Anatomy of Venous Ulceration Flashcards

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1
Q

is the inguinal region/groin a region of the lower limb or abdomen?

A

lower limb

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2
Q

describe arterial supply to upper limb

A

subclavian > becomes axillary > becomes brachial (+ deep brachial) > becomes radial and ulnar at level of elbow) > superficial and deep palmar arches > metacarpal and digital arteries (end arteries)

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3
Q

what are end arteries?

A

the only blood supple to a given area of the body (no collaterals)
e.g - digital arteries

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4
Q

describe the arterial supply to the lower limb

A

external iliac > becomes femoral artery (and deep femoral) > becomes popliteal artery behind knee > becomes anterior and posterior tibial arteries below knee > becomes dorsalis pedis, medial and lateral plantar arteries, arcuate artery and metatarsal and digital arteries

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5
Q

what are the perforating arteries?

A

branch off from deep femoral vein to supply the back of the thigh

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6
Q

where is neck pulse?

A

anterior to sternocleidomastoid at level of upper border of thyroid cartilage

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7
Q

what are the 2 reasons for ischaemia?

A

reduced arterial perfusion pressure

increased venous drainage pressure (DVT, external compression etc)

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8
Q

give 4 differences between superficial and deep veins

A
superficial = small and thin, deep = large and thick
superficial = in superficial fascia, deep = run deep to deep fascia in muscular compartments
superficial =  very variable, deep = more predictable
superficial = drain into deep veins, deep = in NVBs
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9
Q

what is superficial fascia and whats contained within it?

A

subcutaneous tissue

contains loose connective tissue, fat, superficial vessels, cutaneous nerves, lymphatics and sweat glands

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10
Q

describe deep fascia

A

tough, sheet like dense connective tissue

white appearence

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11
Q

what does deep fascia do?

A

covers body deep to skin and superficial fascia and divides limbs into compartments (intramuscular septa)

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12
Q

name deep fascia in upper limb

A

pectoral
deltoid
brachial
antebrachial

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13
Q

name the deep fascia of the lower limb

A
fascia lata (thigh)
iliotibial (lateral thigh)
crural fascia (leg)
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14
Q

describe the course of the cephalic vein

A

arises from lateral dorsal venous arch in hand, continues along lateral limb into deltopectoral groove and drains into axillary

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15
Q

describe the course of the basilic vein

A

arises from medial dorsal venous arch and continues up medial limb and drains into brachial veins

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16
Q

what is the medial cubital vein?

A

connects cephalic and basilic veins at elbow

17
Q

what is the most common variant of upper limb vasculature?

A

median vein of forearm splits into medial cephalic and basilic veins which then become cephalic and basilic veins

18
Q

what is the course of the great saphenous vein?

A

from medial dorsal venous arch in foot, travels anterior to malleolus up medial side of limb and drains into femoral vein

19
Q

what is the course of the small saphenous vein?

A

arises from lateral dorsal venous arch, travels up posterior midline of the leg and drains into popliteal vein

20
Q

what are vena comitantes>

A

veins surrounding an artery encased in a vascular sheath which benefit from the pulsation of the artery as it helps push blood up the vein
(only in deep veins)

21
Q

what are perforating veins?

A

allows flow of blood from superficial veins into deep veins

22
Q

what 2 factors aid unidirectional blood flow in veins?

A

venous valves

musculovenous pump

23
Q

what can cause incompetent valves and what are the consequences of this?

A

old age, dilation of vessel

reverse flow from deep into superficial veins causing varicose veins

24
Q

how can immobility or valve failure cause thrombosis and ulcers?

A

both lead to chronic venous insufficiency which can result in venous stasis which can result in thrombosis/embolism or superficial microcirculatory deficiencies which result ulceration

25
Q

describe the progression to venous ulceration

A

increased venous pressure >damages blood vessels in skin > skin becomes dry, itchy and inflamed > skin cant heal due to bad blood supply > skin breaks down

26
Q

where are limb ulcers most common?

A

gaiter area (medial aspect of distal leg due to great saphenous)

27
Q

what is the general pattern of lymphatics in the limbs?

A

lymphatics follow the veins

28
Q

what are the paths of superficial lymphatics?

A

arise from plexuses in fingers and hands and follow cephalic and brachial veins
basilic = to lateral axillary nodes
cephalic = to apical axillary nodes which drain into subclavian lymphatics

29
Q

what are the paths of deep lymphatics in the upper limb?

A

follow deep veins
drain into lateral axillary nodes
axillary nodes drain into subclavian lymphatics

30
Q

where does lymph from lateral and medial hand end up?

A
lateral = apical nodes
medial = lateral pectoral nodes
31
Q

describe the path of superficial lymphatics in lower limb

A

follow saphenous veins
great = superficial inguinal > external iliac/deep inguinal
small = popliteal nodes > deep inguinal > external iliac

32
Q

describe the path of deep lymphatics in the lower limb

A

follow deep veins > drain into popliteal lymph nodes > deep inguinal nodes > external iliac nodes