Anatomy of the Breast Flashcards
What ribs does the bed of the breast extend between?
rib 2-6 (lateral border of the sternum to mid auxiliary line)
What is the role of the retromammary space and where is it?
allows breast to move
found between the fascia and breast
What do you have around the breast?
lactating lobules - more closer to pregnancy
non lactating lobules
lactating ducts
What would be suggested if the breast is fixed to any underlying tissue?
invasive tumour through the fascia
How is an invasive tumour through the fascia tested for?
patient puts hands on hips and contracts pec muscles
What does >75% of lymphatic drainage from the breast go to?
ipsilateral axillary lymph nodes -> supraclavicular lymph nodes
Where does lymph from the internal breast quadrant go to?
parasternal lymph nodes
Where does lymph from the lower inner breast quadrant go to?
abdominal lymph nodes
Where does lymph from the upper limb go to?
auxillary lymph nodes
What is lymphodema?
swelling that occurs due to damage or removal of lymph nodes
What does the axilla contain?
brachial plexus branches
axillary artery, vein and lymph nodes
fat
How is pain from the superior aspect of the pelvic organs and those touching the perineum transported?
visceral afferents alongside sympathetic fibres
T11-L2
How is pain from the superior aspect of the pelvic organs and perineum percieved?
suprapubic
How is pain from the inferior aspect of the pelvic organs and those not touching the perineum transported?
visceral afferents alongside parasympathetic fibres
S2,3,4
How is pain from the inferior aspect of the pelvic organs and those not touching the perineum percieved?
S2,3,4 dermatome - perineum
How is pain from the structures that are in the pelvis eg cervix and superior vagina ABOVE the levator ani transported?
visceral afferents alongside parasympathetics
S2,3,4
How is pain from the structures that are in the perineum eg inferior vagina, perineal muscles and skin BELOW the levator ani transported?
somatic sensory from the pudendual nerve
Which spinal levels is a spinal anaesthetic inserted to?
L3/L4
What does a spinal anaesthetic aneasthetise?
from waiste down - intra and sub peritoneal plus somatic areas
What is the furthest point that a spinal anaesthetic goes into?
spinal cord
What is the mode of action of a spinal anaesthetic?
blockade of sympathetic tone to all arterioles in the lower limb causing - vasodilation
What is a side effect of spinal anaesthetic?
hypotension
How do you know if spinal anaesthetic is working?
skin of the lower limbs look flushed
warm lower limbs
reduced sweating
What does an epidural anaesthetise?
sub peritoneal plus somatic areas innervated by the pudendual nerve
Which spinal level is used for an epidural?
L3/L4
Which is the furthest point that an epidural goes into?
epidural space
What is the action of a pudendual nerve block?
anaesthetises areas innervated by the pudendual nerve
What is used as a landmark for a pudendual nerve block?
ischial spines - 4 and 8 o’clock positions
What is the route of the pudendual nerve?
exits via the greater sciatic foramen, passes the posterior sacrospinous ligament then reenters via the lesser sciatic foramen
travels in the pudendual canal within the obturator fascia
When is a pudendual nerve block given?
during labour/forceps delivery
painful delivery
episotomy needed
perineal suturing post delivery
What is an episiotomy? What type is usually done?
posterolateral inscison done to prevent tearing into the anus
usually medial lateral done
