Inguinal Region Flashcards
Inguinal Ring
a defect or opening in fascia that permits the passage of structures through the inguinal canal
Inguinal Ligament (Poupart’s Ligament)
this is the folded lower border of the aponeurosis of the external oblique muscle
extends from the anterior superior iliac spine to the pubic tubercle on the pelvis
forms floor of the inguinal canal
Lacunar Ligament
the medial extension of the inguinal ligament, which attaches to the pectineal line on the pubis
sharp free edge forms the medial border of the femoral ring
continuous with the pectineal ligament at the pectineal line of the pubis
Femoral ring
forms the opening of the femoral canal, the small medial compartment for lymph vessels in the femoral sheath, medial to the femoral artery and vein
medial border is formed by the sharp edge of the lacunar ligament
site of a femoral hernia
Pectineal (Cooper’s) Ligament
a thickening of periosteum that is continuous with the lacunar ligament at the pectineal line of the pubis
Conjoint tendon
formed by the fused aponeuroses of the internal oblique and transversus abdominis muscles near their insertion on the pubis
reinforces the medial third of the posterior wall of the inguinal canal
Inguinal falx
reinforces the posterior wall of the inguinal canal
generally considered synonymous with the conjoint tendon, however, some texts define the inguinal falx as only the lower, arcing fibers of the transversus abdominis aponeurosis
Transversalis fascia (what does it form)
the deep inguinal ring
the internal spermatic fascia of the spermatic cord
the entire posterior wall of the inguinal canal.
Interfoveolar (Hesselbach’s) ligament
a fibromuscular extension of transversus abdominis fibers at the medial edge of the deep inguinal ring, extending from the lower border of the transversus muscle to the lacunar ligament
overlies the inferior epigastric vessels and its fibers help to reinforce the posterior wall of the inguinal canal
Hesselbach’s (Inguinal) triangle
a site of weakness in the abdominal wall vulnerable to a direct inguinal hernia
the triangular area in the lower abdominal wall bounded by the inferior epigastric vessels laterally (lateral umbilical fold), the rectus abdominis muscle medially, and the inguinal ligament inferiorly
found in the medial inguinal fossa on the internal surface of the abdominal wall
Inguinal Region (where is it)
junction of abdominal wall and thigh
Inguinal Canal (what is it)
an oblique passage in the inferior part of anterior abdominal wall through which structures pass between the abdominal cavity and the scrotum in the male or the labia majora in the female
Inguinal Canal (whats in it)
spermatic cord (male)
round ligament of uterus (female)
genital branch of genitofemoral nerve (both genders)
ilioinguinal nerve (both genders)
Inguinal Canal (beginning and end)
begins at deep (internal) ring in transversalis fascia
ends at superficial (external) ring in external oblique
Deep Inguinal (Internal) Ring
beginning of inguinal canal at point midway b/w anterior superior iliac spine and pubic symphysis
tubular outpouching in transversalis fascia
above inguinal ligament
lateral to lateral inguinal fossa (inferior epigastric vessels)
Lateral Inguinal Fossa
has inferior epigastric vessels
Transversalis Fascia forms what part of spermatic cord
internal spermatic fascia
Superficial (external) Inguinal Ring
end of inguinal canal and is superior to pubic symphysis
triangular opening in aponeurosis of external oblique muscle- base is pubic crest and sides are medial and lateral crus
Medial and Lateral Crus attach to what (respectively)
pubic symphysis and pubic tubercle
External Oblique Aponeurosis continues as what part of spermatic cord
external spermatic fascia
Anterior Wall of Inguinal Canal
aponeurosis of external oblique muscle (throughout length of canal)
aponeurosis of internal oblique muscle (lateral third of canal)
Posterior Wall of Inguinal Canal
trasversalis fascia throughout the length of the canal
conjoint tendon in meidal third of canal
Roof (Superior Wall) of Inguinal Canal
muscle fibers and aponeurosis of the internal oblique muscle and the aponeurosis of the
transversus abdominis muscle (arching from anterior to posterior)
Floor (Inferior Wall) of Inguinal Canal
Inguinal ligament (from aponeurosis of external oblique muscle) throughout length of canal Lacunar Ligament (medial expansion of inguinal ligament) in the medial third of the canal
Creamasteric reflex (what is it and name the sensory/motor components)
stroking medial aspect of thigh produces a reflex contraction of cremaster muscle and ipsilateral election of testis and scrotum
Sensory Component- ilioinguinal nerve (L1)
Motor Component- genital branch of genitofemoral (L1-L2)
Before testes or ovaries can descend what is formed
processus vaginalis- an evagination of parietal peritoneum
Processus Vaginalis (what is it, what does it form, what happens to it)
evagination of peritoneum into ventral abdominal wall
occurs independent of testes decent
forms inguinal canal
normally obliterated b/w deep inguinal ring and superior aspect of the testes during first postnatal year
Part of processes vaginalis that covers the testis persists as?
tunica vaginalis
derived from parietal peritoneum
Gubernaculum (what is it, where is its location)
condensed band of mesenchyme
extends from the lower pole of of developing gonad through the inguinal canal to the labioscrotal swelling
The gubernaculum is what is the adult male
fibrous cord connecting testes to scrotum
The gubernaculum is what is the adult female
round ligament of the uterus
What layer of the abdominal wall does not contribute a layer to the testes or spermatic cord
transversus abdominis
Where does gonadal development begin?
high in the lumbar region (L1) on posterior wall of abdomen deep to transversals fascia
After gonadal development begins what is the second step the testes take in development (around 3 months gestation)
enter deep ring of inguinal canal
Formation of the processes vaginalis is dependent or independent of testis descent
independent
What occurs to testis around 7 months gestation
testis descends through inguinal canal and picks up layers of abdominal wall along the way
What is cryptorchidism?
incomplete testes descent such that one or both testes remain in the body cavity or inguinal canal
What is the scrotum and what does it contain
out pouching of anterior abdominal wall
contains: testis, epididymis, and spermatic cord
What are the layers of the scrotum
skin dartos layer (fascisa and muscle)
What is darts layer
continuation of camper’s fascia (but not fat)
fat replaced by smooth dartos muscle
Dartos Muscle (what does it do and when)
contracts in response to cold
reduces surface area of scrotum
helps stabilize tesis temperature
Testis (what is it)
sperm and androgen producing organ in scrotum
What are the layers of the testis
tunica albuginea (deep) tunica vagnialis (superficial)
Tunica albuginea (what is it)
white fibrous capsule that surrounds the testis (like a rind of an orange)
covered by visceral layer of tunica vaginalis
Tunica Vaginalis (what is it)
derived from parietal peritoneum
has two layers: visceral and parietal separated by a cavity
Seminiferous tubules (what are they)
site of sperm production
Rete Tesits (what is it)
network of canals that conduct sperm
Epididymis
sperm storage and matruation
Head- coiled end of efferent ductules
Body- convoluted ducts
Tail- continuous with ductus deferens
Ductus (vas) Deferens
transport sperm to ejaculatory duct
Where is androgen produced in testis
Leydig cells
Arteries Supplying Testis
Cremasteric Artery (from inferior epigastric artery) Testicular Artery (from abdominal aorta) Artery of Ductus Deferens (from inferior vesicle artery)
Layers of Spermatic Cord (and corresponding abdominal wall layer)
External Spermatic Facia (external oblique aponeurosis) Cremasteric Fascia (internal oblique muscle and aponeurosis) Internal Spermatic Fascia (transversalis fascia)
Major Components of Spermatic Cord
Testicular Artery (from aorta) Ductus Deferens and artery Pampiniform plexus of testicular vein Genital Branch of Genitofemoral nerve (L1, L2)- motor to cremaster muscle Lymphatics from testis and epididymis Creamasteric Artery (inferior epigastric) and vein Plexus of autonomic nerves (obliterated processus vaginalis)
External Abdominal Oblique Aponeurosis contributes to what in the inguinal region and canal
inguinal ligament lacunar ligament (medial extension of inguinal ligament) superficial inguinal ring (medial crus, lateral crus, intercrus fibers) external spermatic fascia
Internal Abdominal Oblique Aponeurosis contributes to what in the inguinal region and canal
conjoint tendon
cremasteric later of muscle and fascia
Transverses Abdominis Aponeurosis contributes to what in the inguinal region and canal
conjoint tendon
Transverse Fascia contributes to what in the inguinal region and canal
deep inguinal ring
internal spermatic fascia
Peritoneum contributes to what in the inguinal region and canal
in the embryo: processus vaginalis
mature form: tunica vaginalis tesis
Name the laters of the anterior abdominal wall (from superficial to deep) and their corresponding laters in the testis/spermatic cord
skin- skin
fatty layer of superficial fascia (Camper’s)- dartos layer (fascia and muscle)
membranous (deep) layer of superficial fascia (Scarpa’s)- membranous layer of superficial fascia (Colles)
aponeurosis of external abdominal oblique- external spermatic fascia
internal abdominal oblique muscle and aponeurosis- creamaster muscle and fascia
transversus abdominis muscle- no contribution
trasversalis fascia- internal spermatic fascia
extraperitoneal fat- loose connective tissue including fat
parietal peritoneum- tunica vaginalis (obliterated processus vaginalis)
Indirect Inguinal Hernia
more frequent in males and females
neck of hernia passes through deep inguinal ring in lateral inguinal fossa
enters inguinal canal lateral to inferior epigastric vessels
usually transverses entry inguinal canal (may extend into scrotum)
cause is congenital (incomplete obliteration of processus vaginalis)
Most common type of hernia in both children and adults
indirect inguinal hernia
Direct Inguinal Hernias
occur in adults (common in older men)
neck of hernia passes directly through the medial inguinal fossa in Hesselbach’s inguinal triangle
enters inguinal canal medial to inferior epigastric vessels
usually transverse only medial 1/3 of canal
cause is weakness of posterior wall of inguinal canal
Femoral Hernia
occur through femoral ring (small medial compartment for lymph vessels in the femoral sheath)
more common in women
irreducible hernia
neck always lies below and lateral to the pubic tubercle
Corona Mortis (what is it)
important anatomical variant to be aware of during a hernia repair in inguinal region
fairly common vascular connection b/w obturator vessels and the inferior epigastric vessels
aberrant obturator artery can branch from the inferior epigastric in the groin
aberrant artery is in danger of being cut and can bleed profusely
Varicocele (what is it)
dilation and tortuous coursing of pampiniform plexus of testicular veins
often from defective valves in testicular vein
can indicate left kidney or renal vein problems
usually on left side
Hydrocele (what is it)
collection of fluid in testes or spermatic cord that can result from persistent processes vaginalis
inflammation of testes can lead to fluid accumulation in the tunica vaginalis
cannula used to remove excess fluid (tapping a hydrocele)
When tapping a hydrocele what layers are pierced?
cannula goes through-
skin, darts later, collies fascia, external spermatic fascia, cremaster muscle and fascia, internal spermatic fascia, parietal layer of tunica vaginalis
Torsion of the testis (what is it)
rotation of the testis around the spermatic cord with the scrotum
often occurs in young active men and children and is accompanied by severe pain
can lead to necrosis of entire testicle
Vasectomy
surgical ligation of ductus deferent so that no sperm are contained in ejaculate fluid
