G18 Inguinal Region II

Question 1

Spermatic Cord and fascial coverings

Answer 1

Begins at deep ring, ends at testes
-external spermatic fascia (external oblique)
-Cremasteric Fascia (internal oblique)
(inn by Genitofemoral Nerve)
-internal spermatic fascia-transversalis fascia

Question 2

three congenital defects of inguinal canal

Answer 2

Congenital defects
-cryptorchidism: undescended tesits (one or both)
unretractable, 3% of full term/30% prematures
typically somewhere in inguinal canal
requires surgical treatment: increased probability of malignancy

-hydrocele: accumulation of excess serous fluid within tinica vaginalis (will transmit light (tumour/mass will not)
may result from overproduction of fluid within tunica vaginalis
may result from persistent processus vaginalis
can occur in scrotum OR spermatic chord (looks more like a cyst

-femaile hydrocele: canal of nuck 
persistant processus vaginalis in femails
abnormally patent inguinal canal 
20x less common than in men
may develop cysts
potential for inguinal hernias

Question 3

three injuries and diseases of inguinal canal

Answer 3

Hematocele

• blood within tunica vaginalis
• typically due to rupture of testicular artery
• does NOT transilluminate
• injury of the spermatic vessels

Torsion of spermatic chord

• may compress structures in spermatic chord
• could lead to necrosis of testes
• most common in adolescents

Question 4

Lymphatics of the testes/scrotum/uterus

Answer 4

testes and epididymis: drain to the lymph nodes along aorta in lumbar region
-metastatic path from testes (due to descent pattern)

scrotum: drain to superficial inguinal lymph nodes
- metastatic pattern from scrotum

uterus and ovaries: most goes to lumbar nodes
-also follow the round ligament (previous gubernaculum) and cancer cells may pass into labia then to inguinal nodes

Question 5

Cremastic reflex

Answer 5

contraction of cremaster muscle
muscle pulls up testes

genical branch of genitofemoral (L1-L2)

elicit contraction by stimulation in upper thigh

extremely active in young children: hyperactive reflex may simulate undescended testes

Question 6

Vasectomy

Answer 6

sperms pass from testes to ductus (vas) deferens to ejaculatory duct to urethra

common sterilization, in vas deferens, easily palpated through anterior/superior scrotum

ligated, sectioned bilaterally and cauterized

Question 7

inguinal/hesselbacks triangle

Answer 7

boundaries: rectus abdominus

inferior epigastric vessels

inguinal ligament

are of weakness within the wall, susceptible to hernias-
-femoral, 
-abdominal
epigastric
umbilical
inguinal (75%)

Question 8

Inguinal Hernias two types

Answer 8

inguinal (75%) Hesselbacks Triangle

• protrusion of parietal peritoneum and abdominal viscera through the abdominal wall (under skin…giant lump
• two types indirect and direct

indirect (congenital hernia) (86% in males),

• exits abdomen through deep ring, lateral to inferior epigastric vessels, traverses inguinal canal
• exits through superficial ring and enters scrotum
• lies within spermatic cord and has three fascial coverings
• not uncommon in young children

Direct (acquired)
-leaves abdomen MEDIAL to inferior epigastric vessels, passes through inguinal triangle, penetrates posterior wall of inguinal canal, indirect though inguinal canal
pases through inguinal triangle,
-penetrates posterior wall of inguinal canal, mass is palpated superior and medial to pubic tubercle
-lies outside spermatic chord, covered with peritoneum and transversalis fascia only
HOW??