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A/P > Lecture 10; 9/18 > Flashcards

Lecture 10; 9/18 Flashcards

Test 2 (93 cards)

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1
Q

What is in the subarachnoid space?

A

That is the potential space

2 subarachnoid blood vessles

Nothing else

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2
Q

Describe the epidural space

A

Above the dura layer

Filled with fat tissue and blood vessles

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3
Q

In what area do you give a spinal block?

A

Subarachnoid space

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4
Q

What risks do you run with doing a spinal block?

A

Puncture of the spinal cord because closer in the subarachnoid space

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5
Q

Why does a spinal block work faster than an epidural?

A

Epidural is given in the epidural space which has lots of fat so medication spreads slower

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6
Q

Where do you give an epidural?

A

In the epidural space

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7
Q

What risks do you run with giving medications in the epidural space?

A

Lipidphillic drugs get sucked into fat tissue and have longer onset and take longer to wear off

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8
Q

What are the venous blood vessels called in the epidural space?

A

Posterior/anterior internal vertebral venous plexus

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9
Q

If we run the risk of puncturing the spinal cord during a spinal then….

A

Its best we do a spinal in a place after the physical cord ends

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10
Q

Where does the spinal cord start?

A

Medula Oblongata

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11
Q

Where are your spinal cord enlargements?

A

C3-C6

T11-L1

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12
Q

Where does the spinal cord end?

A

Conus Medullaris
L1

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13
Q

Where is the cervical enlargement? Why do we have this?

A

C3-C6

Extra neurons d/t the brachial plexus (shoulder)

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14
Q

Where is your lumbar enlargement? Why do we have this?

A

T11-L1
Extra neurons d/t lumbar plexus and siatic nerve

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15
Q

What is under the conus medullaris?

A

After L1 is spinal roots that form spinal nerves

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16
Q

T/F: The dura layer goes all the way down to the bottom of the sacrum

A

T

Even though the cord ended, the spinal roots will have dura on them

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17
Q

What are the spinal roots called that flow after the conus medullaris?

A

Cauda Equina
“Horse Tail”

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18
Q

What is the Internum Filum Terminale?

A

Extension of pia mater

connective tissue inside the dursal sac that anchors the end of the cord to the end of the dural sac

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19
Q

What is the externum Filum terminale?

A

External anchor that connects the end of the dural sac to the coccyx

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20
Q

What is the purpose of the internum and externum filum terminales?

A

To keep the spinal cord from retracting up

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21
Q

What is another name for the dural sac?

A

Lumbar Cistern

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22
Q

What is in the dural sac?

A

Cauda Equina and CSF

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23
Q

Where does the dural sac end?

A

S2

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24
Q

Why is L4 area a great place for a spinal block?

A

Less risk of spinal cord puncture because the cord itsself ends at L1

We can easily find it via the illiac crest

Easier access midline

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25
Where is the conus medullaris in a newborn?
L3
26
Where can CSF get stale in the spine at?
L-spine
27
What are the access points to give meds in the S spine?
S2 posterior sacral foramina Sacral hiatus (Not used often)
28
Why do we want to give drugs at a 15 degree angle shift vs directly midline?
Incomplete fusion of the ligamentum flava If it didnt completely fuse you'll be missing the middle of it. Going off center counteracts that If you go midline with an incomplete fusion, you'll go right through because you never felt that change in resistance, possibly piercing the spine
29
Where is the grey matter loacted on the brain?
More superior
30
Why are the blood vessles in the brain more superior?
Because the grey matter is more superior and its metabolism is higher because its where the decisions are being made
31
What is an epidural hematoma?
A bleed above the dura layer Arterial bleed from cranial bone Fx Moreso stays in one place but still bad
32
What is the Arachnoid trabeculae?
Pillars between the arachnoid layer and pia mater that has blood vessles and CSF
33
What is a subdural hemorrhage?
Bleed under the dura layer Venous bleed from the sinouses in the brain
34
What is a subarachnoid hemorrhage?
Bleed under the arachnoid layer Arterial... usually worse than a epidural bleed Diffuses into tissues
35
What are the containers for CSF called?
Ventricles
36
What is normal ICP
10mmHg
37
Where is CSF produced?
In the choroid plexus in the ventricles
38
How many CSF ventricles are there?
4
39
Where is CSF reabsorbed back into the CVS? And why does this happen?
Arachnoid granulations To keep the CSF within normal range
40
What are arachnoid granulations?
Pressure blow off valves that help equalize the pressure of CSF circulating
41
Where is the arachnoid granulations located?
Above the longitudinal fissure
42
What happens if the arachnoid granulations are blocked?
Communicative hydrocephalus Increased ICP
43
What does the cerebellum do?
responsible for coordination
44
Where does the 4th ventricle empty CSF?
Median aperture Lateral apertures Central canal
45
What is the cerebellomedullary cistern?
Pool of CSF from the median aperture that circulates CSF around the cerebellum
46
What is communicating hydocephalus vs noncommunicating?
Communicating: CSF not being reabsorbed (arachnoid granulations); high pressures everywhere Non communicating: Pathway blockage; enlarged ventricle
47
What is another name for the median aperature of the 4th ventricle?
Foramen of magendie
48
what is the exit point for CSF?
Central Canal
49
What is another name for the Cerebral aqueduct?
Aqueduct of sylvius
50
What does the cerebral aqueduct do
circulates CSF from 3rd to 4th ventricle
51
What is the other name for the interventricular foramen?
Foramen of Monroe
52
What does the foramen of monroe do?
CSF from lateral ventricles to 3rd ventricle
53
What are the lateral apertures?
exit point for CSF Circulates CSF around the subarachnoid space
54
What is another name for Cerebellomedullary cistern?
Cisterna magna
55
Explain CSF flow
CSF is created in the choroid plexus of the ventricles Lateral ventricles Interventricular foramen (foramen of monroe) 3rd ventricle cerebral aqueduct (aqueduct sylvius) 4th ventricle median aperture (foramen of magendie), central canal, or lateral apertures (foramen of Luschka)
56
What is another name for later apertures?
Foramen of Luschka
57
What perfuses the brain?
Cranial Sinuses
58
Crainal Sinuses: Superior Sagittal Sinus
Midline most superior
59
Crainal Sinuses: Inferior Sagittal Sinus
Midline Inferior to superior sigattal sinus
60
Crainal Sinuses: Straight sinus
Tail end of inferior sagittal sinus connects superior and inferior sagittal sinuses
61
Crainal Sinuses: Sinus Confluence
Where superior and inferior sinuses connect via straight sinus and connects with transverse sinus
62
Crainal Sinuses: Transverse Sinus
Lateral exit point for the straight sinus
63
Crainal Sinuses: Sigmoid Sinus
Makes hairpin turn where blood flows into internal jugular vein
64
Crainal Sinuses: Cavernous sinus
Venous collection pool in front middle part of brain feeds into sigmoid sinus to internal jugular vein
65
What is Falx cerebri?
Connective tissue between the L and R hemispheres Also between superior and inferior sagittal sinuses
66
Where does the occipital lobe sit?
Tentorium cerebelli
67
What is inferior to the tentorium cerebelli?
Cerebellum
68
Where does the sigmoid sinus empty into?
Internal Jugular vein
69
How many jugular veins do we have on 1 side?
2- external and internal external is small
70
What does the lateral apertures do?
Move CSF to the subarachnoid
71
What is arterial blood flow?
750 ml/min 50ml/min per 100grams of brain tissue
72
How much of our body weight is our brain?
2/3%
73
How much of our cardiac output does our brain use?
15%
74
How much of blood flow is for grey matter? White matter?
80% 20%
75
What happens when we metabolic activity in the brain increases
Blood flow increases
76
Why does white matter have less blood flow?
20% efficient at cell signaling
77
CSF composition: pH
7.31
78
The brain is carefully regulated by glial cells__________
astrocytes
79
CSF composition: Na+
140
80
CSF composition: Cl-
140
81
CSF composition: K+
40% LESS than plasma values
82
CSF composition: Mg++
Higher than plasma
83
CSF composition: Glucose
60mg/dL
84
CSF composition: color
clear
85
CSF composition: RBC
None
86
CSF composition: protein
No large amounts
87
CSF composition: volume
150ml
88
How much CFS is produced in a day?
500ml
89
How often is CSF replaced?
About 3 times per day
90
What is a chorois plexus made of?
ependymol cells
91
What are ependymol cells permeable to?
Na, Cl, H2O and they have Na+ pumps and Cl- pumps
92
What does the ependymol cells do?
Separate CVS from CSF circulatory system has access to blood, water, electrolytes, etc
93
What happens if we increase the Na in the Na+ pump in the ependymol cells?
We increase the amount of CSF produces

A/P (33 decks)

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