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Which arteries, superficial or deep, are more important for perfusion in the arms?
Which artieries, superficial or deep, are more important for perfusion in the legs?
What is VSM?
- Vascular Smooth Muscle
- Constricts (dialates) to pump blood through arteries.
- Creates palpable pressure wave.
Where is the Popliteal artery?
- Behind knee cap
- When femoral artery courses posteriorly.
Where is the Dorsa pedis artery
Dorsum (top) of foot, behind great toe lateral to extensor tendon.
Where is the Posterior tibial artery?
- Travels down behind medial malleolus (behind inner ankle).
- Palpate behind medial malleolus.
What are perforator veins?
Connecting veins that join superficial to deep. Have one way valves to rout blood from superficial into deep.
Types of venous blood flow
1) Skeletal muscles: Contraction of muscles forces blood toward heart, ie gastrocnemius and soleus muscles.
2)Inspiration: Inhale/exhale--> pressure gradient. Decreases pressure in thoracic cavity while increasing pressure in abdomen. "Sucks" blood back towards chest.
3)Intraluminal valves- Valves which seal off after diastolic contraction. Keeps blood from returning to lower parts of body and pooling. At risk if prolonged sitting, standing, bed rest
What are Incompetent valves
- Lumens of veins are so wide valve cusps cannot approximate (close).
- At risk with Dilated and tortuous (varicose) veins.
Where do lymphatic ducts empty?
- Right--> Right subclavian vein.
- Drains rt side of head, neck, rt arm, rt side of thorax, rt lung and pleura, rt side of hear, and rt upper section of liver.
- Thoracic--> Left subclavian vein.
- Drains rest of body.
Functions of lymphatic system?
- 1)Conserve fluid and plasma protiens
- 3)Absorb lipids from intestinal tract
What is the thymus and where is it?
- Flat, pink-grey which produces T-lymphocytes in children, but has no function in adults
- Located superior mediastinum behind sternum in front of aorta.
What are DVT and PE
- Deep Vein Thrombosis- Blood clot in deep vein
- Pulminary Embolism-Blockage of artery of the lung.
How is blood amplitude graded and what is normal?
- 1+ thru 4+
- 1+ = very weak pulse
- 4+ = pounding (bounding) pulse.
2+ = normal.
What is the Modified Allen Test?
- Used to test perfusion to palm and fingers for canalization of radial artery.
What is CRT?
- Capillary Refill Time
- 3+ sec think hyperkinetic state (exercise, anxiety, fever), anemia, hyperthyrodisim
Where is the epitrochliar lymph node?
- In depression above and behind medial condyle of humerus.
- Not normally palpable. If so possible nfxn distal to lymph site.
What is Homn's Sign?
- Flex person's knee, then gently compress the calf muscle anteriorly again. Normal = no pain.
- If pain then 35% DVT
What is the Manual Compression Test?
Test to see if varicose vein valves are competent. Compress same vein at an upper and lower locations. Release the upper. Normal = no sensation of movement at distal. If movement felt, blood is returning and valves are incompetent.
How do you test for arteriol deficit?
Raise legs 30cm and wag feet to drain off venous blood. Elevated palor indicates arteriol deficit (low 02) because blood is not perfusing to feet to maintain color.
Pt then sits at side of bed to return venous blood. Note time to return color. Normal <10 seconds, ~15 sec for superficial veins to fill. Not reliable if pt has incompetent semiluminal valves because blood return will be venous, not arteriol.
Dependent rubor (redness): Occurs with severe arterial insufficiency. Chronic hypoxia produces loss of vasomotor tone and pooling of blood in veins-->motor and sensory loss. (Diabetes) Delayed venous filing occurs with arterial insufficiency.
Skin will also be thin, shiney, and possibly hairless. Carelful palpating--may easily tear.
What are some variations in arterial pulse?
Weak thready pulse (1+): Decreased CO, possible PAD (Periferal Artery Disease)
Full bounding pulse (3+): Hyperkinetic states (anxiety, exercise, fever), anemia hyperthyroidism.
Water-Hammer (Corrigan) (3+): Aortic valve regurgitation, patent ductus arteriosus.
Pulses Bigeminus: Conduction distrubance (premature ventricular contraction, premature arterial contraction)
Pulsus Alternans: When HR normal, but "hickups." Occurs with severe lt ventricular railure.
Pulses Bisferiens: Aortic valve stenosis + regurgitation.
What is lymphedema and what can cause it?
Pooling of fluid in tissue due to removal or failure of lymph glands.
Signs of peripheral vascular disease in legs
Arteriosclerosis--> Ischemic ulcer: Well definied, usually on toes or heal or anywhere friction/repetative motion can occur.
Veous (stasis) ulcer: Caused by venous blood pooling. Not well defined, usually below the patella along medial tibia.
Occlusions/Aneurysms of Peripheral Arteries
Occlusion: caused by atherosclerosis/arteriosclerosis--> thrombus formation. Reduces BF (blood flow) with vital O2 and nutrients.
Aneurysm: Sack formed by dilation in artery wall. Atherosclerosis-->weakening of mid layer of vessel wall--> stretching inner and outer layers. Most common site is aorta, most common cause is atherosclerosis.