Neurovasculature of the lower limb Flashcards Preview

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Flashcards in Neurovasculature of the lower limb Deck (97):
1

What are the superior and inferior gluteal arteries branches of?

internal iliac arteries

2

What are the arteries of the gluteal region? (in order of course) (9)

1. superior gluteal
2. inferior gluteal
3. medial femoral circumflex
4. lateral femoral circumflex artery
5. deep artery of the thigh
6. first perforating artery
7. femoral artery
8. second perforating artery
9. third perforating artery

3

What do the arteries around the hip also known as?

cruciate anastomosis

4

Which branches does the cruciate anastomosis involve?

branches of internal iliac and profunda femurs arteries

5

Why is the cruciate anastomosis clinically important?

allows blood to bypass a blockage of the external iliac or proximal femoral arteries

= allows collateral supply

6

What is the artery that supplies the anterior compartment of the thigh, what is it a continuation of and what is it's boundary?

femoral artery

continuation of external iliac artery

boundary - inguinal ligament

7

What are the arteries that supply the posterior compartment of the thigh?

4 perforating arteries

profunda femoris artery

8

What artery supplies the medial compartment of the thigh and what is it a branch of?

obturator artery

internal iliac artery

9

What is the femoral artery called when it enters the popliteal fossa from the anterior compartment of the thigh?

popliteal artery

10

When can pulsation of the popliteal artery be felt?

when knee is flexed

11

What does the genicular anastomosis allow?

maintenance of blood supply to the leg during knee flexion

as knee flexion may impinge the popliteal artery

12

What is the artery of the anterior compartment of the leg and where is it derived from?

anterior tibial artery

terminal branch of popliteal artery

13

What is the artery of the posterior compartment of the leg and where is it derived from?

posterior tibial artery

terminal branch of popliteal artery

14

What is the artery of the lateral compartment of the leg?

fibular artery

branch of posterior tibial artery

15

Where does the femoral artery go through to get to the popliteal fossa to become the popliteal artery?

adductor hiatus

16

What are the arteries of the dorsal aspect of the foot (top of foot) and what is it a continuation of?

dorsalis pedis artery

continuation of anterior tibial artery

17

What are the arteries of the plantar aspect of the foot (sole of the foot) and where are they derived from?

medial and lateral plantar arteries

bifurcation of posterior tibia artery

18

What is the deep plantar arch?

anastomosis of the deep plantar branch of the dorsal is pedis artery with lateral plantar artery

19

What plantar arch is present in only 5% of the population?

superficial plantar arch

20

What is important to do in palpation of lower limb arteries (pulses)?

compare left and right limbs

21

What arteries do you palpate (pulses) in the lower limb? (4)

1. femoral - relatively superficial in groin
2. popliteal - leg in flexion to open up pop fossa and compress it
3. posterior tibial - behind medial malleolus of the ankle
4. dorsalis pedis - anterior aspect of foot over dorsum - gap between 1st and 2nd toes

22

Where is the femoral artery in the femoral triangle?

quite superficial

23

As the femoral artery is quite superficial in the femoral triangle what is it vulnerable to?

injury and laceration

24

The femoral artery is easily accessible in people for what?

for ABG in emergencies if poor peripheral perfusion/pulses

for minimally invasive procedures (catheters):

- coronary angioplasty
- coronary angiography
- embolisation of berry aneurysm

25

What temporary problems can minimal invasive procedures cause?

- false aneurysms
- big haematomas
- bleeding

26

What is peripheral vascular disease (PVD)?

1. arteries of the pelvis and lower limbs affected by atheroscelorosis

27

What can happen in peripheral vascular disease?

the lower limb arteries can become occluded by embolus or thrombus

28

What is acute ischaemia caused by?

acute occlusion by thrombus or emboli

usually by trauma or compartment syndrome

29

How worrying is acute ischaemia of the limb?

a medical emergency

requires urgent revascularisation

30

What is the presentation of acute ischaemic leg? (6Ps)

1. pain - due to anaerobic reps of cells - build up of lactic acid
2. pallor
3. perishingly cold
4. pulseless
5. paraesthesia
6. paralysis

31

What is the treatment for acute ischaemic leg?

1.revascularisation to prevent tissue loss

2.imaging will show site of occlusion

3. graft from the common femoral to popliteal bypasses the occluded vessel

32

In acute ischaemia of the leg what do atheroscelorotic changes often affect which artery?

lower femoral artery

33

How does the body try to compensate for the acute ischaemic limb?

collateral circulation via anastomoses between branches of profunda femoris and popliteal

34

What are the symptoms of chronic ischaemia?

1. assymptomatic
2. mild intermittent claudication
3. severe intermittent claudication
4. rest pain/ night pain
5. tissue loss/ ulceration/ gangrene

35

Why might the symptoms and signs of acute ischaemia be less marked in someone already affected by chronic ischaemia?

onset is slow

may not have much changes with 6 Ps

36

What is claudication?

pain when walking

37

What are the superficial veins of the lower limb?

1. great saphenous veins
2. short saphenous vein

38

Where do the superficial veins lie?

subcutaneous tissue

superficial to deep fascia

39

What do the superficial veins drain into?

deep veins

femoral and popliteal

40

What are the major arteries accompanied by?

deep veins of the limb

41

What veins are venae commitantes (or accompanying veins)?

anterior and posterior tibial veins

fibular veins

42

What do the venae commitantes (anterior and posterior tibial veins, fibular veins) join to to become the femoral vein?

popliteal vein

43

What are perforating veins?

drain blood from the superficial veins into the deep veins?

44

What do perforating veins contain to prevent the back flow of blood?

valves

45

What is venous return aided by?

muscular contraction - muscle pump

deep fascia - compression stocking

46

What can the femoral vein be used for in an emergency?

emergency IV access

47

When can the femoral vein be temporarily accessed?

1. trauma
2. burns
3. people with difficult access - obesity, shock, IVDU, thromboses peripheral veins
4. venepuncture in emergencies

48

Where does the great saphenous vein lie immediately in front of and what can this site be used for?

medial malleolus

obtain IV access

49

What are varicose veins?

increased pressure in spahenous veins that can be caused by proximal venous obstruction - pregnancy or pelvic tumour

50

What happens in varicose veins?

veins become dilated and incompetent

blood then may stagnate in the skin - leading to breakdown and ulceration

51

What are the complication so varicose veins?

1. bleeding
2. superficial thrombophelbitis
3. venous/varicose ulcers - medial side of the ankle, dermatitis and skin thickening

52

What is deep vein thrombosis?

abnormal clotting in the pelvis or legs

53

What can happen to the clots in a DVT?

clots can break off an travel to the lungs - PE

54

What happens if the DVT remains untreated?

1-2% mortality from PE

55

What do 50% of patients with DVT have?

pain and swelling in affected leg

56

What are the risk factors for DVT? (7)

1. previous VTE
2. immobility
3. recent surgery
4. malignancy
5. pregnancy
6. IV drug use
7. sepsis

57

What is the lumbar plexus formed from?

anterior rami L1-L4

58

What is the sacral plexus formed from?

anterior rami of L4-S5

59

What is the sacral plexus joined by?

lumbosacral trunk - branch of L4 anterior rams that joins L5

60

What nerves does the lumbar plexus give rise to?

obturator nerve - L2-L4

femoral nerve - L2-L4

61

What nerves does the sacral plexus give rise to?

sciatic nerve - L4-S3

superior gluteal nerve L4-S1

Inferior gluteal nerve L5-S2

62

Why are the nerves of the lumbar and sacral plexus rarely damaged?

because they are deep within pelvis and abdomen

63

What does the femoral nerve supply?

anterior compartment of the thigh

64

What does the femoral nerve pass under to enter the thigh?

inguinal ligament

65

What is the terminal branch of the femoral nerve and what doe sit pass through and what doe sit supply?

saphenous nerve

adductor hiatus

lies more lateral

66

What does the obturator nerve supply?

medial compartment of the thigh

67

What does the obturator nerve divide into and where do these divisions lie?

anterior and posterior branches

lie either side of the adductor brevis

68

What does the sciatic nerve supply?

posterior thigh and all of the leg and foot

69

What is the sciatic nerve composed of?

tibial nerve - anteiror divisions of the anterior rami

Common fibular nerve - posterior division of the anterior rami

70

Where does the sciatic nerve usually bifurcate?

in distal thigh

71

When is the sciatic nerve at risk of injury? (2)

intramuscular injections

hip injuries and dislocations

72

Where should intramuscular injections be performed?

superolateral quadrant - gluteal maximus

73

What does the common fibular nerve bifurcate into?

superficial and deep branches

74

What does the superficial branch of the common fibular nerve supply?

lateral compartment of the leg

75

What does the deep fibular branch of the common fibular nerve supply

anterior compartment of the leg

76

Why is the common fibular vein vulnerable?

as it winds around the neck of the fibula

77

What happens in an injured common fibular nerve?

paralysis of dorsiflexor muscles

resulting in foot drop and altered gait

78

What does the tibial nerve supply?

posterior compartment of the leg

79

Where does the tibial nerve bifurcate and what does it bifurcate into?

where - deep to the flexor retinaculum

what - medial and lateral plantar nerve

80

How big is the medial plantar nerve in comparison to the lateral plantar nerve?

it is smaller

81

What muscles and digits does the medial plantar nerve supply?

4 muscles

skin to medial 3 1/2 digits

82

What does the lateral plantar nerve supply?

all other plantar muscles

skin to lateral 1 1/2 digits

83

NOTE

learn dermatomes

84

Myotomes

What nerve root is involved in lateral external rotation of the hip?

L5,L1

85

Myotomes

What nerve roots are involved in medial internal rotation of the hip?

L1,L2 and L3

86

Myotomes

What nerve roots are involved in adduction of the hip?

L1,L2,L3 and L4

87

Myotomes

What nerve roots are involved in abduction of the hip?

L5 and S1

88

Myotomes

What nerve roots are involved in subtalar inversion?

L4 and L5

89

Myotomes

What nerve roots are involved in subtalar eversion?

L5 and S1

90

Myotomes

What nerve roots are involved in dorsiflexion of the toes?

L5 and S1

91

Myotomes

What nerve roots are involved in plantar flexion of the toes?

S1 and S2

92

Myotomes

What nerve roots are involved in extension of the hip?

L4 and L5

93

Myotomes

What nerve roots are involved in flexion of the hip?

L2 and L3

94

Myotomes

What nerve roots are involved in flexion of the knee?

L5 and S1

95

Myotomes

What nerve roots are involved in extension of the knee?

L3 and L4

96

Myotomes

What nerve roots are involved in dorsiflexion of the ankle?

L4 and L5

97

Myotomes

What nerve roots are involved in plantar flexion of the ankle?

S1 and S2