Inguinal Canal, hernias and testis Flashcards
Find the following surface markings
1) linea alba
2) linea semilunaris
3) tendinous intersections
4) arcuate line
5) costal margin
6) ASIS
7) inguinal ligament
What types of hernias can we see on surface anatomy?
inguinal
femoral
umbilical
epigastric
incisional
How long is the inguinal canal?
4cm long from deep ring to the superifical ring
What does the inguinal canal contain?
spermatic cord in men
round ligament in women
Describe the borders of the inguinal canal
floor = medial half of inguinal ligament
anterior wall = external oblique aponeurosis - reinforced laterally by internal oblique muscle fibers
roof = overarching fibers of internal oblique
posterior = transversalis fascia -reinforced medially by conjoint tendon
Where can you find the deep ring on surface anatomy?
above the mid-point of the inguinal ligament
What is the venous drainage of the testis?
right drain into the inferior vena cava
left drain to left renal vein
What is the inguinal ligament made of?
it is made up of the rolled in free lower border of the external oblique muscle - from the ASIS to the pubic tubercle
What nerve roots supply the internal oblique muscle?
Nerves T7-L1
What muscle does the internal oblique muscle become in the spermatic cord?
cremasteric muscle
what structures do the deep and superficial ring form in?
deep ring = defect in transversalis fascia
superficial ring = defect in external oblique aponeurosis
Where does an inguinal hernia present?
depends on type
indirect: congenital - forms through the deep ring to the scrotum neck is lateral to inferior epigastric artery
direct: acquired - forms though superficial ring and neck is medial to inferior epigastric artery
Describe the descent of the testes
start in posterior wall below the kindey, gubernaculum shortens and pulls the testes inferiorly bringing the transversalis fascia covering (internal spermatic fascia), then it passes through the external oblique, then it brings a layer of internal oblique (cremasteric muscle) , then it brings a layer of the external oblique (external spermatic fascia) with it and passes into the scrotum
What aspect of the male anatomy becomes the round ligament in women?
The gubernaculum
Does the vas deferens pass through the inguinal canal?
yes, it follows the spermatic cord up through the inguinal canal, through the deep ring, before connecting with the spermatic vesicles to form the common ejaculatory duct
What is the epididymis?
What is the blood supply to the testis?
testicular artery
cremasteric artery (from inferior epigastric)
artery to the vas def from vesical arteries
What composes the spermatic cord?
Rule of 3’s
3 layers
inernal spermatic fascia
cremasteric muscle
external spermatic fascia
3 arteries
testicular artery
cremasteric artery (from inferior epigastric)
artery to the vas def from vesical arteries
3 nerves
genital branch of genitofemoral (L2)
visceral sensory
ilioinguinal (lies on the spermatic cord)
3 other things
testicular veins
lymphatics
vas deferens
What would cause the testicle to feel like a bag of worms?
left renal vein has a sharp angle and can cause pressure leading to varicose veins of the scrotum - most common on the left side b/c there is more direct pressure on this region - if it happens on the right side it’s more likely to be due to tumor or some other obstruction
how long could the testi survive without a blood supply?
3-4 hours
Find murphy’s sign
McBurney’s point
Midpoint of inguinal ligament
mid-inguinal point
Murphy’s sign
- gallbladder
- Tip of 9th costal cartilage and lineasemilunaris
McBurney’s point
- base of the appendix
- 1/3 between ASIS and umbilicus
Mid point of inguinal ligament
- 1/2 way between ASIS and pubic tubercle
Mid inguinal point
-1/2 way between ASIS and pubic sysmphysis
What is Striae
Stretch marks = rupture of collagen in dermis with intact epidermis
What are Caput Medusae and what could cause them?
porto-caval anastomosis (portal and caval venous system)
they can reopen in the case of portal pressure-
