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Colin GI > GA Inguinal Canal > Flashcards

GA Inguinal Canal Flashcards

1
Q

Where do the ovaries/testes form and from what embryonic tissue are they derived?

A

Ovaries/Testes develop in the lumbar region of the posterior abdominal wall

They are derived from intermediate mesoderm.

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2
Q

When and how does the decent of ovaries/testes occur?

A

Starts at 8-11 weeks.

Ovaries descend into pelvis and stop (no scrotum).

Testes complete their descent into the scrotum at 8 months and, in doing so, pass through muscle and fascia via the inguinal canal (and pull these layers of tissue along with them).

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3
Q

What is the gubernaculum, what is its purpose, and what does it become?

A

Gubernaculum (“Little Man that Leads”) is a structure that aids with guiding the descent of the developing testes/ovaries

In males, remnant of gubernaculum becomes the Scrotal Ligament (which restricts the movement of the testicles within the scrotum)

In Females, remnant of the gubernaculum becomes the Round Ligament of the Uterus (supports the uterus in the pelvis)

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4
Q

What is the arrangement of tissues from most external to most interior in the abdominal wall and between which layers are the developing testicles found?

A 
Skin
Scarpa's Fascia
External Oblique M.
Internal Oblique M.
Tranversus Abdominis M.
Transversalis Fascia
(TESTICLES)
Peritoneum
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5
Q

As the testes descend into the scrotum, which tissue layer is the only one not dragged along?

A

Transversus Abdominus M.

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6
Q

What layers form the scrotum (from most external to most interior)?

A

Skin
Dartos Fascia & Dartos Smooth Muscle

Note: Dartos is derived from the Scarpa’s fascia

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7
Q

What layers from the spermatic cord (from most external to most interior)?

A

External Spermatic Fascia (derived from External Oblique M.)

Cremasteric Fascia & Muscle (derived from Internal Oblique M.)

Internal Spermatic Fascia (derived from Transversalis Fascia)

Tunica Vaginalis (parietal) (derived from Peritoneum)

Tunica Vaginalis (visceral) (derived from Peritoneum)

NOTE: Tunica Vaginalis does not loop around the testicle like the other layers, it forms a loop adjacent to the testicle; The layer of the loop closest to the Testicle is the Visceral layer, and the layer of the loop closest to the surrounding tissue layers is the Parietal layer)

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8
Q

What innervates the Dartos Muscle?

A

Dartos smooth muscle is innervated involuntarily by autonomic nerves, specifically sympathetics

Sympathetic innervation will cause the Dartos muscle to contract, forcing the scrotum to constrict and bring the testes closer to the body.

Testes must be kept at an ideal temperature for sperm production. Too hot, Dartos M. relaxes; Too cold, Dartos muscle constricts

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9
Q

What innervates the Cremaster M.?

A

Cremaster skeletal muscle is innervated voluntarily by the Genital Branch of the Genital Femoral N.

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10
Q

What arteries supply blood to the scrotum?

A

Posterior Scrotal Branches (from the Pudendal A.)

Anterior Scrotal Branches (from the External Pudendal A.)

Cremasteric A. (from the Inferior Epigastric A.; supplies blood to the Cremaster M.)

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11
Q

What nerves supply sensation of the posterior side of the scrotum?

A

Posterior scrotal nerves (supply posterior surface of the scrotum; from the Pudendal N.)

Perineal Branches of the Posterior Cutaneous N. of the Thigh (supply the postero-inferior surface of the scrotum)

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12
Q

What nerves supply the sensation of the anterior side of the scrotum?

A

Anterior Scrotal Nerves (supply the anterior surface of the scrotum; from the Ilioinguinal N.)

Genital branch of the Genitofemoral N. (supply the anterolateral surface of the scrotum)

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13
Q

What is a Hydrocele?

A

It is a congenital anomaly where excess fluid drains into the scrotum through a Persistent Processus Vaginalis

Processus Vaginalis is the space between the two layers of the Tunica Vaginalis. The layers normally forma tight seal, but if this does not occur, fluid from the peritoneal cavity will drain into the scrotum between the two layers.

Hydrocele is detected via Transillumination of the scrotum (shining a light through the scrotum, if translucent it is fluid)

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14
Q

What is a hematocele?

A

Blood in the scortum. Detected by Transillumination of the scrotum (shine light through scrotum, if light does not pass through, then likely blood)

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15
Q

What is an Encysted Hydrocele?

A

Fluid cyst in the spermatic cord (specifically the Processus Vaginalis (space between the parietal and visceral layers of the Tunica Vaginalis). Normally a seal is made between the layers, but an incomplete seal will trap Peritoneal cavity fluid, forming a cyst.

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16
Q

What are the contents of the Spermatic Cord?

A
  • Ductus Deferens (Vas Deferens)
  • Artery to the Ductus Deferens (aterial plexus winding around Ductus Deferens
  • Testicular A. (Male) / Ovarian A. (Female) / Gonadal A.
  • Pampiniform Plexus of Veins
  • Cremasteric A.
  • Cremasteric V.
  • Genital Branch of the Genitofemoral N.
  • Sympathetics and Visceral Afferents
  • Lymphatics
  • Remnants of Processus Vaginalis
17
Q

What is a Varicocele?

A

Varicocele (think varicose veins) is when the Pampiniform Plexus of Veins become dilated to the point where scrotal fullness occurs

Feels like a bag of worms

Can be assymptomatic or can cause dull scrotal pain

Generally occur on the left side

18
Q

What is the Inguinal Region and what are the two structures define its limits?

A

Region where structures exit and enter the abdominal cavity (as well as sites of herniation)

Inguinal region spans the area between the ASIS and the Pubic Tubercle

19
Q

What is the Spermatic Cord called in Females?

A

The Round Ligament OF THE UTERUS

(important to include the OF THE UTERUS part)

Round ligament is formed form the remnant of the gubernaculum in females

20
Q

What tissue forms the Deep Inguinal ring?

A

Transversalis Fascia

21
Q

What tissue forms the Superficial Inguinal Ring?

A

External Obliqe Aponeurosis

22
Q

What are the two extensions off the Inguinal Ligament at the Superficial Inguinal ring, and what bony features are they attached to?

A

Medial Crus (attached to the Pubic Crest)

Lateral Crus (attached to the Pubic Tubercle)

23
Q

What structure is formed from fibers of the Inguinal Ligament that attach to a different bony feature than the Two Cruses (and what is this feature called)?

A

Lacunar Ligament; attached to the Pectineal Line

24
Q

What structure forms the floor of the MEDIAL aspect of the Inguinal Canal?

A

The Lacunar Ligament

25
Q

What structure forms the floor of the middle third aspect of the Inguinal Canal?

A

The Inguinal Ligament

26
Q

What structure forms the posterior wall of the MEDIAL aspect of the Inguinal Canal, what bony feature is it attached to, and what structures fuse together to form it?

A

The Conjoint tendon

Attaches to the Pectineal Line

Formed via fusion of the Internal Oblique Aponeurosis and the Tranversus Abdominis Aponeurosis

27
Q

What structures form the borders of the Inguinal (Hesselbach’s) triangle?

A

Rectus Abdominis M.
Inferior Epigastric Vessels
Inguinal Ligament

28
Q

Where would you find a Direct Inguinal Hernia?

A

Medial to Inferior Epigastric Vessels (within the Inguinal/Heselbach’s Triangle)

29
Q

Where would you find an Indirect Inguinal Hernia?

A

Lateral to the Inferior Epigastric Vessels

Indirect Hernias are more common than Direct Hernias

30
Q

What nerve travels through the Deep inguinal Ring?

A

The Genital Branch of the Genitofemoral N.

31
Q

What nerve travels through the Superficial Inguinal Ring but DOES NOT travel through the Deep Inguinal ring?

A

Ilioinguinal N.

32
Q

What is an Indirect Inguinal Hernia?

A

Occurs lateral to the Inferior Epigastric vessels.

Gut contents enter and exit the inguinal the Deep Inguinal Ring and Superifical Inguinal ring respectively

Gut contents end up in scrotum/labia majora

More common than Direct Inguinal Hernias

33
Q

What is a Direct Inguinal Hernia?

A

Occurs medial to the Inferior Epigastric vessels

Gutt contents push against Parietal Peritneum, the Transversalus Fascia, and the skin.

Gut contents is pushed in the direction toward the Superficial Inguinal ring (least resistance)

Turn your head and cough tests for Direct Inguinal Hernias (increased abdominal pressure from coughing causes gut contents to push against wall where physician can hopefully feel it)

34
Q

What is a femoral hernia?

A

Herniation at the Femoral Ring (inferior to the Inguinal ligament)

More common in women

40% of Femoral Hernias cause strangulation of gut contents, requiring emergency surgery.

35
Q

Where is lymph from testes/ovaries drained to?

A

Lumbar Lymph nodes (where the testes/ovaries originally came from)

36
Q

Where is lymph from the scrotum drained to?

A

Superficial inguinal nodes

Colin GI (10 decks)

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