Vascular System

Question 1

Subclavian Artery Branches

Answer 1

• vertebral
• internal thoracic
  
  • pericardiophrenic
  • (rami perforantes)
  • (ant intercostales)
  • musculophrenic
  • sup epigastric
• post cervical trunk
  
  • intercostalis superior
  • cervicalis profunda
• thyrocervical trunk
  
  • inferior thyroid
  • ascending cervical
  • transverse cervical
  • superficial cervical
  • suprascapular
• dorsal scapular (sometimes a branch of trans cervical)

Continues on to become axillary artery

Question 2

Axillary Artery Branches

Answer 2

• sup thoracic
• thoracoacromial:
• rami pectoralis, deltoid, acromial
• subscapular
• thoracodoraslis and circumflexa scapulae
• circumflexa posterii humerii
• circumflexa anterior humerii
• thoracolateralis

BRACHIAL

• branches
  
  • profunda brachii
  • sup ulnar collateral
  • inf ulnar collateral

Question 3

Thoracic Aorta Branches

Answer 3

Visceral and Parietal Branches:

• bronchial (v)
• pericardial (v)
• oesophageal (v)
• mediastinal (v)
• post intercostal (3 - 11) (p)
• sup phrenic (p)
• subcostal (p)

Question 4

External Carotid Artery

Answer 4

• sup thyroid
• lingual
• facial
• (sternocleidomastoid)
• ascending pharyngeal
• occipital
• post auricular
• maxillary
• superficial temporal

Question 5

Opthalmic Artery

Answer 5

1. lacrimalis
2. centrales retinae
3. ciliares longis i brevis
4. ciliares anteriores
5. rami musculares
6. supraorbitalis
7. palpabralis mediales
8. ethmoidal anteriores
9. ethmoidal posteriores
10. dorsalis
11. frontalis

Question 6

Abdominal Aorta

Visceral Paired

Answer 6

• suprarenalis media
• renalis
• ovaria / testicularis

Question 7

Abdominal Aorta

Visceral Unpaired

Answer 7

• celiac trunk
• superior mesenteric
• inferior mesenteric

Question 8

Abdominal Aorta

Parietal Branches

Answer 8

• aa lumbales
• a phrenic inf
• median sacral

Question 9

Coeliac Trunk

T12 level

Answer 9

• splenic:
• left gastroepiloic
• panceatic branches
• short gastric arteries (to fundus)
• common hepatic:
• proper hepatic, left and right hepatic, cystic from right
• right gastric
• gastroduodenal; right gastroepiploic and pancreaticoduodenalis sup
• left gastric

Question 10

Superior Mesenteric Artery

L2

Answer 10

• pancreaticoduodenalis inf
• jejunalis et ilei
• iliocolica - appendicularis
• colica dextra
• colica media

Question 11

Inferior Mesenteric Artery

L3

Answer 11

• colica sinsistra
• sigmoidei
• rectalis sup

Question 12

Inetrnal Iliac

Visceral Branches

Answer 12

• umbilicales - vesicales sup
• vesicales inf
• rectalis media
• pudenda interna - uterina - vaginalis, tubarius, ovaricus
• ductus deferens

Question 13

Internal Iliac

Parietal Branches

Answer 13

1. iliolumbar
2. sacralis lateralis
3. gluteal (sup et inf)
4. pudenda interna (both parietal and visceral)
5. obturator

Question 14

IMA Anastamoses

Answer 14

There are two major anastamoses of the IMA, both involving a union with branches of thesuperior mesenteric artery:

Marginal artery (of Drummond) – forms a continuous arterial circle along the inner border of the colon. Straight vessels (vasa recta) arise from the artery to supply the colon. It is formed by the union of several branches; the ileocolic, right colic and middle colic of the SMA and left colic and sigmoid branches of the IMA.

Arc of Riolan – anastamosis between the middle colic branch of SMA and the left colic branch of IMA. It is less common than the marginal artery, and indeed its existence has been questioned by some surgeons.

Question 15

External Iliac

Answer 15

The common iliac artery bifurcates into the internal iliac artery and external iliac artery at the level of the pelvic brim anterior to the sacroiliac joint.

The external iliac artery courses medially along the iliopsoas muscle . After it enters the thigh under the inguinal ligament, it changes name and continues as the femoral artery, supplying the lower limb.

Branches

inferior epigastric artery
deep circumflex iliac artery

Question 16

Femoral Artery

Answer 16

The main artery of the lower limb is femoral artery. It is a continuation of the external iliac artery (terminal branch of the abdominal aorta). The external iliac becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle.

In the femoral triangle, the profunda femoris artery arises from the posterolateral aspect of the femoral artery. It travels posteriorly and distally, giving off three main branches:

Perforating branches – Consists of three or four arteries that perforate the adductor magnus, contributing to the supply of the muscles in the medial and posterior thigh.

Lateral femoral circumflex artery – Wraps round the anterior, lateral side of the femur, supplying some of the muscles in the lateral side of the thigh.

Medial femoral circumflex artery – Wraps round the posterior side of the femur, supplying the neck and head of the femur. In a fracture of the femoral neck, this artery can easily be damaged, and avascular necrosis of the femur head can occur.

Question 17

Obturator Artery

Answer 17

The obturator artery arises from internal iliac artery in the pelvic region. It descends via the obturator canal to enter the medial thigh, bifurcating into two branches:

Anterior branch – This supplies the pectineus, obturator externus, adductor muscles and gracilis.

Posterior branch – This supplies some of the deep gluteal muscles.

Question 18

Gluteal Arteries

Answer 18

The gluteal region is largely supplied by the superior and inferior gluteal arteries. These arteries also arise from the internal iliac artery, entering the gluteal region via the greater sciatic foramen.

The superior gluteal artery leaves the foramen above the piriformis muscle, the inferior below the muscle. In addition to the gluteal muscles, the inferior gluteal artery also contributes towards the vasculature of the posterior thigh.

Question 19

Popliteal Artery

Answer 19

The popliteal artery descends down the posterior thigh, giving off genicular branches that supply the knee joint. It moves through the popliteal fossa, exiting sandwiched between the gastrocnemius and popliteus muscles. At the lower border of thepopliteus, the popliteal artery terminates by dividing into anterior and posterior tibial arteries.

The branches of the popliteal artery are:

anterior tibial artery
posterior tibial artery
sural artery
medial superior genicular artery
lateral superior genicular artery
middle genicular artery
lateral inferior genicular artery
medial inferior genicular artery

Question 20

Posterior Tibial Artery

Answer 20

The posterior tibial artery continues inferiorly, along the surface of the deep muscles (such as tibialis posterior). It accompanies the tibial nerve in entering the sole of the foot via the tarsal tunnel. During the descent of the posterior tibial artery in the leg, the fibular artery arises. This artery moves laterally, penetrating the lateral compartment of the leg. It supplies muscles in the lateral compartment, and adjacent muscles in the posterior compartment.

Question 21

Anterior Tibial Artery

Answer 21

The other division of the popliteal artery, the anterior tibial artery, passes anteriorly between the tibia and fibula, through a gap in the interosseous membrane. It then moves inferiorly down the leg. It runs down the entire length of the leg, and into the foot, where it becomes the dorsalis pedis artery.

Question 22

Arteries in the Foot

Answer 22

Arterial supply to the foot is delivered via two arteries:

Dorsalis pedis (a continuation of the anterior tibial artery)
Posterior tibial

The dorsalis pedis artery begins as the anterior tibial artery enters the foot. It passes over thedorsal aspect of the tarsal bones, then moves inferiorly, towards the sole of the foot. It thenanastamoses with the lateral plantar artery to form the deep plantar arch. The dorsalis pedis artery supplies the tarsal bones and the dorsal aspect of the metatarsals. Via the deep plantar arch, it also contributes to the supply of the toes.

The posterior tibial artery enters the sole of the foot through the tarsal tunnel. It then splits into the lateral and medial plantar arteries. These arteries supply the plantar side of the foot, and contributes to the supply of the toes via the deep plantar arch.

Question 23

Branches of Pudenda Interna

Answer 23

1. inf rectal
2. perineal
3. posterior labial/scrotal
4. bulb of vestibule/penis
5. dorsal artery of clitoris/penis
6. deep artery of clitoris/penis

Question 24

Veins Superior to Heart

Answer 24

• empty into SVC
  
  • azygous (from below)
  • brachiocephalic
    
    • internal jugular
    • vertebral
    • external jugular
    • subclavian
    • axillary
    • cephalic
    • brachial

Question 25

Veins of the Thorax

Answer 25

* superior vena cava * located in anterior right mediastinum * formed by left and right brachiocephalic veins * brachiocephalic veins * internal thoracic vein * drains chest wall and breasts * arises bilaterally from sup epigastriv vein * terminates in brachiocephalic trunk * inferior thyroid vein * arises in venous plexus on thyroid gland * joins middle and superior thyroid veins

Question 26

Fetal Development of Heart

Answer 26

* from week 3 to 5 * endocardial tube develops from vascular plexus in cardiogenic mesoderm * horse shoe shaped * gaps around pericardial tube merge to form pericardial cavity with connections to general body cavity * inner layer of peri cavity forms myocardium * epicardium develops from cells which migrate from septum transversum and the liver primodium * lateral crus of endocardial tube fuse to form cardiac tube - starts contraction after 3rd week * cardiac tube comprises a paired atrium with sinus venosus collecting incoming blood, one ventricle, and the conus arteriosus as an outflow segment * during weeks 4 to 5 * cardiac tube develops its s-shaped heart loop * from weeks 5 to 7 * interventricular septum develops (pars muscularis) * conus arteriosus and saccus aorticus form pulmonary trunc and aorta * from 6 aortic arches, 3rd, 4th and 6th contribute to the development of: * common carotid (3) * subclavian and aortic arch (4) * proximal R and L pulmonary arteries and ductus arteriosus (6)

Question 27

Pericardium

Answer 27

* surrounds heart * allows for contraction without friction * layers: * pericardium fibrosum: outer layer, dense CT * pericardium serosum * at posterior side of atria, the reflection of the epicardium and the parietal layer forms a vertical fold between the IVC and SVC and a horizontal fold between uper pulmonary veins. These folds create sinuses: * sinus transversus pericardi * sinus obliquous pericardi * pericardium fibrosi is connected to: * centrum tendineum of diaphragm * post aspect of sternum * tracheal bifurcation * epicardium: visceral layer of pericardium serosum

Question 28

Fibrous Skeleton

Answer 28

annuli fibrosi trigonum fibrosum septum memranacum functions to: provide cardiac insulation and provide attachment points for pappillary muscles and indifferent muscles

Question 29

Portal Vein

Answer 29

* vein that drains blood from abdominal part of GI, from the lower part of the oesophagus to halfway down the anal canal.. including spleen, pancreas, gall bladder * formed by the union of sup mesenteric vein and splenic vein, behind the neck of the pancreas * ascends to the right behind the first part of the duodenum and enters the free margin of the lesser omentum * entering through porta hepatis, it divides into left and righr branches which further branch up in the sinusoids * blood from sinusoids is collected by hepatic veins that form the vena cava inferior * anastamoses: * at lower third of oesohagus * halfway down anal canal * tributaries of portal vein: * splenic and superior mesenteric * left gastric * right gastric and cystic

Question 30

Veins of the Lower Limb

Answer 30

* common iliac vein (internal and external iliac) * below the inguinal ligament, external iliac vein becomes femoral vein * The GSV originates from where the dorsal vein of the first digit (the large toe) merges with the dorsal venous arch of the foot. After passing anterior to the medial malleolus (where it often can be visualized and palpated), it runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone. The great saphenous vein then courses anteriorly to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening. It forms an arch, the saphenous arch, to join the common femoral vein in the region of the femoral triangle at the sapheno-femoral junction * saphenous nerve runs with large saphenous vein * small saphenous vein runs with sural nerve * At the ankle it receives branches from the sole of the foot through the medial marginal vein; in the lower leg it anastomoses freely with the small saphenous vein, communicates by perforator veins (Cockett perforators) with the anterior and posterior tibial veins and receives many cutaneous veins; near the knee it communicates with the popliteal vein by the Boyd perforator, in the thigh it communicates with the femoral vein by perforator veins (Dodd perforator) and receives numerous tributaries; those from the medial and posterior parts of the thigh frequently unite to form a large accessory saphenous vein which joins the main vein near the sapheno-femoral junction.[2] Near the fossa ovalis it is joined by the superficial epigastric, superficial iliac circumflex, and superficial external pudendal veins. The thoracoepigastric vein runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral vein and the axillary vein.

Question 31

Veins of the Arm

Answer 31

* superficial: * basilic and cephalic, vena mediana cubiti * deep: * subclavian gives branches: * thoracoepigastric * axillary: * brachial * radial and ulnar * interosseus

Question 32

Porto Caval Anastamoses

Answer 32

I. esophageal (→esophageal varices) II. paraumbilical III. rectal (→hemaerrhoids) IV. retroperitoneal

Question 33

Cavo Caval Anastamoses

Answer 33

The thoracoepigastric vein runs along the lateral aspect of the trunk between the superficial epigastric vein below and the lateral thoracic vein above and establishes an important communication between the femoral vein and axillary vein. This is an especially important vein when the inferior vena cava (IVC) becomes obstructed, by providing a means of collateral venous return. It creates a cavocaval anastomosis by connecting with superficial epigastric veins arising from femoral vein just below inguinal ligament.

Question 34

Fetal Circulation

Answer 34

The fetal circulatory system includes three shunts to divert blood from undeveloped and partially functioning organs, as well as blood supply to and from the placenta.

Question 35

Radial Arteries

Answer 35

* forearm: * radial recurrant * palmar carpal * superficial palmar branch * wrist: * dorsal carpal * first dorsal metacarpal artery * hand: * princeps pollicis * radialis indicis * deep palmar arch

Question 36

Ulnar Artery

Answer 36

* anterior ulnar recurrant * posterior ulnar recurrant * common interosseous * muscular * volar carpal * dorsal carpal * deep volar * superficial volar arch