Anatomy of Anaesthetics and Incisions

Question 1

motor functions of the uterus?

Answer 1

uterine cramping
contraction
pelvic floor muscles

Question 2

nerves in pelvis

Answer 2

sympathetic/ parasympathetic

visceral afferents

Question 3

nerve types in the perineum

Answer 3

somatic motor and sensory

Question 4

two important spinal levels in pain

Answer 4

• 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.

Question 5

what level is spinal and epidural anaesthetic injected?

Answer 5

L3-5 region to anaesthetise the cauda equina

Question 6

what parts does the spinal anaesthetic pass through?

Answer 6

supraspinous ligament > interspinous ligament > ligamentum flavum > epidural space (fat and veins) > dura mater > arachnoid mater

Question 7

signs the anaesthetic is working?

Answer 7

skin of lower limbs looks flushed
warm
reduced sweating

Question 8

risk in using anaesthetics

Answer 8

hypotension risk

Question 9

when would you want to use a pudendal nerve block?

Answer 9

episiotomy incision
forceps use
perineal stitching post-delivery

Question 10

describe the passage of the pudendal nerve

Answer 10

exits the pelvis via the greater sciatic foramen, passes posterior to sacrospinous ligaments, re-enters via lesser sciatic foramen and travels in pudendal canal

Question 11

landmark used for pudendal nerve block?

Answer 11

ischial spine

Question 12

common O&G incisions

Answer 12

lower segment C/S (hysterectomy)

laparoscopy (midline)

Question 13

which way is the muscle incised?

Answer 13

same direction as the fibre to avoid injury

Question 14

rectus muscle in LSCS

Answer 14

pulled apart

Question 15

why is there an increased chance of complications in a midline incision?

Answer 15

relatively bloodless so increases chance of complications (dehiscence and hernia)

Question 16

what do you need to be aware of in lateral port?

Answer 16

inferior epigastric artery medial to the deep inguinal ring

Question 17

position of inguinal ring

Answer 17

halfway from ASIS and pubic tubercle

Question 18

layers of the anterolateral abdominal wall

Answer 18

skin
superficial fascia
muscles with deep fascia

Question 19

anterolateral abdominal wall muscles

Answer 19

1. external obliques
2. internal obliques
3. transversus abdominis
4. rectus abdominis

Question 20

attachments of external oblique

Answer 20

ribs 5-12 and iliac crest, pubic tubercle and linea alba

run inferomedial ending at spinal-umbilical level

Question 21

what forms the inguinal ligament?

Answer 21

external oblique by inferior free edge

Question 22

attachments of internal oblique

Answer 22

attached to lower ribs, thoracolumbar fascia, iliac crests and linea alba. Runs posterolateral

Question 23

attachments of transversus abdominis

Answer 23

attaches same as IO. Neurovascular plane between transversus abdominis and internal oblique

Question 24

position of rectus abdominis

Answer 24

tendinous intersections divide. Linea alba runs from the xiphoid process to pubic symphysis, defect in the middle is the umbilical ring (foetal umbilical vessels)

Question 25

what is the rectus sheath?

Answer 25

deep to superficial fascia and is the combined aponeuroses of the anterolateral abdominal wall

Question 26

superior to umbilicus rectus sheath

Answer 26

anterior and posterior

Question 27

below umbilicus rectus sheath?

Answer 27

only anterior, no splitting

Question 28

what lies below the anterolateral abdominal wall muscles

Answer 28

there is transversalis fascia (membrane covering internal abdominal wall), extra peritoneal fat and parietal peritoneum

Question 29

blood supply to anterolateral abdominal wall

Answer 29

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.