Inguinal Canal

Question 1

Deep inguinal ring

Answer 1

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

Question 2

Superficial inguinal ring

Answer 2

Exit for inguinal canal
Where spermatic cord or round ligament exit from the canal
Ring is really a partial split in the external oblique aponeurosis`

Question 3

Iliohypogastric nerve

Answer 3

L1
Motor to IO and TA
Skin above pubis (hypogastric region)

Question 4

Ilioinguinal nerve

Answer 4

L1
Transverses inguinal canal, exits superficial ring lateral to cord
Motor to IO and TA
Skin over upper/medial thigh and at root of penis/clitoris and anterior scrotum/labia

Question 5

Genitofemoral nerve

Answer 5

L1-2
Motor to cremasteric muscle
Sensory to small part of medial thigh and scrotal/labial fascia

Question 6

Gonadal descent

Answer 6

Gonads form near T10 axial level
Connected to future scrotal swellings by gubernaculum
Descent along with an out-pocketing of peritoneal cavity (processes vaginalis) into future scrotum carrying nerves and vessels with them- future suspensory ligament
Connection to peritoneum closed

Question 7

Layers of abdominal wall carried inferiorly as spermatic cord develops

Answer 7

Transversalis fascia
Internal oblique
External oblique

Question 8

Cryptorchid testes

Answer 8

Undescended testis- increased risk for testicular cancer

Question 9

External spermatic fascia derived from

Answer 9

External oblique aponeurosis

Question 10

Cremasteric fascia derived from

Answer 10

Internal oblique

Question 11

Internal spermatic fascia derived from

Answer 11

Transversalis fascia

Question 12

Parietal and visceral layers of tunica vaginalis derived from

Answer 12

Processus vaginalis (peritoneum)

Question 13

Testicular varicocele

Answer 13

Varicosities of pampiniform plexus (testicular veins)

Swelling in scrotum with dull and recurring pain in scrotum

Question 14

Spermatic cord contents

Answer 14

Vas deferens
Testicular artery and veins
Gonadal nerves
Gonadal lymphatics

Question 15

Persistent processus vaginalis

Answer 15

Patent connection b/w tunica vaginalis and abdomen

Question 16

Hydrocele

Answer 16

Peritoneal fluid accumulation within tunica vaginalis
More common in babies
In adults- inflammation or injury in scrotum, testis or epididymis
Communicating and non communicating types

Question 17

Hematocele

Answer 17

Accumulation of blood in tunica vaginalis

Question 18

Ovarian descent

Answer 18

Begins descending but gubernaculum becomes attached to developing uterus
Upper gubernaculum forms ovarian ligament (from inguinal fold) and lower gubernaculum forms round ligament of uterus
Round ligament of uterus enters deep inguinal ring and exits superficial ring attached to labial swellings

Question 19

Contents of female inguinal canal

Answer 19

Round ligament of uterus
Ilioinguinal nerve
Geniofemoral nerve

Question 20

Scrotum lymph drainage

Answer 20

Drains into superficial inguinal nodes and eventually travel into iliac and lumbar lymph nodes

Question 21

Testes lymph drainage

Answer 21

Lumbar and pre-aortic lymph nodes

Question 22

Inguinal triangle borders

Answer 22

Superolaterally- inferior epigastric vessels
Laterally- lateral margin of rectus abdominis/rectus sheath
Inferiorly- inguinal ligament

Question 23

Direct hernia location

Answer 23

Inferior to conjoin tendon and medial to lateral umbilical ligament
Medial to inferior epigastric artery
Peritoneum/transversalis fascia alongside spermatic cord

Question 24

Iliopubic tract

Answer 24

Thickened transversalis fascia running posterior to inguinal ligament, reinforces floor of inguinal canal

Question 25

Indirect hernia

Answer 25

Enters deep ring and peritoneum within spermatic cord

Question 26

Femoral hernia

Answer 26

Below inguinal ligament; more common in women, many present as emergencies with incarceration or strangulation

Question 27

Ventral abdominal wall hernia sites

Answer 27

Umbilical
Epigastric- weakness in wall in midline fusion point
Spigelian- through fascia b/w the abdominal muscles but along the semilunar line of the rectus abdominis muscle

Question 28

Flank hernia

Answer 28

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