Anatomy of Anaesthetics and Incisions Flashcards
motor functions of the uterus?
uterine cramping
contraction
pelvic floor muscles
nerves in pelvis
sympathetic/ parasympathetic
visceral afferents
nerve types in the perineum
somatic motor and sensory
two important spinal levels in pain
- T11-L2= visceral afferents from organs that touch the peritoneum. Pain perceived as suprapubic.
- S2-S4= pudendal nerve from perineum (visceral afferents run alongside parasympathetics) and those that do not touch peritoneum. Pain perceived in perineum dermatome.
what level is spinal and epidural anaesthetic injected?
L3-5 region to anaesthetise the cauda equina
what parts does the spinal anaesthetic pass through?
supraspinous ligament > interspinous ligament > ligamentum flavum > epidural space (fat and veins) > dura mater > arachnoid mater
signs the anaesthetic is working?
skin of lower limbs looks flushed
warm
reduced sweating
risk in using anaesthetics
hypotension risk
when would you want to use a pudendal nerve block?
episiotomy incision
forceps use
perineal stitching post-delivery
describe the passage of the pudendal nerve
exits the pelvis via the greater sciatic foramen, passes posterior to sacrospinous ligaments, re-enters via lesser sciatic foramen and travels in pudendal canal
landmark used for pudendal nerve block?
ischial spine
common O&G incisions
lower segment C/S (hysterectomy)
laparoscopy (midline)
which way is the muscle incised?
same direction as the fibre to avoid injury
rectus muscle in LSCS
pulled apart
why is there an increased chance of complications in a midline incision?
relatively bloodless so increases chance of complications (dehiscence and hernia)
what do you need to be aware of in lateral port?
inferior epigastric artery medial to the deep inguinal ring
position of inguinal ring
halfway from ASIS and pubic tubercle
layers of the anterolateral abdominal wall
skin
superficial fascia
muscles with deep fascia
anterolateral abdominal wall muscles
- external obliques
- internal obliques
- transversus abdominis
- rectus abdominis
attachments of external oblique
ribs 5-12 and iliac crest, pubic tubercle and linea alba
run inferomedial ending at spinal-umbilical level
what forms the inguinal ligament?
external oblique by inferior free edge
attachments of internal oblique
attached to lower ribs, thoracolumbar fascia, iliac crests and linea alba. Runs posterolateral
attachments of transversus abdominis
attaches same as IO. Neurovascular plane between transversus abdominis and internal oblique
position of rectus abdominis
tendinous intersections divide. Linea alba runs from the xiphoid process to pubic symphysis, defect in the middle is the umbilical ring (foetal umbilical vessels)
what is the rectus sheath?
deep to superficial fascia and is the combined aponeuroses of the anterolateral abdominal wall
superior to umbilicus rectus sheath
anterior and posterior
below umbilicus rectus sheath?
only anterior, no splitting
what lies below the anterolateral abdominal wall muscles
there is transversalis fascia (membrane covering internal abdominal wall), extra peritoneal fat and parietal peritoneum
blood supply to anterolateral abdominal wall
Anterior abdominal wall
Superior epigastric arteries are continuation of internal thoracic. Emerges superiorly
Inferior epigastric arteries from external iliac artery. Emerge inferiorly.
Lateral abdominal wall
Intercostal and subcostal arteries from posterior intercostals. Emerge laterally.
