Inguinal Canal

Question 1

What is the inguinal ligament? What is it attached to?

Answer 1

rolled-under the inferior border of external oblique muscle aponeurosis

attached to ASIS and pubic tubercle

Question 2

What is the conjoint tendon (inguinal falx)? Where does it insert?

Answer 2

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

inserting into pubis

Question 3

What is the lancunar ligament? What does it continue as along the pectin pubis?

Answer 3

between pubic rami and inguinal ligament, anchors inguinal ligament into pubis

Pectineal ligament

Question 4

Where is the femoral canal?

Answer 4

Subinguinal space, lateral to lacunar ligament

Question 5

Is the deep inguinal ring an entrance or exit? What passes through?

Answer 5

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

vas deferens and gonadal vessels in males and round lig in females

Question 6

Is the superficial inguinal ring an entrance or exit? What passes through? What splits it?

Answer 6

exit from inguinal canal

spermatic cord or round

external oblique aponeurosis

Question 7

What level in the genitofemoral nerve? What does it supply?

Answer 7

L1 and 2

Motor to cremasteric m.
Sensory to medial thigh and scrotal/labia fascia

Question 8

Describe testicular descent

Answer 8

Descent along with out pocketing of peritoneal cavity aka procesuss vaginalis into future scrotum carrying vessels and nerves (supersensory lig)

Connection to peritoneum closed, tunica vaginalis represents the remains of processus vaginalis around testes

Question 9

What happens as the spermatic cord develops?

Answer 9

Layers of abdominal wall carried: transversalis fascia
–> internal spermatic fascia, internal oblique –> cremasteric muscle and external oblique -> external spermatic fascia

Question 10

What are the contents of the spermatic cord?

Answer 10

vas deferens, testicular artery and veins (pampinform plexus), gonadal nerves, and lymphatics

Question 11

When does the processus vaginalis normally close?

Answer 11

1st year postnatally

Question 12

What are cryptorchid testis?

Answer 12

undescended testis, increase risk of testicular cancer

Question 13

What is testicular varicocele?

Answer 13

varicosities of pampiniform plexus, swelling in scrotum with dull recurring pain

Question 14

What is persistent processus vagingalis?

Answer 14

patent connection between abdomen and tunica vag

Question 15

What is hydrocele?

Answer 15

Peritoneal fluid accumulation within tunica vaginalis –> swollen scrotum
Most common in babies, communicating and non-communicating types

Question 16

What is hematocele?

Answer 16

Accumulation of blood in tunica vaginalis

Question 17

Describe ovarian descent

Answer 17

begins descending but gubernaculum becomes attached to developing uterus

Question 18

What does the gubernaculum form?

Answer 18

ovarian ligament and round ligament of uterus

Question 19

Where is the round ligament?

Answer 19

enters deep ring and exits superficial attaching to labial swellings

Question 20

Where does lymph from the scrotum drain into?

Answer 20

superificial inguinal LNs which travel to iliac and lumbar LNs

Question 21

Where does lymph from the testes drain?

Answer 21

into lumbar and pre-aortic LNs

Question 22

What composes the female inguinal canal and what are its contents?

Answer 22

Superficial and deep rings, medial/lateral curs, lacunar/pectineal ligs, conjoint tendon

Round lig of uterus, ilioinguinal n, genitofemoral nerve, scrotal/labia relation

Question 23

What is the iliopubic tract?

Answer 23

thickened transversalis fascia running posterior to inguinal lig, reinforces floor of inguinal canal

Question 24

What is the lateral umbilical ligament?

Answer 24

direct hernia inf to conjoint tendon and medial to lateral umbilical lig

Question 25

Describe a direct inguinal hernia

Answer 25

medial to inf epigastric a, peritoneum/transversalis fascia alongside the spermatic cord

Question 26

Describe a indirect inguinal hernia

Answer 26

enters deep ring, peritoneum within spermatic cord

Question 27

Describe a femoral hernia

Answer 27

below inguinal lig, more common in women, emergent with incarceration or strangulation

Question 28

What causes a flank hernia?

Answer 28

defects in posterolateral abdominal wall allowing tissue inside abdomen to protrude

Question 29

What can cause a hernia at a ventral site?

Answer 29

umbilical epigastric (weakness in wall in midline fusion point), Spigelian (through fascia between abdominal muscles but along semilunar line of rectus abdominis