How much of a human body is water
60% by weight
How much of the water in the human body is intracellular, and how much is extra cellular
2/3 in intra cellular, 1/3 is extra cellular
How is the extracellular fluid distributed
1/5 is blood plasma, 4/5 is interstitial fluid
How does one determine the IV flow when replacing liquids
4cc/hr/kg for the first 10 kg of body weight, then add 2cc/hr/kg for the next 10 kg of body, and for the remaining body weight add 1cc/hr/kg
What is the governing principle of all fluid movement in the body
It flows from areas of high pressure to areas of lower pressure
What is the direction of lymphokinetic motion
blood capillaries > interstitial fluid > Lymph capillaries >Lymph veins > lymph ducts > large circ. veins
What is the main function of interstitial fluid
Carries cell waste products to the lymph system for purging
Where is the subclavian artery located
Between the anterior and middle scalenes, deep to the clavicle, to the lateral border of the first rib
Where is the axillary artery located
From the first part of the 1st rib to the lower edge of teres major
Where is the brachial artery located
Extends from the teres major down to the bifurcation of radial and ulnar arteries, which normally happens near the elbow, but can happen near the axilla
Where is the profunda brachii artery located
It branches from the brachial artery just distal to the teres major and travels along a similar path as the radial nerve in the posterior arm
What is collateral circulation
The situation of having multiple pathways for blood to reach a particular organ or region of the body
What are anastomosis
Connecting branches formed between adjacent blood vessels
Where is the dorsal scapular a. located
It branches from the subclavian and travels along the vertebral border of the scapula.
Where is the suprascapular a. located
It branches from the subclavian and travels along the axillary a to the suprascapular notch and then to the infraspinatus. Anastomoses with the scapular circumflex a.
Where is the scapular circumflex a. located
It branches from the axillary a. and travels between the teres major, minor and long head of the triceps to the infraspinatus. Anastomoses with the suprascapular a.
What is the purpose of the collateral circulation around the scapula
If the axillary artery s occluded, then blood i shunted away from the subclavian artery to the distal axillary artery by reverse flow in the circumflex scapular and subscapular aa. This is all based on pressure
Why would the body create new anastomosises
To get around blockages
When would creating new anastomosises be deleterious
In diabetic retinopathy repeated blockage and growth of replacement vessels leads to impaired vision
What goes through the vertebral transverse foramina
Vertebral artery
What is subclavian steal syndrome
occlusion of the subclavian artery causes retrograde flow in the vertebral artery
What is Thoracic outlet syndrome
Compression of the brachial plexus and blood vessels where they pass between the scalenes, 1st rib and clavicle, or under pectoralis minor
What are cervical ribs and how are they clinically relevant
incomplete ribs off the cervical vertebrae found in .5-1% of the population that greatly increase the risk of developing thoracic outlet syndrome
What are common causes of thoracic outlet syndrome
fractures, bad posture, and bone spurs
What is the physician’s #1 way to test for a nerve problem
They try to make the symptoms worse
What is Adson’s test
Pt’s arm is abducted and externally rotated while his head is turned away from the affected arm and he inhales deeply. This activated scaliness and raises the first rib. If his radial pulse is diminished, then the test is positive
Which artery do inflatable blood pressure cuffs utilize
The brachial artery
Where is the radial artery located
It travels down the forearm through the anatomical snuffbox and around MC 1 to enter palm and form the deep palmar arch
How does the radial artery terminate
anastomoses with the ulnar artery in the deep and superficial palmar arteries
Where is the ulnar artery located
It travels down the forearm through the tunnel of Guyon to form the superficial palmar arch
How does the ulnar artery terminate
It anastomoses with the radial artery in the superficial and deep palmar arches
What do the palmar arches branch into
Metacarpal, common, and proper digital arteries that parallel the cutaneous nerves
Where are the digital aa and nn located
On the sides of the digits so that they don’t get squashed during digit movement
Where does one inject anesthetic in a digit
Anesthetic is injected on both sides of the affected digit to effectively numb the entire digit
When does one NOT use anesthetic with epinephrine
When numbing the fingers, toes, penis, or nose because of the limited blood supply
Where is the cephalic vein located
Anterolateral forearm, over biceps and between the deltoid and pectoralis major
Where is the basilic vein located
anteromedial forearm, penetrates medial side of arm
Where is the median cubital vein
The communicating vein between the cephalic and basilic vv, it is located between them in the elbow
What veins are great for blood venipuncture
The median cubital is number one, but the cephalic and basilic vv can be used as well
What are venae comitantes
Veins that are paired with major arteries (radial, ulnar, brachial, etc)
What is the purpose of venae comitantes
They are an alternate course for blood to return to the heart and serve to capture some of the heat that is lost from arterial blood to reheat venous blood
How much of the blood returns to the heart via deep veins
90%
What is the cubital fossa
Triangular space bordered by pronator teres, brachioradialis, and imaginary line connecting epicondyles of humerus
What structures are in the cubital fossa
Superficial vv, median and radial nn, brachial a, biceps tendon
What is the function of lymphatic capillaries
They recover excess fluid from interstitium and transport the lymph to lymph nodes
What causes blocked lymphatics
Mostly commonly destruction by surgery, radiation, or infection
What happens if lymphatics are blocked
There is a lack of lymph drainage which causes a fluid build up called ‘edema’ in the affected tissues
Can you repair blocked lymphatics
Not really. They are too fragile for angioplasty or other procedures done on blood vessels. Manual therapy can be used to empty some of the fluid buildup
How is fluid in lymph vessels propelled
Predominantly by muscle action around the vessels, but a few lymphatics have smooth muscles with rhythmic peristaltic motion
What does the right supraclavicular node drain and what diseases is it indicative when swollen
Drains: Mediastinum, lungs, esophagus
Disease: Lung, retroperitoneal, or gastrointestinal cancer
What does the left supraclavicular node drain, and what diseases is it indicative of when swollen
Drains: thorax, abdomen via thoracic duct
Disease: lymphoma, thoracic or retroperitoneal cancer, bacterial or fungal infection
What does the axillary node drain, and what diseases is it indicative of when swollen
Drains: arm, thoracic wall, breast
Disease: infections, cat-scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma
What does the epitrochlear node drain, and what diseases is it indicative of when swollen
Drains: Ulnar aspect of forearm and hand
Disease: Infections, lymphoma, sarcoidosis, tularemia, secondary syphilis
What is the function of a lymph node
Filters and monitors interstitial fluid to detect antigens
Where do lymphatics drain
Lymphatics follow superficial veins and deep arteries and then drain into the venous system
What are mammary glands
Modified sweat glands embedded in adipose tissue
How are breasts attached to deep fascia
Via suspensory (cooper’s) ligaments
Which 4 nodes receive lymph from breasts
pectoral nodes in axilla (75% this si the site of metastasis), opposite breast, parasternal nodes, abdominal nodes
systemic infection such as the flu often causes enlargement of which nodes
Axillary lymph nodes
