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Questions and Answers
A patient presents with a compromised blood supply to the gluteal region following a traumatic injury. Which arterial branch, originating from the internal iliac artery, is MOST likely affected, leading to this condition?
A patient presents with a compromised blood supply to the gluteal region following a traumatic injury. Which arterial branch, originating from the internal iliac artery, is MOST likely affected, leading to this condition?
- Inferior vesical artery
- Obturator artery
- Superior gluteal artery (correct)
- Middle rectal artery
A surgeon is planning a complex pelvic surgery and needs to understand the potential impact of ligating the internal iliac artery. Ligation of the internal iliac artery would LEAST directly affect blood flow to which of the following regions or structures, assuming adequate collateral circulation?
A surgeon is planning a complex pelvic surgery and needs to understand the potential impact of ligating the internal iliac artery. Ligation of the internal iliac artery would LEAST directly affect blood flow to which of the following regions or structures, assuming adequate collateral circulation?
- The bladder
- The rectum
- The lower limb via the femoral artery (correct)
- The uterus
During a fetal ultrasound, a cardiologist observes abnormal blood flow patterns. Which alteration in fetal circulation would be MOST concerning, indicating a failure of normal circulatory transition after birth?
During a fetal ultrasound, a cardiologist observes abnormal blood flow patterns. Which alteration in fetal circulation would be MOST concerning, indicating a failure of normal circulatory transition after birth?
- Closure of the ductus venosus
- Closure of the umbilical arteries and vein
- Patency of the foramen ovale with left-to-right shunting
- Patency of the ductus arteriosus with right-to-left shunting (correct)
A researcher is studying the development of the aortic arch and its derivatives. Failure of the fourth aortic arch to properly develop on the left side would MOST directly affect the formation of which adult structure?
A researcher is studying the development of the aortic arch and its derivatives. Failure of the fourth aortic arch to properly develop on the left side would MOST directly affect the formation of which adult structure?
A 2-day-old neonate presents with cyanosis. Echocardiography reveals blood flowing from the pulmonary artery to the aorta. Which fetal structure failed to close?
A 2-day-old neonate presents with cyanosis. Echocardiography reveals blood flowing from the pulmonary artery to the aorta. Which fetal structure failed to close?
A patient presents with ischemia in the anterior compartment of the leg. Which artery is MOST likely compromised?
A patient presents with ischemia in the anterior compartment of the leg. Which artery is MOST likely compromised?
Following a traumatic injury to the gluteal region, a patient exhibits impaired hip abduction and thigh external rotation. Damage to branches of which artery is MOST likely contributing to these functional deficits?
Following a traumatic injury to the gluteal region, a patient exhibits impaired hip abduction and thigh external rotation. Damage to branches of which artery is MOST likely contributing to these functional deficits?
A surgeon needs to ligate a major artery in the thigh to control bleeding. If they ligate the profunda femoris artery, what is the MOST likely consequence given the collateral circulation in the lower limb?
A surgeon needs to ligate a major artery in the thigh to control bleeding. If they ligate the profunda femoris artery, what is the MOST likely consequence given the collateral circulation in the lower limb?
A patient is diagnosed with deep vein thrombosis in the lower limb. If a thrombus (blood clot) dislodges from the popliteal vein, through which vessel will it MOST likely travel next as it moves towards the heart?
A patient is diagnosed with deep vein thrombosis in the lower limb. If a thrombus (blood clot) dislodges from the popliteal vein, through which vessel will it MOST likely travel next as it moves towards the heart?
A patient has a compromised great saphenous vein and requires an alternative route for venous drainage. Which of the following veins could potentially serve as a collateral pathway to maintain venous return from the lower limb?
A patient has a compromised great saphenous vein and requires an alternative route for venous drainage. Which of the following veins could potentially serve as a collateral pathway to maintain venous return from the lower limb?
Following a traumatic injury that compromises the subscapular artery, which arterial anastomosis is MOST critical for maintaining blood supply to the scapular region?
Following a traumatic injury that compromises the subscapular artery, which arterial anastomosis is MOST critical for maintaining blood supply to the scapular region?
A patient with severe peripheral artery disease experiences complete occlusion of the popliteal artery. Which set of genicular arteries would be MOST crucial in providing collateral circulation to maintain blood supply to the lower leg?
A patient with severe peripheral artery disease experiences complete occlusion of the popliteal artery. Which set of genicular arteries would be MOST crucial in providing collateral circulation to maintain blood supply to the lower leg?
During a complex surgical procedure involving the pelvic region, the external iliac artery requires temporary ligation. Which arterial network provides the MOST significant collateral circulation to bypass the ligation and maintain perfusion to the lower limb?
During a complex surgical procedure involving the pelvic region, the external iliac artery requires temporary ligation. Which arterial network provides the MOST significant collateral circulation to bypass the ligation and maintain perfusion to the lower limb?
In the context of coronary circulation, what is the MOST critical role of anastomoses between the anterior interventricular and posterior interventricular arteries?
In the context of coronary circulation, what is the MOST critical role of anastomoses between the anterior interventricular and posterior interventricular arteries?
A patient with cirrhosis develops portal hypertension. Which of the following portosystemic anastomoses is MOST likely to contribute to the formation of esophageal varices?
A patient with cirrhosis develops portal hypertension. Which of the following portosystemic anastomoses is MOST likely to contribute to the formation of esophageal varices?
A patient presents with a suspected occlusion in the inferior vena cava. Which venous anastomosis is MOST likely to provide an alternative route for venous return to the heart?
A patient presents with a suspected occlusion in the inferior vena cava. Which venous anastomosis is MOST likely to provide an alternative route for venous return to the heart?
In a patient with portal hypertension, which portosystemic anastomosis is MOST directly responsible for the development of caput medusae?
In a patient with portal hypertension, which portosystemic anastomosis is MOST directly responsible for the development of caput medusae?
A patient presents with rectal varices secondary to portal hypertension. Which portosystemic anastomosis is MOST directly involved in the formation of these varices?
A patient presents with rectal varices secondary to portal hypertension. Which portosystemic anastomosis is MOST directly involved in the formation of these varices?
Following a traumatic injury, a patient experiences a blockage in the superior mesenteric artery (SMA). Which anastomotic network would be MOST crucial in maintaining perfusion to the intestines?
Following a traumatic injury, a patient experiences a blockage in the superior mesenteric artery (SMA). Which anastomotic network would be MOST crucial in maintaining perfusion to the intestines?
In a patient undergoing a complex abdominal surgery, the surgeon identifies an area where the superficial epigastric vein is unusually engorged. This finding MOST likely suggests an underlying issue with which of the following?
In a patient undergoing a complex abdominal surgery, the surgeon identifies an area where the superficial epigastric vein is unusually engorged. This finding MOST likely suggests an underlying issue with which of the following?
In a patient with significant atherosclerosis affecting the celiac trunk, which anastomoses would be MOST important in ensuring continued perfusion to the pancreas and duodenum?
In a patient with significant atherosclerosis affecting the celiac trunk, which anastomoses would be MOST important in ensuring continued perfusion to the pancreas and duodenum?
A surgeon is planning a complex shoulder reconstruction. Understanding vascular anastomoses is crucial to avoid compromising blood supply. Which anastomosis is MOST relevant to consider during this procedure?
A surgeon is planning a complex shoulder reconstruction. Understanding vascular anastomoses is crucial to avoid compromising blood supply. Which anastomosis is MOST relevant to consider during this procedure?
A patient is diagnosed with a slow-growing occlusion of the left anterior cerebral artery. Which anatomical feature will MOST likely play a crucial role in maintaining adequate blood flow to the affected areas of the brain?
A patient is diagnosed with a slow-growing occlusion of the left anterior cerebral artery. Which anatomical feature will MOST likely play a crucial role in maintaining adequate blood flow to the affected areas of the brain?
A patient with a history of cardiovascular disease develops a thrombus in a branch of the superior mesenteric artery. What is the MOST likely consequence if the anastomotic connections are insufficient?
A patient with a history of cardiovascular disease develops a thrombus in a branch of the superior mesenteric artery. What is the MOST likely consequence if the anastomotic connections are insufficient?
In the context of coronary artery disease, if the anastomoses between the septal branches of the RCA and LCA within the interventricular septum are poorly developed, what is the MOST probable outcome following a significant blockage in one of these arteries?
In the context of coronary artery disease, if the anastomoses between the septal branches of the RCA and LCA within the interventricular septum are poorly developed, what is the MOST probable outcome following a significant blockage in one of these arteries?
Flashcards
Common Iliac Vessels
Common Iliac Vessels
The aorta and IVC divide into the common iliac arteries and veins.
Internal Iliac Artery Supply
Internal Iliac Artery Supply
The internal iliac supplies pelvic organs, perineum, gluteal region, thigh, and also the fetus/placenta.
External Iliac to Femoral
External Iliac to Femoral
The external iliac exits the pelvis via the inguinal canal and becomes the femoral artery/vein.
Internal Iliac Trunks
Internal Iliac Trunks
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Vascular Anastomoses
Vascular Anastomoses
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External iliac artery
External iliac artery
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Profunda femoris artery
Profunda femoris artery
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Popliteal artery
Popliteal artery
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Posterior tibial artery
Posterior tibial artery
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Great saphenous vein
Great saphenous vein
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Dorsal Venous Arch
Dorsal Venous Arch
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Coronary Anastomoses
Coronary Anastomoses
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Cerebral Anastomoses (Circle of Willis)
Cerebral Anastomoses (Circle of Willis)
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Azygos System Anastomosis
Azygos System Anastomosis
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Celiac Trunk & SMA Anastomoses
Celiac Trunk & SMA Anastomoses
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SMA & IMA Anastomoses
SMA & IMA Anastomoses
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Upper Limb Anastomoses
Upper Limb Anastomoses
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Circumflex Scapular Artery
Circumflex Scapular Artery
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Genicular Anastomosis
Genicular Anastomosis
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Occlusion
Occlusion
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Surgical Ligation
Surgical Ligation
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Portosystemic Anastomoses
Portosystemic Anastomoses
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Varices
Varices
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Portal Hypertension
Portal Hypertension
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Study Notes
- The lecture covers blood vessels of the pelvis and lower limb, including anastomoses, and development.
- The cardiovascular learning objective is to recall structures for gas and nutrient exchange by tracing blood flow.
Pelvis and Lower Limb Lecture Learning Objectives:
- Identify arteries/veins of the pelvic cavity, noting what they supply/drain.
- Recall major vascular anastomoses, vessels involved, and clinical importance.
- Diagram development of aortic arches, linking adult derivatives of each arch.
- Describe the flow of fetal circulation.
- Explain fetal and neonate circulation variations, addressing foramen ovale, ductus arteriosus, ductus venosus, and umbilical vessels.
Blood Vessels in the Pelvis
- The Aorta and IVC split into the common iliac, which splits into the internal and external iliac.
- Arteries are more superficial than veins.
- External iliac exits pelvis through the inguinal canal, created by the inguinal ligament and surrounding structures, to become femoral a/v.
- Anterior trunk of the internal iliac serves pelvic organs, perineum, gluteal region, thigh, and the fetus/placenta
- Posterior trunk of the internal iliac serves the lower posterior abdominal wall, posterior pelvic wall, and gluteal region
Blood Vessel in the Lower Limb
- Branches of the external iliac include the profunda femoris/deep femoral (with circumflex and perforating arteries), femoral, popliteal, posterior tibial, fibular, and anterior tibial.
- Veins exist in pairs with shared names.
- Superficial veins are unpaired overall.
- The femoral circumflex aa. hug the proximal shaft of the femur.
- Profunda femoris hugs the lateral side and helps wrap around the posterior knee.
- The order of structures from lateral to medial near the femoral triangle in the thigh: Nerve, Artery, Vein, Lymph Node, of the femoral structures
Vascular Anastomoses
- Septal arteries provide blood to interventricular septum
Coronary Anastomoses
- Involve branches of anterior and posterior interventricular arteries on the heart's inferior aspect.
- Connections occur between the RCA, left circumflex artery (in the coronary sulcus), and septal branches of both RCA and LCA within the interventricular septum.
- Vascular anastomoses have limited but present circulatory pathways.
Cerebral Anastomoses
- Vessels: anterior communicating artery, anterior cerebral arteries, posterior communicating arteries, and posterior cerebral arteries
- Located in the circle of Willis
- Maintains blood supply to the brain during occlusions or strokes.
Azygos System Anastomoses
- Vessels: azygos vein, hemiazygos vein, and accessory hemiazygos vein.
- The azygos system can return venous blood from the lower body to the heart if the inferior vena cava is blocked.
Abdominal Anastomoses
- Celiac Trunk Anastomoses: The pancreaticoduodenal arteries meet with the celiac axis and SMA, supplying the pancreas and duodenum.
- SMA Anastomoses: Anastomose at the marginal artery of Drummond and the arc of Riolan.
- Blockages in the SMA Anastomoses: Are a Common site for thromboses; Ensure intestines perfusion.
Upper Limb Anastomoses
- The Suprascapular is an alternate route through the thyrocervical trunk
- At the shoulder, anastomoses occur between suprascapular and subscapular arteries (via circumflex scapular artery).
- Anastomoses also connect the suprascapular to the dorsal scapular artery and connect the anterior to posterior humeral circumflex arteries.
- These are essential to maintain blood supply during traumatic vascular injuries or limb ischemia
Lower Limb Artery Anastomoses
- At the knee: genicular anastomoses involving the femoral, popliteal, and geniculate arteries protect the knee and lower limb.
- Essential to maintain blood supply during traumatic vascular injuries or limb ischemia.
- Anastomoses of the internal iliac artery meets with the external iliac and deep circumflex iliac.
- These could be valuable when dealing with traumatic pelvic injuries, where circulation must be maintained.
Hepatic Portal System/ Portacaval Anastomoses
- Happen between the portal and systemic venous systems, specifically in the IVC such as the Esophageal connections.
- Connections include in this case:
- Left gastric vein, connecting with esophageal veins and azygos vein
- Right hepatic vein and paraumbilical veins.
- Those connect with the superficial epigastric connecting to inferior thoracic and subclavian v.
- Superior rectal vein, connecting with middle and inferior veins via internal iliac vein and Superior and inferior mesenteric, splenic veins connecting with various retroperitoneal veins,
- Superficial epigastric and inferior vena cava
Pharyngeal Arch Arteries
- Pharyngeal arch arteries consist of pharyngeal arches and the aortic sacs, 3rd, 4th and 6th pharyngeal arch arteries
- Arches 1, 2, 3, 4, 5, 6 with 4th continuing as aorta
- Pulomanary arteries are derived from one of the 2 branches from the heart
Aortic Arches:
- The 3rd arch is formed from common carotids with internal carotids and common carotid, where external carotid forms as outgrowth
- The Left 4th arch is formed from the aortic arch/descending aorta. plus left subclavian forms as 7th intersegmental artery
- The right Arch: as the Right subclavian, brachiocephalic trunk forms from ventral aorta connecting right subclavian and common carotid
- The 6th Left Arch: Portion of the Left Pulmonary arteries
- Ligamentum arteriosum: pulmonary trunk forms fromaortic sac -Right 6th division: the Right Pulmonary arteries
Fetal and Neonatal Systems
- Fetal System: designed for prenatal needs.
- Fetal lungs do not provide pulmonary exchange, resulting in it being vasoconstricted
- Post birth: system has to modify its process to serve the babies needs
Fetal Circulation
- Umbilical veins carry high-oxygen blood from placenta to fetus.
- Flows through the ductus venosus connection from IVC, flows from blood from the vein mixes oxygenates blood IVC with systemic cicrulation
- Blood receives from IVC (fetal systemic circulation)
- Receives blood from the liver, which then enters the right atria
After Entering Right Atrium
- Most bypasses system due to lung constriction, or skips the way via Right atrium→ foramen ovale→ left atria → left ventricle → aorta
- Foramen ovale- is still raised, from right atrio, it pushes to the septal circulation Small amounts of from atrial blood flow through goes toward the - Pulmonary circulation
- Goes to right ventricle→ pulmonary trunk→ lungs
- Aorta via ductus arteriosus Final Step: Blood in aorta enters fetal systemic circulation through the lower part of the system
- Blood returns to the heart, or returns to the placenta which requires oxygen translated to "to pressure in 100. heart.
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