Inguinal Canal Flashcards
What are the attachment sites of the inguinal ligament?
It is the inferior border of what structure?
ASIS to pubic tubercle
it is the inferior border of the external abdominal oblique aponeurosis
Are testes intra or extra peritoneal?
What attaches them to the abdominal wall guiding the descent?
extparitoneal
gubernaculum
What is the name of the double folding of tissue around the testes?
What is it formed from?
Process vaginalis (fetus) –> the tunica vaginalis (adult)
Formed from parietal peritoneum evaginating & forming a sac
What is cryptorchidism?
When a child is born and the testes are not visible/palpable
“incomplete descent”
What is the name for the complication when the testes end up in the wrong spot?
What problem can this cause?
Maldescent
can cause sterility
What is unique about dartos fascia of the scrotum?
There is a layer of muscle
causes wrinkling of the scrotum when it is cold
Identify the indicated aspects of the scrotum
What nerve innervates the anterior of the scrotum?
What nerves innervate the postior of the scrotum?
Anterior: Illio-inguinal (L1) through inguinal canal
Posterior: parietal nerve (S2-24) and parietal branch of posterior femoral cutaneous (S1-S3)
Identify the indicate features of the testis
What structures are contained within the spermatic cord?
- Ductus deferens with it sartery
- pampiniform venous plexus (testicular veins)
- testicular artery
- nerves
- somatic sensory
- sympathetic- perivascular
- parasympathetic- ductus deferens
- lymph channels
Where do testicular lymphatics drain?
Where do scrotal lymphatics drain?
testicular: para-aortic lymph nodes
scrotal: superficial inguinal lymph nodes
How does the inguinal canal start and end? Landmarks for these sites?
What is its relationship with the inguinal ligament?
What structure forms the anterior and inferior border of the inguinal canal?
starts deep ring (femoral artery lined up here)
ends superficial ring (pubic tubercle)
superior to inguinal ligament
external abdominal aponeurosis curls over formting the anterior and inferior wall of inguinal canal
What is the name of the structure that is deep to and parallels the inguinal ligament
iliopubic tract
Attachment site of the medial crus?
Attachment site of the lateral crus?
what exists between them?
Medial: pubic symphisis
Lateral: pubic tubercle
Between them: intercrural fibers
Which muscles cross over the inguinal canal?
The aponeurosis of which muscle forms the superficial ring?
Which structures form the conjoint tendon?
Traversis Abdominis crosses over inguinal canal
Internal Oblique arches over to form the roof
External oblique aponeurosis forms the superficial ring
combination of rectus sheath (from transversis abdominis) with internal oblique aponeurosis forms the conjoint tendon
Where is the conjoint tendon located with relation to the superficial ring?
posterior
External spermatic fascia is the continuation of what structure?
External abdominal oblique aponeurosis
Identify the freatures indicated in the image
What are the attachment poins of the lacunar ligament?
What is the name of its posterolateral continuation?
Lacunar: between inguinal to pubic bone
pectineal ligament
What are the walls of the inguinal canal:
floor?
anterior?
roof?
posterior?
- Floor
- inguinal ligament
- Anterior wall
- aponeurosis of external oblique and internal oblique muscle
- Roof
- Arches of TA & IO (&EO as superficial ring)
- Posterior wall
- transversalis fascia (laterally) and conjoint tendon (medially, behind superficial ring)
What two nerve pass through the inguinal canal?
genital branch of the genitofemoral nerve (runs through entire canal)
ilioinguinal nerve (drops in on external surface of IO, then exits superficial ring)
List the coverings of the spermatic cord from external to internal. Include the origination of these coverings.
- External Spermatic Fascia
- EO aponeurosis
- Cremaster fascia/muscle
- IO muscle/aponeurosis
- innervated by genital branch of the genitofemoral nerve
- Interal Spermatic Fascia
- From Transversalis fascia
- Tunica vaginalis
- testis only, not in cord - Parietal peritoneum
“Rule of Threes” for each of the following categories with reference to the spermatic cord
Fascia?
Areties?
Veins?
Nerves?
Others?
- Fascia
- external spermatic fascia
- cremaster fascial/muscle
- internal spermatic fascia
- Areties
- testicular
- artery to the ductus
- cremaster artery
- Veins
- pampiniform plexus
- vein of the ductus
- cremaster vein
- Nerves
- ilionguinal ( on cord)
- genitofemoral
- sympathetics
- Others
- ductus deferens
- lymphatics
- (possively) patent process vaginalis
Straight through which structure forms a direct hernia?
What is the path of an indirect hernia?
Where would you find a femoral hernia?
Direct hernia: conjoint tendon
Indirect hernia: deep ring, down canal, out into the scrotum
Femoral hernia: right next to femoral vessels, inferior to iliopubic tract
What type of hernia is most common in males?
What type of hernia is most common in females?
males: indirect inguinal
females: femoral
The presentation of the following hernias indicates which types? Which landmark shoud you be using to orient yourself?
pubic tubercle
medial to pubic tubercle: indirect inguinal
anterolateral: direct inguinal
inferolateral: femoral
