Circulation of the lower limb

Question 1

Where does oxygenated blood which supplies the lower limb come from?

Answer 1

Oxygenated blood is ejected by the left ventricle
- to the Ascending aorta
- to the aortic arch
- to the descending aorta (thoracic and abdominal)

Question 2

Where does the abdominal aorta terminate?

Answer 2

Into the left and right common iliac arteries

Question 3

What landmark do the common iliac arteries give rise to external and internal iliac arteries?

Answer 3

Sacroiliac joint

Question 4

What is the function of the external and internal iliac arteries?

Answer 4

External iliac artery supplies the majority of the lower limb while Internal iliac also contributes

Question 5

What are the 4 branches of the internal iliac artery?

Answer 5

1) Superior gluteal artery
2) Inferior gluteal artery
3) Internal pudendal artery
4)Obturator artery

Question 6

Where does the Superior gluteal artery pass through

Answer 6

Passes from the pelvic cavity to the gluteal region via the greater sciatic foramen, above piriformis muscle

Question 7

Where do the inferior gluteal artery pass through?

Answer 7

Enters the gluteal region via the greater sciatic foramen, below piriformis muscle

Question 8

Where do the obturator artery pass through?

Answer 8

Lies on lateral wall of pelvis and passes through obturator canal

Question 9

Where does the external iliac artery pass through?

Answer 9

The external iliac artery passes under the inguinal ligament

Question 10

What does the external iliac artery become?

Answer 10

the femoral artery

Question 11

Where is the pulse of the external iliac artery felt?

Answer 11

the pulse is found inferior to the mid-inguinal point

Question 12

Where does the femoral artery enter and pass into?

Answer 12

enters the adductor canal to pass into the popliteal fossa

Question 13

What branches does the profunda femoris give off?

Answer 13

medial circumflex femoral artery
- lateral circumflex femoral artery
-3 to 4 perforating arteries

Question 14

Where are there rich number of anastamoses?

Answer 14

there are rich anastomoses around the hip with the gluteal vessels (with branches of internal iliac artery) and around the knee

Question 15

What does the profunda femoris supply?

Answer 15

the posterior compartment of the thigh

Question 16

What are the 4 arteries of the trochanteric anastomosis?

Answer 16

• Medial circumflex femoral artery (and retinacular branches)
• Lateral circumflex femoral artery
• Superior gluteal artery
• Inferior gluteal artery

Question 17

What do the trochanteric anastomosis provide circulation for?

Answer 17

the trochanteric anastomosis provides circulation around the head of the femur

Question 18

What are the 4 arteries of the cruciate anastomosis?

Answer 18

• First perforator
• Inferior gluteal artery
• Lateral circumflex femoral artery
• Medial circumflex femoral artery

Question 19

What do the cruciate anastomosis provide circulation?

Answer 19

The function of the cruciate anastomosis is to provide an alternative route for the blood supply of the lower limb when there is a blockage of the blood flow between the external iliac and femoral arteries

Question 20

What are the two possible fractures of the hip joint?

Answer 20

1. Femoral Neck Fracture (Intracapsular Fracture)
2. Intertrochanteric Fracture (Extracapsular Fracture)

Question 21

What may be affected by the fracture of the femoral neck?

Answer 21

Retinacular vessels and will lead to necrosis of femoral head

Question 22

What are retinacular vessels?

Answer 22

retinacular arteries are branches of the medial and lateral circumflex femoral arteries that extend to the head of the femur within retinacuar folds of synovial membrane surrounding the neck of the femur. Collectively, these arteries provide the main blood supply to the femoral head.

Question 23

What structures do the popliteal artery lie between?

Answer 23

Between Hiatus tendineus and lower border of popliteus muscle

Question 24

What is a main characteristic of the popliteal artery?

Answer 24

Deepest structure in the popliteal fossa and so it is therefore difficult to get the pulse

Question 25

Where can the popliteal pulse be felt?

Answer 25

it can be found at the medial aspect of the popliteal fossa

Question 26

What does the popliteal artery give rise to?

Answer 26

5 genicular branches

Question 27

How does the popliteal artery exit the popliteal fossa?

Answer 27

Exit the popliteal fossa by passing through tendinous arch of soleus

Question 28

how does the popliteal artery become?

Answer 28

the posterior and anterior tibial arteries.

Question 29

What does the popliteal artery supply?

Answer 29

Supplies the knee joint

Question 30

When may the popliteal artery be compromised?

Answer 30

may be compromised in dislocation of the knee and in fractures of the lower femur, it is also the second most common site of aneurysm

Question 31

What are the 5 genicular branches pf the popiteal artery?

Answer 31

- superior lateral genicular artery - inferior lateral genicular artery - superior medial genicular artery - middle genicular artery - inferior medial genicular artery

Question 32

What branches off of the profunda femoris?

Answer 32

Descending branch of the lateral circumflex femoral artery

Question 33

What branches off of anterior tibial artery?

Answer 33

anterior tibial recurrent artery

Question 34

What does the anterior tibial recurrent artery form?

Answer 34

genicular anastamosis

Question 35

in what two ways, does blood continue to reach the popliteal artery when there is a blockage between the external iliac artery and femoral artery?

Answer 35

1) iliac artery >> inferior gluteal artery>> a perforating branch of the profunda femoris artery>> the lateral circumflex femoral artery >> its descending branch>> the superior lateral genicular artery the popliteal artery 2) via the anastomoses between the obturator artery and branches of profunda femoris

Question 36

What is the anterior tibial artery accompanied by?

Answer 36

the anterior tibial artery descends, deep to the anterior compartment muscles accompanied by the deep fibular (peroneal) nerve

Question 37

What does the anterior tibial artery supply?

Answer 37

Anterior compartment muscles

Question 38

Where does the anterior tibial artery become the dorsalis pedis artery?

Answer 38

inferior to the extensor retinaculum

Question 39

What kind of branch is the dorsalis pedis?

Answer 39

the dorsalis pedis is an arcuate branch as well as the the 1st dorsal metatarsal branch and flows into dorsal digital arteries

Question 40

Where is the dorsalis pedis felt?

Answer 40

the dorsalis pedis pulse is felt in the first intermetatarsal space

Question 41

What does the posterior tibial artery accompany?

Answer 41

the posterior tibial artery accompanies the tibial nerve as it descend deep to the soleus muscle

Question 42

What branches off of the posterior tibial artery?

Answer 42

- Fibular artery - Circumflex fibular artery - Nutrient arteries

Question 43

What does the posterior tibial artery supply?

Answer 43

it supplies the muscles of the posterior compartment of the leg (plantar flexors)

Question 44

What does the posterior tibial artery terminate and become?

Answer 44

t terminates and becomes the medial and lateral plantar arteries after running posterior to the medial malleolus

Question 45

Where can the pulse of the posterior tibial artery be felt

Answer 45

the pulse of the posterior tibial artery can be felt behind the medial malleolus

Question 46

What do the medial and lateral plantar arteries supply?

Answer 46

the medial and lateral plantar arteries supply the sole of the foot along with their branches: superficial plantar arches (medial plantar arteries) and deep plantar arches (lateral plantar arteries)

Question 47

What does the deep plantar arch give rise to?

Answer 47

The deep arch gives rise to plantar digital arteries of the phalanges

Question 48

Where do the superficial veins originate from

Answer 48

superficial veins originate from the dorsal venous network of the foot and dorsal veins of foot

Question 49

Where does the great saphenous vein ascend and pierce through?

Answer 49

Great (long) saphenous vein ascends 2.5 cm anterior to the medial malleolus, posterior to medial condyle of femur (Hands breadth behind the patella) and pierces the fascia lata to join the femoral vein.

Question 50

Where does the small saphenous vein ascend and penetrate through and merge with?

Answer 50

Small (short) saphenous vein ascends posterior to lateral malleolus and penetrates the deep fascia of the leg in the popliteal fossa and merges with deep veins to form the popliteal vein

Question 51

Where do the deep veins of the lower limb ascend to?

Answer 51

They ascend internal to the deep fascia of the lower limb

Question 52

Where does the femoral vein ascend to and terminate as?

Answer 52

Femoral vein ascends in the adductor canal from the popliteal vein, it enters the femoral sheath and ends as the external iliac vein.

Question 53

Where does the femoral vein receive drainage from?

Answer 53

It receives drainage from profunda femoris, great saphenous and other small branches.

Question 54

What is the order of venous flow?

Answer 54

Venous flow is from superficial to deep veins, via perforators

Question 55

What 3 things help venous return to the heart, against gravity

Answer 55

Arterial pulsation, negative intra-thoracic pressure and contraction of muscles

Question 56

What do valves do?

Answer 56

Prevent backflow

Question 57

What do superficial lymph vessels accompany?

Answer 57

Superficial lymph vessels accompany the superficial veins

Question 58

where do the lymph vessels accompanying the great saphenous vein drain to? and eventually lead to?

Answer 58

The lymph vessels accompanying the great saphenous vein drain to the superficial inguinal lymph nodes leading to the deep inguinal nodes then the external iliac nodes

Question 59

where do the lymph vessels accompanying the small saphenous vein drain to?

Answer 59

popliteal lymph nodes.

Question 60

where do the deep lymph vessels drain to?

Answer 60

Deep lymph vessels accompany deep veins and enter the popliteal lymph nodes, accompany femoral vein to the deep inguinal nodes.

Question 61

What structure is formed by the superficial inguinal nodes?

Answer 61

“T” along inguinal ligament and saphenous vein

Question 62

What 5 places do superficial inguinal nodes receive lymph nodes?

Answer 62

Anterior abdominal wall (under umbilicus) Skin of back below iliac crests Gluteal region Perineum Superficial Lower limb

Question 63

What is the femoral canal?

Answer 63

a short and conical space between the medial wall of the femoral sheath and the femoral vein

Question 64

What does the femoral contain?

Answer 64

deep inguinal lymph nodes

Question 65

Where are deep inguinal nodes located?

Answer 65

In the femoral triangle, medial to femoral vein

Question 66

What 3 places are deep inguinal nodes located?

Answer 66

- Lower limp - Superficial inguinal nodes - External genitalia

Question 67

What do deep and superficial inguinal nodes drain to?

Answer 67

1. external iliac nodes 2. common iliac nodes 3. lumbar lymph nodes 4. cisterna chyli 5. thoracic duct 6. Pirogov’s venous angle (left) 7. venous system