Inguinal Canal, Ischiorectal fossa Flashcards
What type of hernias account for 75% of hernias in the body?
Inguinal hernias
Where does the inguinal ligament extend from?
It extends from anterior superior iliac spine to the pubic tubercle.
From what structure does the inguinal ligament formed from?
It is formed by the lower-free border of the external oblique aponeurosis, which is thickened and folded backward on itself.
What structure forms the floor of Inguinal canal?
The grooved upper surface of inguinal ligament.
What structure forms the medial boundary of femoral canal?
Lacunar ligament
Where does the Lacunar ligament (Gimbernat’s Ligament) meet the pectineal ligament of Cooper ?
At the pubic tubercle
Where does the ilioinguinal ligament extend from?
From the inferior aspect of the inguinal ligament to the iliopectineal eminence.
Where is the pelvifemoral ( subinginal space) located?
Between the inguinal ligament and the hip bone
What two muscles pass the through the sub-inguinal space?
Psoas Major & Iliacus
Fill in the blanks. “ The sub-inguinal space is divided into two parts the _________ & __________.
Large lateral part called lacuna musculorum
Small medial part called lacuna vasculorum.
What is the name of the structure that divides the sub-inguinal space into two?
Ilioinguinal ligament
What structures pass through the large lateral part ( lacuna musculorum)?
Psoas major, Iliacus , femoral and lateral cutaneous nerves of thigh.
Fill in the blanks.” The ___________in abdomen become __________as they pass through the medial part of the subinguinal space—the _____________.”
External iliac vessels in abdomen become femoral vessels
Lacuna vasculorum
What are the three compartments in which the Femoral sheath is divided into?
Lateral compartment
Middle compartment
Medial compartment
Which compartment of the Femora sheath is known as the Femoral canal ?
Medial compartment
True or False? The middle compartment of the Femoral sheath lodges the femoral artery and genital branch of the genitofemoral nerve.
FALSE!!! The lateral compartment does this!!
What structure is contained in the middle compartment of the femoral sheath?
Femoral vein
What structures are contained in the Medial compartment of the femoral sheath?
It contains lymph node of Cloquet and
fibrofatty tissue.
What are the boundaries of the Femoral canal?
Anterior: Inguinal ligament.
Medial: Sharp edge of the lacunar ligament.
Posterior: Pecten pubis
Lateral: Femoral vein
Fill in the blanks. “ The upper end of the femoral canal, which opens into the abdominal cavity is called ________.”
The femoral ring
How long is the inguinal canal?
3-5 cm
Where is the deep inguinal ring located?
It is an oval opening in the fascia transversalis.
Where is the superficial inguinal ring located?
It is a triangular opening located in the aponeurosis of external oblique muscle.
Fill in the blanks. “ The deep inguinal ring lies _______ above the _________.”
1.25 cm above midponit of the inguinal ligament.
Fill in the blanks. “ The superficial inguinal ring lies above the _________.”
Lies above and lateral to the pubic crest.
Superficial - creSt
What are the structures passing through the deep inguinal ring in MALES?
Da - Ductus deferens and its artery.
G- Genital branch of
genitofemoral nerve.
O- Obliterated remains of
processus vaginalis.
A- Autonomic nerves and
lymphatics.
T- Testicular artery and the accompanying veins.
What are the structures passing through the deep inguinal ring in FEMALES?
L- Lymphatics from the
uterus.
O- Obliterated remains of
processus vaginalis.
R- Round ligament of uterus.
“LOR”
What are the structures passing through the superficial inguinal ring in Females?
Ilioinguinal nerve
Round ligament of uterus.
What are the structures passing through the superficial inguinal ring in Males?
Ilioinguinal nerve
Spermatic cord
Fill in the blanks. “ At the opening of the deep inguinal ring , the Transversalis fascia forms an out-pouching which is the _______.”
Internal spermatic fascia
For the boundaries of inguinal canal, The anterior wall is formed by?
Superficial to deep
- Skin
2.Superficial fascia - External oblique
aponeurosis - Internal oblique muscle fibres, in lateral one-third.
For the boundaries of the inguinal canal, the posterior wall is formed by?
From deep to superficial
- Fascia transversalis, in the whole extent.
- Conjoint tendon, in medial two-third.
3.Reflected part of the inguinal ligament,in medial-most part.
What structure forms the roof of the Inguinal Canal?
It is formed by the lower arched fibres of internal oblique and transversus abdominis
muscles.
What structures form the floor of the inguinal canal?
(a) Grooved upper surface of the inguinal ligament in the whole extent.
(b) Abdominal surface of the ligament at the medial end.
What is the round ligament of uterus a remnant of ?
Gubernaculum
What are the structures passing through the spermatic cord?
1.Ductus deferens
2.Three arteries :
C- Cremasteric artery
A - Artery to ductus deferens.
T - Testicular artery
- Veins, the pampiniform venous plexus
4.Lymphatic draining into para-aortic nodes.
5.Nerves, genital branch of genitofemoral nerve and sympathetic fibres which accompany the arteries.
6.Remains of processus vaginalis.
What muscle fibres make up the Conjoint tendons ( Inguinal Falx) ?
Muscle fibres form the Internal oblique muscle and the Transversus Abdominis .
What are the arteries found in the spermatic cord branches of ( CAT)?
Cremasteric artery - Branch of Inferior epigastric artery
Artery to the Ductus deferent - Superior/Inferior Vesical artery
Testicular artery - Branch of the Abdominal Aorta
At what vertebral level does the Testicular artery branch off the abdominal aorta?
L2-L3
True or False? The right testicular veins are shorter than the left testicular veins.
TRUE!!
Left are Longer! “ LL”
Where does the left testicular veins drain into?
They drain into the left renal vein at a right angle.
Where does the right testicular vein drain into?
They drain into the IVC
What are the fascial coverings for the spermatic cord from deep to superficial?
- Internal Spermatic fascia.
- Cremasteric Fascia & muscle.
- External Spermatic fascia.
Which fascia covering of the spermatic cord is formed from the fascia of the superficial and deep surfaces of internal oblique muscle?
Cremasteric Fascia & muscle.
Which fascia covering of the spermatic cord is formed from transversalis fascia?
Internal Spermatic fascia
Fill in the blanks. “ The External spermatic fascia is formed from _______.”
The External oblique aponeurosis.
“Ex for ex”
How long is the ductus deferens ( vas deferens)?
45 cm
What is the name of the structure that guards the deep inguinal ring anteriorly?
The internal oblique muscle
What is the name of the structure that guard the superficial inguinal ring posteriorly?
Conjoint tendon and reflected part of the inguinal ligament
What are the boundaries of the Inguinal Triangle ( Hesselbach’s triangle) ?
Medial:Lower 5 cm of the lateral border of the rectus abdominis muscle ( linea semilunaris).
Lateral: Inferior epigastric artery.
Inferior :Medial half of the inguinal ligament.
“MLI - RIM”
What is the floor of the Inguinal triangle covered with?
Peritoneum, extraperitoneal tissue, and fascia transversalis.
What is the most known location for Direct Inguinal Hernias?
The lateral part of the floor of the Inguinal triangle
What is the name of the structure that divides the Inguinal triangle into a medial and lateral triangle?
Medial umbilical ligament
Fill in the blank.” The medial umbilical ligament is a remnant of _______.”
Obliterated umbilical artery.
In relation to the inferior epigastric artery and hernias , Fill in the blanks. “ Direct hernias occur _______ to the inferior epigastric artery while Indirect hernias occur _______ to The inferior epigastric artery.”
- Direct Hernia occurs MEDIAL to the Inferior epigastric artery
“ DM”
*Indirect Hernias occur LATERAL to the Inferior epigastric artery .
“ IL”
True or False? Direct hernias are more common in infants and young adults while Indirect hernias are more common in the elderly .
FALSE!! Indirect hernias are more common in infants and young adults while Direct hernias are more common in the elderly.
” INdirect hernias pass through the INternal ring, INto the scrotum, and are common in INfancy. “
“ in in in”
Which hernia is associated with the complete or partial patency of the processus vaginalis?
Indirect Inguinal Hernias
What are the two subdivisions of Indirect Inguinal hernias?
Acquired and Congenital
State the difference between Acquired Indirect Inguinal Hernia and Congenital Indirect Inguinal Hernia.
Congenital - occurs due to patent processus vaginalis (an outpouching of the peritoneum), connecting peritoneal cavity with the tunica vaginalis.
Acquired - It occurs due to increased intra-abdominal pressure as during weight lifting. When intra-abdominal pressure is increased immensely, the abdominal contents are pushed through the deep inguinal ring into the inguinal canal
What is the name of the structure that divides the femoral sheath into its different compartments?
Two anteroposterior fibrous septa
What is the weakest point of the Inguinal ligament ?
Deep Inguinal Ring
Fill in the blanks. “ The superficial inguinal ring has 2 crura. The lateral is attached to the ______ while the medial is attached to the __________.”
Lateral- Pubic Tubercle
Medial- Pubic symphysis
What is the difference between midpoint of the inguinal ligament and midinguinal point?
The midinguinal point is halfway between the ASIS and pubic symphysis.
The midpoint of the inguinal ligament is halfway between ASIS and pubic tubercle ( where the inguinal ligament is)
Fill in the blank. “ Thickening of the transversalis fascia medial to deep ring forms the ________.”
Inferior alveolar ligament
What is the Ischiorectal Fossa?
The ischiorectal fossa is a wedge-shaped, fat-filled space situated on each side of the anal canal below the pelvic diaphragm
What is the function of the ischiorectal fossa?
They help in dilatation of the anal canal, during defecation (i.e., passage of flatus and faeces).
What is the measurements of the Ischiorectal fossa?
Each fossa measures about 5 cm in length, 5 cm in width, and 5 cm or slightly more in depth.
What is the lateral boundary of the Ischiorectal fossa?
Fascia covering the obturator internus muscle and ischial tuberosity.
What is the medial boundary of the Ischiorectal fossa?
Fascia covering the levator ani muscle and external anal sphincter.
What is the Posterior boundary of the Ischiorectal fossa?
Sacrotuberous ligament, on the posterior surface of which is gluteus maximus.
Fill in the blanks . “The floor of the ischiorectal fossa is ________.”
Perineal skin
What is the anterior boundary of the Ischiorectal Fossa?
Posterior border of the perineal membrane.
What is the roof of the Ischiorectal fossa?
Meeting point of the fascia covering obturator internus and inferior fascia of the pelvic diaphragm.
What are the contents found in the Ischiorectal Fossa?
- Ischiorectal pad of fat.
- Inferior rectal nerves and vessels (running from lateral to medial side).
- Perineal branch of fourth sacral nerve enters the posterior angle of the fossa running over levator ani to reach sphincter ani externus which it innervates.
4.Posterior scrotal (or labial) nerves and vessels cross the anterolateral part of the fossa to enter the urogenital triangle.
What is the Hiatus of Schwalbe and where is it located ?
It is a gap exists between the tendinous origin of the levator ani and obturator fascia.
Through what structure may pelvic organs herniate into the ischiorectal fossa?
Hiatus of Schwalbe
Fill in the blanks. “ The perineal space is bounded above by ______ and below by ________.”
Bounded above by perianal fascia and bounded below by Perianal skin.
What is the name of the structure that divides the Perianal space into numerous compartments?
Fibroelastic septa.
Where is the Pudendal Canal ( Alcock’s canal) found ?
It is located in the LATERAL wall of the ischiorectal fossa and is 2.5 cm (1 inch) above the ischial tuberosity.
What are the contents of the Pudendal canal?
- Pudendal nerve which divides within the canal into the dorsal nerve of penis and the perineal nerve.
- Internal pudendal vessels.
From what structures does the pudendal canal extend from?
It extends from the Lesser sciatic foramen to the posterior limit of the deep perianal pouch.
Fill in the blanks. “The pudendal nerve arises from ________. “
Ventral rami of S2, S3, S4.
What are the terminal branches of the Pudendal nerve?
A large perineal nerve and a small dorsal nerve of the penis (or clitoris).
