Inguinal Region Flashcards
Inguinal canal is formed by
Relocation of testis during development
Where does the inguinal canal start? (2)
Intraabdominally on the deep aspect of the abdominal wall where the spermatic cord passes through a hiatus in the transversalis fascia
The hiatus in the transversalis fascia is called
The deep or inguinal ring
Where does the inguinal canal end?
On the superficial aspect of the abdominal wall musculature at the superficial/external inguinal ring
Anterior boundary of the inguinal canal (2)
External oblique aponeurosis and internal oblique muscle laterally
Posterior boundary of the inguinal canal (2)
Fusion of transversalis fascia and transversus abdoiminis muscle
Superior boundary of the inguinal canal (3)
Arch formed by fibers of the internal oblique muscle and the transversus abdominis muscle and aponeurosis
Inferior boundary of the inguinal canal (2)
Formed by the inguinal ligament and lacunar ligament
Inguinal ligament is comprised of
Inferior fibers of the external oblique aponeurosis
Inguinal ligament stretches from
Anterior superior iliac spine to pubic tubercle
What forms the inferior floor of the inguinal canal?
Inguinal ligament
What is the lacunar ligament?
Triangular fanning out of the inguinal ligament as it joins the pubic tubercle
The lateral edge of the lacunar ligament forms
The medial border of the femoral canal
What is the pectineal ligament?
The lateral portion of the lacunar ligament that is fused to the periosteum of the pubic tubercle
The pectineal ligament may include fibers from (4)
Transversus abdominis
Iliopubic tract
Internal oblique
Rectus abdominis
What is the iliopubic tract?
An aponeurotic band that begins at the anterior suprior iliac spine and inserts into the pectineal ligament from above
Where does the iliopubic tract form? (3)
The deep side of the inferior margin of the transversus abdominis and transversalis fascia
What is the on the superficial side of the iliopubic tract?
Inguinal ligament
What connects the iliopubic tract to the inguinal ligament?
Shelving edge
The iliopubic tract helps form (2)
The inferior margin of the internal inguinal ring as it courses medially
The iliopubic tract continues as (2)
The anterior and medial border of the femoral canal
The conjoined tendon is (3)
The fusion of the inferior fibers of the internal oblique and transversus abdominis aponeurosis at the point where they insert on the pubic tubercle
What is the purpose of the internal ring? (2)
It is the enterance to the inguinal canal for the spermatic cord (round ligament) and genital branch of the genitofemoral nerve
Where is the internal ring located? (3)
Superior to the middle of the inguinal ligament
Lateral to the inferior epigastric artery
Inferior border: iliopubic tract
The internal ring starts as (3)
an envagination in the transversalis fascia that forms and opening which the vas deferens (round ligament) passes to enter the inguinal canal
Transversalis fascia continues into the inguinal canal to form
The internal fasica
What is the purpose of the external ring? (3)
It is the exit for the spermatic cord, genitofemoral nerve, and ilioinguinal nerve from the inguinal canal
The external ring splits to form
the lateral and medial crus
What are the lateral and medial crus?
portion of the external oblique aponeurosis that forms the lateral and medial margins of the superficial ring respectively
Where is the external ring located? (2)
Superior and lateral to the pubic tubercle
What does the lateral crus attach to?
The pubic tubercle
What does the medial crus attach to?
Pubic crest
What helps prevent the crua from opening? (2)
Intercrural fibers from the superficial layer of the deep fascia overlying the external oblique muscle
What is the gubernaculum? (3)
Fibrous tract connecting the testis to the anterolateral abdominal wall at the site of the deep ring of the inguinal canal
In females, the gubernaculum connects (3)
the ovary and uterus to the developing labium majus
In females, the gubernaculum becomes (2)
The ovarian and round ligaments
What is the processus vaginalis? (3)
A pertinoneal diverticulum that crosses the developing inguinal canal carrying the muscular and fascial layers of the anterolateral abdominal wall into the scrotum
Embryology- testis develop in the (3)
extraperitoneal connective tissue in the superior lumbar region of the posterior abdominal wall
Embryology- what happens to the processus vaginalis
It crosses crosses the developing inguinal ring carrying the muscular and fascial layers of the anterolateral abdominal wall before it as it enters the scrotum
Embryology- what happens as the testis enter the scrotum?
they are covered by the musculofascial extensions of the anterolateral abdominal wall
Embryology- the distal part of the processus vaginalis forms the
Tunica vaginalis
In females, ovaries develop (2)
in superior lumbar region of the posterior abdominal wall and migrate to the lateral abdominal wall in the pelvis
In females, the gubernaculum is (3)
a fibrous cord connecting the ovary and the primordial uterus to the developing labium majus
The ovarian ligament connects
The ovary and uterus
The round ligament connects
The uterus and labium majus
In females, which ligament passes through the inguinal region?
Round ligament
In females, the inguinal canal is ___, compared to males
Narrower
What are the nerves of the inguinal region? (4)
Ilioinguinal
Iliohypogastric
Genitofemoral
Lateral femoral cutaneous
Function of the spermatic cord
Suspends the testis in the scrotum
The spermatic cord contains (8)
Vas deferenes
vas deferens artery and vein
cremasteric artery and vein
testicular artery and vein
pampiniform venous plexus
genital branch of genitofemoral nerve
sympathetic nerves
lymphatic vessels
What are the 3 fascial layers that envelope the spermatic cord?
External
Cremasteric
Internal
The external fascial layer of the spermatic cord is formed from
The external oblique aponeurosis
The cremasteric fascial layer of the spermatic cord is formed from
superficial and deep surfaces of the internal oblique muscles
The internal fascial layer of the spermatic cord is formed from
Transversalis fascia
The testicular artery supplies
Testis and epididymis
Testicular artery arises from
The aorta
Vas deferens artery arises from
Inferior vesical artery
Cremasteric artery arises from
Inferior epigastric artery
What is the pampiniform plexus?
A VENOUS network formed by 12 veins
What is the function of the pampiniform plexus?
Drains into the right or left testicular veins
The pampiniform plexus runs in the
Spermatic cord
What are the main arteries and veins of the spermatic cord? (4)
Testicular artery
Vas deferens artery
Cremasteric artery
Pampiniform plexus
Descend of the testis occurs ___ the peritoneum
Beneath/behind
The abdominal skin of the abdominal wall (i.e. Scarpa’s fascia) becomes the ___ in the testis
Scrotal skin with tunica dartos (dartos muscle of the scrotum)
The superficial fascia of the abdominal wall/external abdominal oblique becomes the ___ in the testis
External spermatic fascia
The external oblique muscle of the abdominal wall becomes the ___ in the testis
IT HAS NO COUNTERPART
The transversalis fasica of the abdominal wall becomes the ___ in the testis
Internal spermatic fascia
The peritoneum of the abdominal wall becomes the ___ in the testis
Tunica vaginalis
Inguinal hernias are caused by
A failure of the processus vaginalis to close
What is the superior/lateral border of Hesselbach’s triangle?
Inferior epigastrics
What is the meidal border of Hesselbach’s triangle?
Lateral edge of the rectus abdominis muscle
What is the inferior border of Hesselbach’s triangle?
Inguinal ligament
What is the Triangle of pain?
It is a space bordered by the iliopubic tract and gonadal vessels
What does the triangle of pain contain? (3)
Lateral femoral cutaneous nerve
Femoral branch of the genitofemoral nerve
Femoral nerve
What is the triangle of doom?
A space bordered by the vas deferens and spermatic cord vessels
The triangle of doom contains (4)
external iliacs
deep circumflex iliac vein
femoral nerve
genital branch of genitofemoral nerve
What is the circle of death? (4)
A vascular anastomosis between the obturator and the external iliac vascular systems that passes over Cooper’s pectineal ligament and posterior to the lacunar ligament
Direct vs. indirect hernia
Any hernia that occurs inside Hesselbach’s triangle is a direct hernia
Any hernia that occurs on the lateral side of the triangle is an indirect hernia
What is Scarpa’s Triangle/the Femoral triangle?
Subfascial space that appears as a triangular depression inferior to the inguinal ligament when the thigh is flexed, abducted, and laterally rotated.
What is the superior border of Scarpa’s/the Femoral Triangle?
Inginal ligament
What is the medial border of Scarpa’s/the Femoral Triangle?
Lateral border of the adductor longus
What is the lateral border of Scarpa’s/the Femoral Triangle?
Medial border of the Sartorius muscle
What is the floor of Scarpa’s/the Femoral Triangle?
Pectinous and adductor longus muslces medially
Iliopsoas muscles laterally
What is the roof of Scarpa’s/the Femoral Triangle?
Fascia lata
What structures are contained within the femoral triangle? (6)
Femoral nerve + terminal branches
Femoral sheath which contains:
- Femoral artery
- Femoral vein
- Deep inguinal lymph nodes
What are the borders of the subinguinal hiatus superiorly and inferiorly? (1+3)
Superior: inguinal ligament
Inferior: iliopubic eminance, body, and pubic tubercle
What are the 3 compartments of the subinguial hiatus? (3)
Lacuna musculonervosa
Lacuna vasorum
Lacuna lymphatica
The lacuna musculonervosa contains
The femoral nerve and the iliopsoas muscle
The lacuna vasorum contains
femoral artery and vein
The lacuna lymphatica is a common site of
Herniation
The cremaster muscle is a derivative of
The internal abdominal oblique
In the subinguinal hiatus, what divides the subinguinal hiatus into the lacuna visorum and the lacuna musculorum?
Subinguinal hiatus
The external abdominal oblique fascia becomes the ___ in the testis
External spermatic fascia
The transversalis fascia in the abdominal wall becomes __ in the testis
The internal spermatic fascia
The transversus abdominis muscle in the abdominal wall becomes ___ in the testis
Nothing
The external abdominal oblique fascia in the abdominal wall becomes the ___ in the testis
External spermatic fascia
The right gonadal vein drains into the ___
The left gonadal vein drains into the ___
Right = IVC
Left = renal vein
From lateral to medial, what is located in the femoral sheath? (5)
Lateral femoral cutaneous nerve
Femoral artery
Femoral vein
Nodes/fat of the femoral canal/ring
Lacunar ligament
What is located superiorly to the femoral sheath?
Inguinal ligament/inguinal canal (superficial ring)
Femoral hernias occur
Below the inguinal ligament
Cloquet’s hernia occurs between
The pectineus msucle and its aponeurosis and behind the femoral vessels
Be’clard’s hernia occurs
Through the saphenous ring