2. Inguinal Canal Flashcards
Where is the Inguinal Ligament?
Basically the rolled-under inferior boarder of external oblique muscle aponeurosis
What is the inguinal ligament attached to?
to the ASIS and Pubic tubercle
What is the conjoint ligament?
Combined aponeurosis of inferior/medial margins of internal oblique and transverse abdominal m
-inserts into pubis
What is the superficial Inguinal ring?
External opening within the aponeurosis for spermatic cord or round ligament (for ovary)
Has medial, lateral and intercrural that support and provide stability
Lacunar Ligament
Ligament between pubic rami and inguinal ligament
-anchors inguinal ligament to pubis
Pectineal Ligament
Continuation of fibers from lacunar ligament running along pectin pubis
Where is the Femoral canal?
Lies immediately lateral to lacunar ligament, inferior to inguinal ligament
What is the deep inguinal ring?
It is the entrance to the inguinal canal and beginning of the invagination of peritoneum into transversalis fascia
Where Vas deferens and gonads vessels pass through for males, while round ligament passes through for females
Where is the deep inguinal ligament?
superior to inguinal ligament, lateral to inferior epigastric artery
What are the layers of the abdomen and inguinal ring?
- External oblique aponeurosis
- Internal oblique m
- Transversus abdominis m
- Transversalis fascia
- Parietal peritoneum
- Inguinal ligament
What is the iliopubic Tract?
Thickening of transversalis fascia running posterior to inguinal ligament
Iliohypogastric N
L1
-motor to abdominal m (IO and TA)
-sensory to skin above pubis
—hypogastric
Ilioinguinal N
L1
-transverse inguinal canal, exits superficial ring lateral to cord
- motor to abdominal m (IO and TA)
- sensory to medial thigh and penis/clit, and anterior scrotum/labia
Genitofemoral N
L1, L2
- motor to cremaster m
- sensory to small part of medial thigh and lateral scrotal/labial fascia
How do the testes descend?
Form near T10 and are connected to future scrotal swellings by gubernaculum
-descend along w out-pocketing of peritoneal cavity (processus vaginalis) into future scrotum
—carries vessels and nerves w
How are layers of abdominal wall incorporated into spermatic cord?
As testes descend, pulls layers down with
- transversalis fascia
- internal oblique
- external oblique
What is the embrological origin of tunica vaginalis?
Remnant of processus vaginalis around testes after peritoneum closes
What is the processus vaginalis?
Evagination of peritoneal cavity
-usually closes w/in 1st year
Crytorchid Testes
Undescended testis
-increases risk of developing testicular cancer
Tx: nothing, most resolve
Spermatic Cord layers
Transversalis Fascia
-internal spermatic fascia
Internal Oblique
-cremasteric m
External Oblique
-external spermatic fascia
What is important about the deep inguinal ring?
It’s where Vasculature runs to testes, but it is also a site of abdominal weaknesses
-so prone to hernias
Spermatic Cord Contents
Vas deferens Testicular A and V -panpiniform plexus cools blood Gonadal N Gonadal lymph
Testicular Varicocele
Varicosities of pampiniform plexus
-swelling in scrotum w dull and recurring pain in scrotum
Persistent Processus Vaginalis
Patent connection between tunica vaginalis and abdomen
Hydrocele
Peritoneal serous fluid accumulates within tunica vaginalis
-more common in babies, but can happen from trauma
Hematocele
Accumulation of blood in tunica vaginalis
How do the ovaries descend?
Begin descending but gubernaculum becomes attached to developing uterus
-forms ovarian ligament
Where does the round ligament of the uterus run?
Enters deep ring and exits superficial ring attaching to labial swellings
What are the contents of the female inguinal canal?
Deep and superficial rings
Medial/lateral crus
Lucanar/pectineal ligaments
Conjoint lig
What does the female inguinal canal contain?
- Round ligament of uterus
- Ilioinguinal N
- Geniofemoral N
Inguinal (Hasselbach’s) triangle
Inguinal ligament
-w iliopubic tract behind
Lateral boarder of rectus abdominis
Lateral Umbilical ligament (fold)
What is the iliopubic Tract?
Thickened transversalis fascia running behind inguinal ligament
-reinforces floor of inguinal canal
Direct hernia
Medial to inferior epigastric a
-peritoneum fascia alongside the spermatic cord
Indirect Hernia
Enters deep ring
-peritoneum within spermatic cord
Femoral Hernia
Below inguinal ligament
Is a femoral hernia more in women or men?
Women
Ventral Hernia Sites
Umbilical
Epigastric
-through wall in midline
Spigelian
-through fascia between the abdominal muscles but along the semilunar line of rectus abdominis
—more common in obese people
Groin Hernia Sites
Inguinal and Femoral
What can cause a flank hernia?
Due to defects in the posterolateral abdominal wall allowing tissues inside the abdomen to protrude
Where does lymph from gonads and scrotum/labia majora drain into?
Gonads drain into lumbar and pre-aortic lymph nodes along suspensory ligament
Scrotum/labia Majora drains into superficial inguinal nodes
