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Reproduction Week 3 2018/19 > 1: Anatomy - Anaesthesia of labour > Flashcards

1: Anatomy - Anaesthesia of labour Flashcards

1
Q

Where is visceral pain felt when organs are affected in

a) the superior pelvis
b) the inferior pelvis?

A

a) Suprapubic region

b) S2,3,4 region (bullseye around the anus i.e the perineum)

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2
Q

What colour is the ligamentum flavum?

Why?

A

Yellow

Contains elastin

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3
Q

What are the main symptoms of raised intracranial pressure?

A

Headache

Visual changes

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4
Q

The uterine contractions of menstruation and childbirth are controlled by ___ which trigger which type of nerve?

A

hormones

autonomic nerves (sympathetic and parasympathetic, or ‘visceral motor’)

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5
Q

Which modality of nerve controls the pelvic floor muscles?

A

Somatic motor

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6
Q

Which sensory modality supplies organs

a) above the pelvic pain line
b) below the pelvic pain line
c) in the perineum?

A

a) Visceral afferent

b) Visceral afferent

c) Somatic sensory

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7
Q

Which organs are above the pelvic pain line?

A

Those which touch the parietal peritoneum

So the bladder, ovaries and uterine tubes, uterus, superior vagina

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8
Q

Which organs are below the pelvic pain line?

A

Those which are above the levator ani muscle but don’t touch the parietal peritoneum

Cervix, inferior vagina

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9
Q

Which named nerve supplies somatic sensory fibres to structures in the perineum?

A

Pudendal nerve (S2,3,4)

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10
Q

Which nerve roots supply sensory fibres to structures

a) above the pelvic pain line
b) below the pelvic pain line
c) in the perineum?

A

a) T11 - L2

b) S2-4

c) S2-4

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11
Q

Are organs below the pelvic pain line all supplied by the pudendal nerve?

A

No - VISCERAL AFFERENTS from S2,3,4 (I appreciate this is confusing)

Structures in the perineum are supplied with somatic sensory fibres by the pudendal nerve (S2,3,4)

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12
Q

How do

a) visceral afferents from above the pelvic pain line
b) visceral afferents from below the pelvic pain line
c) somatic sensory fibres from the perineum

plug into the spinal cord, and at which levels?

A

a) Travel with sympathetics back to T11-L2 within periarterial plexuses
b) Travel with parasympathetics back to S2-4 within pelvic splanchnic nerves
c) Travel back to S2-4 within the pudendal nerve

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13
Q

What are the two important sets of spinal cord levels for the female reproductive system?

A

T11 - L2 (visceral afferents ABOVE pelvic pain line)

S2 - S4 (visceral afferents BELOW pelvic pain line; perineum)

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14
Q

What are three kinds of anaesthesia which can be given to pregnant women?

A

Spinal anaesthesia

Epidural anaesthesia

Pudendal nerve block

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15
Q

Where are spinal and epidural anaesthetics injected?

A

L3/4 or L4/5

Just like a lumbar puncture

Remember L2 is the termination of the spinal cord

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16
Q

What is the difference between a spinal and epidural anaesthetic?

A

Spinal anaesthetic injected through all layers into SUBARACHNOID SPACE

Epidural anaesthetic injected into EPIDURAL SPACE - fewer layers breached

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17
Q

From superficial to deep, name the layers a needle passes through when giving spinal anaesthesia.

A

Skin

Fascia

Supraspinous lig.

Interspinous lig.

Ligamentum flavum

Epidural space

Dura

Arachnoid

Subarachnoid space!

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18
Q

From superficial to deep, name the layers a needle passes through when giving epidural anaesthesia.

A

Skin

Fascia

Supraspinous lig.

Infraspinous lig.

Ligamentum flavum

Epidural space!

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19
Q

At what levels can

a) spinal
b) epidural anaesthesia be given?

A

Both are L3/4 or L4/5

Same as a lumbar puncture

20
Q

What are the risks involved in giving spinal anaesthesia?

A

Raised ICP - increased volume in subarachnoid space

Hypotension - widespread vasodilation due to anaesthetic’s effect on sympathetics

Also: nerve damage, haemorrhage, infection

21
Q

What structures are numbed by a spinal anaesthetic?

A

Intraperitoneal structures and everything below the waist - above PPL, below PPL, perineum, lower limbs

22
Q

What structures are numbed by an epidural anaesthetic?

A

Structures above and below PPL + perineum

23
Q

Can an epidural anaesthetic cause

a) raised intracranial pressure
b) hypotension?

A

a) No - doesn’t penetrate subarachnoid space

b) Yes - same effect on sympathetic nerves

24
Q

Why can spinal and epidural anaesthetics cause hypotension?

A

All spinal nerves contain sympathetics

Sympathetics control arteriolar vasoconstriction (sympathetic tone)

Sympathetics blocked - widespread vasodilation, hypotension

25
Q

Which branch of the sacral plexus has roles in the GI, renal and female reproductive systems?

A

Pudendal nerve (S2,3,4)

26
Q

Which nerve supplies somatic sensory fibres to the external anal and urethral sphincters?

A

Pudendal nerve

27
Q

Which type of anaesthesia numbs the perineum only?

A

Pudendal nerve block

28
Q

Which type of anaesthesia would be given to a woman undergoing an episiotomy?

A

Pudendal nerve block

29
Q

Where does the pudendal nerve EXIT the pelvis?

A

Greater sciatic foramen

30
Q

Where does the pudendal nerve RE-ENTER the pelvis?

A

Lesser sciatic foramen

31
Q

Which pelvic structure does the pudendal nerve pass POSTERIOR to?

A

Sacrospinous ligament

32
Q

Which passageway, found within the pelvis, does the pudendal nerve travel within?

A

Pudendal canal

33
Q

Which fossa is the pudendal canal found in?

A

Ischioanal fossa

34
Q

Which fascia is the pudendal canal found in?

A

Obturator fascia

35
Q

What are the contents of the pudendal canal?

A

Pudendal nerve

Internal pudendal artery

Internal pudendal vein

Nerve to obturator internus

36
Q

Which muscle is in close relation to the obturator canal?

A

Obturator internus

37
Q

The pudendal canal is found in the ___ fossa, within the ___ fascia. It contains the ___ nerve and ___ ___ artery and vein. It is bounded by the muscle called ___ ___.

A

ischioanal fossa

obturator fascia

pudendal nerve

internal pudendal artery and vein

obturator internus

38
Q

The pudendal nerve supplies which area with somatic sensory fibres?

A

Perineum

39
Q

Which bony landmark is used in pudendal nerve block?

Why?

A

Ischial spine

Palpated with one hand in vagina and anaesthetic injected at fingertips

Pudendal nerve travels closely with sacrospinous ligament

40
Q

What is pudendal nerve block used for?

A

Episiotomy

Repair of tears

Forceps delivery

41
Q

What can happen to the pudendal nerve during childbirth?

A

Stretching > Nerve damage

42
Q

Which specific muscles can be damaged during childbirth?

A

Puborectalis (part of levator ani group)

External anal sphincter

43
Q

What is an episiotomy?

A

Incision made below posterior fourchette to prevent spontaneous tearing during childbirth

44
Q

In which direction is an episiotomy usually made?

A

Inferolaterally

45
Q

Median (vertical) episiotomy isn’t commonly done.

Why not?

A

Potential to damage PERINEAL BODY - mass acting as insertion for loads of pelvic floor muscles

AND

Further tearing in that direction will involve the external anal sphincter

46
Q

What is the bony landmark for L4?

A

Posterior iliac crests

Reproduction Week 3 2018/19 (8 decks)

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