ANATOMY 3 Flashcards
nerves in pelvis (above levator ani)
visceral afferents (sensory) autonomic (visceral motor)
nerves in perineum
somatic sensory and motor
what are the superior pelvic organs (touching peritoneum)
uterine tubes
uterus
ovaries
what do visceral afferents to superior pelvic organs run alongside
sympathetics
where is pain from superior pelvic organs felt
suprapubic pain (T11-L2)
what are inferior pelvic organs
cervix
superior vagina
what do visceral afferents to inferior pelvic organs run alongside
parasympathetics
where is pain from inferior pelvic organs felt
perineal pain (S2-S4)
what are the perineal organs
inferior vagina
perineal muscles, glands and skin
what nerve is sensory supply to perineum
pudendal nerve (S2-4)
where is spinal anaesthetic injected into
L3-L4 subarachnoid space
how is L4 process found
draw a straight line from most superior point of iliac crests (intercristal line)
L4 process is first palpable spinous process superiorly
onset of spinal anaesthesia and how long does it last
5 mins
wears off quickly
side effects of spinal and epidural
hypotension
decreased sweating
warm, flushed lower limbs
where is epidural anaesthetic injected into
L3-L4 epidural space
what does epidural space contain
fat and veins
onset of epidural and how long does it last
slower onset, lasts longer
when is a pudendal nerve block used
anaesthetise perineum in epiostomy, forceps and stitching
course of pudendal nerve
exits pelvis via greater sciatic foramen
passes posterior and lateral to sacrospinal ligament (next to ischial spines)
re-enters via lesser sciatic foramen
travels in pudendal canal through obturator membrane
what is used as a landmark to administer pudendal nerve block
ischial spines (felt in vaginal exam)
external oblique muscle attachments
ribs 5-12
iliac crest
pubic tubercle
linea alba
internal oblique muscle attachments
ribs 10-12
thoracolumbar fascia
iliac crest
linea alba
transversus abdominis attachments
7-10 costo-cartilages
thoracolumbar fascia
iliac crest
linea alba
what are in rectus abdominis muscles
tendinous intersections
what is rectus sheath
combined aponeuroses of anterolateral abdominal wall muscles
completely surrounds rectus abdominis muscles
layer of lateral abdominal wall
external oblique internal oblique transversus abdominis transversalis fascia extra peritoneal fat parietal peritoneum
what layer do cutaneous nerves to lateral abdominal wall run
between internal oblique and transversus abdominis
blood supply of anterior abdominal wall
superor and inferior epigastric arteries
what are superior epigastric arteries a continuation of
internal thoracic artery
where do inferior epigastric arteries arise from
external iliac arteries
what layer are anterior abdominal wall arteries immediately below
rectus abdominis
what is arterial supply to lateral abdominal wall
intercostal and subcostal arteries (subcostal 7th-11th ribs)
where do epigastric arteries anastomose
ubilicus
course of inferior epigastric arteries and clinical relevance
start lateral (medial to deep inguinal ring) and means middle has poor blood supply so worse wound healing
what way should muscles be cut in an incision
same direction as their fibres
why should rectus abdominis be cut transversely despite its fibres running longitudinally
creates another transverse band
what is LSCS
lower segment caesarean section
describe LSCS
rectus muscles not cut (linea alba is if laparotomy)
bikini line/supra pubic is most common
complications of midline incision and why
poor wound healing - relatively bloodless area
where is deep inguinal ring located
halfway between ASIS and pubic tubercle
how to differentiate between uterine artery and ureter
ureter under artery (bridge over water)
ureter will vermiculate when touched
