APE 5: Peripheral Vasculature and the Autonomic Nervous System Flashcards
Where is the subclavian artery found?
Between the clavicle and the first rib
What is the origin of the right and left subclavian artery?
Right= from the brachiocephalic trunk Left= from the arch of aorta
How is the subclavian artery divided, based on its position relative to the anterior scalene?
First part= origin of subclavian artery to medial border of anterior scalene
Second part= posterior to anterior scalene
Third part= lateral border of anterior scalene to lateral border of first rib
Where does the subclavian artery become the axillary artery?
At the lateral border of the first rib
Where does the axillary artery become the brachial artery?
At the distal border of the teres major
How is the axillary artery divided, based on its position relative to the pectoralis minor muscle?
First part= proximal to pec minor
Second part= posterior to pec minor
Third part= distal to pec minor
What does the brachial artery bifurcate into?
The radial and ulnar arteries
Where does the brachial artery normally bifurcate into the radial and ulnar arteries?
About 1cm distal to the bend of the elbow, roughly at the level of the neck of the radius
Which three structures lie in the cubital fossa?
Biceps tendon, brachial artery and median nerve
Why would a clinician become very familiar with the brachial artery?
To measure blood pressure
What are the borders of the cubital fossa?
Lateral border= medial border of the brachioradialis muscle
Medial border= lateral border of pronator teres muscle
Superior border= hypothetical lines between epicondyles of humerus
What is the route of the ulnar artery in the forearm?
Descends to the anterior compartment and enters the palm anterior to the flexor retinaculum
What is the route of the radial artery?
Crosses the lateral aspect of the wrist beneath tendons that pass to the thumb, and passes into the posterior aspect of the hand
What is the anatomical snuffbox?
Triangular area bounded by tendons
Give 2 reasons why a clinician will be familiar with the radial artery?
- taking a pulse
- arterial blood gas
Which 2 palmar arteries are there?
Superficial and deep
What are venae comitantes?
A pair (or more) of veins
Which vein drains the blood from the upper half of the body?
The superior vena cava
What does the superior vena cava bifurcate into?
The left and right brachiocephalic veins
What are the two superficial veins of the upper limb?
Cephalic and basilic
What is the positioning of the cephalic and basilic veins?
Cephalic= lateral, radial side Basilic= medial, ulnar side
Where does the cephalic vein drain into the deep venous system?
In the delto-pectoral groove
Where does the basilic vein drain into the deep venous system?
Cubital fossa
What is the antecubital fossa and where does it lie?
A shallow depression anterior to the elbow, where the median cubital vein is found
Why would a clinician be familiar with the ante-cubital fossa?
Venupuncture
What does the abdominal aorta divide into?
The two common iliac arteries
At which vertebral level does the abdominal aorta bifurcate?
L4
What are the two divisions of the common iliac artery?
Internal and external
What does the internal iliac artery supply?
The pelvis
Where does the external iliac artery pass into?
The inguinal ligament
What is the position of the femoral artery?
Medial to the femmoral nerve
Lateral to the femoral vein
Where can the pulse of the femoral artery be felt?
At the mid-inguinal point
What is the importance of the femoral artery at the mid-inguinal point?
It is where blood samples are taken for blood gas determination and taking pulse
Where is the inguinal ligament found?
Between the pubic symphysis and the ASIS
Which profession is commonly associated with penetrating wounds involving the femoral artery?
Butchers
Where does the profunda femoris artery arise from?
The lateral and posterior part of femoral artery, 2-5cm below the inguinal ligament
What does the profunda femoris artery supply?
The head and neck of the femur
What would a fracture to the head and neck of the femur cause?
Death from avascular necrosis
What are the borders of the femoral triangle?
Superior border= inguinal ligament
Lateral border= medial border of sartorius muscle
Medial border= medial border of adductor longus muscle
What is the arrangement of the neurovascular structures in the femoral triangle?
N- femoral nerve A- femoral artery V- femoral vein E- empty space L- lymph canal (outside to inside)
What is the importance of the empty space in the femoral triangle?
Allows veins and lymph vessels to distend, so they can cope with diff levels of flow
Where does the femoral artery cross?
The posterior aspect of the thigh
Where is the femoral artery accessed?
The base of the femoral triangle
Which medical procedures use the femoral artery?
Coronary angiography
When does the femoral artery become the popliteal artery?
When it enters the popliteal fossa
What are the two branches of the popliteal artery?
Anterior and posterior tibial arteries
What does the anterior tibial artery branch into?
Dorsalis pedis artery
What does the posterior tibial artery branch into?
Fibular artery
Where does the fibular artery run?
It descends along the medial side of the fibula
What is a popliteal aneurysm and how can it be detected?
- dilation of popliteal artery
- compresses tibial nerve
- detected by palpable pulsation in popliteal fossa (swelling behind the knee)
What are the 2 superficial veins of the lower limb?
Great and small saphenous veins
Where does the great saphenous vein run?
Posterior to the knee and anterior to the medial malleolous
What is the great saphenous vein used for?
Emergency fluid resuscitation
Where does the small saphenous vein run?
Starts at the continuation of the veins in the lateral side of the dorsum of the foot, then runs proximally, posterior to the lateral malleolus
Where does the small saphenous vein drain into?
The popliteal fossa
What happens when veins have incompetent connections to the deep system?
They become varicosed
What does the pooling of blood in the deep veins of the lower limb result in and what can it be caused by?
Deep Vein Thrombosis
Can be caused by sitting on a long flight for example
What is the saphenous vein often used for?
Graft to bypass a narrowing of the coronary arteries
What is found in the neurovascular bundle of the neck?
Common carotid artery, internal jugular vein and vagus nerve
What are the borders of the carotid triangle/anterior triangle of the neck?
Superiorly= inferior border of mandible Laterally= anterior border of sternocleidomastoid Medially= sagittal line down the midline of the neck
What are the 2 common carotid arteries and what do they supply?
External= supplies the face Internal= enters the skull and supplies the brain
What are the two different origins of the subclavian artery on the right and left?
Right= brachiocephalic trunk Left= aorta
What is the first, and largest, branch of the subclavian artery?
Vertebral artery
Where does the vertebral artery run?
Posteriorly towards transverse foramen of 6th cervical vertebra and then cranially through the foramina of the transverse processes
Where do the vertebral arteries give rise to the posterior cerebral arteries?
After they enter the foramen magnum
What do the posterior cerebral arteries contribute to?
The Circle of Willis
Where does the external jugular vein run?
From the base of the skull, on a level with the angle of the mandible, to where it drains into the deep venous system
Why is the external jugular vein important in clinical examination?
Used for venous access during cardiac arrest
Where does the internal jugular vein begin?
In the posterior compartment of the jugular foramen at the base of the skull
Why is the internal jugular vein commonly used for clinical intervention?
Observed for pulsations to give an estimation of right atrial pressure
What landmarks are used to identify the position of the internal jugular vein?
On either side of thyroid gland, above clavicle, found in the carotid triangle
What are the 2 components of the autonomic nervous system and what is their outflow?
Sympathetic- thoraco-lumbar outflow
Parasympathetic- cranio-sacral outflow
How does the sympathetic chain communicate with the spinal nerves?
Via white and grey rami communicantes
Which of the sacral nerves carry parasympathetic outflow?
S2-4
