Lymphatic Drainage Of Lower Limb Question And Answers

Blood Supply And Lymphatic Drainage Of Lower Limb Question And Answers

Arterial Supply Of Lower Limb

Question 1. Explain in detail about the femoral artery under the headings—origin, course, relations, and branches.
Answer:

The femoral artery

Read And Learn More: Anatomy Question And Answers 

Chief artery of the lower limb.

Femoral Artery Origin

• Continuation of the external iliac artery.
• Begins behind the inguinal ligament at the level of mid inguinal point.

Femoral Artery Extend and Course

• Runs downwards and medially through the femoral triangle and adductor canal.
• At the lower end of the adductor canal, i.e. junction between the upper 2/3rd and lower 1/3rd of thigh, it passes through the opening of the adductor magnus muscle to enter popliteal fossa.
• From there it continues as a popliteal artery.

Femoral Artery Relations in Femoral Triangle

• Anterior: Skin, superficial fascia, deep fascia, the anterior wall of the femoral sheath.
• Posterior: Psoas major, pectineus, adductor longus muscles.
• Femoral vein lies posterior to the femoral artery
• Above the level of apex of the femoral triangle, femoral vein lies medial to femoral artery.
  • At the level of apex of femoral triangle, the femoral vein lies directly behind to femoral artery.
  • Below the level of the apex of femoral triangle, femoral vein it crosses and lies lateral to femoral artery.
• Femoral nerve lies lateral to the upper part of femoral artery.
• Femoral branch of the genitofemoral nerve also lies lateral to the upper part of the femoral artery.
• The Profunda femoris artery and its companion vein lies posterior to the femoral artery in its upper part, lower down they are separated by adductor muscle.

Femoral Artery Branches

• In the femoral canal
  • Three superficial branches:
    • Superficial epigastric artery
    • Superficial external pudendal artery
    • Superficial circumflx iliac artery.
  • Three deep branches:
    • Profunda femoris artery
    • Deep external pudendal artery
    • Muscular branches.
• In the adductor canal
  • Muscular branches
  • Descending genicular artery.
• Clinical Anatomy
  • Femoral artery pulsations can be felt in the femoral triangle just below the mid-inguinal point.
  • Since femoral artery is superficial in the femoral triangle, blood can be easily withdrawn for arterial blood gas analysis.
  • It is the preferred artery for coronary artery angiography and angioplasty.
  • Since femoral vein runs behind the femoral artery in the apex of the triangle any stab wounds in this area can be fatal.

Mnemonics

• Femoral artery deep branches: ‘Put My Leg Down Please’
  • Profundus femoris (deep femoral artery)
  • Medial circumflex femoral artery
  • Lateral circumflex femoral artery
  • Descending genicular arteries
  • Perforating arteries

Question 2. Explain about profunda femoris artery under the headings—origin, course, termination, and branches.
Answer:

Profunda Femoris Artery Origin

• The largest branch of femoral artery.

Profunda Femoris Artery Course

• Arises from the lateral side of femoral artery 4 cm below the inguinal ligament in the femoral triangle.
• Gives of lateral and medial circumflex arteries.
• Descends down close to femur giving branches to muscles and terminal branches.

Profunda Femoris Artery Termination

• After piercing adductor magnus ends at the posterior part of leg.

Profunda Femoris Artery Branches

• Muscular branches
• Medial circumflex femoral artery
• Lateral circumflex femoral artery
• Four perforating arteries.

Profunda Femoris Artery Clinical Anatomy

• Since it lies close to the shaft of the femur, a fracture of femur or surgery in the area may injure the artery.

Question 3. Write a short note on the obturator artery.
Answer:

Obturator Artery

• It is a branch of the internal iliac artery.
• It accompanies obturator nerve in pelvis and passes through the obturator canal.
• Then, it divides into medial and lateral branches and anastomose with medial circumflex femoral artery.
• They supply:
  • Neighboring muscles
  • Fat in acetabular fossa
  • Head of femur through round ligament.

Question 4. Write a short note on medial circumflex femoral artery.
Answer:

Medical Circumflex Femoral Artery

• Branch of profunda femoris artery
• It divides into 2 branches:
  • Ascending branch
    • It anastomosis with the ascending branch of the lateral circumflex femoral artery and superior gluteal artery to form trochanteric anastomosis.
    • This anastomosis gives of retinacular branches which supply the head of femur.
  • Transverse branch
    • It anastomosis with the transverse branch of lateral femoral circumflex, inferior gluteal, and fist perforating branch of profunda femoris to form a cruciate anastomosis.
• Before the terminal branches, it gives off
  • Muscular branches
  • Acetabular branches to supply fat in acetabular fossa
  • Branch supplying head of femur.

Medical Circumflex Femoral Artery Clinical Anatomy

Intracapsular fracture of the neck of the femur can cause avascular necrosis of the head of the femur due to damages to retinacular branches.

Question 5. Explain the popliteal artery under the headings—origin, course, termination, relation, and branches.
Answer:

Popliteal artery

Popliteal Artery Origin

• Continuation of femoral artery.

Popliteal Artery Course

• From the adductor hiatus, it runs downwards and slightly laterally, to reach the lower border of popliteal muscle.

Popliteal Artery Termination

• Terminates at the lower border of popliteus into anterior and posterior tibial arteries.

Popliteal Artery Relation

• Anterior/deep relations:
  • Popliteal surface of femur
  • Back of knee joint
  • Fascia covering popliteus muscle
• Posterior/superficial relations:
  • Popliteal vein
  • Tibial nerve
• Laterally:
  • Upper part of artery related to biceps femoris and lateral condyle of femur
  • Lower part related to plantaris and lateral head of the gastrocnemius muscle
• Medially:
  • Upper part related to biceps femoris and lateral condyle of the femur
  • Lower part is related to tibial nerve, popliteal vein, and medial head of the gastrocnemius.

Popliteal Artery Branches

• A number of large muscular branches
• Cutaneous branches
• Genicular branches—5 in number:
  • Medial and lateral superior genicular branches
  • Middle genicular branch
  • Medial and lateral inferior genicular branches
  • They form anastomosis around the knee joint.

Popliteal Artery Clinical Anatomy

• Popliteal pulsation is felt by flexing the knee and palpating the popliteal artery in the popliteal fossa, against the underlying femur. It is difficult to feel.
• Popliteal artery aneurysm is the most common arterial aneurysm.

Question 6. Write a short note on the anterior tibial artery.
Answer:

Anterior Tibial Artery Beginning

• The smaller terminal branch of the popliteal artery.
• It begins on the back of leg at the lower border of the popliteus, opposite the tibial tuberosity.

Anterior Tibial Artery Course

• Reaches front of leg through an opening in the upper part of the interosseous membrane.
• Runs downward in between the muscles of leg and continues as dorsalis pedis artery from the point between medial and lateral malleolus.

Anterior Tibial Artery Branches

• Muscular branches to anterior compartment of leg
• Cutaneous branches
• Branches to knee and ankle joints.

Question 7. Write a short note on posterior tibial artery.
Answer:

Posterior Tibial Artery Beginning

• Larger terminal branch of popliteal artery.
• It begins at the lower border of the popliteus, between the tibia and fibula, and deep to the gastrocnemius.

Posterior Tibial Artery Course

• It runs down through the flexor muscles to reach at the level between the medial malleolus and medial tubercle of the calcaneus and pass under flexor retinaculum.

Posterior Tibial Artery Termination

• Terminates by dividing into medial and lateral plantar arteries under the flxor retinaculum.

Posterior Tibial Artery Branches

• Muscular branches
• Articular branches to knee and ankle joints
• Nutrient artery to tibia.

Question 8. Write a short note on dorsalis pedis artery.
Answer:

Dorsalis Pedis Artery Beginning

• Continuation of anterior tibial artery.
• Begins in front of the ankle between two malleoli as the ‘continuation of the anterior tibial artery.’

Dorsalis Pedis Artery Course

• Runs along the medial side of dorsum of foot from the midpoint of medial and lateral malleoli.
• From there, it runs downwards to reach the proximal end of 1st metatarsal space.
• It eventually enters to sole to complete the plantar arch by meeting lateral plantar artery.

Dorsalis Pedis Artery Branches

• Lateral tarsal artery
• Medial tarsal artery, both supplying tarsal bones and joints
• First dorsal metatarsal artery
• Arcuate artery → gives of 2nd, 3rd, and 4th dorsal metatarsal arteries.

Question 9. Explain in brief about medial plantar artery, lateral plantar artery, and plantar arch.
Answer:

Medial Plantar Artery

• Division of posterior tibial artery.
• Runs along medial border of foot and terminates by giving of digital arteries.

Lateral Plantar Artery

• Division of posterior tibial artery
• It runs laterally between the 1st and 2nd layer of muscles of sole and becoming continues with plantar
  arch.

Plantar Arch

• It is located in between 1st and muscle layers.
• Formed by the union of continuation of dorsalis pedis artery medially and lateral plantar artery laterally.
• Gives of four plantar metatarsal arteries, each of them again gives of two digital branches.

Venous Drainage of Lower Limb

Question 10. What are the peculiarities of venous drainage of the lower limb? How it is classified?
Answer:

The peculiarities of venous drainage of the lower limb

• The venous drainage of lower limb is working against gravity.
• But a number of factors help to make the venous return from lower limb efficient. They are:
  • Calf pump/the peripheral heart: Contraction of calf muscles squeezes the blood up along the deep veins from venous sinuses present in them.
  • Accompanying arteries exerts pressure on veins by arterial pulsations.
  • Valves in the vein support the blood column against gravity and ensure unilateral blood flw.
  • Arterial pressure and overflow from capillary bed.
  • Negative intrathoracic pressure.
  • Veins in the lower limb are more muscular.
• Veins of lower limb are classifid into 3 groups:
  • Superficial veins
  • Deep veins
  • Perforating veins
• Blood is being drawn from the lower limb via superficial veins and deep veins and eventually reaches the femoral vein.
• The perforator veins connect and ensure unilateral blood flow from superficial to deep veins.

Question 11. How is the superficial venous system in the lower limb is organized? Explain in detail about long and short saphenous veins under the headings—formation, course, termination, tributaries, and valves.
Answer:

• It consists of dorsal venous arch, long saphenous vein, short saphenous vein, and tributaries situated in the superficial fascia.
• Two dorsal digital veins form one dorsal metatarsal vein. Four dorsal metatarsal veins unites and forms dorsal venous arch on the dorsum of the foot over the proximal part of the metatarsal bones.
• This dorsal venous arch ascends up medially as a great saphenous via and laterally as short saphenous vein.
• They are enriched by a number of tributaries.
• A considerable amount of blood is drained by them to deep veins directly or via perforators.

Great Saphenous Vein

• Longest vein in the body
• Easily seen in the lower limb (saphenous = easily seen).
  • Formation
    • By union of the medial end of dorsal venous arch of the foot and medial marginal vein of the foot.
  • Course
    • It runs upward and medially to reach the posteromedial aspect of the knee joint.
    • From there it ascends to reach up to the level of saphenous opening.
    • It reaches the saphenous opening by piercing the cribriform fascia and drains into a femoral vein after piercing the femoral sheath.
    • Throughout its course, it receives tributaries.
  • Termination
    • In the femoral triangle.
  • Valves
    • Consists of 10–20 valves.
  • Tributes

Short/Small Saphenous Vein

• Formation
  • Union of the lateral marginal vein with lateral end of dorsal venous arch.
  • After formation, it ascends behind the lateral malleolus along the lateral edge of the talocalcaneal, accompanied by the sural nerve to reach back of leg.
  • It pierces the back of leg to reach the deep fascia and progresses through the head of the gastrocnemius and eventually drains to the popliteal vein after piercing deep fascia.

• Termination
  • In to popliteal vein in the popliteal fossa.
• Valves
  • It have 7–13 valves.

Question 12. Write a note on the deep veins of lower limb. Explain separately about the femoral vein.
Answer:

Deep Veins Of Lower Limb

• The major deep veins of lower limb are:
  • Deep vein of sole → medial and lateral plantar veins
  • Venae comitantes accompanying dorsalis pedis, anterior tibial, and posterior tibial arteries
  • Popliteal vein
  • Femoral vein
• They are located in the tight fascial compartments.
• Thy, below the knee are arranged as pair of venae comitantes along with arteries, but above knee, they are almost individual.
• More valves are provided to them.

Femoral Vein

• It is the upward continuation of the popliteal vein and continues as the external iliac vein beyond the inguinal ligament.
  • Course
    • Begins at the lower end of adductor canal
    • Ascend up in the adductor canal and enters the femoral triangle
    • Though the middle compartment in the femoral triangle, it ascends upwards and continues as an external iliac vein behind the inguinal ligament.
  • Tributaries
    • Great saphenous vein
    • Profunda femoris vein
    • Medial and lateral circumflex veins
    • Deep external pudendal vein
    • Direct muscular tributaries.
  • Clinical Anatomy
    • The femoral vein is the most commonly used vein for 4 infusions in case of peripheral circulatory failure and in infants.
    • This vein is also used to insert a catheter into right atrium and ventricle to measure pressure.

Question 13. Classify and list the perforating veins.
Answer:

Perforating veins

• They communicate superfiial veins with deep veins.
• Called as perforators because they perforate deep fascia.
• They are of 2 types:
  • Indirect perforators: Connect superficial vein to deep vein only through muscular veins
  • Direct perforators: Connect superficial and deep veins directly
• Among them, five to six are important. They are:
  • Adductor canal/Hunterian perforator: Great saphenous vein ↔ femoral vein at the lower part of adductor canal
  • Knee perforator/Boyd’s perforator: Great saphenous vein ↔ posterior tibial vein below the knee close to tibia
  • Lateral ankle perforator: Short saphenous vein ↔ peroneal vein at junction of middle and lower 1/3rd of leg
  • Three medial ankle perforators (of Cockett): Great saphenous vein ↔ posterior tibial vein
    • Upper medial
    • Middle medial
    • Lower medial.

Perforating Veins Clinical Anatomy

• Incompetency of the valves or other mechanisms helping venous return from lower limb can cause varicose veins and deep vein thrombosis.
• In about 80% of individuals, external iliac vein possesses a valve which prevents high back pressure by blood column on the saphenofemoral valve located in the femoral triangle. In those when the valve is absent, chances of occurrence of varicose veins are higher.
• Calf muscles: Are known as the peripheral heart.

Question 14. Explain in detail about lymphatic drainage of lower limb.
Answer:

Lymphatic drainage of lower limb

The lymph nodes of lower limb are classified into:

Superficial lymph nodes: Includes superficial inguinal lymph nodes

Deep lymph nodes: Includes:

• Deep inguinal lymph nodes
• Popliteal lymph nodes
• Anterior tibial lymph nodes.

Superficial Inguinal Lymph Nodes: They are arranged in T shape into two groups:

1. Upper horizontal group
   • Have lateral set and medial set
2. Lower vertical group.

Deep Inguinal Lymph Nodes

• Four to five in number.
• Located in the medial side of upper part of the femoral vein in the femoral triangle.
• The most proximal node of this group is known as (the gland of Cloquet or Rosenmuller) which lies in the femoral canal.
• All the lymphatics from the lower limb ultimately drain into deep inguinal node directly or indirectly
• Only deep part of the gluteal region and upper aspect of the posterior part of the thigh are not drained by them.

Clinical Anatomy

• Lymphadenopathy of vertical groups of lymph nodes are seen in infection to the lower limb.
• Filariasis is characterized by lymphangitis, lymphadenitis, and lymphedema and is manifested in the lower limb fist before appearing in any other parts of the body.

Blood Supply And Lymphatic Drainage Of Lower Limb Multiple Choice Questions

Question 1. Which of the following is not a branch of dorsal pedis artery?

1. First dorsal metatarsal
2. Tarsal branches
3. First plantar metatarsal
4. Arcuate

Answer: 3. First plantar metatarsal

Question 2. Which genicular artery pierces the fibrous capsule of the knee joint?

1. Descending genicular
2. Middle genicular
3. Anterior tibial recurrent
4. Circumflex fibular

Answer: 2. Middle genicular

Question 3. Boyd’s perforator vein is located in the:

1. Saphenous ring
2. Hunterian canal
3. Below the knee close to the tibia
4. Popliteal fossa

Answer: 3. Below the knee close to the tibia

Question 4. How many valves can be presents in the great saphenous veins?

1. None
2. Two to four
3. Ten to twenty
4. Around thirty

Answer: 3. Ten to twenty