Pelvic

Common iliac external & internal iliac artery external to femoral artery
internal to soft tissues of pelvic (bladder)

renal arteries are end arteries, no anastomoses if blocked kidney failure
femoral vein in front of femoral artery

Upper Limb
subclavian artery axillary artery brachial artery

Lower Limb
femoral triangle: floor formed (medial to lateral) by pectineus, psoas, illiacus
Sartorius
adductor longus

femoral artery surface markings draw line
femoral artery palpable at midpoint of inguinal ligament
femoral artery divide into deep & superficial femoral

Avascular necrosis (AVN) of the femoral head is a pathologic process that results
from interruption of blood supply to the bone. Femoral head ischemia results in
the death of marrow and osteocytes and usually results in the collapse of the
necrotic segment. from dislocation/ fracture of femur

3 blood supply to head of femur:
obturator artery to fovea
medial femoral circumflex artery
artery of ligamentum teres



if femoral artery supply cut off by trauma, still has blood supply to leg due to
collateral dilatation
to see if femoral artery blood supply cut off, check by raising up leg, blood flows
back to thigh, blood at thigh not strong enough to flow to leg avascular necrosis
repair femoral artery by using saphenous vein - graft

femoral artery posterior popliteal fossa popliteal artery anterior tibial
artery

fractured head of femur soleus (strong internal adductor) lose fulcrum, cause
leg to be externally rotated
repaired by intramedullary nail fixation


Thorax
carina at 5
th
rib I(t4-t5 IV disc) n anatomy, the carina is a cartilaginous ridge within
the trachea that runs antero-posteriorly between the two primary bronchi at the site of the tracheal
bifurcation at the lower end of the trachea (usually at the level of the 5th thoracic vertebra, which is
in line with the angle of Louis, but may raise or descend up to two vertebrae higher or lower with
breathing).

abdominal aortic bifurcate L4

cancer (crabs) metastasise (claws) in bronchus block airway ventilation one
lungs consolidate
to oesophagus cause obstructive dysphagia

thoracic duct drain lymph to subclavian vein

thyroidectomy, surgeons damage LEFT recurrent laryngeal nerve (branch of
vagus nerve, pass under aortic arch), cause bovine cough and hoarse voice
laryngeal folds cannot appose tightly
normal cough reflex build up intrathoracic pressure then force air out

RIGHT recurrent laryngeal nerve pass under subclavian artery.

patent ductus arteriosus:
1. Ductus arteriosus is a normal part of the circulation of the fetus. It is a blood
vessel that connects the two large arteries coming out of the heart, the aorta
and the pulmonary artery.
2. During fetal life, the ductus arteriosus is a normal structure that allows most
of the blood leaving the right ventricle to bypass the pulmonary circulation
and pass into the descending aorta (R-L shunt). Typically, only about 10% of
the right ventricular output passes through the pulmonary vascular bed,
because gas exchange occurs at placenta.
3. Blood coming out of the right ventricle has a choice. It can flow to the lungs,
as it will later in life, or it may flow across the ductus arteriosus to the aorta
and back to the placenta.
4. Since there is fluid and no air in the fetal lungs, there is little need for blood to
flow in that direction. Thus, in the fetus, the ductus allows blood from the right
side of the heart to bypass the non-functioning lungs.
5. With the baby's first breath, the lungs fill with air and become the source of
oxygen for the newborn once the umbilical cord is cut. At that moment, the
blood from the right ventricle changes course, and begins to flow to the lungs.
The ductus is no longer necessary for diverting blood from the lungs.
6. The ductus arteriosus connects the pulmonary artery to the aorta to shunt
most of the blood away from the lungs.
7. In normal newborn, it closes 12-24 hours after birth, and the blood passes
through the opened lungs.
8. Patent ductus arteriosus allows a portion of the oxygenated blood from the
left heart to flow back to the lungs by flowing from the aorta (which has
higher pressure) to the pulmonary artery.
9. In the child with a PDA, oxygenated blood flowing through the aorta has a
choice. It can either flow forward into the body against the normal high blood
pressure, or it can flow across the PDA to the low pressure in the lungs. Since
it is easier for the blood to flow to the lungs, blood will preferentially flow in
that direction, and mix with the deoxygenated blood coming out of the right
heart.
10. Thus, a patent ductus arteriosus (PDA) produces a left-to-right shunt. In
other words, it allows blood to go from the systemic circulation to the
pulmonary circulation.
11. Therefore, pulmonary blood flow is excessive. Pulmonary engorgement
results with decreased pulmonary compliance.
12. Beginning at the ductus arteriosus, the course of blood flow (through systole
and diastole) in a typical patent ductus arteriosus (PDA) with pulmonary
overcirculation is as follows: patent ductus arteriosus (PDA), pulmonary
arteries, pulmonary capillaries, pulmonary veins, left atrium, left ventricle,
aorta, patent ductus arteriosus (PDA). Therefore, a large left-to-right shunt
through a patent ductus arteriosus (PDA) results in left atrial and left
ventricular enlargement. The pulmonary veins and the ascending aorta can
also be dilated with a sufficiently large patent ductus arteriosus (PDA).
Pulmonary hypertension results due to additional fluid returning to the lungs
increases lung pressure to the point that the neonate has greater difficulty
inflating the lungs.
13. Neonate becomes short of breath use more calories than normal, interferes
with feeding in infancy.

Abdomen
5 anterolateral muscles

inguinal canal

Brain
brain supplied by internal carotid artery

subdural hematoma crescent shaped blood pathway