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Head and Neck > Session 3 - major blood vessels and lymphatics > Flashcards

Session 3 - major blood vessels and lymphatics Flashcards

1
Q

which vein drains the head

A

internal jugular

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2
Q

which vein drains the neck

A

external jugular

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3
Q

what arteries branch of the subclavian artery at the base of the neck

A

vertebral, internal thoracic, and thyrocervical

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4
Q

what are the branches of the thyrocervical trunk and what do they supply

A

ascending cervical and transverse cervical supply the neck
suprascapular supplies the shoulder
inferior thyroid supplies the lower pole of the thyroid gland

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5
Q

which arteries supply the brain

A

vertebral arteries

internal craotid

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6
Q

what is the path of the vertebral arteries

A

the arise from the subclavian arteries and ascend in the neck through the foramina in cervical vertebrae 6-1 and pass through the foramen magnum

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7
Q

through which structure does the internal carotid artery enter the skull

A

the carotid canal

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8
Q

what is the location at which the common carotid artery bifurcates

A

C4

at about the level of the superior border of the thyroid cartilage

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9
Q

what is a common site for atheroma formation and why

what does this lead to

A

the bifurcation of thee carotid artery
this is because of turbulence at the bifurcation
if the clot ruptures it can cause an embolus to travel to the brain causing a TIA or stroke

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10
Q

what is the location of the baroreceptors

A

carotid sinus - at the bifurcation

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11
Q

what is the location of the chemoreceptors and what do they detect

A

carotid body

detect arterial oxygen

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12
Q

where can you feel the carotid pulse

A

in the carotid triangle just below the bifurcation

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13
Q

when would you give a patient a carotid sinus message

A

given to someone with a supraventricular tachycardia
as this will make the barorecptors stretch and emulate high BP so vagus imput will increase to try to decrease the heart rate

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14
Q

what is the route of the internal carotid artery

A

enters the skull through the carotid canal in the petrous part of the temporal bone
turns medially and horizontally
enters the cranial cavity then makes S shaped bend
courses through the cavernous sinus

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15
Q

what are the contents of the cavernous sinus

A

plexus of extremely thin walled veins on the upper surface of the sphenoid
internal carotid artery
CNIII oculomotor
CNIV trochlear
CNVI abducent
2 branches of trigeminal- CNV1 opthalmic and CNV2 maxillary

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16
Q

name three branches of the opthalmic artery

A

supratrochlear
supraorbital
central retinal

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17
Q

what artery does the opthalmic artery branch from

A

internal carotid artery

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18
Q

what are the six branches of the external carotid artery

and the two terminal branches

A 
superior thyroid
lingual
facial
ascending pharyngeal
occipital
posterior auricular

superficial temporal
maxillary

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19
Q

what is the blood supply to the scalp

A

from the internal carotid- supra orbital artery and supra trochlear arterty

from the external carotid artery- superficial temporal, posterior auricular and occipital artery

rich blood supply with many anastamoses

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20
Q

what are the layers of the SCALP

A 
Skin
Connective tissue dense
Aponeurosis
Loose connective tissue
Periosteum
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21
Q

in which layer do the vessels of the scalp lie

A

they lie in the subcutaneous dense connective tissue layer

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22
Q

why can you get profuse bleeding of the scalp

A

the walls of the arteries are closely attached to connective tissue, this limits the ability of the vessels to constrict
and deep laceration involving the aponeurosis can cause profuse bleeding because of the opposing pull of occipitofrontalis

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23
Q

why is the blood supply to the skull not compromised in scalp injury

A

the blood supply to the skull is mostly via the middle meningeal artery- so loos of the scalp does not lead to bone necrosis

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24
Q

what are the superficial arteries supplying the face

A 
supra orbital
supratrochlear
transverse facial
angular
lateral nasal
maxillary
superior and inferior labial
facial
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25
Q

where can you feel the facial artery pulse

A

inferior border of the mandible, anterior to the masseter muscle

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26
Q

what is the blood supply to the nasal septum

A

septal branch sphenopalatine artery (branch of the maxillary)
anterior ethmoidal arteries- (branch of opthalmic artery)
anastamoses of arteries in the kiesselbach area

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27
Q

what is a common site of epistaxis

A

kiesselbach area

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28
Q

what is the blood supply to the dura and the skull

A

middle meningeal artery

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29
Q

what structure of the skull does the middle meningeal artery travel through

A

foramen spinosum

30
Q

what type of haemorrhage do you get if you fracture the skull at the pterion
and which artery ruptures

A

extradural haemorrhage

middle meningeal artery ruptures

31
Q

what is a craniotomy

A

when a flap of bone and scalp is reflected inferiorly to preserve blood supply
craniotomy gives access to cranial cavity

32
Q

what is the venous drainage of the scalp

A

superficial veins- superficial temporal, occipital, posterior auricular, posterior auricular veins
supraorbital and supratrochlear veins unite at medial angle of eye to form angular vein which drains into the facial vein

33
Q

how are the veins in scalp connected to the veins in the skull

A

veins of the scalp connect to diploic veins of skull through several emissary veins and thus to dural venous sinuses

34
Q

why does infection from the scalp spread easily to the cranial cavity and affect meinges

A

the emissary veins connecting the scalp and skull are valveless

35
Q

which veins drain the face

A 
supraorbital
supratrochlear
angular
superior and inferior labial veins
facial
common facial
external jugular
internal jugular
36
Q

why can infection spread from facial vein to dural venous sinuses

A

the facial vein communicates with the superior opthalmic vein at the medial angle of eye
they both drain into the cavernous sinus
deep facial veins drain into pterygoid venous plexus- and infection can spread from facial vein to dural venous sinuses
the veins of the face are valveless

37
Q

where can a thrombophlebitis of the facial vein end up

A

intracranial venous system

so a infected clot can travel this way

38
Q

what structure do the internal jugular veins exit through

A

jugular foramina

39
Q

what vessel can be used to measure jugular venous pressure

A

right internal jugular vein is the best indicator of pressure in the right atrium but the external jugular vein is much easier to see as the internal jugular vein is behind the SCM

40
Q

describe the formation of tissue fluid

A

net filtration of fluid is not equal to the net reabsorbtion of fluid
not all the fluid that was filtered out of the capillaries at the arteriole end is reabsorbed by the capillaries and the venule end
this is because some of the small proteins that move out of the capillary bed and into the interstital fluid do not get reabsorbed
this means some water remains with these proteins due to the oncotic pressure exerted by the small proteins in the intestitial fluid

41
Q

describe the formation of lymph fluid

A

lymphatic capillary walls are much more porous so it is easier for small proteins and hence water to move into the lymphatic vessels at the venous end
this is eventually returned back into venous circulation

42
Q

what are the contents of lymph fluid

A 
tissue fluid
small proteins
damaged cells
bacteria
lipids
cancer cells
43
Q

how much lymph does the body produce a day

A

3-4L

44
Q

what is the purpose of lymphatic vessels

A

to continuously remove the remaining tissue fluid in the extracelluar space via series of lymph nodes back into the circulation

45
Q

what are the main features of the lymph system

A

uni directional flow
low pressure system
no central pump

46
Q

why is the lymphatic system under low pressure

A

there are multiple entry points but only one exit point so this will slow the lymph down
this gives time for the lymph nodes to clean the lymph
needs to be under low pressure so the lymphatics can can move into the low pressure venous system
pressure of lymphatic system only need to be slightly higher than that of the venous system

47
Q

describe the drainage of lymph from the tissue fluid to the venous system

A

tissue fluid - lymphatic capillary - lymphatic vessels - lymph node - lymphatic vessels - lymph node - lymphatic vessels - lymphatic trunks (right and left) - drain into the right lymphatic duct and left thoracic trunk

48
Q

what aids in the flow of lymph

A

passive constriction -the run in line with blood vessels so the pulsation from the vessels will help move the blood along
intrinsic constriction- the lymphatic vessels automatically constrict when they start to feel themselves fill up

49
Q

why does lymph only go in one direction

A

valves which prevent lymph going in wrong direction

50
Q

which vein does the thoracic duct drain into

A

left subclavian vein

51
Q

which vein does the right lymphatic duct drain into

A

right subclavian vein

52
Q

which duct drains most of the body

A

thoracic duct

53
Q

what parts of the body does the right lymphatic duct drain

A

half of the head and thorax and the right upper limB

54
Q

what is lymphodema

A

it is the collection of protein rich fluid causing tissue swelling due to compromised lymphatic swelling

55
Q

why does lymphodema occur

A

removal or enlargement of lymph nodes
infections (parasites)- elephantitis
damage to lymphatic system e.g. in cancer treatment
lack of limp movement ( movement of lymph fluid not aided by muscle contraction)
congenital e.g. Milory’s syndrome

56
Q

describe the structure of a lymph node

A

tough fibrous outer capsule
reticular connective tissue inside
contains B and T lymphocytes and macrophages

57
Q

who do lymph nodes swell and cause pain in infection

A

when infection is present the number of B cells increases so the lymph nodes swell
can only stretch so much because of the tough fibrous outer capsule
as it cannot stretch past this we get pain

58
Q

how do lymph nodes defend against infection

A

physical filter
phagocytic filter
full of lymphocytes which activate and proliferate in response to antigens

59
Q

how can you tell the difference between an infected lymph mode and a malignancy

A

infected lymph nodes are tender and mobile

in malignancy they are hard, matted and non-tender

60
Q

what is the difference between a regional and terminal node

A

a regional node drains a specific area and them drains into a terminal node
a terminal node receives drainage from multiple regional nodes
regional nodes are superficial
terminal nodes are deep

61
Q

where in the body are collection of lymph nodes most palpable

A

in the neck and armpit

62
Q

what separates superficial regional and deep terminal lymph nodes

A

separated by investing layer of deep cervical fascia in the neck

63
Q

what is waldeyer’s ring

A

it is an annular collection of lumphatic tissue (nodules) that surround the entrance to the aerodigestive tracts
completely encircle the upper pharynx

64
Q

what does waldeyer’s ring consist of

A

pharyngeal tonsil (adenoids)
tubal tonsils
palatine tonsils
lingual tonsils

65
Q

where do lymphatics from tonsils draining the upper pharynx drain into

A

retro-pharyngeal lymph nodes

66
Q

what could enlarged supraclavicular nodes be a sign of

and why

A

Abdominal malignancy
supraclavicular lymph nodes oversee the transport of lymph from thoracic cavity to abdomen
left node - abdomen and thorax
right node- mid section chest, oesophagus and lungs

67
Q

which lymph nodes are most commonly enlarged in viral conjunctivitis

A

pre-auricular

68
Q

which lymph nodes are most commonly enlarged in an ulcer of the lip

A

submental

69
Q

which lymph nodes are most commonly enlarged in tonsillitis

A

jugulo-digastiric

70
Q

which lymph nodes are most commonly enlarged in tongue cancer

A

submandibular and deep cervical

71
Q

what are deep cervical lymph nodes found in close relation to
and what muscle do they run deep to

A

the IJV within the carotid sheath

they run deep to SCM

Head and Neck (11 decks)

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