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Ana/Phys/Patho I > Unit 9: spinal/arterial circulation > Flashcards

Unit 9: spinal/arterial circulation Flashcards

1
Q

which groove does the anterior spinal artery fit into?

A

anterior median fissure

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2
Q

where do the posterior spinal arteries get their blood supply? (3)

A
  1. vertebral arteries (from above cord)
  2. cerebellar arteries (2/3) (from above cord)
    * AICA
    * PICA
  3. intercostal arteries (from lower cord)
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3
Q

what do radicular arteries do? where are they located?

A

radicular arteries connect intercostal arteries to either the anterior spinal artery or the posterior spinal arteries

radicular arteries are “EITHER/OR”, but they do NOT connect from BOTH the anterior AND posterior on the same level

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4
Q

how many intercostal arteries are there?

A

24 total
(12 sets)

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5
Q

radicular artery aliases (2)

A

segmental arteries
medullary arteries

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6
Q

relate the following terms: coronal arteries, SC, colateral circulation

A

the SC does NOT have as good of colateral circulation as there is in the brain; the coronal arteries are not continuous around the cord.

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7
Q

what percentage of the SC gets blood supplied by the anterior spinal artery? posterior spinal arteries?

A

75% from anterior s.a.
25% from posterior s.a’s (combined; 12.5% each)

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8
Q

how many posterior spinal veins run along the spinal cord? anterior spinal veins?

A

3 posterior spinal veins (one midline, two lateral)

1 midline anterior spinal vein

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9
Q

what is the spinal branch? where is the spinal branch located?

A

the spinal branch “branches” off the dorsal branch into the spinal cord circulation

the spinal branch lies on top of the spinal root ganglion

occurs on every level of SC

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10
Q

with aortic cross clamping, what complications would you expect?

A
  1. SC injury (ischemia > neuronal death)
  2. ischemia to the lower extremities
  3. ischemic organ damage (ex. kidney injury)
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11
Q

about how many radicular arteries feed the anterior spinal artery in the neck? thorax? lumbar region?

A

2-3 in the neck
2-3 in the thorax
1-3 in the lumbar region

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12
Q

what is the Great Radicular Artery (GRA)?

A
  • this is the “feed artery” that supplies blood to the lower 2/3 of the spinal cord
  • this structure is AKA Artery of Adamkiewicz
  • the GRA typically enters on the left side of spinal cord d/t the aorta also being on the left side
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13
Q

localize the great radicular artery

A

most approximate location: T10
range: T9-T12 (in the vast majority of people)
extreme range: T5-L5

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14
Q

what are the implications of cross clamping above or below the GRA?

A

cross clamping below GRA:
* not an issue; no obstruction to flow

cross clamping above GRA:
* possible lower extremity paralysis
* GRA feeds into anterior spinal artery which is the most important artery in the anterior spinal cord
* Ant. SA is closest to gray matter in spinal cord, where many motor neurons are located > possible ischemia > possible paralysis

the lower the GRA is in the SC, the safer it is to do an aneurysm repair

if imaging can be done prior to AAA repair, MRI can be done to localize

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15
Q

cerebral perfusion pressure (CPP) = ?

A

MAP - ICP

“normal 50-150 mmHg” per schmidt

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16
Q

by how much does aortic cross clamping increase a patient’s CSF pressure?

A

an increase in 10 mmHg

this is why putting in a lumbar drain might be beneficial

17
Q

while patient is cross clamped, what are (3) interventions to consider to prevent ischemic injury?

A
  1. inflammation reduction
  2. slowing metabolic rate
    * slower energy reserve consumption
  3. preventing reperfusion injury (by gradually restoring blood flow rather than all at once; or, by measuring oxygen levels to not overload)
18
Q

what is reperfusion injury?

A

in terms of cross clamping, reperfusion injury occurs when a massive blood flow is restored to an ischemic tissue too rapidly and the oxygen and free radicals can actually overwhelm the regulatory anti-oxidants and destroys the tissue

19
Q

describe the spinocerebellar tracts

A
  1. anterior spinocerebellar tract
    * located on anterior/lateral SC
    * ascends sensory info about the level of synaptic activity in the ventral horn to the cerebellum
    * this info gets routed through the anterior spinocerebellar tract > superior cerebellar peduncle > cerebellum
  2. posterior spinocerebellar tract
    * located on posterior/lateral SC
    * ascends sensory info about the tendons (golgi tendons) & muscle spindle activity to the cerebellum
    * this info gets routed through the posterior spinocerebellar tract > inferior cerebellar peduncle > cerebellum
20
Q

describe parietal pain

A
  • connective tissue pain
  • direct conduction into SC from peritoneum, pleura, or pericardium (3P)
  • highly localized
  • sharper pain/faster pain (delta fibers)
21
Q

describe visceral pain

A
  • organ pain
  • transmitted through ANS
  • difficult to localize; pain may be referred outside the origin
  • dull/achy pain/slower pain (c-fibers)
22
Q

what is referred pain?

A

pain that is sensed outside the origin of pain

ex) pain from kidney stones may be felt as back pain
ex) stomach pain > umbilicus

23
Q

why is appendix pain considered dual pain?

A

parietal pain:
* pain localized to RLQ
* can induce lateral inhibition w/ pressure (once pressure is released, pain will return)

visceral pain:
* pain felt in the umbilicus
* cannot induce lateral inhibition by pressing on umbilicus

24
Q

why does the heart refer pain to the LEFT arm as opposed to the RIGHT arm?

A

visceral pain from the heart is referred to the left arm not because the heart is to the left of the thorax, but because the right heart is less prone to ischemia

25
Q

describe the structures of the limbic system and where they’re located

A
  1. amygdala
    * on bilateral sides of the diencephalon
  2. HYPOthalamus
    * in the diencephalon
  3. cingulate gyrus
    * buried deep in the middle of the brain, part of the cerebral cortex
26
Q

motor neurons use these neural fibers:

A

A-alpha

also
* muscle spindles
* muscle tendons
* pressure sensors

27
Q

DCML pathway uses these types of neural fibers

A

A-alpha to A-gamma

28
Q

lateral inhibition uses these neural fibers:

A

A-beta

29
Q

fast pain uses these neural fibers

A

A-delta

also stabbing/sharp pain

30
Q

slow pain uses these neural fibers:

A

C-fibers

achy pain
dull pain
thermal pain

still can move quickly, but just longer than A or B fibers

this type of pain engages the limbic system

31
Q

if you smash your hand with a hammer, what is the neural fiber pathway

A
  1. pressure noticed first (A-alpha)
  2. sharp pain second (A-delta)
  3. dull achy pain (C-fibers)

Ana/Phys/Patho I (16 decks)

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