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GI Midterm > Inguinal Canal > Flashcards

Inguinal Canal Flashcards

1
Q

What is the inguinal ligament?

A

rolled-under inferior border of external oblique muscle aponeurosis

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2
Q

What is the inguinal ligament attached to?

A

ASIS and pubic tubercle

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3
Q

What is the conjoint tendon (inguinal falx)?

A

combined aponeurosis of inferior/medial margins of internal oblique and transversus abdominal m. inserting into pubis

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4
Q

What is the superficial ring?

A

external opening within aponeurosis for spermatic cord or round ligament

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5
Q

What are the crural fibers?

A
  • medial crus
  • lateral crus
  • intercrural fibers
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6
Q

What is the lacunar ligament?

A

ligament between pubic rami and inguinal ligament; anchors inguinal ligament to pubis

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7
Q

What is the pectineal ligament?

A

continuation of fibers from lacunar ligament running along pectin pubis

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8
Q

What is the other name for the femoral canal?

A

subinguinal space

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9
Q

Where is the femoral canal?

A

lies immediately lateral to lacunar ligament

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10
Q

What are the inguinal rings?

A
  • deep ring

- superficial ring

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11
Q

What is the deep ring?

A

entrance to inguinal canal and beginning of the invagination of peritoneum into transversalis fascia

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12
Q

Where is the deep ring?

A

superior to inguinal ligament and lateral to inferior epigastric artery.
Where vas deferens and gonadal vessels/nerves pass in males and round ligament pass in females

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13
Q

What is the superficial ring?

A

exit for inguinal canal

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14
Q

Where is the superficial ring?

A

where spermatic cord or round ligament exit from the canal

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15
Q

What is split by the superficial ring?

A

external oblique muscle aponeurosis

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16
Q

What are the abdominal layers? (superficial to deep)

A
  1. external oblique aponeurosis
  2. internal oblique m
  3. transversus abdominis m
  4. transversalis fascia
  5. parietal peritoneum
  6. inguinal ligament
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17
Q

What is the iliopubic tract?

A

thickening of transversalis fascia running posterior to inguinal ligament

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18
Q

What are the nerves near inguinal ligament, canal, and ring?

A 
iliohypogastric N (L1)
ilioinguinal N (L1)
genitofemoral N (L1, L2)
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19
Q

What does the iliohypogastric N innervate?

A
  • motor to abdominal muscles (IO and TA)

- skin above pubis

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20
Q

What does the ilioinguinal N innervate?

A
  • motor to abdominal muscles (IO and TA)

- skin over upper/medial thigh and skin at root of penis/clitoris and anterior scrotum/labia

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21
Q

What is the path of the ilioinguinal N?

A

transverses inguinal canal, exits superficial ring lateral to cord

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22
Q

What does the genitofemoral N innervate?

A

genital branch

  • motor - cremasteric muscle
  • sensory - small part of medial thigh and scrotal/labial fascia
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23
Q

Where are the gonads from?

A

near T10 axial level

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24
Q

What connects gonads to future scrotal swellings?

A

gubernaculum

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25
Q

Describe testicular (gonadal) descent

A
  • gonads from near T10 axial level
  • gonads are connected to future scrotal swellings by gubernaculum
  • descent along with an out-pocketing of peritoneal cavity (processus vaginalis) into future scrotum
  • connection to peritoneum closed; tunica vaginalis represents the remains of processus vaginalis around testes
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26
Q

What layers of abdominal wall are carried as spermatic cord develops?

A
  • transversalis fascia
  • internal oblique
  • external oblique
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27
Q

What is processus vaginalis?

A

evagination of peritoneal cavity

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28
Q

When does the processus vaginalis usually close?

A

wtihint 1st year postnatally

29
Q

What is cryptorchid testis?

A

undescended testis

30
Q

What does cryptorchid testis increase the risk of?

A

developing testicular cancer

31
Q

What forms as the gonad “herniates” along with its blood supply and vas deferens out?

A

spermatic cord

32
Q

What are the spermatic cord layers?

A
  • external oblique - external spermatic fascia
  • internal oblique - cremasteric muscle
  • transversalis fascia - internal spermatic fascia
33
Q

Where is a site of abdominal wall weakness?

A

spermatic cord

34
Q

What are the contents of the spermatic cord?

A
  • vas deferens (ductus deferens)
  • testicular artery
  • testicular veins
    • pampiniform plexus
  • gonadal nerves
  • gonadal lymphatics

artery to ductus deferens, cremasteric A and V, genital branch of genitofemoral n, sympathetics and visceral afferents, remnants of processus vaginalis

35
Q

What is testicular varicocele?

A
  • varicosities of pampiniform plexus

- swelling in scrotum with dull and recurring pain in scrotum

36
Q

What is persistent processus vaginalis?

A

patent connection between tunica vaginalis and abdomen

37
Q

What is hydrocele?
Who is this most common in?
What causes this in other groups?
Types?

A
  • peritoneal fluid accumulation with tunica vaginalis
  • most common in babies
  • inflammation or injury in the scrotum, testis, or epididymis
  • communicating and non-communicating types
38
Q

What is hematocele?

A

accumulation of blood in tunica vaginalis

39
Q

How does hydrocele present? How is it detected?

A

swollen scrotum due to accumulation of peritoneal serous fluid. detected via trans-illumination

40
Q

Describe ovarian descent

A
  • begins descending but gubernaculum becomes attached to developing uterus
  • gubernaculum forms ovarian ligament and round ligament of the uterus
41
Q

What is the round ligament of the uterus?

A

enters deep ring and exits superficial ring attaching to labial swellings

42
Q

Describe the female inguinal canal

A
  • deep and superficial rings
  • medial/lateral crus
  • lacunar/pectineal ligaments
  • conjoint tendon (inguinal falx)
43
Q

What are the ccontents of the female inguinal canal?

A
  • round ligament of uterus
  • ilioinguinal N
  • genitofemoral N (genital branch)
44
Q

Describe the lymph drainage of testes and scrotum

A

scrotum/labia –> superficial inguinal nodes –> lumbar nodes

gonads –> upper pelvic lymph nodes –> pre-aortic lymph nodes

45
Q

What are the folds of the posterior aspect of the anterior abdominal wall? What are they remnants of?

A
  • median - remnant of urachus
  • medial - remnant of distal most portion of umbilical arteries
  • lateral - fold due to inferior epigastric arteries and veins
46
Q

What is inguinal (Hasselbach’s) triangle?

A
  • inguinal ligament
  • lateral border of rectus abdominis
  • lateral umbilical ligament (fold)
    • direct hernia inferior to conjoint tendon and medial to lateral umbilical ligament
  • iliopubic tract
47
Q

What is the function of the iliopubic tract?

A

reinforces floor of inguinal canal

48
Q

What are the types of inguinal hernias?

A

direct, indirect, femoral

49
Q

What is a direct hernia?

A

medial to inferior epigastric A; peritoneum/transversalis fascia outside of spermatic cord

50
Q

What is an indirect hernia?

A

enters deep ring; peritoneum within spermatic cord

51
Q

What is a femoral hernia?

A

below inguinal ligament; more common in women; 40% present as emergencies with incarceration or strangulation

52
Q

Are femoral hernias more common in men or women?

53
Q

What are abdominal wall and groin hernia sites?

A

ventral

  • umbilical
  • epigastric
  • spigelian

groin

  • inguinal
  • femoral

flank (lumbar)

54
Q

Where is the weakness in a epigastric hernia?

A

wall in midline fusion point

55
Q

Where is the spigelian hernia site?

A

through fascia between the abdominal muscles but along the semilunar line of the rectus abdominis m.

56
Q

Why is the flank (lumbar) able to be herniated?

A

defects in the posteriolateral abdominal wall allowing the tissues inside the abdomen to protrude

57
Q

Where do the testes and ovaries develop? From what?

A

posterior abdominal wall from intermediate mesoderm

58
Q

What are the layers of the scrotum?

A
  • skin

- dartos fascia

59
Q

What is the blood supply of the scrotum?

A
  • posterior scrotal branches; from pudendal artery
  • anterior scrotal branches; from deep external pudendal artery
  • cremasteric artery
60
Q

What is the nerve supply of the scrotum?

A
  • posterior scrotal nerves; supply posterior surface
  • perineal branches of posterior cutaneous N of thigh; supply posterioinferior surface
  • anterior scrotal nerves; supply anterior surface
  • genital branch of genitofemoral nerve; supply anterolateral surface
61
Q

What is the external spermatic fascia from?

A

external oblique aponeurosis

62
Q

What is the cremasteric fascia from?

A

internal oblique

63
Q

What is the internal spermatic fascia from?

A

transversalis fascia

64
Q

What are the parietal and visceral layers of the tunica vaginalis

A

processus vaginalis (peritoneum)

65
Q

Where do varicoceles generally occur?

66
Q 
A 45-year-old male entered the emergency department with a complaint of sever abdominal pain. During physical examination it is observed that his cremasteric reflex is absent. Which of the following nerves is responsible for the efferent limb of the cremasteric reflex.
A.Ilioinguinal
B.Iliohypogastric
C.Genitofemoral
D.Pudendal
E.Ventral ramus of T12
A

LOOK at answer in lecture

67
Q

What is the floor of the deep ring/lateral third, middle third, and superficial ring/medial third?

A

lateral third/deep ring - iliopubic tract
middle third - inguinal ligament
medial third/superficial ring - lacunar ligament

68
Q

What is the most common hernia in males and females?

A

indirect hernia

GI Midterm (10 decks)

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