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Head, Neck & Neuro > Session 3 - Vessels + Lymph > Flashcards

Session 3 - Vessels + Lymph Flashcards

1
Q

What are the main arteries of the neck?

A

On right, subclavian and common carotid arteries arise from the brachiocephalic trunk.

Vertebral, internal thoracic and thryocervical arteries all arise from subclavian.

Inferior thyroid a. comes from the thyrocervical trunk.

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2
Q

Which arteries branch from the thyrocervical trunk?

A

Ascending cervical and transverse cervical supply the neck.

Suprascapular supplies shoulder

Inferior thyroid supplies lower pole of thyroid gland.

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3
Q

Describe the origin, route and path of the Vertebral arteries.

A

Originate from the subclavian arteries (L+R)

Run through the transverse foramina of the C6-C1 vertebrae.

Pass through foramen magnum.

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4
Q

Where does the internal carotid artery originate from and enter the skull?

A

Common carotid on right branch from the brachiocephalic artery, on left from aorta.

Common carotid bifurcated at the level of the superior border of the thyroid cartilage.

Internal carotid enters through the carotid canal into the skull.

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5
Q

Why is the bifurcation of the carotid a common site of atheroma? Why is this significant?

A

Bifurcation cause turbulent flow.

Plaque formation more likely due to increased vessel damage etc.

Can rupture and cause an embolus to move to the brain, which can cause a TIA (transient ischaemic attack) or a stroke.

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6
Q

What is the carotid sinus?

A

Swelling at the region of bifurcation of the common carotid.

Location of the baroreceptors which detect changes in arterial BP.

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7
Q

What is the carotid body?

A

Peripheral chemoreceptors which detect arterial O2.

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8
Q

What is significant about the carotid triangle?

A

Area of importance for surgical approach to carotid arteries or IJV.

Access vagus and hypoglossal nerves also.

Pulse can be felt just below the bifurcation, and carotid sinus massage can be applied.

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9
Q

What is the route of the internal carotid artery into the skull?

A
  • Enters through carotid canal
  • Turns medically and horizontally
  • Enters the cranial cavity, then makes S-shaped bend
  • Courses through the cavernous sinus
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10
Q

What is contained within the cavernous sinus?

A

Carotid artery.

  • Plexus of extremely thin-walled veins on upper surface of sphenoid.
  • CNIII Oculomotor
  • CNIV Trochlear
  • CNVIabducent

2 branches of trigeminal:

  • CNV1 - ophthalmic
  • CNV2 - Maxiallry
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11
Q

Where does the ophthalmic artery branch from?

A

From the internal carotid.

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12
Q

What are the branches of the external carotid artery?

A
  1. Superior thyroid
  2. Lingual
  3. Facial
  4. Ascending pharyngeal
  5. Occipital
  6. Posterior auricular
  • Plus, 2 terminal branches:
    - Superficial temporal
    - Maxillary
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13
Q

Name the blood supplies to the scalp!

A

INTERNAL CAROTID:

  • Supra-orbital artery
  • Supra-trochlear artery

EXTERNAL CAROTID:

  • Superficial temporal artery
  • Posterior auricular
  • Occipital artery
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14
Q

Why is a scalp laceration particularly prone to heavy bleeding?

A

Connective tissue keeps artery open, preventing reduced flow of blood.

Lots of anastomoses to other arteries.

Pull from occipitalis and frontalis causes aponeurosis to be pulled open, preventing wound closure.

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15
Q

Name the layers of the scalp.

A
  1. Skin
  2. Connective tissue (dense)
  3. Aponeurosis
  4. Loose connective tissue
  5. Periosteum
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16
Q

What are the names of the superficial arteries of the face?

A

Most arise from external carotid.

  • Facial
  • Superior + Inferior labial
  • Maxillary
  • Lateral Nasal
  • Angular
  • Transverse facial

From INTERNAL carotid

  • Supra-trochlear
  • Supra-orbital
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17
Q

Which are two important branches of the maxillary artery?

A

Middle Meningeal

Sphenopalatine

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18
Q

What is kiesselbach’s plexus?

A

An area in the anteroinferior part of the nasal septum where four arteries anastomose.

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19
Q

What is clinically relevant about the Kiesselbach area?

A

Common site for nose bleeds (epistaxis)

20
Q

Which artery supplies blood to the dura and skull?

A

The middle meningeal artery.

Bifurcated into:
Anterior branch (under pterion)
Posterior branch
21
Q

Which structure in the skull does the middle meningeal artery pass though?

A

Foramen spinosum

22
Q

What sort of haemorrhage is caused by rupture to the middle meningeal artery?

A

Extradural Haemorrhage

Between the dura mater, and the arachnoid mater.

Confined by suture lines.

23
Q

How are veins from the scalp connected to venous drainage within the cranium?

A

Veins of scalp connect to diploeic veins through emissary veins, thus into the dural venous sinuses.

24
Q

What may be a problem of emissary veins in the scalp?

A

As age increases, brain is smaller, and a small head injury could tear the veins causing a bleed.

Infection could track from the scalp into the cranial cavity, affecting the meninges.

25
Q

How do the facial veins connect to the intracranial space?

A

Facial vein and superior ophthalmic - drain into cavernous sinus.

Deep facial veins drain into the pterygoid venous plexus.

  • Infection from facial vein can spread to Duran venous sinuses
  • Thrombophlebitis of facial vein - infected clot can travel to intracranial venous system.
26
Q

What is the cavernous sinus?

A

Plexus of thin-walled veins on upper surface of sphenoid.

27
Q

Where is the internal jugular vein contained?

A

Under the sternocleidomastoid.

28
Q

How is jugular venous pressure measured?

A

Use Right Internal Jugular Vein. (Almost direct connection to right atrium)

  • Patient at 45 degree angle.
  • IJV largely hidden by SCM.
  • Pulsations observed through muscle.
  • Measured in cmH20

Height from eternal angle + 5cm

29
Q

Why can not all of the fluid filtrate into the intersitium be recovered?

A

Some small proteins leave, so not all fluid can be reabsorbed.

30
Q

What substances/ things are found in lymph?

A 
-Tissue fluid
&
Small proteins
Damaged cells
Bacteria
Cancer cells
Lipids (chylomicrons from gut lymphatics)
31
Q

How much lymph is produced per day?

A

Around 3-4L of lymph is produced per day.

32
Q

How is lymph helped along the vessels back to the venous system?

A

Passive constriction: Pulsation of an artery, or muscle contraction.

Intrinsic constriction:
Vessels themselves can constrict if there is an increase in pressure due to fluid build up there.

33
Q

Outline the pathway of lymph from tissue fluid back to the venous system.

A
  • Tissue fluid
  • Lymphatic capillary
  • Lymphatic vessels
  • At least 1 lymph node
  • Lymphatic vessels
  • Lymphatic trunks (L + R)
  • Lymphatic ducts (L + R)
  • Venous system
34
Q

Where does the lymph drain back into the venous system?

A

Right Lymphatic Duct
Thoracic Duct

Drains into left and right subclavian veins.

35
Q

What is lymphedema? What causes it?

A
  • Abnormal collection of protein-rich fluid causing tissue swelling due to compromised lymphatic system.

Chronic conditions:

  • Removal/ enlargement lymph node
  • Infections (parasite)
  • Damage to lymphatic system (e.g. cancer treatment)
  • Lack of limb movement
  • Congenital
36
Q

What are some of the main lymph nodes?

A

Spleen
Tonsils
Thymus
(Lymphoid organs)

37
Q

What is the basic structure of lymph nodes?

A

Connective tissue structure.
Tough fibrous outer capsule.
Reticular connective tissue inside.

38
Q

How do lymph nodes defend against infection?

A

All lymph passes through at least one node.

  • Physical filter
  • Phagocytic filter
  • Full of lymphocytes: activate/proliferate in response to antigens.
39
Q

What are the causes of enlarged lymph nodes?

A

Very common (lymphadenopathy)

1) Infection (most common):
Tender, mobile

2) Malignancy:
Hard, matted, non-tender

40
Q

What needs to be investigated if a lymph node is found to be enlarged?

A
  • Comprehensive history
  • Examine the area of tissue it drains
  • If disease/malignancy suspected, examine other lymph nodes/ systems.
41
Q

What are the two classes of lymph nodes?

A

-Regional Nodes-
Drain specific areas.
Superficial.

-Terminal Nodes-
Receive drainage from number of regional nodes
Deep structures.

42
Q

How are the lymph nodes of the neck organised?

A

Superficial and deep.

Separated by investing layer of deep cervical fascia of neck.

43
Q

What are the names of the superficial (regional) lymph nodes of the head/neck?

A
  • Submental
  • Submandibular
  • Pre-auricular
  • Post-auricular
  • Occipital

Cervical:

  • Superficial EJV
  • Posteior EJV
  • Anterior AJV (anterior jugular)
44
Q

What are the deep cervical lymph nodes of the neck (Terminal)?

A
  • Jugulo-digastric
  • Jugulo-omohyoid
  • Supraclavicular lymph nodes.

(Deep to SCM, closely related to IJV)

45
Q

Where do the supraclavicular (deep) lymph nodes drain to? What is their function?

A

Transport of lymph from thoracic cavity and abdomen.

LEFT: Abdomen and thorax (virchow’s node).

RIGHT: Mid section chest, oesophagus and lungs.

Head, Neck & Neuro (7 decks)

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