Blue Boxes I Flashcards
Varicose Veins
Dilation of veins (great saphenous and tributaries) preventing valve cusp closure.
(dilated vein with backflow, can lead to venous stasis)
Thrombophlebitis
DVT from loose venous fascia (resists muscular expansion that pumps blood up) or inactivity, combined with inflammation around affected veins.
Pulmonary thromboembolism
Thrombus breaks free –> travels to lung (pulmonary TE) to occlude a pulmonary artery
Saphenous vein graft
- Easily accessible, usable distance between perforating veins/tributaries, thicker muscular/elastic wall than other veins.
- Redundant function with deeper veins, and may facilitate superficial to deep venous drainage taking advantage of the musculovenous pump.
- Commonly harvested for coronary artery bypasses (vein inverted so valves don’t interfere with blood flow).
Saphenous Nerve Injury
- runs alongside great saphenous vein
- can be damaged during saphenous cutdown causing pain or numbness on the medial aspect of the foot
Enlarged inguinal lymph nodes
Abrasions and minor sepsis (via pathogenic microorganisms or their toxins in the blood or other tissues) –> may produce moderate enlargement of the superficial inguinal lymph nodes (lymphadenopathy)
Regional Nerve Blocks of Lower Limbs
interruptions of conduction of impulses in peripheral nerves
femoral nerve (L2–L4) can be blocked 2 cm inferior to the inguinal ligament, ~ finger’s breadth lateral to the femoral a.
Saphenous n. block –> Paresthesia (tingling, burning, tickling) radiates to the knee and over the medial side of the leg.
Palpation, Compression and Cannulation of the Femoral Artery
- Femoral Pulse: Palpated midway between ASIS and pubic symphysis (PT).
- Compression of superior pubic ramus, psoas major and femoral head will diminish flow through the artery.
- Cannulation: Inferior to the midpoint of the inguinal ligament; common for passing up to the left heart via the external iliac artery to the aorta.
Location of femoral vein
- Not palpable, located below inguinal ligament just medial to pulsating femoral artery.
- No tributaries at this level until the great saphenous about 3cm below inguinal ligament
(do not mistake for great saphenous vein if palpable!)
Patellar reflex
Tests the integrity of the femoral nerve and the L2–L4 spinal cord segments.
If the reflex is normal, a hand on the person’s quadriceps should feel the muscle contract.
Mech: activate muscle spindles in the quadriceps –> afferent impulses from the spindles travel in the femoral nerve to the L2–L4 segments of the spinal cord –> efferent impulses transmitted via motor fibers in the femoral n to the quadriceps –> contraction
Lumbar Spinal Nerve Root Compression
Lumbar spinal nerves inc in size inferiorly with dec. intervertebral foramina size.
(L5 = thickest nerve with narrowest foramen)
^Increased chance of nerve compression with bony spurs (osteophytes) or disc herniation
Lumbar spinal puncture
LP withdraws CSF from lumbar cistern below conus medullaris (retracted nerve cord at L1/L2) by inserting needle between L3/L4 or L4/L5 with spine flexed to open intervertebral space
Plane thru top of iliac crest marks line through L4
Spinal Epidural Block
Anesthetic injected into extradural (epidural) space as with LP, but w/o passing through the meninges
Spinal Cord Injuries
Cervical intervertebral disc dislocation or herniation –> spinal cord shock or paralysis inferior to lesion due to encroachment of the spinal canal
Also swelling of ligamenta flava, osteoarthritis of zygapophysial joints can pressure nerve roots of the cauda equina (in lumbar region) –> sensorimotor weakness in associated muscles
-Lumbar Spondylosis: Degenerative joint disease; causes localized pain/stiffness.
Spinal transection
Spinal Transection
C1-C3: No function below head; ventilator required.
C4-C5: Quadriplegia.
C6-C8: Low of lower limb function, variable hand/upper limb function.
T1-T9: Paraplegia; trunk control varies with lesion height.
T10-L1: Loss of lower leg muscle function; some thigh muscle fuction remains.
L2-L3: Most leg function retained, may require short leg braces.
Ischemia of Spinal cord
Fractures, dislocations, and fracture–dislocations, obstructive arterial disease –> may interfere with the blood supply to the spinal cord from the spinal and segmental medullary arteries
aorta can be purposely occluded during surgery, or with ruptured aneurysms –> loss of all sensation and voluntary movement inferior to the level of impaired blood supply to the spinal cord
Femoral hernia
Femoral ring –> medial to femoral triangle, a small, weak opening through which the abdominal viscera may pass to enter the femoral canal
results in a mass inferolateral to pubic tubercle and medial to femoral NAVL(H)
can pass out through saphenous opening, cause strangulation and necrosis of herniated intestine
Dif from inguinal hernia because NECK of the hernia is BELOW the inguinal ligament
women>men (wider pelvis)
Leg compartment infections
- Closed intraseptal/fascial compartments of leg suffer inc pressure with pus formation –> distal spread of infection in anterior/lateral compartments
- Posterior compart. infections may spread to popliteal fossa along fibular nerve, requiring fasciotomy to relieve pressure
Tibial Nerve Injury
Deep in popliteal fossa (rare injury) but deep lacerations may affect it (posterior dislocation of knee joint).
Causes paralysis of leg flexor muscles and intrinsic foot muscles.
Tibialis Anterior Strain
“Shin Splints”
- repetitive microtrauma to tibialis anterior along tibia periosteum
Common Fibular Nerve Injury
Most superficial nerve in lower limb (fibular neck). Splits into deep and superficial fib n.
Flaccid paralysis of anterior/lateral leg compartments (ankle dorsiflexors and foot evertors) causing footdrop (foot does not clear floor on swing phase (A)).
May present with (B) waddling gait, (C) swing-out gait or (D) steppage gait.
or loss of sensation to anterolateral leg and dorsum of foot.
Deep Fibular Nerve Entrapment
Excessive use of anterior leg muscles (tibialis anterior, extensor hallucis longus and extensor digitorum longus) –> EDEMA in anterior compartment compressing the nerve
Causes pain in dorsal of foot –> radiates to 1st webbed phase
Calcaneal Tendon
Rupture: Audible snap during push-off (plantarflexion with knee flexed) causing inability to plantarflex and excessive passive dorsiflexion (affects gastrocnemius, soleus, plantaris)
-Calcaneal Reflex: Tests S1/S2 nerve roots by tapping tendon, causing myotactic plantarflexion
Posterior Tibial Pulse
- Palpation between posterior surface of medial malleolus and medial border of calcaneal tendon
- Foot must be inverted to relax flexor retinaculum to allow palpation of the tibial artery deep to it
- Absence of pulse if age > 60: Sign of peripheral arterial disease, concomitant with intermittent claudication (pain during walking disappearing after rest.)
Dorsalis Pedis Pulse
- Palpated with feet dorsiflexed; feeling along extensor retinaculum lateral to EHL tendons
weak –> vascular insufficiency via arterial disease
- pain
- pallor
- paresthesia
- paralysis
- pulselessness
Compartment syndrome
Fracture causing increased pressure within a compartment also presents with 5P
- pain
- pallor
- paresthesia
- paralysis
- pulselessness
leg compartment syndrome can cause loss of DP pulse, ischemic loss of affected muscles. Treat with surgical decompression.
