Peripheral Peripheral Vascular SystemVascular System

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Lymphatic SystemLymphatic System

Vascular SystemVascular System

Transports blood through the bodyTransports blood through the body Any vascular disease results in lack Any vascular disease results in lack

of oxygen to tissue or build-up of of oxygen to tissue or build-up of waste productswaste products

ArteriesArteries

High pressure system b/c of pumping High pressure system b/c of pumping from the heartfrom the heart

Walls are strong, tough, stretch, & Walls are strong, tough, stretch, & withstand pressure demandswithstand pressure demands

Also contain vascular smooth muscle Also contain vascular smooth muscle that allows to contract & dilate, which that allows to contract & dilate, which affects blood flowaffects blood flow

All arteries have a pulse throughout All arteries have a pulse throughout their length, but can only feel where their length, but can only feel where artery lies close to skin & over a boneartery lies close to skin & over a bone

Brachial – runs in Brachial – runs in biceps/triceps biceps/triceps furrow of upper furrow of upper arm. Feel in arm. Feel in antecubital fossa on antecubital fossa on medial aspectmedial aspect

Radial – just medial Radial – just medial to radius at the to radius at the wristwrist

Ulnar – just medial Ulnar – just medial to ulna but deeper to ulna but deeper & difficult to feel& difficult to feel

Femoral artery – under Femoral artery – under inguinal ligament, ½ inguinal ligament, ½ way btw pubis & way btw pubis & anterior superior iliac anterior superior iliac spinespine

Popliteal – posterior to Popliteal – posterior to knee, lateral to the knee, lateral to the medial tendon. Very medial tendon. Very difficult to feeldifficult to feel

Dorsalis pedis – dorsum Dorsalis pedis – dorsum of foot, lateral to & of foot, lateral to & parallel with extensor parallel with extensor tendon of big toe. Use tendon of big toe. Use light touchlight touch

Posterior tibial – behind Posterior tibial – behind medial malleolus, in medial malleolus, in groove btw malleolus & groove btw malleolus & Achilles tendonAchilles tendon

Arteries function to supply oxygen & essential Arteries function to supply oxygen & essential nutrients to tissuesnutrients to tissues

IschemiaIschemia – deficient supply of oxygenated arterial – deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood blood to a tissue caused by obstruction of a blood vesselvessel

Complete blockage - Complete blockage - leads to death of the distal leads to death of the distal tissue (severe leg pain, pale cold skin, loss of tissue (severe leg pain, pale cold skin, loss of sensation)sensation)

Partial blockagePartial blockage - apparent only when exercising - apparent only when exercising when oxygen needs increase (leg pain relieved by when oxygen needs increase (leg pain relieved by rest)rest)

Claudication = pain/cramping resulting from lack of blood Claudication = pain/cramping resulting from lack of blood flowflow

Also note temporal artery & carotid pulse sites Also note temporal artery & carotid pulse sites

VeinsVeins

Run parallel to arteriesRun parallel to arteries Have more veins & lie closer to skin Have more veins & lie closer to skin

surface so easier to examinesurface so easier to examine A low pressure system.A low pressure system. Need a mechanism to pump blood back to Need a mechanism to pump blood back to

heartheart Skeletal muscles milk blood back to heartSkeletal muscles milk blood back to heart Pressure gradient caused by breathingPressure gradient caused by breathing Intraluminal valves ensure unidirectional flowIntraluminal valves ensure unidirectional flow

Walls are thinner Walls are thinner than arteries, larger than arteries, larger diameter, more diameter, more distensibledistensible

Problems with Problems with contracting skeletal contracting skeletal muscle, competent muscle, competent valves, & patent valves, & patent lumen results in lumen results in venous stasisvenous stasis

As long as deep veins As long as deep veins remain intact, remain intact, superficial veins can superficial veins can be excised without be excised without harming circulationharming circulation

LymphaticsLymphatics

Separate vessel systemSeparate vessel system Retrieves excess fluid from tissue Retrieves excess fluid from tissue

space & returns it to blood streamspace & returns it to blood stream Without lymphatic drainage, fluid Without lymphatic drainage, fluid

would build up in interstitial spaces, would build up in interstitial spaces, causing edemacausing edema

Also major part of immune systemAlso major part of immune system

Lymph nodes filter fluid before it is Lymph nodes filter fluid before it is returned to blood stream & filters returned to blood stream & filters out microorganisms that could be out microorganisms that could be harmful to the bodyharmful to the body

Lymphocytes in the lymph nodes Lymphocytes in the lymph nodes eliminate pathogenseliminate pathogens

With local inflammation, nodes With local inflammation, nodes become swollen & tenderbecome swollen & tender

Lymph node locationsLymph node locations Cervical nodes – drain Cervical nodes – drain

head & neckhead & neck Axillary nodes – drain Axillary nodes – drain

the breast & upper armthe breast & upper arm

Epitrochlear node – in Epitrochlear node – in the antecubital fossa & the antecubital fossa & drains the hand & lower drains the hand & lower armarm

Inguinal nodes – in the Inguinal nodes – in the groin, drain lymph of the groin, drain lymph of the lower extremity, external lower extremity, external genitalia, & anterior genitalia, & anterior abdominal wallabdominal wall

Related organsRelated organs Spleen – destroys old Spleen – destroys old

RBC’s, produces RBC’s, produces antibodies, stores antibodies, stores RBC’s, filters RBC’s, filters microorganisms from microorganisms from bloodblood

Tonsils – respond to Tonsils – respond to local inflammationlocal inflammation

Thymus – flat pink-gray Thymus – flat pink-gray gland, developing T-gland, developing T-lymphocytes in immune lymphocytes in immune system in children, no system in children, no function in adultsfunction in adults

Subjective DataSubjective Data

Leg pain or crampsLeg pain or cramps Skin changes on arms or legsSkin changes on arms or legs Swelling in arms or legsSwelling in arms or legs Lymph node enlargementLymph node enlargement

Arterial UlcerArterial Ulcer

Absent pulseAbsent pulse > 3 sec cap refill> 3 sec cap refill CoolCool Smooth edgesSmooth edges PainfulPainful Pale, thin skinPale, thin skin Toes, foot, lateralToes, foot, lateralMalleolusMalleolus Dependent ruborDependent rubor

Venous UlcerVenous Ulcer Pulse presentPulse present < 3 sec cap refill< 3 sec cap refill Warm (normal)Warm (normal) Irregular marginsIrregular margins Aching, not painfulAching, not painful Edema Edema Medial malleolusMedial malleolus Thickened, bronzy,Thickened, bronzy,

skin around ulcerskin around ulcer