ANATOMY 3

Question 1

nerves in pelvis (above levator ani)

Answer 1

visceral afferents (sensory)
autonomic (visceral motor)

Question 2

nerves in perineum

Answer 2

somatic sensory and motor

Question 3

what are the superior pelvic organs (touching peritoneum)

Answer 3

uterine tubes
uterus
ovaries

Question 4

what do visceral afferents to superior pelvic organs run alongside

Answer 4

sympathetics

Question 5

where is pain from superior pelvic organs felt

Answer 5

suprapubic pain (T11-L2)

Question 6

what are inferior pelvic organs

Answer 6

cervix

superior vagina

Question 7

what do visceral afferents to inferior pelvic organs run alongside

Answer 7

parasympathetics

Question 8

where is pain from inferior pelvic organs felt

Answer 8

perineal pain (S2-S4)

Question 9

what are the perineal organs

Answer 9

inferior vagina

perineal muscles, glands and skin

Question 10

what nerve is sensory supply to perineum

Answer 10

pudendal nerve (S2-4)

Question 11

where is spinal anaesthetic injected into

Answer 11

L3-L4 subarachnoid space

Question 12

how is L4 process found

Answer 12

draw a straight line from most superior point of iliac crests (intercristal line)
L4 process is first palpable spinous process superiorly

Question 13

onset of spinal anaesthesia and how long does it last

Answer 13

5 mins

wears off quickly

Question 14

side effects of spinal and epidural

Answer 14

hypotension
decreased sweating
warm, flushed lower limbs

Question 15

where is epidural anaesthetic injected into

Answer 15

L3-L4 epidural space

Question 16

what does epidural space contain

Answer 16

fat and veins

Question 17

onset of epidural and how long does it last

Answer 17

slower onset, lasts longer

Question 18

when is a pudendal nerve block used

Answer 18

anaesthetise perineum in epiostomy, forceps and stitching

Question 19

course of pudendal nerve

Answer 19

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

Question 20

what is used as a landmark to administer pudendal nerve block

Answer 20

ischial spines (felt in vaginal exam)

Question 21

external oblique muscle attachments

Answer 21

ribs 5-12
iliac crest
pubic tubercle
linea alba

Question 22

internal oblique muscle attachments

Answer 22

ribs 10-12
thoracolumbar fascia
iliac crest
linea alba

Question 23

transversus abdominis attachments

Answer 23

7-10 costo-cartilages
thoracolumbar fascia
iliac crest
linea alba

Question 24

what are in rectus abdominis muscles

Answer 24

tendinous intersections

Question 25

what is rectus sheath

Answer 25

combined aponeuroses of anterolateral abdominal wall muscles completely surrounds rectus abdominis muscles

Question 26

layer of lateral abdominal wall

Answer 26

``` external oblique internal oblique transversus abdominis transversalis fascia extra peritoneal fat parietal peritoneum ```

Question 27

what layer do cutaneous nerves to lateral abdominal wall run

Answer 27

between internal oblique and transversus abdominis

Question 28

blood supply of anterior abdominal wall

Answer 28

superor and inferior epigastric arteries

Question 29

what are superior epigastric arteries a continuation of

Answer 29

internal thoracic artery

Question 30

where do inferior epigastric arteries arise from

Answer 30

external iliac arteries

Question 31

what layer are anterior abdominal wall arteries immediately below

Answer 31

rectus abdominis

Question 32

what is arterial supply to lateral abdominal wall

Answer 32

intercostal and subcostal arteries (subcostal 7th-11th ribs)

Question 33

where do epigastric arteries anastomose

Answer 33

ubilicus

Question 34

course of inferior epigastric arteries and clinical relevance

Answer 34

``` start lateral (medial to deep inguinal ring) and means middle has poor blood supply so worse wound healing ```

Question 35

what way should muscles be cut in an incision

Answer 35

same direction as their fibres

Question 36

why should rectus abdominis be cut transversely despite its fibres running longitudinally

Answer 36

creates another transverse band

Question 37

what is LSCS

Answer 37

lower segment caesarean section

Question 38

describe LSCS

Answer 38

rectus muscles not cut (linea alba is if laparotomy) | bikini line/supra pubic is most common

Question 39

complications of midline incision and why

Answer 39

poor wound healing - relatively bloodless area

Question 40

where is deep inguinal ring located

Answer 40

halfway between ASIS and pubic tubercle

Question 41

how to differentiate between uterine artery and ureter

Answer 41

ureter under artery (bridge over water) | ureter will vermiculate when touched