PVS

  1. Major Arteries:

    • Aorta: The largest artery, carries oxygenated blood from the left ventricle to the body.

      • Ascending Aorta: Extends from the left ventricle.

      • Aortic Arch: Curves and gives rise to the brachiocephalic trunk, left common carotid artery, and left subclavian artery.

      • Descending Aorta: Divided into thoracic and abdominal aorta.

    • Coronary Arteries: Supply blood to the heart muscle.

    • Carotid Arteries: Supply blood to the head and neck.

    • Subclavian Arteries: Supply blood to the arms.

    • Femoral Artery: Supplies blood to the thigh and leg.

    • Popliteal Artery: Located behind the knee.

    • Tibial Arteries: Supply blood to the lower leg and foot.

  2. Major Veins:

    • Superior Vena Cava: Drains deoxygenated blood from the upper body into the right atrium.

    • Inferior Vena Cava: Drains deoxygenated blood from the lower body into the right atrium.

    • Jugular Veins: Drain blood from the head and neck.

    • Subclavian Veins: Drain blood from the arms.

    • Femoral Vein: Drains blood from the thigh.

    • Popliteal Vein: Drains blood from the knee area.

    • Tibial Veins: Drain blood from the lower legs.

Venous Flow Physiology

  • Venous Flow: Blood flows back to the heart through veins, assisted by:

    • Muscle Pump: Contraction of skeletal muscles (e.g., in the legs) compresses veins and helps move blood toward the heart.

    • Valves: Prevent backflow and ensure unidirectional flow.

    • Respiratory Pump: Changes in thoracic pressure during breathing help draw blood back to the heart.

Medical Terminology

  • Ischemia: Reduced blood flow to a tissue, leading to a deficiency in oxygen and nutrients needed for cellular metabolism.

  • Pre-Tibial Edema: Swelling in the lower legs, just above the ankles, often due to fluid accumulation.

  • Pitting Edema: Swelling that retains an indentation after pressure is applied. The severity is rated as follows:

    • 1+: Slight indentation, disappears rapidly.

    • 2+: Deeper indentation, disappears in 10-15 seconds.

    • 3+: Noticeable swelling, lasts more than a minute.

    • 4+: Severe swelling, lasts 2-5 minutes.

  • Varicose Veins: Enlarged, twisted veins often caused by:

    • Valve Failure: Insufficient valve function leading to blood pooling.

    • Increased Venous Pressure: Due to prolonged standing or pregnancy.

Arterial Pulses

  • Rating Pulses:

    • 0: Absent

    • 1+: Weak

    • 2+: Normal

    • 3+: Strong

    • 4+: Bounding

  • Locations:

    • Carotid: Neck

    • Brachial: Inner elbow

    • Radial: Wrist

    • Femoral: Groin

    • Popliteal: Behind the knee

    • Dorsalis Pedis: Top of the foot

    • Posterior Tibial: Ankle area

Assessing Circulation for Arterial Insufficiency

  • The 5 Ps: Key signs of arterial insufficiency:

    • Pain: Often described as cramping or aching.

    • Pallor: Pale skin, especially in elevated positions.

    • Pulselessness: Weak or absent pulses.

    • Paralysis: Weakness or inability to move the affected limb.

    • Paresthesia: Numbness or tingling.

  • Difference Between Arterial & Venous Insufficiency:

    • Arterial Insufficiency: Often leads to ischemia and ulceration on toes or feet, skin may appear pale, cool, and dry.

    • Venous Insufficiency: Causes pooling of blood, resulting in skin changes like brownish discoloration, swelling, and often ulceration around the ankles.

Venous vs. Arterial Ulcers

  • Venous Stasis Ulcer:

    • Location: Typically around the ankles.

    • Appearance: Irregular edges, shallow, and often surrounded by edema and pigmentation changes.

    • Symptoms: Aching or heaviness in the legs.

  • Arterial Ulcer:

    • Location: Often on toes, heels, or pressure points.

    • Appearance: Well-defined edges, deep, and often with a pale or necrotic base.

    • Symptoms: Severe pain, especially with elevation.

Deep Vein Thrombosis (DVT)

  • Assessment:

    • Signs/Symptoms: Swelling, pain, redness, and warmth in the affected leg. Sometimes no symptoms are present.

    • DVT Scoring: Use tools like the Wells score to assess risk.

  • Risks: Include prolonged immobility, surgery, trauma, and conditions like cancer or pregnancy.

Ankle-Brachial Index (ABI)

  • Definition: A test comparing blood pressure in the ankle with blood pressure in the arm. A reduced ABI indicates possible arterial insufficiency. Specific numbers are not required to memorize but understanding the concept is essential.

Lymphatic System

  1. Lymphatic Ducts:

    • Thoracic Duct: Drains lymph from the lower body and left side of the upper body into the left subclavian vein.

    • Right Lymphatic Duct: Drains lymph from the right side of the upper body into the right subclavian vein.

  2. Related Organs:

    • Spleen: Filters blood and helps fight infections.

    • Thymus: Develops T-cells critical for the immune response.

    • Bone Marrow: Produces blood cells, including lymphocytes.

  3. Lymphedema:

    • Definition: Swelling due to lymphatic obstruction or damage, often resulting in fluid accumulation in the tissues.

Lymph Nodes of the Lower Body

  • Inguinal Nodes: Located in the groin area; drain the lower limbs and pelvis.

  • Axillary Nodes: Located in the armpit; drain the upper limbs, chest, and parts of the back.

  • Epitrochlear Nodes: Located above the elbow; drain parts of the forearm and hand.