Abdomen: Inguinal Region Flashcards
1
Q
Inguinal region
A
- Area between ASIS and pubic tubercle
- Structures enter/exit abdominal cavity to/from
lower extremity
Scrotum/labia majora
Clinical: site of inguinal hernias
2
Q
Structures of inguinal region enter/exit abdominal cavity to/from
A
- Lower extremity
- Scrotum/labia majora
3
Q
Clinical importance of inguinal region
A
- Site of inguinal hernias
4
Q
Inguinal canal
A
- Oblique passageway through inferior abdominal wall
- Narrower in females
5
Q
Inguinal canal is formed by
A
- Layers of abdominal wall
- Parallels inguinal ligament
6
Q
Inguinal canal is the pathway for
A
- Structures to pass from abdomen to external genitalia
7
Q
Inguinal canal in males transmits
A
- Spermatic cord with all of its content
- Ilioinguinal nerve (males and females)
- Genital branch of genitofemoral nerve (males and females)
8
Q
Inguinal canal in females transmits
A
- Round ligament (females)
- Ilioinguinal nerve (males and females)
- Genital branch of genitofemoral nerve (males and females)
9
Q
Inguinal canal is strengthened by
A
- Oblique orientation
- Abdominal wall muscle contraction
- Aponeuroses and fascias
10
Q
Posterior boundary of inguinal canal
A
- Transversalis fascia
- Conjoint tendon (falx inguinalis)
11
Q
Conjoint tendon (falx inguinalis)
A
- Combined aponeurosis of TA and IO
12
Q
Conjoint tendon (falx inguinalis) inserts onto
A
- Pubic crest
- Pectineal line (pecten pubis)
13
Q
Anterior boundary of inguinal canal
A
- EO aponeurosis & IO muscle
14
Q
Roof of inguinal canal
A
- TA and IO
- Transversalis fascia
- Medial crus
15
Q
Floor of inguinal canal
A
- Lateral crus
- Inguinal ligament
- Lacunar ligament
16
Q
2 openings of inguinal canal
A
- Deep inguinal ring
- Superficial inguinal ring
17
Q
Deep inguinal ring is created by
A
- Created by invagination of transversalis fascia
18
Q
Deep inguinal ring is located
A
- Lateral to inferior epigastrics
- Above midpoint of inguinal ligament
19
Q
Superficial inguinal ring
A
- Opening located ~ 1cm superolateral to pubic tubercle
20
Q
Superficial inguinal ring is created by
A
- External oblique aponeurosis
21
Q
Superficial inguinal ring is formed by
A
- Medial and lateral crura
- Intercrural fibers
22
Q
Derivatives of EO aponeurosis
A
- Inguinal ligament (Pouparts ligament)
- Superficial inguinal ring
- Lacunar ligament (Gimbernat)
- Pectineal ligament (Cooper)
- Reflected inguinal ligament
23
Q
Inguinal ligament (Pouparts ligament)
A
- Inferior reflection of EO aponeurosis
24
Q
Inguinal ligament (Pouparts ligament) attaches to
A
- ASIS to pubic tubercle
25
Superficial inguinal ring is formed by
- Medial crus
| - Lateral crus
26
Medial crus (of superficial inguinal ring) attaches to
- Pubic symphysis
27
Lateral crus (of superficial inguinal ring) attaches to
- Pubic tubercle
28
Lacunar ligament (Gimbernat) attaches to
- Superior pubic ramus
29
Pectineal ligament (Cooper) runs along
- Pectineal line of pubis (pecten pubis)
30
Testes develop in
- Upper lumbar region
31
Gubernaculum
- Fibrous cord
| - Attaches testes/ovaries to anterolateral abdominal wall
32
Gubernaculum is involved in
- Gonadal descent
33
Gubernaculum degenerates, and remnant becomes
- Posterior scrotal ligament (M)
| - Ovarian & round ligaments (F)
34
Process vaginalis
- Diverticulum of the peritoneum
35
Process vaginalis outpouches and
- Carries abdominal wall layers with it
36
Process vaginalis degenerates except for
- Distal portion (tunica vaginalis)
37
Testes descend into scrotum and become
- Ensheathed by abdominal wall layers
| * Except for transversus abdominis*
38
Cryptorchidism
- Undescended testicle
39
Scrotum
- Outpouching of lower abdominal wall
| - Thin, pigmented skin
40
Content of scrotum
- Testicles
- Epididymis
- Spermatic cord
41
Layers of the scrotum
- Skin
- Dartos fascia/muscle (superficial fascia)
- External spermatic fascia
- Cremaster fascia/muscle
- Internal spermatic fascia
- Tunica vaginalis parietal layer
- Tunica vaginalis visceral layer
42
Dartos fascia/muscle (superficial fascia) contains
- Fat free superficial fascia (contains smooth muscle)
- Continuous abdominal superficial fascia
- Dartos muscle
43
Dartos muscle
- Thermoregulation (autonomically innervated)
44
External spermatic fascia is derived from
- EO aponeurosis
45
Cremaster fascia/muscle is derived from
- IO aponeurosis
46
Internal spermatic fascia is derived from
- Transversalis fascia
47
Tunica vaginalis parietal layer is derived from
- Process vaginalis
48
Tunica vaginalis visceral layer is derived from
- Process vaginalis
49
Testes
- Male reproductive organ
- Suspended by spermatic cord
- Consists of lobules of seminiferous tubules
50
Testes are involved with
- Production of spermatozoa and testosterone
51
Tunica albuginea
- Fibrous covering of the testes
52
Pathway of testes
- Seminiferous tubules > straight tubules > rete teste (MT) > efferent ductules > epididymis
53
Epididymis
- Storage and maturation of sperm
| - Highly convoluted and densely packed tube
54
Epididymis consists of
- Head
- Body
- Tail: connected to vas deferens
55
Tunica vaginalis
- Closed off distal part of process vaginalis (outpouching of peritoneum)
- Visceral and parietal layer
56
Visceral layer of tunica vaginalis
- Covers testis, epididymis
57
Parietal layer of tunica vaginalis
- Lines internal spermatic fascia & distal spermatic cord
58
Cavity of tunica vaginalis
- Between parietal and visceral layers
| - Small amounts of fluid
59
Spermatic cord
- Contains structures going to and from testis
| - Passes into the scrotum
60
Vas deferens
- Connects epididymis to ejaculatory duct
61
Testicular artery
- Arises from abdominal aorta
| - Supplies testis and epididymis
62
Artery to vas deferens
- Arises from inferior vesicular artery
63
Cremasteric artery
- Arises from inferior epigastric artery
64
Pampiniform venous plexus
- Network of veins
| - Converge to form testicular vein
65
Lymph vessels
- Drain into lumbar lymph nodes
66
Sympathetic nerves
- Travel with testicular artery and ductus deferens
67
Genital branch of genitofemoral nerve
- Supplies cremaster muscles
68
3 fascial layers of spermatic cord
- Internal spermatic fascia
- Cremasteric muscle and fascia
- External spermatic fascia
69
Ilioinguinal nerve is NOT a content of the spermatic cord, but a content of the
- Inguinal canal
70
Ilioinguinal nerve doesn’t pass through deep ring, but does exit the
- Superficial ring
71
Testicular arteries (paired) pathway
- Branch from abdominal aorta
- Cross ureter
- Enter deep inguinal ring and pass through inguinal canal
72
Pampiniform plexus
- Network of veins (8-12)
- Surround testicular artery in spermatic cord
- Converge to form testicular veins
73
Function of pampiniform plexus surrounding testicular artery in spermatic cord
- Thermoregulation
| - Cools arterial blood
74
Right testicular vein drains to
- IVC
75
Left testicular vein drains to
- Left renal vein
76
Lymphatic drainage of testes
- Lumbar nodes (paraaortic)
77
Lymphatic drainage of scrotum
- Superficial inguinal nodes
78
Hydrocele
- Accumulation of fluid in the cavity of tunica vaginalis
79
Hydrocele is commonly caused by
- Patent process vaginalis
| - Transilluminates
80
Testicular hematocele
- Accumulation of blood in cavity of TV
81
Varicocele
- Varicose veins of the pampiniform plexus
| - “bag of worms”
82
Varicocele cause
- Defective venous valves or venous problem
- Left more common than right
- Can cause fertility problems
- Do not transilluminate
83
Inguinal Hernia
- Abnormal protrusion of abdominal content
from area where it normally resides
- M >F
84
Indirect Inguinal Hernia
- Usually the result of a patent process vaginalis
| - Most common inguinal hernia
85
Indirect Inguinal Hernia enters
- Deep ring, lateral to inferior epigastric vessels
| - Can exit superficial ring and pass into scrotum
86
Direct Inguinal Hernia occurs in
- Inguinal triangle
87
Direct Inguinal Hernia enters
- Medial to inferior epigastric a.
- Can exit through superficial ring
- Rarely enters scrotum
88
Inguinal Triangle Boundaries
- Medial: rectus abdominis
- Lateral: inferior epigastric vessels
- Inferior: inguinal ligament
89
Inguinal triangle medial boundary
- Rectus abdominis
90
Inguinal triangle lateral boundary
- Inferior epigastric vessels
91
Inguinal triangle inferior boundary
- Inguinal ligament
92
Femoral Hernia
- Passes through femoral ring and canal
- Posterior-inferior to inguinal ligament
- F>M because of wider bone structure
93
The necks of inguinal hernias are
- Superomedial to pubic tubercle
94
The necks of femoral hernias are
- Inferolateral to pubic tubercle
