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Medicine Year 1 - Semester 2 - Part 2 > Lower Limb: Blood supply and Lymphatics > Flashcards

Lower Limb: Blood supply and Lymphatics Flashcards

1
Q

Where does the lower limb receive its blood supply from ?

A

The common iliac arteries

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2
Q

Describe the formation of the common iliac arteries

A

Aorta bifurcates at L4 to form 2 common iliac arteries

2 common iliac arteries bifurcate at S1 joint, to form an external and internal iliac artery.

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3
Q

What does the external iliac artery supply ?

A

Major supply to the lower limbs

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4
Q

What does the internal iliac artery supply ?

A

Pelvic Viscera
(gluteal region and anastomosis)

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5
Q

Where is bifurcation of the common iliac arteries ?

A

Bifurcation occurs at S1 joint
At the point of the sacroiliac joint

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6
Q

State the important branches of the internal iliac arteries

A

Superior + Inferior gluteal arteries

Obturator artery

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7
Q

Where do the internal iliac branches come out of ?

A

Pass out through the greater sciatic notch

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8
Q

Where is the external iliac artery located ?

A

Heads towards the lower limb and passes behind the inguinal ligament.

(inguinal ligament runs from the anterior superior iliac spine to the pubic tubercle)

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9
Q

What does the external iliac artery become and when ?

A

After the external iliac artery passes behind the inguinal ligament, it becomes the femoral artery.

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10
Q

Where is the femoral artery located ?

A

Deep to the inguinal ligament

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11
Q

State some branches of the external iliac artery that supply the body wall

A

Deep circumflex iliac artery
Inferior epigastric

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12
Q

State the branches of the femoral artery that are not necessarily involved in the lower limb

(used to be external iliac artery before the inguinal ligament)

A

Superficial circumflex iliac artery
Superficial epigastric

External pudendal artery

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13
Q

What does the external pudendal artery supply ?

A

Supplies the external genitalia.

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14
Q

State the branches of the femoral artery

A

Profunda femoris artery

Femoral artery just continues down the lower limbs

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15
Q

State the major blood supply of the thigh

A

The profunda femoris artery

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16
Q

Where does the femoral artery continue to ?

A

Femoral artery continues to the adductor hiatus

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17
Q

Where can you feel a pulse from the external iliac branches ?

A

Halfway between the anterior superior iliac spine and the pubic symphysis, there is a midpoint called the mid-inguinal point.

The pulse can be felt inferior to the mid-inguinal point.

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18
Q

Describe the location of the obturator artery

A

Obturator artery is a branch of the internal iliac artery.

Heads towards the obturator foramen and passes through a little hole called the obturator canal

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19
Q

State the accessory/branch of the femoral artery

A

Obturator artery passes over the superior pubic ramus to then go through the obturator canal.

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20
Q

Corona Mortis

A

Accessory/Replaced obturator artery - variation

Potential origins:

  • External iliac
  • Femoral
  • Inferior epigastric
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21
Q

Where is the corona mortis found ?

A

Passing over the superior pubic ramus

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22
Q

State some complications that can occur due to corona mortis

A

Hernia surgery complications

Pelvic trauma

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23
Q

Function of the profunda femoris artery

A

Main arterial supply to the thigh

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24
Q

Branches of the profunda femoris artery

A

Medial circumflex femoral
Lateral circumflex femoral - transverse & descending

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25
Q

How many perforating branches of the profunda femoris are there ?

A

3-4 perforators

They pierce Adductor Magnus

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26
Q

What do the perforating branches of the profunda femoris supply ?

A

Lateral and Anterior thigh

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27
Q

State the blood supply to the hip

A

2 MAIN ANASTOMOTIC SYSTEMS

  1. Trochanteric anastomosis
  2. Cruciate anastomosis
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28
Q

Describe the trochanteric anastomosis

A

More superficial anastomotic system
Comprised of junctions between the :

Medial and lateral circumflex arteries

AND

Superior and inferior gluteal arteries

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29
Q

Trochanteric anastomosis

A

Medial circumflex
Lateral circumflex
Superior gluteal
Inferior gluteal

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30
Q

Cruciate anastomosis function

A

More intimately associated with the bones of the hip joint.

Found deeper than the trochanteric anastomosis.

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31
Q

Cruciate anastomosis

A

Medial circumflex
Lateral circumflex

1st Perforator

Inferior gluteal

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32
Q

Neck of femur fracture

A

Damage to retinacular vessels

(avascular) Necrosis of femoral head

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33
Q

State the blood supply to the head of the femur

A

Artery of the head of the femur

(from the obturator)

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34
Q

Describe a blockage between the external iliac and femoral arteries

How can blood get around it ?

A

Internal iliac
Inferior gluteal
Perforating branch of profunda femoris
Lateral circumflex (descending branch)
Superior lateral genicular artery
Popliteal artery

(Obturator to Profunda femoris)

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35
Q

State the lower limb arteries (above the knee)

A

Aorta
Common iliac arteries
Internal and external iliac arteries

Profunda femoris (deep femoral)
Femoral (superficial femoral)

Popliteal

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36
Q

What is the popliteal artery ?

A

A continuation of the femoral artery

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37
Q

State the boundaries of the popliteal artery

A

Extends from the adductor hiatus to the inferior border of popliteus.

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38
Q

Describe the location of the popliteal artery

A

Pass along the adductor canal and through the adductor hiatus.

The adductor hiatus is a gap in the adductor magnus muscle.

Passes deep to the tendinous soleal arch.

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39
Q

Popliteal pulse

(also, when is it vulnerable ?)

A

Deep and Medial
(felt in the back of the knee)

  • Hard to palpate
  • Vulnerable during knee dislocation and femoral fracture
40
Q

State the branches of the popliteal artery

A

5 Genicular branches

2 above the knee
2 below the knee
1 in the middle

41
Q

State the 5 Genicular Branches

A

Superior medial genicular artery
Superior lateral genicular artery

Middle genicular artery

Inferior lateral genicular artery
Inferior medial genicular artery

42
Q

After the popliteal artery has passed through the popliteal fossa where does it go ?

A

Passes deep to the soleus muscle

43
Q

Clinical relevance of the popliteal artery

A

Potential site of aneurysm
2nd most common site for aneurysms to form.

44
Q

State the blood supply to the knee

A

5 Genicular arteries
Genicular anastomosis

Branch from profunda femoris

Branch from anterior tibial

45
Q

State the lower limb arteries (below the knee)

A

Popliteal artery
Posterior tibial artery (tibio peroneal trunk)

Anterior tibial artery

Peroneal (fibular) artery
Posterior tibial artery

46
Q

What happens to the posterior tibial artery ?

A

It trifurcates

  1. Anterior tibial artery
  2. Peroneal (fibular) artery
  3. Posterior tibial
47
Q

Peroneal

A

Fibular

48
Q

Where does the anterior tibial artery come from ?

A

The posterior tibial artery behind the knee gives off an anterior tibial artery.

49
Q

Location of the anterior tibial artery

A

Crosses above the interosseous membrane into the anterior compartment.
(supplies the anterior compartment of the leg)

50
Q

What does the anterior tibial artery run with ?

A

Runs with the deep peroneal nerve

51
Q

What does the anterior tibial artery become ?

A

Becomes dorsalis pedis in the foot

52
Q

What does the dorsalis pedis terminate as ?

A

Arcurate artery

1st Dorsal Metatarsal artery

53
Q

Arcurate artery

A

Dorsal metatarsal –> Dorsal digital arteries

54
Q

1st Dorsal Metatarsal

A

Deep plantar arteries

55
Q

Function of the posterior tibial artery

A

Supplies the posterior compartment of the leg

56
Q

Function of the anterior tibial artery

A

Supplies the anterior compartment of the leg

57
Q

State the branches of the posterior tibial artery

A

Gives off peroneal, circumflex fibular and nutrient arteries.

58
Q

What does the posterior tibial artery run with ?

A

Runs with the tibial nerve.

59
Q

What does the posterior tibial artery terminate as ?

A

Medial and Lateral plantar arteries

AFTER the flexor retinaculum

60
Q

Where is the posterior tibial artery pulse ?

A

Palatable pulse posterior to medial malleolus

61
Q

Location of peroneal (fibular) artery

A

Runs in the posterior compartment

62
Q

Function of the peroneal (fibular) artery

A

Supplies lateral compartment
- perforating vessels

63
Q

Feature of the peroneal artery

A

Runs in the posterior compartment
Supplies the lateral compartment

64
Q

What does the posterior tibial artery branch into in the foot ?

A

Medial and Lateral plantar arteries

65
Q

Describe a feature of the sole of the foot

A

The lateral plantar artery is larger than the medial plantar artery

66
Q

Function of the lateral plantar artery

A

Comes across and arches across the forefoot, as the deep plantar arch.

The deep plantar arch gives plantar metatarsal arteries and perforating arteries (branches into plantar digital arteries)

67
Q

Function of the deep plantar arch

A

Main blood supply to the toes (including nail beds)

68
Q

Function of the medial plantar artery

A

Can form the superficial plantar arch
(doesn’t always occur)

  • sends off mostly muscular branches
69
Q

State the superficial veins of the lower limb

A

Dorsal Venous Arch

Great Saphenous - runs medially

Small (short) Saphenous - runs posterolaterally

70
Q

Location of the great saphenous vein

A

(2.5cm) Anterior to the medial malleolus
(Hands width) Posterior to the patella

71
Q

Location of the small saphenous vein

A

Posterior to the lateral malleolus
Middle of the leg

72
Q

Function of the small (short) saphenous vein

A

Penetrates the crural fascia to join deep veins and form the popliteal vein.

73
Q

Function of the great saphenous vein

A

Pierces the fascia late and enters the femoral vein in the femoral triangle

74
Q

What runs alongside the great saphenous vein ?

A

Saphenous nerve

75
Q

What runs alongside the small saphenous vein ?

A

Sural nerve

76
Q

Describe deep veins of the lower limb

A

Deep to deep fascia

Vena comitantes - usually paired

77
Q

Deep veins of the lower limb

popliteal
femoral

A

Popliteal vein –> Femoral vein

78
Q

What does the femoral vein receive ?

A

Receives profunda femoris, great saphenous and other small veins.

79
Q

Where does the femoral vein enter ?

A

Enters the femoral sheath and becomes the external iliac vein.

80
Q

Describe perforating veins

A

Perforating veins flow superficial to deep and contain valves.

81
Q

Function of perforating veins

How does venous return occur against gravity ?

A

Venous return against gravity
- arterial pulsation
- negative intra-thoracic pressure
- contraction of muscles (muscle pump)

82
Q

Varicose veins

A

Failure of the valves in the perforating veins

83
Q

Rules of lymphatics of the lower limb

A

Superficial lymph vessels accompany superficial veins

Deep lymph vessels accompany deep veins

84
Q

State the lymph nodes of the lower limb

A

Superficial inguinal lymph nodes

Popliteal lymph nodes

85
Q

Where does the great saphenous vein drain ?

A

Go to the superficial inguinal nodes

86
Q

Where does the small saphenous vein drain ?

A

Go to the popliteal nodes

87
Q

Where do the deep lymph vessels go ?

A

Go to the popliteal nodes

Onwards with femoral vein to deep inguinal nodes

88
Q

State the 2 groups of inguinal lymph nodes

A

Superficial
Deep

89
Q

Describe the superficial group of inguinal lymph nodes

A
  • Arranged in a T shape
  • Horizontal and vertical groups

Vertical group lies alongside the great saphenous vein
Horizontal group runs alongside the inguinal ligament

90
Q

What does the superficial group of inguinal lymph nodes drain ?

A

Anterior abdominal wall - inferior to umbilicus
Skin of back - below iliac crests
Perineum
Gluteal region

Superficial lower limb

91
Q

What do the superficial lymph nodes drain into ?

A

The deep lymph nodes

92
Q

Where are the deep lymph nodes found ?

A

Femoral triangle, medial to femoral vein

93
Q

What do the deep lymph nodes drain ?

A

Lower limb

Superficial inguinal
External genetalia

94
Q

What is found in the femoral canal ?

A

Node of Cloquet

95
Q

State where the deep and superficial inguinal lymph nodes drain into

A

External iliac nodes
Common iliac nodes
Lumbar lymph nodes
Cisterna chyli
Thoracic duct
Pirogov’s venous angle (left)
Venous system

Medicine Year 1 - Semester 2 - Part 2 (53 decks)

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