M Vasculature of the upper limb Flashcards
(77 cards)
1
Q
What arteries are involved in the vasculature of the upper limb (in correct order)? (5)
A
- subclavian artery
- brachiocephallic artery
- axillary artery
- brachial artery
- radial artery and ulnar artery
2
Q
What are the 3 branches of the aorta?
A
- branchiocephalic artery
- left common carotid artery
- left subclavian artery
3
Q
What does the brachiocephalic artery divide into?
A
- right common carotid artery
2. right subclavian artery
4
Q
What are the branches of the subclavian artery?
A
- inferior thyroid artery
- thyrocervical artery
- axillary artery
- r.subclavian artery
- vertebral artery
- r common carotid artery
- l common carotid artery
- l subclavian artery - left upper limb
- brachiocephalic trunk
- internal thoracic artery
5
Q
Where does the vertebral artery pass through? (2)
A
- transverse foramina of C1-C6
2. foramen magnum
6
Q
What does the vertebral artery unite with? (2)
A
- opposite vertebral artery
2. basilar artery
7
Q
What is subclavian steal syndrome?
A
a group of signs and symptoms that arise from the following:
- retrograde (reversed) flow of blood in the ipsilateral vertebral artery or the internal thoracic artery
- this is due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery
8
Q
What is the stenosis in subclavian steal syndrome usually due to?
A
atheroscelorosis
9
Q
Why does the blood supply not stop in subclavian steal syndrome and what does this supply?
A
As blood is stolen from the circular vertebral-basilar artery system.
supplies the distal territory of the occluded or stenosed artery
10
Q
SUBCLAVIAN STEAL SYNDROME SCENARIO
Blockage in left subclavian artery:
- What would happen to the blood pressure in the left and right arm?
- Would their be a difference in pulses?
- Why would the patient experience dizziness?
A
- LEFT -lowRIGHT - high
- yes - stronger on RIGHT
- use of circle of willis
11
Q
Where does the subclavian artery become the axillary artery?
A
lateral border of rib 1
12
Q
What muscle divides the subclavian artery into thirds?
A
pectoralis minor muscle
13
Q
Where is the first part of the subclavian artery in relation to pectoralis minor?
A
superior to pec minor
14
Q
Where is the second part of the subclavian artery in relation to pec minor?
A
deep to pec minor
15
Q
Where is the third part of the subclavian artery in relation to pec minor?
A
inferior to pec minor
16
Q
What is the course of the subclavian artery? (4)
A
- subclavian artery
- axillary artery
- posterior circumflex artery
- anterior circumflex artery
17
Q
Which nerve and arteries loop around the surgical neck of the humerus?
A
- axillary nerve
- posterior circumflex artery
- anterior circumflex artery
18
Q
What muscle overlies the axillary artery?
A
pec minor
19
Q
What is the brachial artery a continuation of?
A
axillary artery
20
Q
At what level does the axillary artery become the brachial artery?
A
inferior border of teres major
21
Q
What are the 3 main branches of the brachial artery?
A
- profunda brachii
- superior ulnar collateral artery
- inferior collateral artery
22
Q
In the cubital fossa what does the brachial artery split into?
A
- radial artery
2. ulnar artery
23
Q
What is the profunda brachii artery?
A
deep artery of the arm
can feel pulse
24
Q
What does the profunda brachia supply?
A
the posterior compartment of the arm
25
What does the profunda brachii wrap around?
posterior surface of the humerus
26
What groove does the profunda brachii run through and what nerve does it run along with?
Radial/sprial groove
Radial nerve
27
What groove is a potent site for fractures?
radial/spinal groove
28
How are the brachial vessels commonly injured?
1. penetration
| 2. humeral fractures
29
Why are the brachial vessels prone to damage?
It is quite superficial
30
What does the degree of ischaemia caused by damage to brachial artery depend on?
Whether the damage is proximal or distal to the profunda brachii
31
What percentage of cases will result in limb loss if ligation of the brachial artery is proximal to profunda brachii?
50%
32
What percentage of cases will result in limb loss if ligation of the brachial artery is distal to profunda brachii?
25%
33
What is peri-articular anastomoses ?
- network of anastomoses
- of brachial and profunda brachii arteries in the arm
- with radial and ulnar arteries in forearm
34
In detail, what arteries are involved n the peri-articular anastomoses?
1. profunda brachii artery
2. superior and inferior collateral ulnar arteries
3. radial collateral arteries
4. radial recurrent artery
5. anterior and posterior ulnar recurrent arteries
6. brachial artery
35
What does the radial artery supply?
ANTEROLATERAL aspect of the forearm
-flexors and extensors
36
What does the ulnar artery supply?
MEDIAL side of the forearm
- flexors and pronators
37
What does the ulnar artery run through and what nerve does it run with?
foramen
ulnar nerve
38
What branch does the ulnar artery give off and what branches does this branch off into?
1. common interosseous artery
2. anterior interosseous artery
3. posterior interosseous artery
39
What does the anterior and posterior interosseous arteries supply?
deep muscles of the posterior and anterior compartments
- middle of the flexor and extensor compartments
40
What crosses the floor of the anatomical snuffbox dorsally?
radial artery
41
What does the radial artery pierce?
1st dorsal interosseous muscle
42
What does the radial artery pass through in order to enter the palmar surface of the hand?
through the transverse and oblique heads of adductor pollicis
43
Through which canal does the ulnar artery enter the hand and where is it in relation to the flexor retinaculum?
Guyons
Superificial
44
What test is carried out to test the collateral blood supply to the lateral aspect of the hand through the ulnar artery?
Allen's test
45
When can Allens test be carried out and why?
prior to surgery
to check if the superior palmar arches are formed
46
How do you palpate pulses?
push them against humerus
47
What do the 6 pulse points in the upper limb allow localisation of?
localisation of potential blockages in these arteries
48
Where can you apply pressure to to stop blood loss?
6 pulse points
49
Upper limb pulse points (4)
1. Axillary pulse: located inferiorly of the lateral wall of the axilla
2. Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (brachial artery)
3. Radial pulse: located on the lateral of the wrist (radial artery). It can also be found in the anatomical snuff box.
4. Ulnar pulse: located on the medial of the wrist (ulnar artery).
50
Where can you palpate the brachial pulse?
mid arm
medial side of the arm
between biceps brachii and triceps brachii
51
Where can you palpate the radial pulse?
lateral to the tendon of flexor carpi radialis
52
Where can you palpate the ulnar pulse?
lateral to the tendon of flexor carpi ulnaris
53
Why is it not easy to feel the ulnar pulse?
as it is covered by flexor carpi ulnaris
54
What can be palpated in the anatomical snuffbox?
radial artery
55
How do you palpate the radial artery in anatomical snuffbox?
1. fully extend thumb
2. palpate in depression
between EXTENSOR POLLICIS LONGUS and ABDUCTOR POLLICIS LONGUS and EXTENSOR POLLICIS BREVIS
EPL - Radial artery - APL + EPB
56
Where does superficial venous drainage begin and where does it receive blood from?
With in dorsal venous arch.
digits
57
Where does the cephalic vein drain?
laterally
58
Where does the basilic vein drain?
medially
59
What are the most superficial veins of the dorsal aspect of the hand?
1. basilic vein
| 2. cephalic vein
60
What is the course of the cephalic vein?
1. lateral side of forearm and arm in subcutaneous fat
2. through deltopectoral triangle
3. pierces clavipectoral fascia
4. drains into the axillary vein
61
What makes up the deltopectoral triangle? (2)
pec major
deltoid
62
Where does the basilic vein run?
medial side of forearm
63
Where does the basilar vein receive venous drainage from?
median cubital vein
64
What vein lies superficial to the bicipital aponeurosis and what is it useful for?
median cubital vein
venepuncture
65
What does the joining of the deep veins and the basilic vein form?
axillary vein
66
What are venae comitantes?
2 veins that closely accompany an artery.
the pulsations of the artery help venous return.
67
Where are venae comitantes most commonly found and why?
found - at peripheries (fingers and toes)
as bp is lowest
68
Which arteries of the upper limb are venae comitantes found at?
all the major arteries
69
Where do the venae comitantes drain blood to and from?
TO
vessels accompanying the radial and ulnar arteries
FROM
superficial and deep palmar arches
70
What happens to the venae comitantes in the cubital fossa?
unite to form the venae comitantes of the brachial vein
71
How is the axillary vein formed?
brachial venae comitantes merge with basilic vein in axilla
72
What is the venous drainage of the upper limb venae comitantes?
1. superficial palamar arches venae comitantes
2. deep palamar arch venae comitantes
3. ulnar and radial venae comitantes
4. brachial venae comitantes
5. basilic vein
6. axillary vein
73
What are the deep veins? (2)
1. subclavian
| 2. axillary
74
Where does the axillary vein receive blood from?
cephalic vein
75
What is the axillary vein called after it passes the clavicle?
subclavian vein
76
Which vein joins with the internal jugular vein to form the brachiocephalic vein?
subclavian vein
77
What is the superior vena cava made up?
2 brachiocephalic veins
