axillary nodes
47
Label these nodes.
48
Where do both lateral and apical axillary nodes drain into?
subclavian lymphatics
49
Where do deep lymphatics of upper limb drain into?
Mainly to lateral axillary lymph nodes
50
What do the superficial lymphatics of the lower limbs follow?
saphenous veins
51
What nodes do the lymphatics that follow the great saphenous vein tend to drain into?
superficial inguinal nodes and then into the deep inguinal nodes or external iliac nodes
52
What nodes do lymphatics that follow the small saphenous vein drain into?
First into popliteal nodes then to deep inguinal nodes and then onto external iliac nodes
53
Label this diagram.
54
Where do deep lymphatics drain into?
popliteal lymph nodes then into deep inguinal nodes and then into external iliac nodes
55
Where do the external lymph nodes then drain into after lower limb drainage?
into common iliac nodes and then enter lumbar lymphatics
56
Interruptions of what can lead to ischaemia? (2 things)
- interruption of arterial blood supply
- interruption of venous drainage
57
List 6 possible causes of 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
58
How can interruption of venous drainage lead to ischaemia?
increased venous drainage pressure can cause back pressure into the capillary bed and thus into the arteriole preventing normal blood flow into arteries
59
List 3 possible causes of interruption to venous drainage.
- Right (or congestive) heart failure
- DVT
- external compression e.g. tumour
60
How can chronic venous insufficiency (due to immobility/venous valve failure) lead to thrombosis/embolism + skin ulceration?
- can cause thrombosis or embolism due to deep venous stanis
- can cause skin ulceration due to superficial microcirculatory deficiences i.e. poor blood supply
61
Venous pressure increase can lead to venous ulceration. True or false?
True
62
What happens to the skin in venous ulceration?
Becomes dry, itchy and inflamed and eventually begins to break down as poor blood supply
63
What is the name and significance of the darker blue area of this image?
- Gaiter area
- is most common site for venous ulceration
64
Where do arterial ulcerations most commonly tend to affect?
foot
65
What different arteries can a thrombus block in the lungs? (5)
- small peripheral artery
- segmental artery
- lobar artery
- pulmonary artery
- pulmonary trunk
66
What is a saddle embolus?
When a thrombus breaks away forming an embolus and completely occludes the pulmonary trunk arresting circulation
