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GI Exam 1 > Inguinal Canal > Flashcards

Inguinal Canal Flashcards

1
Q

[Where] does the testes and ovaries develop and [what tissue] are they derived from?

A

Testes and ovaries develop in the posterior abdominal wall in the lumbar region. They are derived from intermediate mesoderm.

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2
Q

As we go through develoment, the testes descend into _______ and the ovaries stop at the _________. What is the result of the testes descending into the scrotum?

A

Scrotum.

D/t this migration, they pull the musles and fascia via the inguinal canal, causing them to end in the scrotum.

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3
Q

Describe the process of [testicular migration] (4 steps)

A
  1. Testes develop in the posterior abdominal wall in the lumbar region(T10 axial region)
  2. Testes will descends with a pocket of the peritoneal cavity (processus vaginalis) and follow the gubernaculum .
  3. Pulls muscle and fascia with in–> inguinal canal
  4. Migration ends in the scrotum.
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4
Q

What is the [remnant of the gubernaculum] in M and F?

A

Males: scrotal L.

Females: round L. of the uterus.

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5
Q

What are the muscles and fascia that the testes pull into the scrotum during migration? (6)

A
  1. Skin
  2. Scarpa’s muscle and fascia
  3. External oblique M
  4. Internal Oblique M
  5. Transversalis fascia
  6. Peritoneum
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6
Q

What are the abdominal layers?

(of which the testes will descend through)

A

Exterior–> interior

    1. Skin
    1. Dartos (scarpas) muscle and fascia
    1. External spermatic fascia
    1. Cremasteric fascia
    1. Internal spermatic fascia
    1. Tunica vaginalis (parietal)
    1. Tunica vaginalis (visceral)- attaches to the testes.
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7
Q

What abdominal layers form the spermatic cord?

A

1 and 2. Peritoneum forms the tunica vaginalis (visceral and parietal)

  1. Transversalis fascia forms the internal spermatic fascia
  2. Internal oblique m. forms the cremasteric fascia.
  3. External oblique m. forms the external spermatic fascia
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8
Q

What abdominal layers form the scrotum?

A

1. Skin

2. Dartos (Scarpa’s) fascia

3. Dartos smooth muscle

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9
Q

What is the only layer that the testes does not pull with it as it descends to the testes?

A

Transversus abdominus m.

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10
Q

Name where the following come from:

  1. External spermatic fascia
  2. Cremasteric fascia
  3. Internal spermatic fascia
  4. Tunica vaginalis (parietal and visceral)
A
  1. External spermatic fascia: comes from the EO m.
  2. Cremasteric fascia: skeletal m. that comes from the IO m.
  3. Internal spermatic fascia: comes from the TF
  4. Tunica vaginalis (parietal and visceral): comes from the peritoneum.
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11
Q

What is Dartos s.m innervated by?

What happens when it contracts?

A
  • Dartos S.M is innervated by the ANS (sympathetics).
  • Purpose: regulate the temperature of the testes. Thus, if it is too cold, the dartos SM will contract and bring the testes closer to body cavity to regulate the temperature.
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12
Q

What is the cremaster m. innervated by?

A

Cremaster m. is skeletal muscle and under voluntary control.

It is innervated by the genital branch of the genitofemoral N.

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13
Q

What is the blood supply of the scrotum?

A

Anterior and posterior parts of the scrotum have different blood supplies.

  1. Anterior scrotal branches come from the [deep external pudendal artery].
  2. Posterior scrotal branches come from the [pudendal artery].
  3. Cremaster m. gets blood from the cremasteric artery, which is a branch of the [inferior epigastric a].
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14
Q

What nerves is the scrotum innervated by?

A

Different parts of the scrotum are innervasted by different nerves.

Posterior surface:

  • Posterior scrotal nerves from the pudendal N.

Postero-inferior surface

  • Perineal branches of the posterior cutaneous n.

Anterior surface

  • Anterior scrotal nerves from the ilioinguinal n

Anterolateral surface

  • genital branch of the genitofemoral N
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15
Q

What is a hydrocele and how can we detect one?

A

A hydrocele is excess fluid in the scrotum that is d/t persistant processus vaginalis (a connection between the tunica vaginalis and abdomen).

It is detected via transillumination.

  • If you can see through it–> hydocele.
  • If you cannot, it is a hematocele (blood)
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16
Q

What forms from the processus vaginalis (from the peritoneum)?

A

parietal and visceral layer of the tunica vaginalis

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17
Q

What are the contents of the spermatic cord?

A
  1. Ductus deferens and the artery to the ductus deferens (inferior vesicular a.)
  2. Gonadal artery (which includes the testicular a. and ovarian a.), from the R aorta and L renal a.
  3. Pampiniform plexus of veins, which helps with thermoregulation.
  4. Cremasteric artery and vein.
  5. Genital branch of the genitofemoral n.
  6. Sympathetics and visceral afferents (sympathetics innervate Dartos)
  7. Lymphatics
  8. Remnants of the processus vaginalis
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18
Q

Describe the case:

Ben comes into the office with a “scrotal fullness” that feels like a bag of worms. He has a full, aching scrotal pain on his L side.

What is wrong with him?

A

Ben has varicocele, which are dilated veins in the pampiniform plexus that surrounds the spermatic cord. They vary in size and feel like a bag of worms.

They can be asymptomatic or be a dull, aching pain, often on the L ball.

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19
Q

The cresmasteric reflex has a afferent and efferent component.

What are responsible for both?

A

Afferent (sensory)–> ilioinguinal n.

Efferent (motor)–> genitofemoral n.

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20
Q

What is the inguinal region?

A
  • Inguinal region is the region where structures exit and enter the abdominal cavity.
  • It extends from the ASIS–> pubic tubercle
  • Site of herniation.
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21
Q

Testicles descend through the inguinal canal.

Describe the path.

A

Inguinal canal connects the testes–> abdominal wall. It begins as the deep inguinal ring and exits as the superficial inguinal ring. It is bordered by the abdominal muscles.

  • In males–> spermatic cord exits
  • In females–> round ligament of the uterus exits.
22
Q

What is the roof of the inguinal canal from deep inguinal ring to superficial ring?

What is the floor of the inguinal canal from the deep inguinal ring–> superficial inguinal ring?

A
  • Trasversalis fascia–> muculo-aponeurotic arches of the IO and TA–> medial crus of the EO aponeurosis
  • Iliopubic tract–> inguinal L–> lacunar L
23
Q

What are the contents of the inguinal canal?

A
  1. Spermatic cord in M and round ligament of the uterus in F.
  2. Blood and lymphatic vessels
24
Q

What is the floor of the inguinal canal?

A
  1. Deep inguinal ring–> Iliopubic tract, made up of TF
  2. Middle–> made up of the inguinal L.
  3. Superficial inguinal ring–> made up of the lacunar L, an extension of the inguinal L. Thus, it comes from the E.O aponeurosis.
25
Q
  • What is the anterior wall of the inguinal canal from deep ring to superficial ring?
  • What is the posterior wall of the inguinal canal from the deep ring to the superficial ring?
    *
A

IO and lateral crus of EO aponeurosis–> EO aponeurosis (lateral crus/intercrural fibers)–> EO aponeurosis + fascia from EO that becomes the external spermatic fascia

Transversalis fascia –> Transversalis fascia –> Conjoin tendon and the inguinal L

26
Q

Describe the inguinal L.

A
  • Inguinal L goes from the ASIS–> pubic tubercle and is rollled under from the bottom part of the EO aponeurosis.
  • Inguinal L forms the floor of the middle third of the inguinal canal.
  • Part of it will flow over to the pectineal line and form the lacuna L, which makes the floor of the superficial inguinal ring.
27
Q

What is the conjoint tendon (inguinal falx)?

A

The IO and TA aponeurosis arch over the spermatic cord, and insert onto the pectineal line

28
Q

Describe the superficial inguinal ring.

A

It is the exit of the inguinal canal, formed by the splitting of the aponeurosis of the EO m. Reforced by crural fibers.

  • Medial crus attaches to the pubic crest.
  • Lateral crus attaches to the public tubercle
  • Intercrural fibers prevent the superficial inguinal ring from spreading
29
Q

Describe the deep inguinal ring.

A

Deep inguinal ring is the entrance of the inguinal canal and begining of the invagination of the peritoneum into transversalis fascia.

  • Vas deferens and gonadal vessels/nerves pass in M
  • Round ligament passes in F.
30
Q

What does the external oblique aponeurosis form?

A
  1. Superficial inguinal ring
  2. Lateral crus
  3. Medial crus
  4. Inguinal L.
  5. Pectineal L.
  6. Lacunar L.
31
Q

What forms the conjoint tendon?

A

Both the internal oblique and transversus abdominis m. will arch over the spermatic cord –> form the conjoint tendon, which inserts on the pectineal line.

32
Q

What forms the boundaries of the inguinal triangle?

A
  1. Medial: Rectus Abdominis M
  2. Lateral: Inferior epigastric A and V
  3. Inferior: Inguinal Ligament
33
Q

Inguinal triangle is the site of ________ hernias.

A

Direct inguinal hernias

34
Q

What landmarks can we use to help us identify the deep inguinal rings?

A

1. Testicular vessels

2. Ductus deferens

35
Q

What is the most common hernia in males and females that occurs lateral to the inferior epigastric A.?

Where does the hernia go?

Why are they they most common

A

Indirect inguinal hernia- into deep/superficial inguinal ring into the scrotum

They are the most common because the gubernaculum weakens the wall.

36
Q

What are direct hernias?

A

Direct hernias are located medial to the inferior epigastric arteries, inside Hasselbach’s triangle.

OccurL in the peritoneum/TF, outside of the spermatic cord.

37
Q

Nerves of the anterior abdominal wall pass through what?

A

Internal oblique and transversus abdominus

38
Q

What does the ilioinguinal nerve pass through?

A

Does not go through the deep inguinal ring, however it does exit the superficial inguinal ring and travels with the spermatic cord–> scrotum–> medial thigh.

39
Q

Where do the gut contents of indirect hernias pass through and and what layers would surround them?

A
  • Go through the deep inguinal ring–> follow spermatic cord–> into superficial inguinal ring–> scrotum.
  • The hernia would be surrounded by the same layers as the spermatic cord.
40
Q

Where do the gut contents of direct hernias pass through and and what layers would surround them?

A

The conjoint tendon is weak is pushed out of the way. Gut contents are only surrounded by the parietal peritoneum. TF and skin. The hernia will try to come out of the superficial inguinal ring.

41
Q

What are femoral hernias and where are they located?

A

Femoral hernias herniate through the femoral ring and are located below to the inguinal L.

42
Q

Femoral hernias are most common in: M or W?

A

W.

43
Q

40% of femoral hernias are emergencies d/t incarceration or strangulation.

Why?

A

The lacunar L is very strong. If the gut contents herniates through the lacunar L, it can deprive part of the gut of blood and cause it to die.

44
Q

Where does lymph from the testes or ovaries drain into?

A

Lumbar (caval or aortic) nodes

45
Q

Lymph from ______, drains into the superficial inguinal nodes.

A

4

1. Scrotum

2. Lower limb

3. Butt

4. Inferolateral quadrant of the trunk, below BB

46
Q

What is the inguinal L?

A
  • Extends from ASIS–> pubic tubercle.
  • It is the rolled-under inferior border of the EO m. apopneurosis.
47
Q

Which opening will gut contents pass through in a direct hernia?

A

The superficial inguinal ring (not the deep inguinal ring).

48
Q

What is important to remember about the Testes lymph drainage versus the scrotum?

A

testes –> lumbar (caval or aortic) LN

scrotum –> superficial inguinal LN

49
Q

illioinguinal nerve is the afferent nerve of the cremasteric reflex, because….

A

it provides sensation to the medial thigh

50
Q

What is the lacunar ligament made from and where does it attach? (Note: the pectineal ligament is made from the same fibers)

A

the inguinal ligament which attaches to the pectineal line

GI Exam 1 (13 decks)

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