Groin (Inguinal) Region Flashcards
The inguinal ligament is formed by what?
The lower edge of the external oblique aponeurosis
The inguinal ligament extends from what two structures?
ASIS to the pubic tubercle
What is the lacunar ligament?
The most medial fibers of the inguinal ligament which are inserted into the superior pubic ramus
What is the pectineal ligament?
A lateral extension of the lacunar ligament along the pecten pubis (pectineal line)
How long is the inguinal canal?
3-5cm
Where does the inguinal canal begin and end?
Begins at the deep inguinal ring and ends at the superficial inguinal ring
Within the anterior abdominal wall, how does the deep inguinal ring lie?
Lateral and internal
Within the anterior abdominal wall, how does the superficial inguinal ring lie?
Medial and external
Is the inguinal canal larger in males or females?
Males
Why is the inguinal canal larger in males?
Because it also transmit the spermatic cord
What three things can the inguinal canal transmit?
Spermatic cord (male), round ligament of the uterus (female), and ilioinguinal nerve (both sexes)
What is another name for the conjoint tendon?
Inguinal Falx
The conjoint tendon is formed by the fusion of what two muscles as they insert into the pubic crest and pecten pubis deep to the inguinal ligament?
Internal oblique and transversus abdominis muscles
What is the function of the conjoint tendon?
It strengthens the posterior wall of the medial half of the inguinal canal
What can the conjoint tendon prevent?
Direct inguinal hernias
What makes up the anterior wall boundary of the inguinal canal?
The aponeurosis of the external oblique muscle
What makes up the posterior wall boundary of the inguinal canal?
The conjoint tendon and transversalis fascia
What makes up the roof of the inguinal canal?
The arching fibers of the internal oblique and transversus abdominis muscles
What makes up the floor of the inguinal canal?
The inguinal and lacunar ligaments
What is the superficial inguinal ring?
Triangular opening in the external oblique aponeurosis located immediately lateral to the pubic tubercle
The superficial inguinal ring is formed by the splitting of which muscle’s aponeurosis?
External oblique muscle
Where does the lateral crus of the splitting of the external oblique muscle’s aponeurosis insert?
Into the pubic tubercle, and some of its fibers reflect to the superior pubic ramus as the lacunar ligament
Where does the medial curs of the splitting of the external oblique muscle’s aponeurosis insert?
Into the pubic crest
What is the function of the intercrural fibers?
Strengthen the apex of the superficial inguinal ring
The deep inguinal ring is located in what layer of the abdominal wall?
Transversalis fascia
The deep inguinal ring is located above the inguinal ligament midway between what two structures?
ASIS and pubic symphysis
The deep inguinal ring lies just lateral to which vessels?
Inferior epigastric vessels
What binds the inguinal triangle medially?
Lateral edge of the rectus abdominis muscle
What binds the inguinal triangle laterally?
Inferior epigastric vessels
What binds the inguinal triangle inferiorly?
Inguinal ligament
What is an area of potential weakness in the anterior abdominal wall where direct inguinal hernias occur?
Inguinal triangle
Is the inguinal canal present before birth?
Yes; it is shorter and much less oblique, however.
Before birth, how do the superficial and deep inguinal rings lie relative to each other?
The superficial inguinal ring lies almost directly anterior to the deep inguinal ring.
Why it is important for the inguinal canal to be oblique in adults?
To allow the canal to be compressed by the muscles of the anterior abdominal wall when they contract
What is paradoxical about the muscles that increase intra-abdominal pressure, thus promoting hernia?
They also narrow the inguinal canal to prevent hernia
What is a hernia?
Abnormal protrusion of tissue through an opening
During inguinal hernias, what is usually protruding through the inguinal region?
Abdominal viscera, usually the small intestine
Are inguinal hernias more common in males or females?
Males
Why are hernias more common in males than females?
The inguinal canal is larger in males, and the scrotum creates a large potential space for abdominal viscera to fill because it’s an outpouching
What can lead to hernias?
Anything that increases intra-abdominal pressure, such as pregnancy or constipation
Why don’t the labia majora of the female, which are homologous to the scrotum of the male, make the females more likely to get hernias?
They are mostly filled with fat and therefore aren’t a potential space like the scrotum
Which type of inguinal hernia passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring before descending into the scrotum or labia majora?
Indirect inguinal hernia
Which type of inguinal hernia punches directly through the posterior wall of the inguinal canal, by passing the deep inguinal ring?
Direct inguinal hernia
Which type of inguinal hernia passes lateral to the inferior epigastric vessels?
Indirect inguinal hernia
Which type of inguinal hernia passes medial to the inferior epigastric vessels through the inguinal triangle?
Direct inguinal hernia
Which type of inguinal hernia can be congenital or acquired?
Indirect inguinal hernia
Which type of inguinal hernia is always acquired due to weakness of the conjoint tendon or transversalis fascia?
Direct
What is associated with a congenital indirect inguinal hernia?
A patent processus vaginalis
Which type of inguinal hernia accounts for 75% of inguinal hernias?
Indirect inguinal hernia
Which type of inguinal hernia accounts for 25% of inguinal hernias?
Direct inguinal hernia
Which type of inguinal hernia is most likely to occur to men over 40 years old?
Direct inguinal hernia
Which type of inguinal hernia causes a general palpable bulging of the anterior abdominal wall but does not descend into the scrotum?
Direct inguinal hernia
What is the processes vaginalis?
Embryological outpouching of the peritoneum that usually obliterates & forms the inguinal canal and the tunica vaginalis of the scrotum
Subluxation in which located may affect the functioning of the anterior abdominal wall muscles, thus increasing the risk of inguinal hernias?
Lower thoracic and upper lumbar
What is a femoral hernia?
A hernia that passes through the femoral canal
Where does a femoral hernia occur relative to the inguinal ligament?
Inferior (inguinal hernias occur superior to the inguinal ligament)
Are femoral hernias more common among males or females?
Females (due to their larger femoral rings)
What is an umbilical hernia?
A hernia that usually results from incomplete closure of the anterior abdominal wall after ligation of the umbilicus at birth
What is another cause of an umbilical hernia?
Defects in the linea alba
What results from a minor umbilical hernia?
Retraction and growth as an “outie” belly button
Where does the spermatic cord end and begin?
Begins at the deep inguinal ring an ends at the testis
What are the three concentric layers of fascias surround the spermatic cord?
External spermatic fascia, cremasteric fascia, and internal spermatic fascia
The external spermatic fascia is derived from what structure?
External oblique aponeurosis
The cremasteric fascia is derived from what structure?
Internal oblique aponeurosis
How can the cremasteric fascia be recognized?
Many bundles of muscle fibers that are collectively referred to as the cremaster muscle (derived from the internal oblique muscle)
What is the origin of the cremaster muscle?
Internal oblique muscle, inguinal ligament, pubic tubercle, pubic crest
What is the insertion of the cremaster muscle?
Spermatic cord
What is the nerve supply of the cremaster muscle?
Genital branch of genitofemoral nerve (L1, L2) from the lumbar plexus
What is the function of the cremaster muscle?
Retracts testis, therefore functioning in temperature regulation of sperm
The internal spermatic fascia is derived from what structure?
The transversalis fascia
Subluxations of what area may affect male fertility?
L1, L2 (genitofemoral nerve)
What is the ductus deferens?
Muscular duct which transports sperm from the epididymis to the ejaculatory duct
The testicular artery is a branch of what?
Abdominal aorta
What does pampiniform mean?
Vine-like
What is the name of the extensive network of veins that make up the bulk of the spermatic cord?
Pampiniform plexus
To where does the left testicular vein drain?
Left renal vein
To where does the right testicular vein drain?
Directly into the inferior vena cava
The veins of the pampiniform plexus join together where to form what vein?
Join at the deep inguinal ring to form the testicular vein
The artery to the ductus deferens is a branch of what artery?
Superior vesical artery
The cremasteric artery is a branch of what artery?
Inferior epigastric artery
The lymphatics located in the spermatic cord drain where?
Into the lumbar lymph nodes
What are the nine things that can be found in the spermatic cord?
Ductus deferens, testicular artery, pampiniform plexus of veins, artery to the ductus deferens, cremasteric artery, genital branch of the genitofemoral nerve, remnant of processes vaginalis, autonomic nerves, lymphatics
What nerve accompanies the spermatic cord but is not a part of it?
Ilioinguinal nerve
The ilioinguinal nerve runs through what two structures?
Inguinal canal and superficial inguinal ring
What are the two branches of the ilioinguinal nerve?
Femoral branch and anterior scrotal/anterior labial nerve
What does the femoral branch of the ilioinguinal nerve supply?
Upper medial part of the thigh
What does the anterior scrotal nerve supply?
Root of the penis and anterior part of the scrotum
What does the anterior labial nerve supply?
Mons pubis and anterior part of the labia majora
What can often cause a lump that is generally mistaken as cancer in the scrotum?
Varicocele (varicose veins within the pampiniform plexus)
