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Year 3 - Obs & Gynae Anatomy > Clinical Anatomy of Anaesthesia for Labour > Flashcards

Clinical Anatomy of Anaesthesia for Labour Flashcards

1
Q

What are the reproductive system’s motor functions?

A

Uterine cramping e.g. menstruation
Uterine contraction e.g. during labour
Pelvic floor muscle contraction e.g. during sneezing

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2
Q

What is the reproductive system’s pain (sensory) function?

A

Pain from adnexal (ovaries + Fallopian tubes)
Pain from uterus
Pain from vagina
Pain from perineum

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3
Q

Above the levator ani muscles is referred to as?

A

Pelvis

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4
Q

Below the levator ani muscle is referred to as?

A

Perineum

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5
Q

What supplies structures of the pelvis?

A

Body cavity
Sympathetic, parasympathetic and visceral afferent

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6
Q

What supplies structures of the perineum?

A

Body wall
Somatic motor and somatic sensory

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7
Q

What structures are below and above levator ani muscle in the reproductive system?

A
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8
Q

What nerve fibres supply uterine cramping e.g. menstruation?

A

Hormonal (symp/parasymp)

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9
Q

What nerve fibres supply uterine contraction e.g. during labour?

A

Hormonal (symp / parasympathetic)

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10
Q

What nerve fibres supply pelvic floor muscle contraction e.g. during sneezing?

A

Somatic motor

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11
Q

What nerve fibres supply pain from adnexae?

A

Visceral afferents

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12
Q

What nerve fibres supply pain from uterus?

A

Visceral afferents

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13
Q

What nerve fibres supply pain from vagina?

A

Visceral afferents (pelvic part)
Somatic sensory (perineum)

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14
Q

What nerve fibres supply pain from perineum?

A

Somatic sensory

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15
Q

Superior aspect of pelvic organs / touching the peritoneum are supplied by what nerve fibres?

A

Visceral afferents
Run alongside sympathetic fibres

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16
Q

Visceral afferents from the Superior aspect of pelvic organs / touching the peritoneum enter spinal cord between?

A

T11-L2

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17
Q

Pain is perceived as what from Superior aspect of pelvic organs / touching the peritoneum ?

A

Suprapubic

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18
Q

Inferior aspect of pelvic organs / not touching peritoneum are supplied by what nerve fibres?

A

Visceral afferents
Rung alongside parasympathetic fibres

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19
Q

Inferior aspect of pelvic organs / not touching peritoneum enter spinal cord at what levels?

A

S2, S3 and S4

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20
Q

Pain is perceived as what from Inferior aspect of pelvic organs / not touching peritoneum?

A

In S2, S3 and S4 dermatomes (perineum)

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21
Q

Structures crossing from pelvis to perineum above the levator ani (in pelvis) are supplied by what?

A

Visceral Afferents
Parasympathetic

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22
Q

The nerve fibres from Structures crossing from pelvis to perineum above the levator ani (in pelvis) enter spinal cord where?

A

Levels S2, S3 and S4

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23
Q

Structures crossing from pelvis to perineum below levator ani (in perineum) are supplied by what fibres?

A

Somatic sensory
Pudendal nerve

24
Q

Nerve fibres from Structures crossing from pelvis to perineum below levator ani (in perineum) enter where in spinal cord?

A

Levels S2, S3 and S4

25
Q

Pain from Structures crossing from pelvis to perineum below levator ani (in perineum) are perceived where?

A

Localised pain within perineum

26
Q

The sympathetics from pelvis are supplied by what?

A

Sacral sympathetic trunks
T11-L2
Superior hypogastric plexus

27
Q

The parasympathetics to pelvis are from where and what nerves?

A

Sacral outflow (S2,3,4)
Pelvic splanchnic nerves
Emerge from spinal roots
Mixes with sympathetics in inferior hypogastric plexus

28
Q

What are the 2 important spinal cord levels from where pain from female reproductive system arises?

A

T11-L2
S2-S4

29
Q

Describe the path of visceral afferents in female pelvic pain

A
30
Q

Describe the path of the pudendal nerve in female pelvic pain

A
31
Q

Draw out a diagram explaining the nerve supply from perineum or pelvis

A
32
Q

What anaesthesia procedures of the pelvis exist?

A
33
Q

A spinal block via lumbar puncture anaesthetises what?

A

From waist down - intra and sub peritoneal plus somatic areas

34
Q

A caudal epidural block anaesthetises what?

A

Sub-peritoneal plus somatic areas innervated by pudendal nerve

35
Q

A pudendal nerve block anaesthetises what?

A

Areas innervated by pudendal nerve

36
Q

The spinal cord becomes caudal equine at what vertebral level?

A

L2 vertebra

37
Q

The subarachnoid space ends at level of?

A

S2

38
Q

Spinal and epidural Anaesthetic is injected into what region?

A

L3-L4 (L5) region

39
Q

The needle passes through what in an epidural anaesthetic?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)

40
Q

The needle passes through what in spinal anaesthetic?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)
Dura mater
Arachnoid mater
Finally reaches subarachnoid space (contains CSF)

41
Q

All spinal nerves and their named nerves contain?

A

Sympathetic fibres

42
Q

Sympathetic fibres supply all of what vascular structure?

A

Sympathetic fibres supply all arterioles

43
Q

Blockade of sympathetic tone to all arterioles in lower limb in a spinal anaesthetic can lead to what?

A

Vasodilation and subsequently hypotension

44
Q

Sympathetic nerves exit spinal cord with what spinal nerves?

A

T1-L2 spinal nerves

45
Q

Sympathetic nerves travel to what?

A

Sympathetic chains and pass into all spinal nerves

46
Q

What happens to sympathetic outflow below L2 level?

A

Sympathetic ganglia receive fibres from L2 level via sympathetic chain and distribute them via connections with lumbar, sacral and coccygeal spinal nerves

47
Q

The pudendal nerve plays a role in?

A

GI system
Renal system
Role in motor control of external anal and external urethral sphincters

48
Q

The pudendal nerve is the nerve of?

A

Perineum

49
Q

The pudendal nerve is a branch of?

A

sacral plexus S2, S3 and S4

50
Q

Describe the pathway of the pudendal nerve

A

Exits pelvis via greater sciatic foramen
Passes posterior to sacrospinous ligament
Re enters pelvis / perineum via lesser sciatic foramen
Travels in pudendal canal
Branches to supply structures of the perineum

51
Q

The pudendal nerve crosses posterior to?

A

The lateral aspect of the sacrospinous ligament

52
Q

What bony landmark can be used to identify pudendal nerve?

A

Ischial spine

53
Q

When can pudendal nerve block be used?

A

Can be used during labour
Forceps delivery
Painful vaginal delivery
Episiotomy incision
Perineal suturing post delivery

54
Q

During labour, what can be stretched?

A

The branches of pudendal nerve can be stretched

55
Q

Fibres of what muscles can be torn during labour?

A

Fibres within levator ani (puborectalis) or external anal sphincter muscle could be torn

1st degree
2nd degree
3rd degree
4th degree

56
Q

What is a episiotomy?

A

deliberate incision that is made, made from posterior forchettte out to sischioanal / ischiorectal fossae - fat filled space - prevents tearing going towards external anal sphincter. Also to avoid perineal body

Posterolateral (mediolalateral) incision

Year 3 - Obs & Gynae Anatomy (7 decks)

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