Clinical anatomy of Venous Ulceration Flashcards

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1
Q

What are some regions of the upper limb?

A

Axilla, arm (brachium), elbow/cubital fossa, forearm (ante-brachium), wrist, hand

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2
Q

What parts of the body does the axilla connect?

A

The upper arm and the trunk

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3
Q

What are some regions of the lower limb?

A

Inguinal region/groin, thigh, knee/popliteal fossa, leg, ankle, foot

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4
Q

What parts of the body does the groin connect?

A

The lower limb and the trunk

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5
Q

What does each limb require?

A

Arterial supply, venous drainage and lymphatic supply

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6
Q

What does the subclavian artery pass under?

A

The clavicle

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7
Q

Where does the deep brachial artery bifurcate?

A

In the cubital fossa

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8
Q

What is the direction of arterial blood flow in the arm?

A

Subclavian artery, axillary artery, brachial artery, deep brachial artery, ulnar artery + radial artery, deep and superficial palmar arches, metacarpal and digital arteries

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9
Q

Where does the popliteal artery bifurcate?

A

Within the popliteal fossa

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10
Q

What is the other name for the acuate artery?

A

Dorsal arch

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11
Q

What is the direction of arterial blood flow in the leg?

A

External iliac artery, deep femoral artery, perforators, femoral artery, popliteal artery, anterior + posterior tibial arteries, dorsalis pedis + medial and lateral plantar arteries, acuate artery + deep plantar arch, metatarsal and digital arteries

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12
Q

How do you limit blood loss to an injury?

A

Apply pressure proximal to site of injury-press on pulse point and apply tourniquet

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13
Q

Where in the neck is the bifurcation of the common carotid artery?

A

Anterior to sternocleidomastoid muscle at the level of the upper border of thyroid cartilage

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14
Q

Where can the brachial artery pulse be found?

A

Medial to biceps tendon in the cubital fossa

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15
Q

Where can the radial artery pulse be found?

A

Lateral to the tendon of flexor carpi radialis

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16
Q

Where is the femoral artery pulse located?

A

Inferior to the midpoint of inguinal ligament

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17
Q

Where is the popliteal artery pulse found?

A

In the popliteal fossa (immediately behind the knee)

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18
Q

Where is the posterior tibial artery pulse located?

A

Between the posterior border of the medial malleolus and the achilles tendon

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19
Q

Where can the dorsalis pedis artery pulse point be palpated?

A

Medial to the tendon of extensor hallucis longus distal to the ankle joint

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20
Q

What is ischaemia?

A

Inadequate oxygenation of cells/tissues/organs due to an interruption to blood supply

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21
Q

What are some causes of reduced arterial perfusion pressure?

A

Left ventricular failure, arterial bleed, arterial rupture (aneurysm), occlusion of lumen, arterial spasm, external compression of arterial supply

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22
Q

What are some causes of increased venous drainage pressure?

A

Right/congestive heart failure, DVT, external compression

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23
Q

What are some features of superficial veins?

A

Smaller, thinner, run in superficial fascia, highly variable, drain into deep veins

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24
Q

What are some features of deep veins?

A

Larger, thicker, run into deep fascia, more predictable, often occur in neurovascular bundles

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25
Q

What is another name for superficial fascia?

A

Subcutaneous tissue

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26
Q

What are some features of superficial fascia?

A

Loose connective tissue and fat, varies in depth, superficial blood vessels, cutaneous nerves, lymphatics and sweat glands

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27
Q

What are some features of deep fascia?

A

Relatively tough and sheet like, dense connective tissue, usually white (glistening), named

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28
Q

What does deep fascia divide the limbs into?

A

Compartments

29
Q

What does deep fascia cover?

A

Most of the body deep to the skin and superficial fascia

30
Q

What does deep fascia form when it invests muscles?

A

Intramuscular septa

31
Q

What are some superficial veins of the upper limb?

A

Cephalic vein and Basilic vein

32
Q

What does the cephalic vein arise from and where is it found?

A

Arises from the dorsal venous network; found at the lateral aspect of limb in the deltopectoral groove

33
Q

What does the cephalic vein drain into?

A

The axillary vein

34
Q

Where does the cephalic vein become the subclavian vein?

A

At the lateral border of rib 1

35
Q

What does the basilic vein arise from and where is it found?

A

Arises from the dorsal venous network; found on medial aspect of limb

36
Q

What does the basilic vein drain into?

A

Brachial vein at level of mid-arm

37
Q

What are some superficial veins of the lower limbs?

A

Great saphenous vein and small saphenous vein

38
Q

Where is the great saphenous vein and where does it arise from?

A

Found on medial aspect of limb; arises from dorsal venous arch

39
Q

What does the great saphenous vein drain into?

A

The femoral vein at the femoral triangle

40
Q

Where does the small saphenous vein arise from?

A

The dorsal venous arch

41
Q

Where can the small saphenous vein be found and where does it drain into?

A

Found on the posterior midline of limb; drains into popliteal vein posterior to knee

42
Q

What are the only two veins which aren’t bilateral?

A

The SVC and the IVC

43
Q

What does Vena comitantes mean?

A

Accompanying vein-the vein surrounds an artery

44
Q

How does surrounding an artery benefit the vena comitantes?

A

Benefits from the pulsation of the artery when enclosed within a vascular sheath

45
Q

What is the function of venous valves?

A

Ensure unidirectional blood flow against gravity

46
Q

What can incompetent valves cause?

A

Reverse flow into superficial veins, causing weak and dilated varicose veins

47
Q

What is the direction of venous blood flow?

A

Superficial vein, perforating veins, deep veins

48
Q

What does the musculovenous pump do?

A

Pushes blood back towards the heart

49
Q

How does venous ulceration arise?

A

Venous pressure increases, damages blood vessels in skin, skin becomes dry/itchy/inflamed, can’t heal well due to poor blood supply so begins to break down

50
Q

How can a DVT arise?

A

Due to venous stenosis

51
Q

What can happen if a thrombus breaks off?

A

It can occlude the vessel and cause an infarction

52
Q

What happens if a thrombus becomes lodged in the pulmonary artery?

A

Infarction of one lung

53
Q

What happens if a thrombus becomes lodged in the pulmonary trunk?

A

Complete occlusion by a saddle embolus arrests the circulation

54
Q

What do lymphatics generally follow?

A

Veins

55
Q

Where do the superficial lymphatics of the upper limb arise?

A

Arise from the plexus in fingers and hand

56
Q

What is the direction of flow in the superficial lymphatics that follow the basilic vein in the arm?

A

Basilic, cubital lymph nodes, lateral axillary lymph nodes

57
Q

Where do the superficial lymphatics that follow the cephalic vein in the upper arm drain into?

A

Mainly to apical axillary lymph nodes

58
Q

Where do the deep lymphatics of the upper arm drain into?

A

Lateral axillary lymph nodes

59
Q

What is the direction of flow of the superficial lymphatics of the lower limbs that follow the great saphenous vein?

A

Great saphenous vein, superficial inguinal nodes, external iliac nodes or deep inguinal nodes

60
Q

What is the direction of flow of the superficial lymphatics of the lower limbs that follow the small saphenous vein?

A

Small saphenous vein, popliteal nodes, deep inguinal nodes, external iliac nodes

61
Q

What veins do the superficial lymphatics of the lower limb follow?

A

The saphenous veins

62
Q

What veins do the deep lymphatics of the lower limbs follow?

A

The deep veins

63
Q

What is the direction of flow of the deep lymphatics of the lower limb?

A

Drain into popliteal lymph nodes, then deep inguinal nodes and into the external iliac nodes

64
Q

Where do the external iliac nodes of the lower limbs drain into?

A

Drain into the common iliac nodes and enter the lumbar lymphatics

65
Q

What is the elliptical incision used for?

A

Removing small skin lesions

66
Q

What are some complications of elliptical incisions?

A

Nerve injury, bleeding from superficial veins

67
Q

How should elliptical incisions be closed?

A

Using several simple interrupted sutures

68
Q

What kind of arteries are Digital arteries?

A

End arteries-only blood supply to an area

69
Q

Where is the most common area for venous ulceration?

A

The medial aspect of the distal thigh (known as the gaiter area)