Applied Anatomy Flashcards
What are the three layers of the vessels ?
Tunica intima – thin innermost endothelial lining
Tunica media – middle smooth muscle and elastin layer
Tunica adventitia – outer connective tissue coat with collagen
What are the 5 types of blood vessels?
Arteries –> Arterioles –> Capillaries –> Venules –> Veins
Which is high pressure out of the artery and vein?
The artery
What feature does an artery have and why?
The artery is more muscular
Maintain the high pressure system
Helps to maintain blood pressure
What are the three types of arteries ?
3 types of arteries
Large elastic (conducting)
Medium muscular (distributing)
Small arteries and arterioles (resistance)
What vessel is a large elastic artery ?
What is the normal size
Aorta
Pulmonary trunk
2cm
What is the regular size for a large elastic artery ?
Why is this important ?
2cm
For diagnosing a AAA
What are the features of the medial muscular artery?
smooth muscle
What is the function of the medium muscular artery ?
Distributing blood to areas that require it
What artery does antihypertensives target ?
Arterioles
Which artery does the peripheral resistance/ blood pressure come from ?
arterioles
Explain hydrostatic pressure
Explain osmotic pressure
Explain structure of capilaries
Exchange vessels
Form interweaving networks of capillary beds
Local control through pre-capillary sphincters
When do the sphincters of the capillaries open/ close?
What type of veins is there ?
Venules and veins
What is a venous plexus ?
multiple veins coming together
How big is the inferior vena cava
3cm
Why do we have a volume reservoir in the veins?
- The body will compensate when needed by using the blood in veins whilst making new blood cells.
- Increase ventricular filling and thus cardiac output needed during exercise
accommodate for volume differences in relation to changes in blood pressure
maintain cardiac output by compensatory mechanisms during times of blood loss (small amount of bleeding/ donating blood…)
Which veins do not have valves ?
Those within thoracic cavity
What is anastomoses?
Communication between branches of an artery
What is an AV shunt ?
Connections between small arteries and veins allowing blood flow without going into the capillary beds
What is collateral circulation
where alternate channels increase in size to provide a blood supply beyond a blockage
When do you check for collateral circulaiton ?
When taking an ABG
What is a portal system ?
Where are they ?
2 capillary beds in series e.g. liver, pituitary
What is an Arcade ?
– A series of anastomosing arterial arches between the arterial branches
What problems can you get with blood pressure ?
hypertension/ hypotension/ shock
What problems can you get with an artery wall ?
- Aneurysm
- Dissection
- Coarctation
- Venous insufficiency
What inflammatory problems can you get with the vessels?
vasculitis, arteritis, phlebitis, thrombophlebitis
What obstructions can you get with the vessels ?
- Atherosclerosis
- Arterial occlusion
- VTE/DVT
- Embolism
- Thrombosis, vasospasm, (SOL)
What is the main cause of thrombophlebitis?
Inserting a cannula
What is AV malfromations the main cause of ?
Subarachnoid haemorrhage
What level does the aorta become the abdominal aorta ?
T12
Wher does the right brachial artery supply ?
right head neck and upper limb
What location is the Inferior mesenteric artery?
L3
What location is the Renal ?
L1 + L2
What location is the Gonodal artery ?
L3
Where does the aorta bifurcate into the common illiac artery?
l4
If you had an AAA between 3-5.5 would you intervene ?
No surgical intervention required?
Keep a close eye and regular scans
When does an AAA need repared
5.5 and above
What are the risk factors of AAA?
HTN
Smoking
Age
Connective tissue disorder
> 70 with abdominal pain required a scan to check no AAA!
Where is the most common place for an AAA
Abdominal
Who is commonly gets a aortic disection
men age 50-70 with HTN
Explain the difference between type A and B for a aortic dissection using stanford DeBakey.
Type A - More dangerous.
This can result in a prolapse of the aortic valve which leads to leaking of blood into the pericardium and can result in a tamponade. Includes the aortic arch
Type B - Only includes descending aorta.
What can happen to blood pressure of there is a problem with the aorta eg AAA or aortic disection?
Big difference between two arms !
Whats first line treatment for aortic disections ?
CT scan
Type A - Surgical intervention
Type B - medical intervention
Why is it important that the internal jugular vein is directly connected to the right atrium?
If there is a build-up of pressure in the right atrium you will see it in the right jugular vein.
What is the definition of a pulse?
A palpable systolic blood pressure ?
What are the major pulses in the head and neck ?
- Carotid - C6
- Temporal
- Facial
What condition can you get in the temporal pulse ?
Temporal artertitis ?
The patient can go blind if not found
What are the pulses in the lower limb arteries ?
- Femoral
- Popliteal
- Dorsalis Pedis Pulse
- Posterior Tibial Pulse
Why would you feel for the arteries in the legs?
- Check there is no peripheral arteriole disease
- Reduced blood supply to legs
- This leads to limb ischemia
What are the arteries within the lower limbs?
Iliac arteries
Femoral artery
Popliteal artery
Anterior tibial artery
Posterior tibial artery
Dorsalis pedis artery
What are the common sites of trauma for the lower limb arteries?
Superficial (eg ones you can palpate)
Close to bone/ joints
When a patient gets a fracture or dislocation what do you need to check?
Check they are nuerovascularly intact.
What is an arteriogram ?
An arteriogram is an imaging test that uses x-rays and a special dye to see inside the arteries. It can be used to view arteries in the heart, brain, kidney, and other parts of the body.
What is claudication ?
Intermiditted blood loss - eg when walking
Symptoms of a limb schema? (6 P)
Pain
Pulseless
Palour
Perishingly cold
Paralyses
Paraesthesia (Loss of sensation
Treatment of limb sichema
Potentially surgery
What is this ?
Tissue necrosis
Arterieal ulcers !!
Venous ulcers!!
Common site of compression in lower limb arteries ?
What is this called ?
What is the treatment ?
Popliteal artery
By the tarsal tunnel of the foot
Compartment syndrome
Surgery
What can make you likely to get compartment syndrome?
Fracture
Cast
Deep burns
Ischaemic reperfusion injury
What is this vein ?
Dorsal venous arch
What are the veins in the lower limb ?
Deep veins
Superficial veins
Dorsal venous arch
Short saphenous vein
Long saphenous vein
(direct superficial to deep perforators)
Where is a DVT found ?
Within the deep veins
Usually legs
How much bigger is one leg than the other in a DVT?
3cm bigger than the other
What is this ?
Varicose vein
What are the stages of Virchow’s triad ?
What are the three stages of virchows triad ?
- hypercoagulation state
- Vascular wall injury
- circulatory statis
What does virchows triad assess ?
Risk of DVT
What are the stages of venous insufficiency?
What are the pulces in the upper limb arteries ?
-Axillary
- Radial
- Barchial
- Ulna
What are the arteries in the upper limbs ?
Subclavian artery
Axillary artery
Brachial artery
Radial artery
Ulnar artery
Palmar arches
What can cause problems in arteries ?
Trauma
Athersclerosis
Arterial thombosis vs embolus
What are true end arteries ?
Where there is no anastamosis
What are the veins in the upper limb ?
Deep veins - brachial and riadial
Superficial veins
Basilic vein
Cephalic vein
Cubital vein
CASE STUDY
Primary care:
72 year old male
5/12 intermittent claudication
Sudden onset sever pain in lower limb
PMH & SH:
Hypertension, hypercholesterolaemia,
Smokes 35 cigarettes/ day
On examination:
BMI = 32
Feet on floor while sat in chair = top picture
Feet elevated = bottom picture
When he puts his feet up the colour drains from the right foot.
Peripheral arterial disease secondry to atherosclerosis.
CASE STUDY
Primary care:
25 year old female
2/7 hot and swollen left leg
PMH & SH:
OCP
Smokes 20 cigarettes/ day
On examination:
Left leg pitting oedema to mid thigh
Left leg 5 cm > then right below tibial tuberosity
Localised tenderness along deep veins
HR 74 bpm & BP 115/72 mmHg
Temp 36.8oC
What investigations are we gonna do
Deep vein thrombosis - Most likely
Differential
compartment syndrome
Vasculitis
Superficial thrombolites
Cellulitis
Ruptured bakers cyst
Investigations
well score D dimer - if raised ultrasound known as a Doppler
Case Study
Primary care:
32 year old male
RTC – thrown from motorbike & landed on left arm
10/10 pain
PMH & SH:
Nil
On examination:
Deformity of left arm
Open wound
No other apparent injury
HR 115 bpm & BP 95/52 mmHg
Humeral shaft fracture
Humeral Head fracture
Dislocation
Comprise brachial artery and vein
Radial and Brachial pulse will be compromised
Treatment
- Fluid brings BP up
- Pain brings HR down
- Assess neuromuscular structure
- Refer on to the orthapedic team
