Inguinal Canal, hernias and testis

Question 1

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

Answer 1

Question 2

What types of hernias can we see on surface anatomy?

Answer 2

inguinal

femoral

umbilical

epigastric

incisional

Question 3

How long is the inguinal canal?

Answer 3

4cm long from deep ring to the superifical ring

Question 4

What does the inguinal canal contain?

Answer 4

spermatic cord in men

round ligament in women

Question 5

Describe the borders of the inguinal canal

Answer 5

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

Question 6

Where can you find the deep ring on surface anatomy?

Answer 6

above the mid-point of the inguinal ligament

Question 7

What is the venous drainage of the testis?

Answer 7

right drain into the inferior vena cava

left drain to left renal vein

Question 8

What is the inguinal ligament made of?

Answer 8

it is made up of the rolled in free lower border of the external oblique muscle - from the ASIS to the pubic tubercle

Question 9

What nerve roots supply the internal oblique muscle?

Answer 9

Nerves T7-L1

Question 10

What muscle does the internal oblique muscle become in the spermatic cord?

Answer 10

cremasteric muscle

Question 11

what structures do the deep and superficial ring form in?

Answer 11

deep ring = defect in transversalis fascia

superficial ring = defect in external oblique aponeurosis

Question 12

Where does an inguinal hernia present?

Answer 12

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

Question 13

Describe the descent of the testes

Answer 13

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

Question 14

What aspect of the male anatomy becomes the round ligament in women?

Answer 14

The gubernaculum

Question 15

Does the vas deferens pass through the inguinal canal?

Answer 15

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

Question 16

What is the epididymis?

Answer 16

Question 17

What is the blood supply to the testis?

Answer 17

testicular artery

cremasteric artery (from inferior epigastric)

artery to the vas def from vesical arteries

Question 18

What composes the spermatic cord?

Answer 18

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

Question 19

What would cause the testicle to feel like a bag of worms?

Answer 19

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

Question 20

how long could the testi survive without a blood supply?

Answer 20

3-4 hours

Question 21

Find murphy’s sign

McBurney’s point

Midpoint of inguinal ligament

mid-inguinal point

Answer 21

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

Question 22

What is Striae

Answer 22

Stretch marks = rupture of collagen in dermis with intact epidermis

Question 24

What are Caput Medusae and what could cause them?

Answer 24

porto-caval anastomosis (portal and caval venous system)

they can reopen in the case of portal pressure-