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Surgery.(General 1).Hernia > 1.Anatomy of inguinal canal > Flashcards

1.Anatomy of inguinal canal Flashcards

1
Q

DEFINITION of inguinal canal

A

It is an oblique passage in the lower part of the anterior abdominal wall, through which the testis passes in order to leave the abdomen and reach the scrotum.

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2
Q

LENGTH of inguinal canal

A

1.5 inch

4 cm

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3
Q

DIRECTION of inguinal canal

A

passes downward, forward and medially from deep to superficial ring

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4
Q

SITE of inguinal canal

A

It lies parallel to the medial half of the inguinal ligament.

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5
Q

BEGINNING of inguinal canal

A

DEEP ( INTERNAL) INGUINAL RING

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6
Q

DEEP ( INTERNAL) INGUINAL RING

A

Definition

Site

Boundaries

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7
Q

Definition of DEEP ( INTERNAL) INGUINAL RING

A

It’s an oval opening “vertical longitudinal axis” in the fascia transversalis

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8
Q

Site of DEEP ( INTERNAL) INGUINAL RING

A
  • 1/2 inch above the mid point of inguinal ligament

* just lateral to the inferior epigastric artery.

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9
Q

Boundaries of DEEP ( INTERNAL) INGUINAL RING

A
  • Above and lateral Boundaries

* Below and medial Boundaries

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10
Q
  • Above and lateral Boundaries of DEEP ( INTERNAL) INGUINAL RING
A

The arched lower margin of fascia transversalis.

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11
Q

Below and medial Boundaries of DEEP ( INTERNAL) INGUINAL RING

A

The inferior epigastric vessels

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12
Q

END of inguinal canal

A

SUPERFICIAL (EXTERNAL) INGUINAL RING

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13
Q

SUPERFICIAL (EXTERNAL) INGUINAL RING

A
  • Definition
  • Site
  • Attachements
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14
Q

Definition of SUPERFICIAL (EXTERNAL) INGUINAL RING

A

Triangle opening in external oblique aponeurosis

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15
Q

Site of SUPERFICIAL (EXTERNAL) INGUINAL RING

A

1/2 inch above and medial to the pubic tubercle

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16
Q

Attachements of SUPERFICIAL (EXTERNAL) INGUINAL RING

A
  • The medial “superior” crus

* The lateral “inferior” crus

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17
Q

The medial “superior” crus in Attachements of SUPERFICIAL (EXTERNAL) INGUINAL RING

A

attached to the front of symphysis pubis

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18
Q

The lateral “inferior” crus in Attachements of SUPERFICIAL (EXTERNAL) INGUINAL RING

A
  • Stronger

* Inserted into the pubic tubercle

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19
Q

Boundaries of the inguinal canal

A
  • ANTERIOR WALL
  • POSTERIOR WALL
  • ROOF
  • FLOOR
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20
Q

ANTERIOR WALL Boundaries of the inguinal canal

A

1- External oblique aponeurosis along its whole length.

2- Strengthened laterally by fleshy fibres of internal oblique muscle originating from the lateral 1/2 of the inguinal ligament.

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21
Q

POSTERIOR WALL Boundaries of the inguinal canal

A
  1. Fascia transversalis along its whole length.
  2. Conjoint tendon (also known as inguinal falx) along its medial 1/2
  3. Reflected part of inguinal ligament along its medial 1/4
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22
Q

Alternative name for Conjoint tendon in POSTERIOR WALL Boundaries of the inguinal canal

A

inguinal falx

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23
Q

composition Conjoint tendon in POSTERIOR WALL Boundaries of the inguinal canal

A

Arched fibers of Internal oblique muscle and transversus abdominis

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24
Q

ROOF Boundaries of the inguinal canal

A

Arched fibres of conjoint muscle

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25
Q

FLOOR Boundaries of the inguinal canal

A

Upper grooved surface of medial 1/2 of inguinal ligament

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26
Q

Inguinal ligament

A

Definition

Attachments

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27
Q

Definition of Inguinal ligament

A

It’s the lower free border of external oblique aponeurosis

28
Q

Attachments of Inguinal ligament

A

attached to pubic tubercle medially and ASIS laterally

29
Q

CONTENTS OF THE Inguinal CANAL

A

(A) Ilio-inguinal nerve (L1)

(B) Spermatic cord :

30
Q

Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A

Origin

Course

Sensory supply

Motor supply

31
Q

Origin of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A

The ilioinguinal nerve is a branch of the lumbar plexus which lies within the substance of the psoas major muscle.

32
Q

Course of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A

Ascending to the iliac crest

Piercing the transversus abdominis

Entering the inguinal canal

Leaving the inguinal canal

33
Q

Ascending to the iliac crest in Course of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A
  • It emerges from the lateral border of the psoas major just below the iliohypogastric nerve,
  • passes obliquely across the quadratus lumborum and iliacus.
34
Q

Piercing the transversus abdominis in Course of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A
  • Above the iliac crest, the ilioinguinal nerve pierces the transversus abdominis
  • passes in the plane between the transversus abdominis and the internal oblique muscle.
35
Q

Entering the inguinal canal in Course of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A
  • It enters the inguinal canal by piercing the internal oblique muscle
  • The nerve lies in front of the cord
  • once the nerve enters the canal, it becomes only sensory
36
Q

Leaving the inguinal canal in Course of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A
  • It leaves the canal through the superficial inguinal ring
37
Q

Sensory supply of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A
  • The skin of the inguinal region
  • Upper medial part of the thigh
  • Anterior 1/3 of the scrotum (or labia majora)
  • Root of the penis.
38
Q

Motor supply of Ilio-inguinal nerve in CONTENTS OF THE Inguinal CANAL

A
  • Shares in the motor supply to the internal oblique, transversus abdominis
  • Gives the main motor supply to the conjoint tendon before entering the canal
39
Q

Spermatic cord in CONTENTS OF THE Inguinal CANAL

A

Alternative structure in female

Coverings

Contents

40
Q

Alternative structure in female for Spermatic cord in CONTENTS OF THE Inguinal CANAL

A

Round ligament of the uterus in females

41
Q

Coverings of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A
  1. Internal spermatic fascia
  2. Cremasteric muscle and fascia:
  3. External spermatic fascia:
42
Q

Origin of Internal spermatic fascia in Coverings of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A

From transversalis fascia at deep inguinal ring

43
Q

Origin of Cremasteric muscle and fascia in Coverings of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A

From internal oblique muscle.

44
Q

Origin of External spermatic fascia in Coverings of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A

From external oblique aponeurosis at the superficial inguinal ring.

45
Q

Contents of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A
  • Ordinary classification of contents

* Classification of contents according to their position in the cord

46
Q

Ordinary classification of contents of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A

4 Vessels

2 Nerves

2 Structures

47
Q

4 Vessels in Ordinary classification of contents of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A
  1. Testicular artery & Pampiniform plexus of veins.
  2. Artery of the vas & vein of the vas
  3. Cremasteric artery & vein
  4. Lymphatic vessels.
48
Q

origin of Artery of the vas

A

branch of inferior vesical artery

49
Q

origin of Cremasteric artery

A

branch of inferior epigastric artery

50
Q

2 Nerves in Ordinary classification of contents of Spermatic cord in CONTENTS OF THE Inguinal CANAL

A
  1. Sympathetic nerve fibres along the testicular artey.

2. Cremasteric nerve

51
Q

Alternative name for Cremasteric nerve

A

genital branch of genito-femoral nerve

52
Q

2 Structures in Ordinary classification of contents of Spermatic cord in CONTENTS OF THE Inguinal CANAL ( 2 V)

A
  1. Vas deferens.

2. Vestige of processus vaginalis.

53
Q

Classification of contents of spermatic cord according to their position in the cord

A

(A) Anterior contents:

(B) Posterior contents :

(C) Contents within the coverings of the cord:

54
Q

Anterior contents of spermatic cord

A
  • Pampiniform plexus.

* Lymphatic vessels.

55
Q

Posterior contents of spermatic cord

A
  • Testicular artery with sympathetic fibers along it

* Vas deferens and its vessels.

56
Q

Contents within the coverings of the spermatic cord

A

Cremasteric nerve and vessels.

57
Q

THE PROTECTIVE MECHANISMS OF THE CANAL

A
  1. The obliquity of the canal ( The flap valve mechanism):
  2. The shutter mechanism of the internal oblique muscle

3- The ball valve mechanism

4- The slit valve mechanism

  1. Attachment of the superior crus of the internal ring to the transversus abdominis by facial slips
58
Q

Most important PROTECTIVE MECHANISMS OF THE CANAL

A
  1. The obliquity of the canal

2. The shutter mechanism of the internal oblique muscle

59
Q

The obliquity of the canal in THE PROTECTIVE MECHANISMS OF THE CANAL

A
  • Alternative name
  • Mechanism
  • Note on the mechanism
60
Q

Alternative name of The obliquity of the canal in THE PROTECTIVE MECHANISMS OF THE CANAL

A

The flap valve mechanism

61
Q

Mechanism of The obliquity of the canal in THE PROTECTIVE MECHANISMS OF THE CANAL

A

The internal and external rings do not lie opposite to each other

Therefore when the intra abdominal pressure rises the ant. & post. walls of the canal are approximated thus obliterating the passage.

62
Q

Note on the mechanism of The obliquity of the canal in THE PROTECTIVE MECHANISMS OF THE CANAL

A

This mechanism is absent in infants below 2 years

63
Q

The shutter mechanism of the internal oblique muscle in THE PROTECTIVE MECHANISMS OF THE CANAL

A

On straining, the lower arched fibres of the int. oblique muscle contracts approximating the roof to the floor like a shutter.

64
Q

The ball valve mechanism in THE PROTECTIVE MECHANISMS OF THE CANAL

A

Contraction of the cremasteric muscle helps

both inguinal rings.

65
Q

The slit valve mechanism in THE PROTECTIVE MECHANISMS OF THE CANAL

A

Contraction of the ext. oblique m. approximates the 2 crura of the superficial ring thus narrowing it.

66
Q

Attachment of the superior crus of the internal ring to the transversus abdominis by facial slips in THE PROTECTIVE MECHANISMS OF THE CANAL

A

so that contraction of the transversus abdominis draws the internal ring laterally increasing the obliquity of the canal

Surgery.(General 1).Hernia (13 decks)

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