Inguinal Canal

Question 1

Inguinal Ligament

Answer 1

basically is the rolled under inferior border of external oblique m. aponeurosis/attached to ASIS and pubic tubercle

Question 2

Conjoint tendon (inguinal falx)

Answer 2

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

Question 3

Superficial ring

Answer 3

external opening within aponeurosis for spermatic cord or round ligament
-surrounded by crural fibers (medial and lateral crus, intercrural fibers)

Question 4

lacunar ligament

Answer 4

ligament between pubic rami and inguinal ligament, anchors inguinal l. to pubis

Question 5

pectineal ligament

Answer 5

continuation of fibers from lacunar ligament running along pectin pubis

Question 6

femoral canal (subinguinal space)

Answer 6

lies immediately lateral to lacunar ligament

Question 7

Deep inguinal ring

Answer 7

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

• superior to inguinal ligament and lateral to inferior epigastric a.
• where vas deferens and gonadal vessels/nerves pass in males and round l. pass in female

Question 8

superficial inguinal ring

Answer 8

exit for inguinal canal

• where spermatic cord or round l. exit from canal
• ring is really a partial split in the external oblique m. aponeurosis

Question 9

Abdominal layers

Answer 9

EO aponeurosis
internal oblique m
transversus abdominis m
transversalis fascia
parietal peritoneum
inguinal l. (lower fibers of EO aponeurosis)

Question 10

iliopubic tract

Answer 10

thickening of transversalis fascia running posterior to inguinal l.
reinforces floor of inguinal canal

Question 11

Iliohypogastric nerve

Answer 11

L1
motor to abdominal muscles (IO and TA)
skin above pubis

Question 12

Ilioinguinal nerve

Answer 12

L1
traverses inguinal canal, exits superifical ring lateral to cord
-motor to abdomianl m. (IO and TA)
-skin over upper/medial thigh and skin at root of penis/clitoris and anterior scrotum/labia

Question 13

Genitofemoral nerve

Answer 13

L1/L2
genital branch
motor: cremasteric muscle
sensory: small part of medial thigh and scrotal/labial fascia

Question 14

Testicular (Gonadal) Descent

Answer 14

gonads form near T10 axial level

• connected to future scrotal swellings by gubernaculum
• descent along w/ an outpocketing of periotneal cavity (processus vaginalis) into future scrotum
• connection to peritoneum closed; tunica vaginalis represents the remains of processus vaginalis around testes

Question 15

Processus vaginalis

Answer 15

evagination of periotoneal cavity; communication usually closes w/i 1 year postnatally

Question 16

Layers of abdominal wall carried as spermatic cord develops

Answer 16

transversalis fascia
internal oblique
external oblique

Question 17

Cryptorchid testis

Answer 17

undescended testis (increase of developing testicular cancer)

Question 18

Spermatic cord layers

Answer 18

as gonad herniates along with its blood supply and vas deferens out, it carries layers of abdominal wall with it forming spermatic cord
external oblique: ext spermatic fascia
internal oblique: cremasteric m.
transversalis fascia: internal spermatic fascia

Question 19

Spermatic cord contents

Answer 19

vas deferens
testicular a/v
pampiniform plexus
gonadal nerves/lymphatics
testicular varicocele: varicosities of pampiniform plexus, swelling in scrotum w/ dull and recurring pain in scrotum

Question 20

pampiniform plexus

Answer 20

cobb of webbs that cools down the system. cool down the testis

Question 21

Persistent processus vaginalis

Answer 21

patent connection between tunica vaginalis and abdomen

Question 22

hydrocele

Answer 22

peritoneal fluid accumulation w/i tunica vaginalis
-more common in babies, in adults=inflammation/injury in scrotum, testis, epididymis
communicating/noncommunicating types between tunica vaginalis and peritoneum

Question 23

hematocele

Answer 23

accumulation of blood in tunica vaginalis

Question 24

Ovarian descent

Answer 24

begins descending but gubernaculum becomes attached to developing uterus

• gubernaculum forms ovarian ligament and round ligament of the uterus
• round l. of uterus enters deep ring and exits superficial ring attaching to labial swellings. its lateral to inf epigastric a.

Question 25

Female inguinal canal

Answer 25

-deep and superficial rings
-medial/lateral crus
-lacunar/pectineal ligaments
-conjoint tendon (inguinal falx)
-contents ( round ligament of uterus, ilioinguinal nerve, geniofemoral nerve (genital branch)
scrotal/labia relationship

Question 26

Lymph drainage of gonads

Answer 26

in both sexes

-drain into upper pelvic lymph nodes and then into pre-aortic lymph nodes

Question 27

lymph drainage of scrotum/labia

Answer 27

drain into superficial inguinal nodes and eventually travel into lumbar nodes

Question 28

Borders of inguinal hasselbach’s triangle

Answer 28

inguinal ligament
lateral border of rectus abdominus
lateral umbilical ligament (fold)
-direct hernia inferior to conjoint tendon and medial to lateral umbilical ligament

Question 29

Direct hernia

Answer 29

medial to inferior epigastric a: periotneum/transveralis fascia outside of spermatic cord
(outside the spermatic cord, it doesnt travel through the canal)

Question 30

Indirect hernia

Answer 30

enters deep ring; peritoneum within spermatic cord

peritoneum and trasnversalis coming out

Question 31

femoral hernia

Answer 31

below inguinal ligament; more common in woman; 40% present as emergencies within incarceration or strangulation

Question 32

Ventral hernia sites

Answer 32

umbilical

epigastric: weakness in wall in midline fusion point
spigelian: through fascia between the abdominal mm. but along the semilunar line of the rectus abdominus m.

Question 33

Groin hernia sites

Answer 33

inguinal

femoral

Question 34

flank (lumbar) hernia sites

Answer 34

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