Anatomy 1 Flashcards
1
Q
Where do the presynaptic sympathetic axons for the heart synapse?
A
T1 or cervical PARAvertebral gangli
2
Q
Where are post-synaptic axons for the heart?
A
They pass through cardiopulmonary splanchnic nerves to the SA&AV nodes and the myocardium
3
Q
What does the T9 myotome supply?
A
The 8th-10th intercostal spaces and some of the anterolateral abdominal wall muscles
4
Q
Where do the presynaptic sympathetic axons for the lung synapse?
A
Synapse in the upper thoracic PARAvertebral ganglia
5
Q
Where do the post-synaptic sympathetic axons for the lung travel
A
Pass in cardiopulmonary splanchnic nerves to the bronchiolar smooth muscle and mucous glands
6
Q
Where do the abdominopelive sympathetic presynaptic axons synapse?
A
Synapse in one of the PREvertebral ganglia
7
Q
Foregut ganglia
A
Celiac ganglion of celiac plexus
8
Q
Kidney ganglia
A
Aorticorenal ganglion
9
Q
Midgut ganglion
A
Superior mesenteric ganglion of the SM plexus
10
Q
Hindgut and pelvic/perineal organ ganglion
A
Inferior mesenteric ganglion
11
Q
What is special about the sympathetic supply to the kidney?
A
Presynaptic axons pass directly through the aorticorenal ganglion to synapse directly onto the adrenaline/noradrenaline secreting cells of the adrenal medulla
12
Q
How do parasympathetic axons reach the eye?
A
Via the ciliary ganglion
13
Q
Which glands in the head are under parasympathetic supply?
A
The lacrimal and salivary glands
14
Q
How do PARAsympathetic axons reach the hindgut, pelvis and perineum?
A
They are “carried” on sacral spinal nerves
15
Q
What do the extrinsic back muscles do?
A
Move the upper limb
16
Q
Where does the trapezius attach to superiorly?
A
The occipital bone
17
Q
Where do the levator scapulae attach superiorly?
A
To the cervical vertebrae
18
Q
Superficial intrinsic back muscles
A
Erector spinae
19
Q
Deep intrinsic back muscles
A
Transversospinalis
20
Q
Function of the intrinsic back muscles?
A
Maintain back posture
21
Q
The 3 parts of the trapezius
A
Descending part (to spine of scapula) Middle part Ascending part (to spine of scapula)
22
Q
Low back pain may be due to what
A
Erector spinae strain
23
Q
Which muscles allow extension of the spine?
A
Intrinsic back muscles
24
Q
Nerve supply to the intrinsic back muscles?
A
The posterior rami (of cervical, thoracic, lumbar etc)
25
Primary curvatures of the vertebral column?
Thoracic primary curvature
Sacral primary curvature
(Cervical and lumbar are secondary)
26
What makes the vertebral canal for the spinal cord?
The vertebral foraminae combine to form the vertebral canal
27
Which foraminae do the spinal nerves emerge from?
Intervertebral foramen
28
Which joints affected in arthritis?
Facet joints
29
What makes the facet joint?
Between 2 articular processes
30
Intervertebral discs are between all vertebrae except?
Except C1-C2 and the fused sacrum/coccyx
31
What attaches the laminae together?
The ligamentum flavum
32
Function of the posterior longitudinal ligament?
Prevents over-flexion of spin
33
Function of the anterior longitudinal ligament?
Prevents over-extension of the spine
34
This ligament connects tips of spinous processes
Supraspinous ligament
35
This ligament connects superior and inferior surfaces of adjacent spinous processes
Interspinous ligament
36
This vertebra doesn't have a body or spinous process
C1
| has a posterior and anterior arch instead
37
Atlas
C1
38
Axis
C2
39
This vertebrae has an odontiod process
C2
40
First palpable spinous process
C7
41
Main movements of the atlanto-occipital joints
Flexion and extension (i.e. nodding)
| This is a synovial joint
42
Main movement of the atlanto-axial joint?
Rotations (i.e. head looking side to side)
This joint is made of 3 synovial joints
43
What are the anterior sacral foraminae for?
For the anterior rami of the sacral spinal nerves
44
In caudal anasthaesia, where is local anaesthetic injected into?
Into the sacral hiatus
| numbs the sacral spinal nerves of the cauda equina
45
Where does the spinal cord begin?
C1
46
Where does the spinal cord end?
L2 (conus medullaris)
| this then continues as the filum terminale
47
What makes up the cauda equina?
All the spinal nerve roots from L2 to C0 that have to descend to their numbered verterbae where there spinal nerve is lovated within the intervertebral foramen
48
Why is a laminectomy performed?
To access the spinal cord
49
How do you perform a laminectomy?
Removal of one or more of the spinous processes and the adjacent lamina
50
Common location of a CVA?
Internal capsule
51
When you are examining dermatomes, what do the following mean:
- 0
- 1
- 2
- NT
0 - absent
1 - impaired
2 - normal
NT - not testable
52
C1
Spinal nerve has no significant cutaneous sensory axons
53
C2
Back of scalp and adam's apple
54
C3
Back of neck and jugular notch
55
C4
Clavicle and shoulder tip
56
C5
Badge patch
57
C6
Thumb
58
C7
Middle finger
59
C8
Little finger
60
T1
Medial forearm
61
T2
Medial arm and sternal angle
62
T4
Male nipple
63
T8
Xiphoid process
64
T10
Umbilicus
65
T12
Pubic symphysis
66
L1
Groin
67
L2
Anterior thigh
68
L3
Anterior knee
69
L4
Medial malleolus
70
L5
Dorsum of foot
71
S1
Heel
72
S2
Posterior knee
73
S3
Buttock
74
S4
Perinuem
75
S5
Perianal skin
76
Femoral nerve roots
L2, L3, L4
| so will supply anterior thigh, anterior knee and medial malleolus
77
Great auricular nerve?
C2, C3
78
Supraclavicular nerve?
C3, C4
79
Nerve supply to the upper anterolateral abdominal wall
T2-T11
80
Nerve supply to the lower anterolateral abdominal wall
Iliohypogastric and ilioinguinal nerves (formed from L1)
81
Nerve supply to the posterior parts of the dermatome
Supplied by posterior rami
| - supplied segmentally by the intercostal nerves
82
What is special about T1 and T2 dermatomes?
Explains the pain from an MI! (because the dermatome extends into the arm etc)
83
Axillary nerve
C5, C6
84
Cutaneous branch of the musculocutaneous nerve
C5, C6, C7
85
Radial nerve
C6, C7, C8
86
Median nerve
C6, C7, C8, T1
87
Ulnar nerve
C7, C8, T1
88
What does the cervical motor plexus supply?
Neck postural & strap muscles
| Diaphragm
89
What does the brachial motor plexus supply?
The upper limb muscles
| The extrinsic back muscles
90
Which motor axons supply:
- postural back muscles (via posterior rami)
- intercostal muscles (via anterior motor rami)
- anterolateral abdominal wall muscles (via thoracoabdominal, subcostal, iliohypogastic and ilioinguinal nerves)
T2-L3
91
What does the lumbosacral motor plexus supply?
Plexus= L1 -S4
- Supplies lower limb muscles &
- Perineal skeletal muscles
92
What is the intracranial part of the spinal nerve course?
Between their base of skill foraminae and their connection with the CNS
93
V1, V2, V3
V1 - sensory
V2 - sensory
V3 - sensory and motor
94
The only cranial nerve to attach to the pons
CN V
95
Which foramen does V1 pass through?
Superior orbital fissure
96
Which foramen does V2 pass through?
Foramen rotundum
97
Which foramen does V3 pass through?
Foramen ovale
98
This nerve supplies the:
- upper eyelid
- the cornea
- all the conjunctiva
- the skin of the root/bridge/tip of the nose
V1
99
This nerve supplies:
- the skin of the lower eyelid
- the skin over the maxilla
- the skin of the ala of the nose
- the skin/mucosa of the upper lip
V2
100
This nerve supplies:
-the skin over the mandible and temperomandibular joint (apart from the angle of the mandible - supplied by C2, C3 spinal nerves)
CN V3
101
Which nerve supplies the skin over the angle of the mandible and some of the external ear
The great auricular nerve (C2, C3)
102
This nerve supplies the:
- bones and soft tissue of the orbit
- the upper anterior nasal cavity
- all paranasal sinuses (except antrum)
- the anterior and posterior cranial fossa
CN V1 (deep sensory territory)
103
This nerve supplies:
- the lowest posterior nasal cavity
- the maxilla and maxillary sinus
- the floor of the nasal cavity/palate
- the maxillary teeth and the associated soft tissues (gingivae and mucosae)
CN V2 (deep sensory territory)
104
Which nerve supplies:
- the MIDDLE cranial fossa
- the mandible
- the anterior 2/3rds of the tongue
- the floor of the mouth
- the buccal mucosa
- the mandibular teeth
CN V3 (deep territory)
105
Recap: which CN supplies the paranasal sinuses?
CN V1 (except antrum)
106
Recap, which CN supplies the anterior and posterior fossa?
CN V1
107
Recap, which CN supplies the antrum? (maxilla and maxillary sinus)
CN V2
108
Recap, which CN supplies the middle fossa?
CN V3
109
Where does the masseter attach?
From the angle of the mandible TO
| the zygomatic arch / bone
110
Where does the temporalis attach?
From the CORONOID process of the mandible to the neurocranium
111
Where does the middle pterygoid attach?
```
From the (medial) part of the angle of the mandible TO
the ptyergoid plates (of sphenoid bone)
```
112
Where does the lateral pterygoid attach?
From the CORACOID process AND articuar disc of TMJ to the ptyergoid plates of spehnoid bone
113
Which nerve supplies the tensor veli palatini?
CN V
114
Which nerve supplies the tensor tympani?
CN V
115
These nerves supply the first part of the afferent limb of the corneal (blink) reflex?
Ciliary nerves
116
Which foraminae does the facial nerve pass through?
The internal acoustic meatus and the stylomastoid foramen
| stylomastoid foramen really visible if you look at skull from the bottom
117
This supplies taste to the anterior 2/3rds of the tongue
Chorda tympani
118
This supplies parasympathetic supply to the submandibular and mandibular glands
Chorda tympani
119
This muscle reduces stapes movement to protect the internal ear from excessive noise
Right stapedius
120
Where would you find the facial nerve in the facial canal?
In the petrous temporal bone
121
Why is the facial canal nice?
It connects the internal acoustic meatus to the stylomastoid foramen
122
What nerve does the chorda tympani attach to?
Attaches to CN V3 and then carries taste axons (to anterior 2/3rds of tongue) and parasympathetic axons (to salivary glands)
123
This border must be carefully sutured by a specialist
Vermillion border
124
Loss of this special pad in illness leads to sunken cheek- what is this pad and why is this sign important?
Buccal fat pad
| -important as a clinical sign of malnutrition
125
Which foramen does the glosspharyngeal nerve pass through?
The jugular foramen
126
Special sensory to the vallat papillae
Glossopharyngeal
127
Parasympathetic to the parotid salivary gland
Glossopharyngeal
128
Visceral afferent to the carotid sinus baroreceptors and carotid body chemoreceptors
Glossopharyngeal
129
General sensory to the posterior 1/3rd of tongue
Glossopharyngeal
130
General sensory to the mucosa of most of the nasopharynx
Glossopharyngeal
131
General sensory to the mucosa of the oropharynx
Glossopharyngeal
132
General sensory to the palatine tonsil
Glossopharyngeal
133
General sensory to the eustachian tube
Glossopharyngeal
134
General sensory to the middle ear cavity
Glossopharyngeal
135
Somatic motor to the stylopharyngeus
Glossopharyngeal
136
Which foramen does the vagus nerve pass through?
The jugular foramen
137
How does the vagus nerve pass through the neck?
In the carotid sheath
138
Which muscles does the spinal accessory nerve supply?
The trapezius and the sternocleidomastoid
139
In relation to the triangle of the neck, where would you find the spinal accessory nerve?
It crosses the posterior triangle of the neck
(named nerves of the cervical plexus ALSO pass the posterior border of the sternocleidomastoid but they do NOT pass DEEP to the trapezius like the spinal accessory nerve does)
140
Which foramen does the hypoglossal nerve pass through?
Hypoglossal canal
141
At which level does the hypoglossal nerve pass anteriorly?
At the level of the hyoid bone
| --> passes anteriorly towards the lateral aspect of the tongue (because it supplies muscles of the tongue obv)
142
Five layers of the SCALP
```
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium
```
143
Which layer of the scalp contains the arteries of the scalp?
Layer 2 (connective tissue)
144
How can you tell the difference between the internal and external carotid artery?
The internal doesn't have any branches in the neck
145
The opthalmic artery is a branch of which artery?
The internal carotid
146
Pterygoid is a joint between which bones?
Frontal
Temporal
Parietal
Spehnoid
147
Which artery crosses the deep aspect of the pterion?
The middle meningeal artery
148
The optic canal is in which bone?
The sphenoid bone
149
There is a groove across the deep surface of the pteriod, what is this made by?
Made by the middle meningeal artery
150
Parts of the ethmoid bone i probably shouldn't forget
Crista galli
| Cribriform plate
151
This is a tough sheet of dura mater forming a roof over the pituitary fossa
Diaphragm sellae
152
This separates the right and left cerebral hemispheres
Falx cerebri
153
Where does the left sigmoid sinus drain into?
Drains into the internal jugular at the jugular foramen
154
Where is the confluence of the sinuses?
In the midline at the internal occipital protuberance (this is deep to the external occipital protuberance)
155
What arteries form the basilar artery?
The vertebral arteries
156
What level would you access the spinal cord?
Lumbar puncture at L3/L4 or L4/L5 intervertebral disc
157
This connects the third and fourth ventricles in the midline
Cerebral aqueduct
158
IMPORTANT
| How does the CSF pass from the lateral ventricles to the 3rd ventricle?
FORAMINAE OF MUNRO
159
IMPORTANT
| How does CSF pass from 3rd ventricle to 4th ventricle
Cerebral aqueduct!
160
Treatment of hydrocephalus
Ventricular peritoneal shunt
161
What type of haemorrhage:
- middle meningeal artery
- trauma to the pterion
Extradural haemorrhage
162
Which type of haemorrhage:
- torn cerebral veins
- falls in the elderly and alcoholics
Subdural
163
Which type of haemorrhage:
- into the CSF of the subarachnoid space
- ruptured circle of willis "berry aneurysm"
- congenital aneurysm
Subarachnoid haemorrhage
164
In epidural anaesthesia/lumbar puncture, where is the needle most safely inserted?
1) the subarachnoid space that surrounds the cauda equina NOT the spinal cord
2) where the vertebrae are not fused (i.e. NOT the sacrum)
This is why they usually go for L3/L4
165
Where does the subarachnoid space end?
S2
166
Which nerves make up the cauda equina?
L2-C0
167
Which level does the spinal cord end?
L2
168
How do you know if its an uncal/transtentorial herniation?
The uncus (medial part) of the temporal love herniates INFERIOR to the tentorium cerebelli
169
An uncal herniation could compress which nerve?
The occulomotor nerve
- -> this leads to an IPSILATERAL, fixed DILATED pupil
- a "blown" pupil
170
What is a downward/tonsillar herniation
The cerebellar tonsils herniate into the foramen magnum
171
Where are the ischial spines palpable on vag exam?
About a finger breadth into the vagina, at 4 and 8 o'clock
172
Which ligaments form the greater and lesser sciatic foraminae?
The sacrotuberous and sacrospinous ligaments
173
What forms the pelvic inlet?
- sacral promontory
- ilium
- superior pubic ramus
- pubic symphysis
174
What forms the pelvic outlet?
- pubic symphysis
- ischiopubic ramus
- ischial tuberosity
- sacrotuberous ligaments
- coccyx
175
Why is trauma to the pelvis bad
You can get a life-threatening haemorrhage (common iliac artery, common iliac vein etc)
176
Difference between the occipitofrontal and the biparietal diameter?
The occipitofrontal diameter is longer than the biparietal diameter
177
What is the "station"? What does a negative number mean?
The distance of the fetal head from the ischial spine
| -a negative number means that the head is above the spines
178
While descending through the pelvic cavity, the fetal head should what?
- rotate
| - be in a flexed position (i.e chin on chest)
179
Baby should ideally leave the cavity in which postition?
OA (occiput anterior)
180
During delivery, the baby's head should be in which position?
Extension
| descending through cavity = flexed
181
What happens once the baby's head has been delivered?
There is further rotation so the rest of the baby can then be delivered
182
Ovaries
Pelvic cavity
183
Uterine tubes
Pelvic cavity
184
Uterus
Pelvic cavity
185
Superior part of vagina
Pelvic cavity
186
Inferior part of vagina
Peirneum
187
Perineal muscles
Perineum
188
Bartholin's glands
Perineum
189
Clitoris
Perineum
190
Labia
Perineum
191
Where is the perineum?
Inferior to the levator ani
192
Where does excess fluid collect in the peritoneal cavity?
Collects in the pouch of douglas
193
How can you get fluid out of pouch of douglas?
By passing a needle through the posterior fornix of the vagina
194
Structure and function of the broad ligament?
- Double layer of peritoneum
| - Helps maintain the uterus in the correct midline position
195
Which ligament is an embryological remnant?
Round ligament
196
Course of the round ligament?
Passes through the deep inguinal ring to attach to the superficial tissue of the female peritoneum
197
The 3 layers of the uterus and which one is shed
- perimetrium
- myometrium
- endometrium (shed)
198
Where does implantation of the zygote occur?
Occurs in the body of the uterus
199
Name a ligament which helps support the uterus
Uterosacral ligament
200
What is uterine prolapse?
Movement of the uterus inferiorly
201
Anteverted
Uterus is tipped anteriorly relative to the axis of the VAGINA
202
Anteflexed
Uterus is tipped posteriorly relative to the axis of the VAGINA
203
Retroverted?
Uterus tipped posteriorly in relative to axis of VAGINA
204
Retroflexed?
Uterus tipped posteriorly relative to axis of CERVIX
205
Which part of the cervix are you sampling in a smear?
The squamo-columnar junction
206
Removal of both uterine tubes and ovaries
Bilateral salpingo-oophrectomy
207
Removal of one of the uterine tubes
Salpingectomy
208
How can you assess patency of the uterine tubes?
Hysterosalpingogram !!!
209
What size are the ovaries
Almond sized
210
What hormones do the ovaries secrete?
Oestrogen and progesterone
211
Where do the ovaries develop?
On the posterior abdominal wall
212
Where is the ovum released into?
Ovum released into the peritoneal cavity !!
213
How can you check the position of the uterus?
Bimanual palpation
214
How can you feel the adnexae
- place examining fingers into lateral fornix
- press deeply with other hand in the iliac fossa of the same side
- repeat on other side
- can detect large masses or tenderness affecting these structures.
215
Nerve supply to levator ani
"nerve to levator ani" S3, S4, S5 sacral plexus
216
Nerve supply to the perineal muscles?
Pudendal nerve
217
This is a bundle of collagenous and elastic tissue into which the perineal muscles attach - what is it call, why is it important and where is it located?
- Perineal body
- important to pelvic floor strength
- located just deep to the skin
218
Breast correlates to which ribs?
Ribs 2-6 !!!
219
What is the retromammary space?
Lies between fascia and breast
220
What does the breast lie on top of?
Lies on top of deep fascia covering pec major and serratus anterior
221
Where does most breast lymph drain to?
Drains to ipsilateral axillary lymph nodes and THEN to supraclavicular lymph nodes!!
(problemz with upper limb also draining here etc)
222
Where could lymph from the lower inner breast drain to?
Drain to the abdominal lymph nodes
223
Where is the brachial plexus?
In the axilla
224
Level I
Inferior and lateral to pectoralis minor
225
Level II
Deep to pectoralis minor
226
Level III
Superior and medial to pectoralis minor
227
Incision for lower segment caesarian section
Suprapubic incision
228
Layers of the anterolateral abdominal wall
```
Skin
Superficial fascia
External oblique
Internal oblique
Transversus abdominus
```
Skin
Superficial fascia
Rectus sheath
Rectus abdominus
229
Where does the external oblique attach?
- lower ribs
- iliac crest
- pubic tubercle
- linea alba
230
Linea alba of external oblique, internal oblique and transversus abdominus?
Made from midline blending of aponeuroses
231
Where does the internal oblique attach?
- lower ribs
- thoracolumbar fascia
- iliac crest
- linea alba
232
Where does the transversus abdominus attach?
- lower ribs
- thoracolumbar fascia
- iliac crest
- linea alba
233
How is the aponeuroses of the rectus abdominus made?
From the interweaving of the muscle aponeuroses
234
Where do the rectus abdominus attach?
Xiphoid process and costal cartilage
| Pubic bones
235
Rectus sheaths above and below umbilicus?
Above umbilicus = anterior and posterior rectus sheath
| Below umbilicus = anterior rectus sheath only
236
Which layer would you find the ilioinguinal nerve?
In between the internal oblique and transversus abdominus
237
The 7th-11th intercostal nerves become what?
The thoracoabdominal nerves
238
Subcostal
T12
239
Iliohyogastric
L1
240
Ilioinguinal
L1
241
Thoracoabdominal, subcostal, iliohypogastric and ilioinguinal nerves travel in which plane?
In between the iliohypogastric and ilioinguinal
242
Superior epigastric arteries are a branch of which artery?
Internal thoracic
| lie posterior to rectus abdominus
243
Inferior epigastric arteries are a branch of which artery?
Branch of external iliac
| lie posterior to rectus sheath
244
The intercostal and subcostal arteries are continuations of which arteries?
Posterior intercostal arteries
245
LSCS layers incised through
```
Skin and fascia
Rectus sheath
Rectus abdominus
Fascia and peritoneum
Retract bladder
Uterine wall
Amniotic sac
```
246
Layers to incise through during lapartomy
Skin and fascia
Linea alba
Peritoneum
247
Why can a midline laparotomy be bad?
Relatively bloodless - increases chances of wound complications
248
If you need a lateral port in a laparoscopy, what artery MUST you avoid?
MUST avoid inferior epigastric artery
249
Route of the interior epigastric artery?
- branch of external iliac
- emerges just medial to the deep inguinal ring
- then passes in a SUPEROMEDIAL direction posterior to the rectus abdominus
250
Which incision would you use for an abdominal hysterectomy?
LSCS
251
How can you tell if you are touching the ureter or the uterine artery
Ureter:
- passes inferior to the artery
- will "vermiculate" when touched
252
Uterine "cramping" (e.g menstruation)
Hormonal (sympathetic/parasympathetic)
253
Uterine contraction (e.g. during labour)
Hormonal (sympathetic/parasympathetic)
254
Pelvic floor muscle contraction (e.g. during sneezing)
Somatic motor
255
Pain from adnexae
Visceral afferents
256
Pain from uterus
Visceral afferents
257
Pain from the vagina
```
Visceral afferents (pelvic part)
Somatic sensory (perineum)
```
258
Pain from the perineum
Somatic sensory
259
Pain sensation from superior aspect of pelvic organs/touching the peritoneum
Uterine tubes, uterus, ovaries
Visceral afferents carry the info!
These then run alongside the SYMPATHETIC fibres and enter the spinal cord between T11- L2
(pain perceived as suprapubic)
260
Pain sensation from inferior aspect of pelvic organs/ not touching the peritoneum
Cervix and superior vagina
Visceral afferent also carry the info!
These run alongside the PARASYMPATHETIC fibres and enter the spinal cord at S2, S3, S4
(pain percieved as S2, S3, S4 dermatome i.e. the perineum)
261
Pain sensation from structures ABOVE levator ani
Visceral afferents carry the infor
Parasympathetic
Levels S2, S3 and S4
262
Pain sensation from BELOW levator ani
Inferior vagina
Perineal muscles
Glands
Skin
SOMATIC SENSORY !!!
Pudendal nerve
Spinal cord levels S2, S3 and S4
Localised pain with perineum
263
The 2 most important spinal cord levels for pain from the repro system
T11-L2
and
S2-S4 (as in S2,S3,S4)
264
Spinal cord becomes cauda equina at which level
L2
265
Subarachnoid space ends at which level
S2
| s for subarachnoid
266
Where is the anaesthetic injected into for a spinal/epidural anaesthesia
Injected into subarachnoid space of L3-L5
=anaesthetises the cauda equina
no infection
(LP usually L3/L4 or L4/L5)
267
Layers the needle is passed through for spinal anaesthetic
```
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Finally reaches subarachnoid space (contains CSF)
```
268
Layers needle is passed through for epidural
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)
269
Sympathetic outflow leaves the spinal column in which levels?
T1 - L2
270
All spinal nerves and their named nerves contain what?
They all contain sympathetic fibres
| -including femoral, sciatic, obturator, pudendal
271
There fibres supply all arterioles
Sympathetic
272
Signs that spinal anaesthesia is working
Skin of lower limbs looks flushes
Warm lower limbs
Reduced sweating
(Hypotension)
Remember this is because you are blocking the sympathetic tone to all the arterioles in the lower limb :)
273
Pudendal nerve is from which plexus
Branch of sacral plexus S2, S3, S4
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When might you consider a pudendal nerve block?
Useful for episiotomy incision, forceps use and perineal stitching post delivery
(anaesthetises majority of perineum)
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What is in the pudendal canal?
Pudendal nerve, artery and vein
| Also the nerve to obturator internus
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Where could you find the nerve to obturator internus?
In the pudendal canal
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Which bony landmark can you use to administer pudendal nerve block?
Ischial spine
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During labour, the branches of which nerve can become stretched?
Pudendal nerve
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If your pudendal nerve is stretched in labour, which muscles could be weakened?
Levator ani and external anal sphincter
-this can result in weakened pelvic floor and faecal incontinence
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This incision is made into the relatively "safe" fat filled ischioanal fossa and avoids extending into the rectum
Epesiotomy
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The 3 parts of the levator ani
- puborectalis
- pubococcygeus
- iliococcygeus
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Innervation of levator ani
Pudendal nerve
| Nerve to coccygeus
