Inguinal Canal

Question 1

What are the attachment sites of the inguinal ligament?
It is the inferior border of what structure?

Answer 1

ASIS to pubic tubercle

it is the inferior border of the external abdominal oblique aponeurosis

Question 2

Are testes intra or extra peritoneal?

What attaches them to the abdominal wall guiding the descent?

Answer 2

extparitoneal

gubernaculum

Question 3

What is the name of the double folding of tissue around the testes?

What is it formed from?

Answer 3

Process vaginalis (fetus) –> the tunica vaginalis (adult)

Formed from parietal peritoneum evaginating & forming a sac

Question 4

What is cryptorchidism?

Answer 4

When a child is born and the testes are not visible/palpable

“incomplete descent”

Question 5

What is the name for the complication when the testes end up in the wrong spot?

What problem can this cause?

Answer 5

Maldescent

can cause sterility

Question 6

What is unique about dartos fascia of the scrotum?

Answer 6

There is a layer of muscle

causes wrinkling of the scrotum when it is cold

Question 7

Identify the indicated aspects of the scrotum

Answer 7

Question 8

What nerve innervates the anterior of the scrotum?

What nerves innervate the postior of the scrotum?

Answer 8

Anterior: Illio-inguinal (L1) through inguinal canal

Posterior: parietal nerve (S2-24) and parietal branch of posterior femoral cutaneous (S1-S3)

Question 9

Identify the indicate features of the testis

Answer 9

Question 10

What structures are contained within the spermatic cord?

Answer 10

• Ductus deferens with it sartery
• pampiniform venous plexus (testicular veins)
• testicular artery
• nerves
  
  • somatic sensory
  • sympathetic- perivascular
  • parasympathetic- ductus deferens
• lymph channels

Question 11

Where do testicular lymphatics drain?

Where do scrotal lymphatics drain?

Answer 11

testicular: para-aortic lymph nodes
scrotal: superficial inguinal lymph nodes

Question 12

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?

Answer 12

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

Question 13

What is the name of the structure that is deep to and parallels the inguinal ligament

Answer 13

iliopubic tract

Question 14

Attachment site of the medial crus?

Attachment site of the lateral crus?

what exists between them?

Answer 14

Medial: pubic symphisis

Lateral: pubic tubercle

Between them: intercrural fibers

Question 15

Which muscles cross over the inguinal canal?

The aponeurosis of which muscle forms the superficial ring?

Which structures form the conjoint tendon?

Answer 15

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

Question 16

Where is the conjoint tendon located with relation to the superficial ring?

Answer 16

posterior

Question 17

External spermatic fascia is the continuation of what structure?

Answer 17

External abdominal oblique aponeurosis

Question 18

Identify the freatures indicated in the image

Answer 18

Question 19

What are the attachment poins of the lacunar ligament?

What is the name of its posterolateral continuation?

Answer 19

Lacunar: between inguinal to pubic bone

pectineal ligament

Question 20

What are the walls of the inguinal canal:

floor?

anterior?

roof?

posterior?

Answer 20

• 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)

Question 21

What two nerve pass through the inguinal canal?

Answer 21

genital branch of the genitofemoral nerve (runs through entire canal)

ilioinguinal nerve (drops in on external surface of IO, then exits superficial ring)

Question 22

List the coverings of the spermatic cord from external to internal. Include the origination of these coverings.

Answer 22

• 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

Question 23

“Rule of Threes” for each of the following categories with reference to the spermatic cord

Fascia?

Areties?

Veins?

Nerves?

Others?

Answer 23

• 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

Question 24

Straight through which structure forms a direct hernia?

What is the path of an indirect hernia?

Where would you find a femoral hernia?

Answer 24

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

Question 25

What type of hernia is most common in males?

What type of hernia is most common in females?

Answer 25

males: indirect inguinal
females: femoral

Question 26

The presentation of the following hernias indicates which types? Which landmark shoud you be using to orient yourself?

Answer 26

pubic tubercle

medial to pubic tubercle: indirect inguinal

anterolateral: direct inguinal
inferolateral: femoral