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Phase 1 - Anatomy > Anatomy - The inguinal canal > Flashcards

Anatomy - The inguinal canal Flashcards

1
Q

What forms the floor of the inguinal canal?

A

The inguinal ligament.

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2
Q

What does the inguinal canal transmit in males?

A

The spermatic cord.

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3
Q

What does the inguinal canal transmit in females?

A

The round ligament of the uterus.

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4
Q

What are the nerve roots for the ilio-inguinal nerve?

A

L1.

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5
Q

What does the ilio-inguinal nerve give sensory innervation to?

A
  • Skin on the upper middle thigh. - In males it supplies the skin over the penis and scrotum. - In females it supplies the skin over the mons pubis and labium majora.
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6
Q

How do the testes move from the posterior abdominal wall to the scrotum?

A

The paired gubernacula aid in the descent of the testes. The testes are guided through the inguinal canal and then into the scrotum.

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7
Q

Define hernia.

A

Protusion of an organ through the wall of cavity that normally contains it.

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8
Q

What type of hernia is lateral to the inferior epigastric artery?

A

An indirect hernia.

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9
Q

Where does the inferior epigastric artery lie?

A

Immediately medial to the deep inguinal ring.

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10
Q

What are the 3 layers of tissue surrounding the spermatic cord?

A
  1. External spermatic fasica. 2. Cremaster muscle and fascia. 3. Internal spermatic fascia.
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11
Q

What layer of the abdominal wall is the external spermatic fascia derived?

A

Derived from the aponeurosis of external oblique.

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12
Q

What layer of the abdominal wall is the internal spermatic fascia derived?

A

Transversalis fascia.

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13
Q

What layer of the abdominal wall is the cremaster muscle and fascia derived?

A

Internal oblique.

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14
Q

What is the function of the cremaster muscle?

A

To raise and lower the testes in order to regulate scrotal temperature for optimum spermatogenesis.

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15
Q

What is the vas deferens?

A

The duct that transports sperm from the epididymis to the ejaculatory ducts.

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16
Q

What 3 arteries are contained within the spermatic cord?

A
  1. Testicular artery (from kidneys) 2. Cremasteric artery (branch of inferior epigastric artery) 3. Artery of the vas ( from bladder)
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17
Q

What 3 veins are contained within the spermatic cord?

A
  1. Testicular vein. 2. Cremasteric vein. 3. Vein of the vas.
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18
Q

What 3 nerves are contained within the spermatic cord?

A
  1. Ilio-inguinal nerve (anterior 1/3 of the scrotum) 2. Genitofemoral nerve (branch to the cremaster layer) 3. Sympathetic plexus (to Vas Deferens and testes()
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19
Q

What are ‘3 others’ contained within the spermatic cord?

A
  1. Vas deferens. 2. Lymphatics. 3. Tunica vaginalis.
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20
Q

What is the midline fusion of the scrotum called?

A

The midline raphe.

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21
Q

Where is the dartos muscle located?

A

Immediately underneath the scrotal skin.

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22
Q

What is the function of the dartos muscle?

A

It helps to regulate temperature by wrinkling the skin of the scrotum - this decreases SA and reduces heat loss.

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23
Q

What are the 3 erectile tissues contained within the root of the penis?

A
  1. 2x Crura (form corpus cavernosum in body). 2. 1x Bulb (forms corpus spongiosum in body).
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24
Q

What is the glans of the penis?

A

The most distal part of the penis formed by the expansion of the corpus spongiosum. It contains the urethral orifice.

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25
Q

Is ejaculation caused by parasympathetic or sympathetic innervation?

A

Sympathetic.

26
Q

What is a varicocele?

A

Pampiniform plexus of veins has dilated in the testicle.

27
Q

Where will inguinal hernias lie in relation to the pubic tubercle?

A

Superiorly and medially.

28
Q

What is a hydrocele?

A

Swelling of the scrotum caused by distension of the tunica vaginalis.

29
Q

Which nerves provide sensory innervation to the scrotal skin?

A
  • Ilio-inguinal. - Genital branch of genitofemoral. - Branches from the perineal nerve.
30
Q

What is the tunica vaginalis? How is it connected to the abdominal peritonium?

A
  • closed sac of parietal peritoneal origin that contains a small amount of viscous fluid.
  • sac covers the anterior surface and sides of each testicle
  • lubricating the surfaces of the testes and allowing for friction-free movement.
  • connected to the abdominal peritoneum via the processes vaginalis
    • if not obliterated can cause congenital indirect hernias in crying babies
31
Q

What is the name of the connection between the testes and epididymis?

A

ducti efferens

32
Q

What is the white tunic covering the testes called?

A

tunica albuginia

33
Q

Name the thick fascia surrounding the shaft of the penis? What is its function?

A
  • Buck’s fascia
  • limits blood flow of corpora cavernous and therefore girth
34
Q

Describe the erectile tissue in the penis?

A
  • 2x corpora cavernous
    • larger venous spaces
    • before glans of penis
    • makes the penis hard as they fill with blood
  • 1x corpora spongiosum
    • makes penis erect
    • contains the urethra
35
Q
A
36
Q

How is the penis innervated?

A
  • The penis is supplied by S2-S4 spinal cord segments and spinal ganglia.
  • Sensory and sympathetic innervation to the skin and glans penis is supplied by the dorsal nerve of the penis, a branch of the pudendal nerve.
  • Parasympathetic innervation is carried by cavernous nerves from the peri-prostatic nerve plexus, and is responsible for the vascular changes which cause erection.
37
Q

How long is the inguinal canal?

A

5cm

38
Q

At what layer is the deep inguinal canal?

A

aperture in the transversalis fascia

39
Q

At what layer is the superficial ring?

A

aperture in the external oblique aponeurosis

40
Q

What does the inguinal canal do in females?

A

Support the round ligament of the uterus

41
Q

Describe the contents of the spermatic cord?

A
  • vas deferens
  • testicular artery
  • pampiniform plexus of veins
  • the nerves and lymphatics of the testis
  • processus vaginalis
42
Q

describe the journey of the spermatic cord from the deep inguinal ring to the testes

A
  • from the deep inguinal ring, along the inguinal canal, out of the superficial inguinal ring and down into the scrotum passing above and medial to the pubic tubercle
  • As they pass through the inguinal canal they acquire 3 layers of the abdominal wall layers.
  • After leaving the superficial ring there will be three fascial layers and this marks the start of the spermatic cord.
43
Q

What are inguinal hernias?

A
  • part of the intestine or peritoneum through the canal forming an inguinal hernia.
  • In the male these hernias may pass into the spermatic cord.
44
Q

What is the clinical difference between an indirect and direct hernia?

A
  • indirect: the hernia passes along the length of the canal it passes through each of the three layers of the abdominal wall in a different position
  • direct: passes through the tranversus fascia of the posterior wall, directly through the internal oblique layer and directly though the external ring
  • if you can place your finger over the deep inguinal ring (just above the mid-point of the inguinal ligament), then you can control an indirect inguinal hernia which has been reduced.
  • If when you press the deep ring, the hernia still protrudes, then the hernia is emerging via a defect in the posterior wall medial to this point and is, therefore, a direct hernia.
45
Q

Where would lymph node metastasis be located?

A

around the aorta in the upper abdomen.​

46
Q

Describe renal and gonadal pain?

A
  • The kidney and gonad T10 to L2
  • referred pain: midline at the back immediately posterior to the kidney down to the groin and into the scrotum; loin to groin pain.
  • Kidney pain may be felt in the scrotum and gonadal pain in the loin.
47
Q

Where would you palpate the ductus deferens? By palpation alone, how would you identify the ductus deferens?

A
  • The ductus deferens commences at the lower pole of the testis and runs up the posterior surface of the testis and through the spermatic cord to enter the superficial inguinal ring.
  • The best place to palpate it is between the upper pole of the testis and the superficial inguinal ring.
  • It has a very thick wall and feels hard but flexible (like a rubber cord).
48
Q

What is a varicocele?

A

Dilated veins in the pampiniform plexus.

49
Q

Some indirect inguinal hernias are congenital (meaning “present at birth”) even though they may not appear until later in life. Explain the embryology of these hernias.

A
  • The testis develops just below the kidney and travels down into the scrotum during inter-uterine development.
  • As it passes from the abdomen through the abdominal wall it takes a pouch of peritoneum with it.
  • Usually this pouch becomes disconnected from the peritoneal cavity and forms the tunica vaginalis.
  • However, sometimes the pouch remains connected and bowel can enter the pouch to form a hernia.
50
Q

Where would you try to palpate lymph nodes to assess the spread of testicular cancer?

A
  • In the epigastrium.
  • Remember the rule that lymphatics follow the arteries backwards, hence the lymphatics from the testis follow the testicular artery back to the upper abdominal aorta in the epigastrium.
  • This is where cancer of the testis spreads to.
51
Q

Where might you look for an undescended testis? Is it worth surgically correcting this anomaly?

A
  • The testis develops just below the kidney and travels down the posterior abdominal wall, through the inguinal canal and into the scrotum during inter-uterine development.
  • An undescended testis will be somewhere along this path.
  • Spermatogenesis needs to take place at lower than body temperature so moving an undescended testis to the scrotum is worthwhile.
52
Q

Testicular pain may radiate to the loin. Why?

A
  • The nociceptive nerve fibres to the testis are sympathetic and follow the testicular artery from the aortic sympathetic plexus which is formed from the T11 and T12 nerve roots.
  • Pain is felt in the distribution of the cutaneous nerve of these segments as a referred pain.
53
Q

Which nerves provide sensory innervation to the scrotal skin?

A
  • The anterior 1/3 of the scrotum is L1 nerve root and the ilioinguinal nerve.
  • The posterior 2/3 is the S2, 3, and 4 nerves through the pudendal nerve.
54
Q

What are female external genitalia collectively known as?

A

Vulva.

55
Q

Give 3 functions of the vulva.

A
  1. Sensory tissue in sexual intercourse. 2. Assist in micturition. 3. Defend the internal female reproductive tract from infection.
56
Q

What is the mons pubis?

A

A mass of fatty tissue lying over the pubis symphysis.

57
Q

What are the labia majora?

A

Hair bearing external folds that fuse posteriorly and extend anteriorly to the mons pubis.

58
Q

What are the labia minora?

A

Hairless folds that lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris.

59
Q

What is the vestibule?

A

An area between the labia, the external vagina and urethral orifice are found here.

60
Q

Where are the great vestibular glands located and what is their function?

A

Glands located either side of the vaginal orifice, they secrete mucous during sexual arousal.

61
Q

What is the clitoris derived from embryologically?

A

The genital tubercle.

62
Q

What is the main blood supply to the vulva?

A

Pudendal arteries.

Phase 1 - Anatomy (29 decks)

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