Inguinal Region Flashcards
what is the difference between direct and indirect hernias
direct enters inguinal canal via posterior wall through haseslbach’s triangle due to weakened conjoint tendon
indirect enters inguinal canal via deep inguinal ring outside haseselbach’s triangle due to patent process vaginalis
is there an inguinal canal in females
yes
why is the cremater reflex tested
to test that the iliogenital and iliofemoral nerves are working
how do layers of the spermatic cord relate to the layers of the anterior abdominal wall
skin is the same as the skin of the abdominal wall
campers and scarpas fascia fuse to form the darts- fat lost from campers fascia
external spermatic fascia comes from the external obliques
cremaster muscle comes from internal oblique
internal spermatic fascia comes from transversus abdominis
what is the difference between the deep and superficial inguinal rings
superficial inguinal ring- formed by the external oblique
deep inguinal ring- formed by transversus abdominis
what is the origin of tunica vaginalis in the testis?
process vaginalis disappears, but stays to form the layers around the testis
what is the origin of the tunica vaginalis in females
no tunica vaginalis, the process vaginalis regresses in females
if it doesn’t forms the canal of nuck
what are clinical implications of the gubernaculum
guides the testis into the scrotum
if it doesn’t develop fully testis does not descend fully
what does the gubernaculum become in the male
lower part connects the testis to the scrotum
upper part degenerates
what does the gubernaculum become in the female
round ligament of uterus and round ligament of ovary
where do the testis travel during development
through the inguinal canal
what happens if the wall of the inguinal canal is weakened
hernia
what is a hernia
visceral protrusion beyond normal boundaries
what level do gonads develop at and in what space
T12 in retroperitoneal space
what is in the spermatic cord
nerves
vessels
lymphatics
ductus deferens
describe week 6 of testis development
testis in retroperitoneal space with caudal ligament attached to the skin in the scrotal swelling
what becomes the gobernaculum ligament
caudal ligament
describe week 10 of development
testis travels anteriorly in subserous fascia, taking the nerves, vessels and lymphatics with it from T12
describe 7 month development
process vaginalis forms
testis moves into the deep inguinal canal taking wall layers with it
exit through superficial ring
testis pushes into the processes vaginalis which forms the parietal and visceral layers and cavity of tunica vaginalis
describe testis at birth
testis is in scrotum surrounded by tunica vaginalis and the process vaginalis is closed off
what is the role of the gobernaculum
guides the testis into scrotum
what happens if the gobernaculum is incompletely formed
incomplete testis descent
what is cryptorchidism
undescended testis- usually in the inguinal canal
what are consequences of undescended testes
decreased fertility
increased risk of testicular cancer
what part of the process vaginalis remains
tunica vaginalis- lining testes and the cavity
what is patent process vaginalis
failure of close, leaving a communication between the peritoneal cavity and the scrotum
can lead to an indirect hernia
what is a hydrocele
fluid filled sac in the spermatic cord from a weird closing of the process vaginalis
how is a hydrocele distinguished from an undescended testis
light- hydroceles let light through
what does the gubernaculum become in females and where is it attached
round ligament of uterus
attached to the labia major distally and ovary proximally
middle is attached to the uterus
round ligament of the uterus
gobernaculum between the uterus and labia majora
round ligament of the ovary
gobernaculum between the uterus and ovary
what is significant about the lymphatics associated with the round ligament in females
acts as a communication between the uterus and labia major so cancer cells from the uterus can migrate inferior and result in enlarged superficial inguinal lymph nodes
what happens to the process vaginalis in females
regresses
what is the canal of nuck
failure of the process vaginalis to regress in females
results in abcess and indirect hernia potential
what are the 3 muscles layers involved in the formation of the inguinal canal
external oblique
internal oblique
transversus abdominis
what is the inguinal ligament
thickened inferior edge of the external oblique going from the anterior superior ishial spine to the pubic tubercle
what is the lacunar ligament
triangular ligament next to the pubis
forms medial floor of inguinal canal
what is the pectinal ligament
ligament below the lacunar ligament, on top of the pectinate muscle, right up next to the bone
what is the conjoint tendon
internal oblique + transverses abdominis
strenghten posterior wall of inguinal canal
what forms the deep inguinal ring
transversalis abdominis lateral to inferior epigastric vessels
where does the conjoint tendon move when it weakens
medially
where is an indirect inguinal herina
bowel comes out lateral to inferior epigastric vessels
where is a direct inguinal hernia
bowel enters inguinal canal medial to inferior epigastric vessels
what forms the roof of the inguinal canal
transversus abdominis and the internal oblique muscles
what forms the posterior boarder of the inguinal canal
trasversali fascia and conjoint tendon (transversus and interal)
what forms the anterior wall of the inguinal canal
external oblique
what forms the floor of the inguinal canal
inguinal ligament and the lacunar ligament (both from external oblique)
what is in the male inguinal canal
ductus deferens testicular artery and vein sympathetic innervation ilioinguinal nerve genitofemoral nerve
what is in the female inguinal canal
round ligament of the uterus
ilioinguinal nerve
what contributes to the spermatic cord
internal spermatic fascia- transversalis fascia
cremaster muscle- internal oblique
external spermatic fascia- external oblique
what is a vasectomy
surgical disruption in the ductus deferens as a form of birth control
what is testicular torsion
spermatic cord twisting resulting in loss of blood supply to the testis
what is the cremaster reflex and what does it test
scratch medial thigh (iliofemoral nerve) to make the cremaster muscle contract (genitofemoral nerve)
what i varicocele
varicosities in the pampinform plexus of the scrotum due to obstruction of the left renal vein affecting the testicular vein
what is a hydrocele
fluid filled process vaginalis remant
what does a patent process vaginalis cause
indirect inguinal hernia in men, canal of nuck in females
what is a canal of nuck
patent process vaginalis in female
what is a hematocele
accumulation of blood in the tunica vaginalis
which hernia enters hesselbach’s triangle
direct- bowel enters scrotum due to weakening of conjoint tendon which strengthens the posterior wall of the inguinal canal
where is a indirect hernia palpable
on the tip of the finger
where is a direct hernia palpable
side of finger
what causes an indirect inguinal hernia
congenital latency of process vaginalis
describe a indirect inguinal hernia
bowel enters deep inguinal ring outside hasselbach’s triangle
describe a direct inguinal hernia
bowel enters posterior wall of inguinal canal inside hasselbach’s triangle
what are the boarders of hasselbach’s triangle
inferior epigastric vessels
inguinal ligament
lateral rectus sheath
what is seen on inspection with hernia preseent
buldge in inguinal region
what is felt on palpation with hernia
pain/discomfort
eversion of skin with finger- feel buldge
what is heard on auscultation of a hernia
bowel sounds
what type of hernia is more common in females
femoral
which type of inguinal hernia is more common
indirect
