Anterior Abdominal Wall, Inguinal Region, Testis

Question 1

Layers of abdominal wall

Answer 1

• Skin
• Superficial fascia (Camper’s)
• Membranous layer of superficial fascia (Scarpa’s)
• 3 layers of abdominal muscles w/ corresponding 3 layers of overlaying deep fascia
• Transversalis fascia
• Parietal peritoneum

Question 2

Surface anatomy of abdominal wall

Answer 2

• Linea abla
• Semilunar lines (bilateral)
• Tendinous intersections
• Umbilicus
• Inguinal ligaments

Question 3

What nerves innervate the abdomen?

Answer 3

Thoracoabdominal:

• T7
• T8
• T9
• T10 (umbilicus)
• T11
• T12 (subcostal)

Nerves from lumbar plexus:
- L1 (iliohypogastric + ilioinguinal) (just above pubic symphysis)

Question 4

Name the anterior abdominal wall muscles

Answer 4

1) External oblique (hands in pockets)
2) Internal oblique (perpendicular)
3) Transverse abdominal (horizontal)
4) Rectus abdominis (vertical)

Question 5

Where does the rectus abdominis sheath change orientation and in what manner?

Answer 5

• Arcuate line
• Below umbilicus, internal abdominal oblique aponeurosis + transverse abdominal aponeurosis move to front of rectus abdominis muscle + transversalis fascia is the only thing posterior to RAM

Question 6

Which abdominal muscles do the neurovascular bundles run in between?

Answer 6

• Internal oblique

- Transverse abdominal

Question 7

Name the 3 folds of the anterior abdominal wall

Answer 7

1) Median umbilical fold
2) Medial umbilical folds
3) Lateral umbilical folds

Question 8

Name the 3 fossae formed by the umbilical folds

Answer 8

1) Supravesical fossa
2) Medial inguinal fossa
3) Lateral inguinal fossa

Question 9

Name the 3 structures that form the umbilical folds

Answer 9

1) Remnant of urachus –> median
2) Obliterated umbilical artery –> medial
3) Inferior epigastric artery + vein –> lateral

Question 10

What is located in the medial inguinal fossa?

Answer 10

Superficial inguinal ring

Question 11

What is located in the lateral inguinal fossa?

Answer 11

Deep inguinal ring

Question 12

What are the borders of the inguinal triangle of Hesselbach?

Answer 12

• Medial = lateral border of the rectus abdominis muscle
• Lateral = inferior epigastric vessels
• Inferior = inguinal ligament

Question 13

What is the significance of the inguinal triangle of Hesselbach?

Answer 13

Most direct hernias protrude through this

Question 14

Name the 3 fascia of the scotrum + their origins

Answer 14

1) External spermatic fascia –> external abdominal oblique aponeurosis
2) Cremaster muscle + fascia –> internal abdominal oblique muscle
3) Internal spermatic fascia –> transversalis fascia

*Note: transverse abdominal muscle does not contribute to scrotal fascia

Question 15

What is the Dartos muscle and where does it originate from?

Answer 15

• Wrinkles the skin of the scrotum

- Originates form Scarpa’s fascia

Question 16

What are the contents of the spermatic cord?

Answer 16

1) Ductus deferens
2) Testicular artery
3) Pampiniform plexus of veins

Question 17

What can be traced back to by following the spermatic cord?

Answer 17

Superficial inguinal ring

Question 18

Inguinal hernia

Answer 18

Protrusion of a portion of an abdominal structure through the superficial inguinal ring

Question 19

How to classify hernias based on contents

Answer 19

• Reducible
• Irreducible/incarcerated/obstructed
• Strangulated

Question 20

Direct vs indirect inguinal hernias

Answer 20

Direct

• Medial to inferior epigastric vessels
• Always outside internal spermatic fascia

Indirect

• Lateral to inferior epigastric vessels
• Always within internal spermatic fascia

Question 21

Which type of inguinal hernia tends to occur in older men?

Answer 21

Direct

Question 22

Which type of inguinal hernia tends to occur in infants, children, and young adults?

Answer 22

Indirect (oblique)

Question 23

What passes deep to the inguinal ligament?

Answer 23

• Femoral canal (containing deep inguinal LNs)
• Femoral sheath (containing femoral artery + vein)
• Femoral nerve

Question 24

What type of hernia is more common in females?

Answer 24

Femoral hernia

Question 25

Herniorrhaphy

Answer 25

• Surgical repair of hernia
• Many methods to push bulging tissue back + remove hernia sac
• Tension free (mesh) repairs
• Laparoscopic repairs –> transabdominal preperitoneal approach (TAPP)

Question 26

Where is the primary site of sperm development?

Answer 26

Seminiferous tubules

Question 27

Tunica vaginalis

Answer 27

Pouch of serous membrane that covers the testes

Question 28

Name layers of the tunica vaginalis

Answer 28

• Parietal (outer)
• Visceral (inner)
• Cavity in between

Question 29

Hydrocele

Answer 29

• Accumulation of fluid within tunica vaginalis
• Can see w/ US
• Qualifies as a scrotal mass

Question 30

Name the types of scrotal masses

Answer 30

• Hydroceles (simple, of the cord, connecting, communicating w/ hernia)
• Varicocele (“bag of worms”)
• Spermatocele
• Testicular cancer