Inguinal Canal and Liver Flashcards
Where is the inguinal canal located?
Between deep inguinal ring and superficial inguinal ring, above and parallel to inguinal ligament
Where does the inguinal ligament run?
Anterior superior iliac spine to pubic tubercle
What 4 things can be found in the inguinal canal?
- Ilioinguinal nerve
- Genital branch of genitofemoral nerve
- Spermatic cord (males)
- Round ligament of uterus (females)
Where is the deep inguinal ring located?
Opening in fascia transversalis located ½ inch above mid-inguinal point
What 2 structures pass through deep inguinal ring?
- Spermatic cord
2. Round ligament of uterus
Where is the superficial inguinal ring located?
External oblique aponeurosis above and lateral to pubic tubercle
What 3 structures pass through superficial inguinal ligament?
- Ilioinguinal nerve
- Spermatic cord (males)
- Round ligament of uterus (females)
Why does the midpoint of inguinal canal and inguinal ligament differ?
Inguinal canal inserts at pubic crest but inguinal ligament inserts at pubic tubercle
What is the conjoint tendon?
Lower part of aponeurosis of internal oblique abdominal muscle and transversus abdominis as it inserts into the crest of pubis
What forms the anterior wall of the inguinal canal?
External oblique aponeurosis, reinforced laterally by internal oblique
What forms the posterior wall of the inguinal canal?
Conjoint tendon medially and fascia transversalis laterally
What forms the roof of the inguinal canal?
Arching lowest fibres of internal oblique and transversus abdominis muscles
What forms the floor of the inguinal canal?
Inguinal ligament and at the medial end, the lacunar ligament
What is the lacunar ligament?
Ligament between inguinal ligament and pubic crest
Where is the anterior wall of the inguinal canal strongest?
Opposite the deep inguinal ring
Where is the posterior wall of the inguinal canal strongest?
Opposite the superficial inguinal ring
What is the inguinal ligament?
Fibrous band formed by lower boarder of aponeurosis of external oblique muscle
Where is the inguinal ligament located?
Anterior superior iliac spine to the pubic tubercle
Where do gonads develop?
Extraperitoneal layer of abdomen
What is gubernaculum?
Fibrous band which links ovaries and labia majora/scrotum and testes
What is the order of descent of things to form scrotum?
- Gubernaculum
- Processus vaginalis
- Testes
What is the processus vaginalis?
Portion of the peritoneum
What is a hernia?
Abnormal weakness in the abdominal wall which allows something inside to protrude
What are 2 types of inguinal hernia?
- Indirect
2. Direct
What is an indirect inguinal hernia?
Peritoneal sac transverses the length of the canal and can continue to scrotum
What is a direct inguinal hernia?
Protrusion of abdominal viscera through weakness of posterior wall of inguinal canal
What is the major difference between a direct and indirect inguinal hernia?
Direct hernia runs parallel to spermatic cord while indirect hernia runs within the spermatic cord
What are the 3 hiatuses found in the diaphragm?
- Vena caval hiatus
- Oesophageal hiatus
- Aortic hiatus
Where is the vena caval hiatus located?
Central tendon at vertebral level of T8
What 2 things pass through vena caval hiatus?
- Inferior vena cava
2. Right phrenic nerve
Where is the oesophageal hiatus located?
Right crus at the vertebral level of T10
What 2 things pass through the oesophageal hiatus?
- Oesophagus
2. Anterior and posterior trunks of the vagus nerves
Where is the aortic hiatus located?
Between two crura of the diaphragm at vertebral level T12
What 3 things pass through the aortic hiatus?
- Aorta
- Thoracic duct
- Azygous vein
What separates the two lobes of the liver?
Falciform ligament
What is the name of the free edge of the falciform ligament?
Ligamentum teres
What are the 2 accessory lobes of the right lobe of the liver?
- Caudate (Superior)
2. Quadrate (Inferior)
What is the porta hepatis?
Where hepatic arteries and portal vein enter and hepatic ducts leave the liver
Give the order of arteries supplying the liver
- Common hepatic artery
- Hepatic artery proper
- Left / Right hepatic artery
Where does the common hepatic artery become the hepatic artery proper?
After the origin of the gastroduodenal artery
What forms the portal vein?
The union of splenic and superior mesenteric vein
What happens in patients with elevated portal vein pressure with regards to blood flow?
Less blood flows to the liver and the rest enters collateral channels which drain into the systemic circulation
What are 3 of the largest portosystemic collaterals?
- Gastroesophageal junction
- The anus
- Anterior abdominal wall around umbilicus
What is the portosystemic collateral at the gastroesophageal junction?
Left gastric vein of portosystemic system anastomose with tributaries to azygous system of caval system
What is the portosystemic collateral at the anus?
The superior rectal vein of portosystemic system anastomoses with middle and inferior rectal veins of systemic venous system
What is the portosystemic collateral at the anterior abdominal wall around umbilicus?
Paraumbilical veins of porta system anastomose with veins on anterior abdominal wall of vena cava system
What are 3 origins of the diaphragm?
- Musculotendinous crura
- Medial and lateral arcuate ligaments
- Sternocostal origin
Where is the sternocostal origin of the diaphragm?
Lower 6 ribs and posterior aspect of xiphoid process
Where is the right crus of the diaphragm attached?
L1 - L3 (including associated intervertebral discs)
Where is the left crus of the diaphragm attached?
L1 - L2 (including associated intervertebral discs)
What connects left and right crura?
Median arcuate ligament
What is the name of the second tendinous arch of the diaphragm?
Medial arcuate ligament
What forms the medial arcuate ligament?
Fascia which covers the upper part of the psoas major muscle
What is the name of the third tendinous arch of the diaphragm?
Lateral arcuate ligament
What forms the lateral arcuate ligament?
Thickening of the fascia which covers the quadratus lumborum muscle
Where is the insertion of the diaphragm?
Central tendon
What are the 3 arteries which provide superior arterial supply of the diaphragm?
- Musculophrenic
- Pericardiophrenic (internal thoracic artery)
- Superior phrenic (thoracic aorta)
What artery provides inferior arterial supply to the diagram?
Inferior phrenic arteries (abdominal aorta)
What nerves innervate the diaphragm?
C3 - C5
