1-5 Anatomy of the Abdominal Wall & Inguinal Region part II

Question 1

Inguinal ligament – inferior rolled-under border of the external abdominal oblique aponeurosis extending from the ASIS to the pubic tubercle.

How does it attach to the fascia lata? What does it participate with to form the floor of the inguinal canal?

Answer 1

It forms a “shelving border” which attaches to the fascia lata of the thigh and, with the iliopubic tract of transversalis fascia, participates in forming the floor of the inguinal canal.

Question 2

What do the inguinal ligament and iliopubic tract form together? What does it span and contain?

Answer 2

Together the inguinal ligament and iliopubic tract form a “flexor retinaculum” which spans the subinguinal space containing the iliopsoas, pectineus, and the femoral sheath and its contents.

Question 3

Superficial inguinal ring – medial opening of the inguinal canal through the inguinal ligament.

What passes through this?

Triangular in shape, its apex is directed laterally toward the ASIS, while its base is located at the pubic crest. Superior and inferior margins are referred to as?

Answer 3

Males - spermatic cord passes through

females - round ligament of the uterus

… crura.

Question 4

What forms the lateral (inferior) crus? What does it attach to?

Answer 4

formed by the thick portion of the inguinal ligament which attaches to the pubic tubercle.

Question 5

What forms the medial (superior) crus?

Answer 5

formed by the portion of the inguinal ligament which attaches to the pubic symphysis. It is thinner than its lateral counterpart

Question 6

How are the intercrural fibers oriented? What do they do?

Answer 6

reinforcing fibers located perpendicular to the crura lateral to the superficial inguinal ring.

Question 7

__________________:

medial rolled-under portion of the inguinal ligament which, after being crossed by the spermatic cord, attaches to the pectineal line lateral to the pubic tubercle.

Answer 7

Lacunar Ligament

Question 8

What does the continuation of the lacunar ligament laterally along the pectineal line of the superior ramus of the pubic bone form?

Why is this important?

Answer 8

the pectineal ligament

(Important as an anchoring point for sutures during inguinal hernia repair)

Question 9

Reflected inguinal ligament – fibers continued from the pubic tubercle medially and superiorly toward the linea alba which intersect with the…

Answer 9

contralateral external oblique aponeurosis

Question 10

______________:

outermost fascial layer of the spermatic cord derived from the external abdominal oblique aponeurotic layer

Answer 10

External spermatic fascia

Question 11

_______________________:

the most medial and inferior common fused aponeuroses of the internal abdominal oblique and transversus abdominis muscles. The fibers of these two muscles arch from the inguinal ligament where they originate to the pubis where they terminate immediately deep to the superficial inguinal ring.

Answer 11

Conjoined tendon

Question 12

The fusion of the internal abdominal oblique and transversus abdominis muscle layers helps do what?

Answer 12

strengthen a potentially week area of the anterior abdominal wall.

Question 13

What are the boundaries of the inguinal canal?

Floor

Anterior wall

Roof

Posterior wall

Answer 13

a. Floor: inguinal ligament and iliopubic tract of transversalis fascia
b. Anterior wall: external oblique aponeurosis with lowest fibers of internal oblique
c. Roof: arching fibers of the internal oblique and transversus abdominis which originate from the inguinal ligament and attach medially to the superior pubic ramus
d. Posterior wall: transveralis fascia laterally; conjoined tendon medially

Question 14

The lowest fibers of the internal oblique muscle arise from the inguinal ligament lateral and anterior of the deep inguinal ring. They arch over the canal and insert with the fibers of the transversus abdominis as the _________________ posterior to the superficial ring. The internal oblique therefore participates in forming a portion of the…

Answer 14

conjoined tendon

anterior wall, roof, and a portion of the posterior wall of the inguinal canal.

Question 15

What is the entrance to the inguinal canal? What is this an evagination of?

Answer 15

ENTRANCE to the inguinal canal is via the deep inguinal ring which is an evagination of transversalis fascia through the posterior wall of the inguinal canal at the approximate mid-point of the inguinal ligament.

Question 16

What forms the exit of the inguinal canal?

Answer 16

EXIT of the inguinal canal is via the superficial inguinal ring

Question 17

In men and women, what are the contents of the inguinal canal?

Answer 17

Male: spermatic cord, ilioinguinal n., genital branch of the genitofemoral n.

b. Female: round ligament of the uterus, artery and vein of the round ligament, ilioinguinal n.

Question 18

What cell type gives rise to the testes? Where do they develop?

Answer 18

coelomic epithelial cells

develop in the extraperitoneal connective tissue layer of the posterior abdominal wall at the upper lumbar level in an area known as the urogenital ridge.

Question 19

At its superior and inferior poles, the testis has attached to it peritoneal folds. Describe the destiny of each pole.

Answer 19

The superior fold contains the future testicular vessels, nerves and lymphatics. The inferior fold will eventually form the gubernaculum testis

Question 20

What is the function of the gubernaculum testis?

Answer 20

attaches the inferior pole of the testis to the site of the future deep inguinal ring on the anterior inferior abdominal wall. Draws the testis into the scrotum.

Question 21

After the testis has fully descended, the processus vaginalis is applied to the testis forming an incomplete serous sac, the…

Answer 21

tunica vaginalis testis.

Question 22

It is thought that the processus vaginalis is open in 50% of infants until one month after birth; this may lead to?

Answer 22

to weakness of the anterior abdominal wall in the inguinal region contributing to indirect inguinal hernia.

Question 23

What is cryptochidism?

Answer 23

undescended or incompletely descended testes

Question 24

What are the coverings of the spermatic cord and testes?

5

Answer 24

1. External spermatic fascia
   2. Cremaster muscle and associated fascia
2. Internal spermatic fascia
   4. Tunica vaginalis testis
   5. Tunica albuginea

Question 25

________________ – outermost connective tissue capsule of testis

Answer 25

Tunica albuginea

Question 26

_______________________ ‑ from internal abdominal oblique; applied midway through the inguinal canal

Answer 26

Cremaster muscle and associated fascia

Question 27

___________________ ‑ from external abdominal oblique; applied as cord penetrates the superficial inguinal ring

Answer 27

External spermatic fascia

Question 28

__________________ ‑ from transversalis fascia, covers entire extent of cord

Answer 28

Internal spermatic fascia

Question 29

________________ ‑ peritoneum via processus vaginalis testis

Answer 29

Tunica vaginalis testis

Question 30

What are the contents of the spermatic cord? Which are embedded in extraperitoneal connective tissue?

6

Answer 30

Embedded…

      1. Ductus deferens – efferent duct from epididymis
      2. Testicular artery – branches directly from the abdominal aorta (TV2)
      3. Deferential artery and vein ‑ branch of the umbilical a. from internal iliac a.
      4. Pampiniform plexus of veins ‑ will form testicular vein; on the right will drain to the IVC; on the left will drain to the left renal vein
      5. Lymphatics draining testis ‑ drain to lumbar nodes

Not Embedded…

      6.  Genitofemoral nerve (genital branch L1 ‑ L2) ‑ innervation of cremaster muscle

Question 31

_____________ - innervation of cremaster muscle

Answer 31

Genitofemoral nerve (genital branch L1 ‑ L2)

Question 32

______________ – efferent duct from epididymis

Answer 32

Ductus deferens

Question 33

– branches directly from the abdominal aorta (TV2)

Answer 33

Testicular artery

Question 34

______________ ‑ branch of the umbilical a. from internal iliac a.

Answer 34

Deferential artery and vein

Question 35

__________________ ‑ will form testicular vein; on the right will drain to the IVC; on the left will drain to the left renal vein

Answer 35

Pampiniform plexus of veins

Question 36

Autonomic nerve fibers to the testes course on the surface of the?

Answer 36

testicular artery and ductus deferens.

Question 37

Describe the shape and structure of the epididymis. What does it connect to?

Answer 37

“Comma” shaped structure directly applied to the posterosuperior portion of the testis. It houses a coiled tube, the duct of the epididymis, which connects the seminiferous tubules of the testis with the ductus deferens.

Question 38

What are the subdivisions of the epididymis? Describe them

Answer 38

Head: portion located at the superior pole of the testis

Body: portion located on the posterior surface of the testis

Tail: inferior portion which bends back upon itself and is continuous

            with the ductus deferens

Sinus epididymis ‑ recess of the visceral layer of the tunica vaginalis which exists between the testis and the body of the epididymis

Question 39

What is an appendix of the epididymis? If one exists just beneath the head of the epididymis, what does this represent?

Answer 39

An appendix of the epididymis is an appendage on the head of the epididymis representing a detached efferent duct; occur inconsistently.

represents a remnant of the upper end of the paramesonephric duct.

Question 40

Incomplete closure of the processus vaginalis can lead to fluid accumulation (ascites; blood) in the tunica vaginalis testis resulting in the formation of?

What can the origin of this fluid be due to?

Answer 40

a hydrocele/hematocele of the spermatic cord or testes.

The origin of fluid can be the result of secretion of abnormal amounts of serous fluid by the serous membrane of the tunica vaginalis, or in the case of blood, due to trauma.

Question 41

• a collection of fluid in the epididymis, usually near its head.

Answer 41

spermatocele

Question 42

what is a varicocele? Where does it commonly occur? What can it be due to?

Answer 42

represents dilated veins of the pampiniform plexus. Occurs more often on the left and can be a result of incompetent valves within the plexus or due to the angle at which the testicular v. enters the renal vein.

Question 43

describe testicular torsion. What can this lead to?

Answer 43

ting of the spermatic cord due to an unattached gubernaculum, is a medical emergency. Twisting of the cord can lead to necrosis of the testes due to impeding vascular supply and drainage.