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Anatomy Winter 2012 > Anatomy GI 2 Inguinal anatomy > Flashcards

Anatomy GI 2 Inguinal anatomy Flashcards

1
Q

Objectives

A

Anatomic features of the Inguinal Canal
Know components of SPERMATIC CORD
Understand the concept of abdominal wall hernia
Know the difference between direct and INDIRECT INGUINAL HERNIATION
Become familiar with FEMORAL and UMBILICAL HERNIA

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2
Q

What is the Umbilicus

A

stie of skin fixation to linea abla, congenital weakness due to passage of umbilical cord during fetal development and varying degrees of fusion of fascia

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3
Q

How can congenital umbilical hernia form?

A

can form at this site due to lack of fusion of the fascia or

increased intraabdominal pressure may lead to ACAUIRED umbilical hernia

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4
Q

What happens to the inguinal canal when abdominal wall contracts

A

it normally decreases teh dimmensions of the canal. It runs parallel to inguinal ligament

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5
Q

What canal does the testical go through during spermatogenesis?

A

through Inguinal canal

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6
Q

What ring does spermatic cord exit from

A

external/superficial inguinal ring

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7
Q

what msucle lays on top of spermatic cord

A

Cremaster muscle , which is a continuation of internal boleique?

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8
Q

Where is the Deep inguinal ring located

A

must remove internal and external oblique muscles,

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9
Q

Where is the inguino-canal lcoated

A

oblique and infero-medially oriented

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10
Q

Is inguinal canal above or below inguinal ligament

A

it is below and parallel to it

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11
Q

Whawt does the canal contain

A

Spermatic cord in males

Round ligament of uterus in females

Both ahve similar embryologic origins

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12
Q

Which nerve emerges along with spermatic cord/round ligmaetn of uterus through superficial ring

A 
Ilioinguinal nerve (branch L1) 
Doesn't go through internal ring!
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13
Q

What ist he Roof, of Inguinal Canal?

A

Roof- arch of internal oblique and transverse abdominus muscle

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14
Q

Wha tis the floor of the inguinal canal

A

Inguinal ligament ((densely interowven fibers of lower external oblique aponeurosis and adjecesnt fasica lata of thigh)

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15
Q

What is the Anterior wall of the inguinal canal

A

Aponeurosis of external oblique muscle

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16
Q

What is the posterior wall of the Inguinal canal

A

Trasversalis Fascia (& parietal peritoneum)

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17
Q

Describe characteristics of Spermatic Cord

A

Follows testicle from site of embryonic origin in posterior abdominal wall to scrotal sac of full term male child

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18
Q

what is the function of spermatic cord (what travels through ti)

A

carries sperm from testicle to urinary tract

Carries arteries adn veins

Carries lympahtic and innervasion

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19
Q

What is the spermatic cord encased in

A

Spermatic fascia (cont. of layers of ab walls)

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20
Q

What are the contents of the Spermatic Cord (6)

A
  1. Ductus Deferns (vas deferens(
  2. Spermatic Artery
  3. Pampiniform Venous Plexus
  4. Gentical Branch of Genitofemorla NErve
  5. Lympahtics
  6. Cremasteric Artery
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21
Q

What is the role of ductus deferens (Vas defeens

A

Carries semen from seminal vesciles and the small artery–deferntial artery which nourishes the vas

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22
Q

What is teh spermatic artery

A

Branch of the aorta

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23
Q

What is the Pampiniform Venous Plexus?

A

Returns venous blood to Inferior Vena Cavae(on right side) or Renal vein

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24
Q

what is the role of hte genital branch of the genitofemoral nerve>

A

for anterior general sensation?

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25
Q

Lympathics of the spermatic cord; where does it originate

A

drains the testis (origin, lumbar region)

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26
Q

What is the Cremasteric artery

A

Branchign form teh inferior epigastric artery (blood supply to testicle)

can supply testical if spermatic artery was injured

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27
Q

What are the the fascial layers of the spermatic cord (3)

A
  1. Internal spermatic fascia
  2. Cremasteric Fascia
  3. External Spermatic Fascia
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28
Q

What is the internal spermatic fascia. What does it hold?

A

continuatio of trasnversalis fascia.

Holds vas deferens, lympathics, nerves, and BV

29
Q

What is Cremasteric Fascia

A

Continuation of Internal Oblique Muscle

30
Q

What is extenral spermatic fascia

A

Thin layer, continuation of External oblique aponeurosis

31
Q

What is the landmark that divides the abdomen from the lower extremity?

A

Inguinal Ligament

32
Q

What is the landmark that is used to find the external inguinal ring

A

Pubic Tubercle

33
Q

Where do the gonads develop?

A

int eh posterior abdominal wall

34
Q

What is the role of the gubernaculum in teh inguinal canal

A

Fibrous cord conencts teh embryonic gonads to the inguinal region

35
Q

What is the processus vaginalis

A

carried with gonads as they migrate nto scrotum- overlying peritoneum

The processus vaginalis (or vaginal process) is an embryonic developmental outpouching of the peritoneum. It is present from around the 12th week of gestation, and commences as a peritoneal outpouching.In males, it precedes the testis in their descent down within the gubernaculum, and closes. This closure (also called fusion) occurs at any point from a few weeks before birth, to a few weeks after birth. The remaining portion around the testes becomes the tunica vaginalis.[1] If it does not close in females, it forms the canal of Nuck.[2]

36
Q

what doe sthe processus vaginalis become

A

the Tunica vaginalis

37
Q

Does round ligament have physiological function?

A

no

it passes the inguinal canal where Hernia’s can occur

38
Q

What does the retroperitoneal orirgin of the testes result in

A

lymphatic drainage to the preaortic lymph nodes

39
Q

What are components of a hernia?

A

Hernia- hold in the abdominal wall

Fascia of abdominal wall failed to close, or opened up later in life.

Peritoneal sac comes out, pressure in abdominal cavity

40
Q

How does a Inguinal Hernia occur

A

Patent tube of peritoneum that gradually stretches hernia defect

Defect in peritoneal sac- comes about when diaphragm contracts, pushes down during relaxation , recoils up, positive in abdomien, negative in chest

41
Q

What is an abodminal hernia (defintiion)

A

Protrusion of intraabdominal structure through a defect in the abdominal wall

42
Q

Hernial defect or ring (definition)

A

weakness or absence of abdominal fascia at the site of hernia

any failture of healign of an abdominal incision will likely become a hernia due to a defect of healing of abdominal wall

43
Q

What is a hernial sac

A

peritoneum and adjacent fatty tissue or even viscera which compose the wall of the hernia

44
Q

What is an inguinal hernia

A

Hernia occuring a the region of the internal ring (indirect) or inguinal triangle (direct)

45
Q

What is the difference between a DIRECT inguinal hernia and an INDIRECT inguinal hernia

A

Direct- hernia arising FROM inguinal triangle and coming out of Superificial/external ring

INDIRECT- hernia occurring at the region of the internal ring ;
Medial and Inferior to Inferior Epigastric vessels

46
Q

What is a Femoral Hernia

A

Hernia occurring at the femoral canal,

MEDIAL to FEMORAL VEIN
POSTERIOR to inguinal ligament

47
Q

What is a reducible Hernia?

A

Contents of hernia able to return to abdominal cavity with recumbency or external pressure (Pressure)

Can push down

48
Q

What is an INCARCERATED HERNIA

A

contents of hernia NOT able to be returned to abdomen with external pressure

Surgical intervention needed

49
Q

What is a STRANGULATED HERNIA

A

Contents of hernia rendered ischemic due to obstruction of arterial/venous flow due to pressure within the hernia

50
Q

Where is an indirect inuinal hernia in relation to inferior epigastric vessle

A

it is Inferior and Medial?

51
Q

What way does Indirect Inguinal Hernia pass through inguinal canal in relation to inferior epigastric vessel

A

IndiPasses through inguinal canal LATERAL to inferior epigastric vessels

LIC - lateral, indirect, congenital

52
Q

Where does Direct Inguinal hernia pass in relation to inferior epigastric vessels

A

Medial to inferior epigastric vessles

53
Q

Are Direct Inguinal hernias most likely congenital or acquired?

A

Direct Inguinal Hernias are most likely Acquired (medial to inf. epigastric)

DAM- direct, acquired, medial

54
Q

Are Indirect congenital inguinal hernias most likely acquired or congential

A

Indirect are most likely Congenital (lateral to inf epigastric)

55
Q

What is more common: Femoral Hernias or Inguinal Hernias?

A

Inguinal Hernias are more common (in both sexes)

56
Q

Are femoral hernias more common in females or males

A

Females

femoral = female

57
Q

Clinical aspect of indiret inguinal hernia

A
  1. patent processus vaginalis present at birth (congenital)
  2. may be diagnosed at birth or years later as it dilates
  3. courses along with spermatic cord or round ligametn through both the INTERNAL and EXTERNAL inguinal rings
  4. Runs through the inguinal canal
  5. Most common type of inguinal hernia in both sexus
58
Q

Where does Indirect Inguinal Hernia originate?

A

Lateral to Inferior epigastric vessels

LIC

It travels with round ligament or spermatic cord

59
Q

What are the clinical aspects of Direct Inguinal Hernias

A
  1. Forms later in life (acquired) DAM, as a weakeness in Inguinal Triangle (Hesselbach’s trinagle)
  2. Passes through superficial inguinal ring
60
Q

Where does Direct Inguinal Hernia Originate

A

DAM

Originates Medial to Inferior Episgastric vessels

Boundaies of inguinal trinagle are medial border of rectus sheath

61
Q

What is the clinical aspect of Femoral Hernia

A

Least common of all types

Most often seen in females

Passes through acquired weakness in femoral canal inferior to inguinal ligament,

62
Q

Does the femoral hernia overly pubic tubercle?

A

NO!

63
Q

What usualy appens to bowel with femoral hernia

A

b/c of very tight neck, bowel wehn incarcerated often becomes strangulated/ischemia necrosis

64
Q

What may happen with Communicating Hyrdocele

A

variant of scrotal or indirect hernia

Too small for bowel to go through, but enoguht for fluid to go thorugh
large amt of peritoneum

65
Q

What may happen if ther eis a Hydrocele of Tunica Vaginalis

A

how do we know it’s not viscera? TRANSLUMINATION!

light passes through fluid, not bowel!

Swellign of scrotu, transilumintae through fluid

If you ausculate scrotum, you will hear bowel sounds

66
Q

What normally happens ot the processus vaginalis at birth?

A

it usually obliterates

67
Q

What happens if the processus vaginalis persists?

A

leads to indirect inguinal hernia

can become clinically evident at any time in life

68
Q

What kinds of variations of abnormality can occur

A 
hydrocele,
communicating hydrocele
scrotal hernia
inguinal hernia
hydrocele of the cord
hydrocele of the tunica vaginalis

Anatomy Winter 2012 (12 decks)

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