A&P Test 3 Flashcards by Rae Perry

vein follow the same or close to the same pattern of the

arteries

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What is the artery in the front of the cord called?

Anterior Spinal Artery

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Where does the anterior spinal artery sit?

in the anterior median fissure

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What are the arteries on the back of the cord called?

Posterior lateral arteries

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Where does blood come from that feeds the posterior spinal arteries?

upper portion:
vertebral arteries- found in the neck branching off of the circle of Willis

Anterior inferior cerebellar artery
posterior cerebellar artery

lower portion:
posterior radicular artery/medullary artery/segmental artery

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Where do radicular/medullary artery/segmental artery arteries come from?

intercostal arteries

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how many intercostal arteries do we have?

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radicular/medullary artery/segmental artery branching is very inconsistent between

every person

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Do the arteries in the spinal cord wrap all the way around the spinal cord?

no, they only go to the anterior or posterior median fissure

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for every 5 or 6 levels, we might have a radicular artery coming in from the

top or bottom,
left or right

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what does coronal mean?

crown

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what are the coronal arteries?

the small arteries that come off the the anterior medial artery or posterior lateral arteries and branch towards the sides of the cord

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If you have damage to part of the spinal cord arteries, it can be a little worse off than the brain, why?

There is no complete circle connecting the anterior spinal artery and lateral spinal arteries, so there is nowhere for the blood to take an alternative route on

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What is the difference in the spinal veins vs. arteries?

there is a big medial vein on the posterior side of the cord

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Where does the aorta sit on a thoracic vertebra?

on the left side of the vertebral body

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what branches off of the thoracic aorta?

the intercostal arteries to feed the rib cage

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what does the dorsal branch artery come from?

from the intercostal artery which comes from the thoracic aorta

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Where does the spinal branch come from?

the dorsal branch artery which feeds off of the intercostal artery which comes from the thoracic aorta

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At every level you have a spinal branch coming off of the dorsal branch of the intercostal artery’s, but the step after the spinal branch ______ from level to level

varies

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Where does the spinal branch sit?

on top of the dorsal root ganglion

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What are the options that spinal branch arteries can take?

right front or back of the cord
left front or back of the cord

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What is the top part of the aorta called?

thoracic aorta

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What is the bottom part of the aorta called?

abdominal aorta

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what are the arteries that come off the bottom of the aortic artery on the left and right side?

renal arteries

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What keeps our small intestine supplied with blood?

mesenteric artery

If you want to repair an aneurism, you have to _____ the aorta

clamp

what do you worry about when thinking of clamping the aorta?

the health of all of the organs below the aorta (like kidneys), and the health of the spinal cord below the clamping (worried about motor)

how many radicular arteries do most people have in the front of the cord in the neck?

how many radicular arteries do most people have in the front of the cord in the thorax?

2-3

how many radicular arteries do most people have in the front of the cord in the lumbar spine?

1-2

anterior spinal artery takes care of what percent of cord tissue?

75%

posterior spinal artery takes care of what percent of cord tissue?

25%

The Greater radicular artery feeds what?

2/3 of the lower cord

in the vast majority of patients we would expect the greater radicular artery to feed into the anterior spinal artery from which side of the cord?

left

If you had to pick a vertebra to pinpoint where the greater radicular artery feeds into the anterior spinal artery, which vertebra would it be?

T10

If you had to pick a vertebra range to pinpoint where the greater radicular artery feeds into the anterior spinal artery, which vertebra range would it be?

T9-T12 75% of people

What is the absolute range for where the greater radicular artery feeds into the anterior spinal artery?

T5-L5

what is another name for the GRA (great radicular artery?)

artery of Adamkiewicz

if you clamp below the artery of Adamkiewicz you would or would not be worried about the patient waking up paralyzed?

would not

if you clamp above the artery of Adamkiewicz you would be worried about what consequence?

the patient waking up paralyzed from under profusion of the grey matter where motor neurons are in the cord below the clamp.

What can you do before an aneurysm repair that can prevent paralyzing the patient?

Imaging like an MRI to figure out where the feed vessels, specifically the GRA or Adamkiewicz artery are

the higher the radicular artery is the ____ the aneurysm repair is

safer

normal perfusion pressure is

50-150mmHg

cerebral perfusion pressure formula

Map-ICP

normal ICP is

10mmHg

If you have a high ICP then you're going to have more of an impediment getting normal blood flow to the

brain and spinal cord

There are certain times when CSF pressure ends up being an impediment for spinal cord _____

blood flow, especially if the MAP is low

What is the top reason to have increased CSF pressure high enough that it impedes spinal blood flow?

aortic cross clamping

aortic cross clamping can raise the CSF pressure by an average of

10mmHG or higher

What is a way to decrease CSF pressure during cross cord clamping is to

insert a drain to remove some of the CSF

If you have to cross clamp the aorta to do an aneurysm repair, what are some things you can do to help prevent the cord becoming too ischemic

1. Anything that reduces inflammation in the cord 2. Drugs that slow down the metabolic rate of the cord

What is ischemic reperfusion and why do we worry about it?

When a tissue has been ischemic for a long time and then you restore massive amounts of blood flow all at once (removing the cross clamp during an aneurysm repair). When tissues are close to dying d/t ischemia, they are **wide** open basically begging for any blood to come through, so when you rapidly store massive amounts of blood, there's so much blood flow and Oxygen that it damages the tissues (oxygen getting on a scratch on your car=rust) This is hard to study because no one wants to sign off on with holding oxygen but might be better to release the clamp slowly.

what is in our body that keeps oxygen induced damage in check?

antioxidants

What is the power of oxidative potential of oxygen in the body?

the immune system uses it to destroy stuff

What is the ascending feedback loop that sends information to the cerebellum?

anterior/ventral spinocerebellar tract posterior/dorsal spinocerebellar tract

What does the cerebellum do?

helps coordinate muscle during complex tasks, especially ones with a lot of muscles involved, like driving a car

the anterior spinocerebellar tract sends information regarding what?

level of synaptic activity in the anterior horn There are sensors off to the side of the horn that sense how much activity is happening. If it's motor probably a lot

tract is a

bundle of axons in the cns

the anterior spinocerebellar tract gets fed into the

superior cerebellar peduncle

what is the superior cerebellar peduncle?

a bundle of axons after it has moved out of the ventral cord and brainstem where it filters into the cerebellum

The posterior spinocerebellar tract sends information regarding what?

tendons muscle spindles tells the brain whether the muscles or tendon did what it was supposed to do or if the muscle was shut down by the reflex

What is the inferior cerebellar peduncle?

a bundle of axons after it has moved out of the dorsal cord and brainstem where it filters into the inferior portion of the cerebellum

prostaglandins don't directly cause pain, they just

augment pain

How is ischemia painful?

there's a build up of metabolic byproducts like Lactic acid and it can't be cleared because profusion is bad

what is pain threshold?

ease of difficulty of eliciting a painful feeling

high pain threshold= high pain

tolerance

what factors into pain threshold?

genetics environmental

if the threshold potential is exceeded, then you have an

action potential

what is parietal pain?

Tissue pain. more superficial parts of the organ localizes very well.

what is visceral pain?

referred pain: straight organ pain that is transmitted through the autonomic nervous system which is why it is hard to localize.

What is an example of visceral pain?

feeling pain from an almost burst appendix in the umbilicus

What is an example of parietal pain?

feeling pain from an almost burst appendix in the right lower quadrant

Many of our organs don't have tactile sensors so this means that

the organs aren't very good at localizing pain because the DCML system isn't being stimulated

soft tissues in our lungs do not have the internal liver does not have

pain sensors so you can smoke and drink for 30 years and you wouldn't really feel it

visceral pain is more ______ where parietal pain is more _______

dull achy sharp

what is dual pain?

both parietal and visceral pain appendix visceral pain: outside of the appendix: RLQ parietal pain: inside of the appendix: umbilics

What is the path of visceral pain in the appendix?

visceral pain fibers are routed through the sympathetic chain and is fed into the autonomic ganglia then ascends 2-3 levels and enters the cord via the pain transmission pathways. Specifically **T10** (umbilical region)

visceral pain isn't something that can be suppressed via Why?

lateral inhibition/ physical pressure It isn't localized so the pain is coming from a different area in the body. Also, there aren't any touch sensors that can laterally inhibit it.

What is the pain of decompression?

pressure on top of the appendix helps suppress pain but when you take pressure off it will hurt like hell

why don't we have right side pain in a heart attack?

because the pressures are lower on the right side. the ischemia is typically coming form the left side of the heart

where is the limbic system found?

right on top of the brain stem

why does slow pain mess with our emotions?

because the limbic system is closer in proximity

if you think of limbic system you should think of what structures?

the amygdala hypothalamus cingulate gyrus

what is the amygdala?

a deep brain structure found on either side of the diencephalon that is associated with the limbic system

What is the cingulate gyrus?

a deeper gyrus that sits just outside of the corpus collosum in the middle of the brain. NOT a part of the border of the parietal or frontal lobe but IS a part of the cerebral cortex

which part of the cerebral cortex is probably connected to the slow pain system?

the cingulate gyrus

big myelinated neurons are what type of fibers?

A fibers

lightly myelinated neurons are what type of fibers?

B fibers

Non myelinated neurons are what type of fiber?

C fibers

B and C fibers are probably going to be found in the

more primative parts the nervous system like autonomic nervous system. we don't even realize what the ANS is doing

A fibers are thought to be more well developed or more specialized than the B and C fibers and therefore can conduct information _____

faster and more efficiently

Motor neurons are what type of fiber?

A alpha neurons for the most part

muscle spindle feedback that comes to the cord is pretty important so we tend to send that type of information up to the brain through what type of fibers?

large myelinated fibers

muscle tendons, the safety mechanisms that are built into the tendons to prevent them from being pulled from insertion sites is really important information so is sent via

large myelinated fibers

In terms of what gets fed into the DCML pathway typically can be sent on what type of fibers?

a large span from A alpha fibers to A gamma fibers

pretty much any type of pressure sensor that helps us with lateral inhibition is going to be sent almost exclusively via

A beta fibers

a beta fibers think

lateral inhibition

sharp or stabbing pain is sent through which fibers?

A delta

if you hit your hand with a hammer what order of feelings would you have?

pressure, you know it is going to hurt pain-sharp pain- achy this is going to mess with your head

does the cerebral cortex have pain sensors?

no, there are pain sensors leading to it, and a lot of pain sensors in the dura matter but not directly on the brain

what could give you the worst headache of your life?

if you have a CSF leak and your brain dips down in the cranium