Inguinal Region

Question 1

Define

Answer 1

Junction btw anterior abdominal wall and thigh - where things enter and exit abdominal cavity
Inherent site of weakness - hernia

Question 2

Inguinal ligament

Answer 2

Inferior, rolled over margin of external abdominal oblique

Runs from ASIS to pubic tubercles

Question 3

Lacunar Ligament

Answer 3

Extension of inguinal ligament

Attach to superior pubic ramus

Question 4

Pectineal Ligament

Answer 4

Lateral part of lacunar ligament

Question 5

Inguinal Canal

Answer 5

Slit like passage from internal abdominal cavity to external inguinal region

Question 6

Deep Inguinal Ring

Answer 6

Entrance
From transversalis fascia
Halfway btw ASIS and pubic tubercle
Lateral to inferior epigastric vessels

Question 7

Superficial Inguinal Ring

Answer 7

Exit
Through external oblique aponeurosis
Above pubic tubercle bounded by lateral and medial crura

Question 8

Hesselbach’s Triangle

Answer 8

Site for direct hernias

Question 9

Femoral Ring

Answer 9

Site for femoral hernias

Question 10

Inguinal Canal Boundaries

Answer 10

MALT
Roof = Muscles - IO and TA
Ant wall = Aponeuroses - EO and IO
Floor = Ligaments - Inguinal and lacunar
Post wall = Tendon - conjoint tendon and transversalis fascia

Question 11

Contents in Ingunal Canal - Male

Answer 11

Spermatic Cord

Question 12

Contents in Inguinal Canal - Female

Answer 12

Round Ligament of uterus

Question 13

Contents in Inguinal Canal - Both M and F

Answer 13

Ilioinguinal nerve, genital branch of genitofemoral nerve

Question 14

Layers of Scrotum

Answer 14

Scrotal Skin - from the external skin
Tunica Dartos - smooth muscle and fascia (from scarpas)
External Spermatic Fascia - From EO

Question 15

Layers of Spermatic Cord

Answer 15

From External Spermatic Fascia - from EO
Cremasteric Fascia and Muscle - from IO
Internal spermatic fascia - from transversalis fascia

Question 16

Spermatic Cord Contents

Answer 16

Vas Deferens - what sperm travels up
Deferent and testicular artery
Pampiniform plexus of veins
Lymphatics
Visceral afferents and efferents
Genital branch of genitofemoral nerve

Question 17

Nerves alongisde spermatic cord

Answer 17

Inlioinguinal L1-L2

Question 18

Scrotum COntents

Answer 18

Testis - production of sperm
Epididymis - camp
Vas deferens

Question 19

Testes Coverings

Answer 19

Tunica albuginea - completely encloses it

Tunica Vaginals - parietal and visceral - only partially

Question 20

Cremasteric Reflex

Answer 20

Cremaster muscle is somatic
Stroke upper thigh - will get response from ilioinguinal nerve - testicle will raise from efferent of genital branch of genitofemoral (L1 and 2)

Question 21

Absence of Cremasteric Reflex

Answer 21

L1/L2 injury

Testicular torsion - twisting so can’t pull up

Question 22

Gonadal Development - Processus Vaginalis

Answer 22

Early extension of peritoneal cavity into scrotum (labia majorum)

Question 23

Gonadal Development - Gubernaculum

Answer 23

The testes descends via gubernaculum into scrotum and through inguinal canal
Males = stays as testes
Females = Round and ovarian ligament

Question 24

Gonadal Development - Tunica Vaginalis

Answer 24

Remnant of distal poscessus vaginalis in males

Question 25

Indirect Inguinal Hernia

Answer 25

Lateral to inferior epigastric vessels, passes through inguinal canal through deep ring Stays in spertic cord

Question 26

Direct Inguinal Hernia

Answer 26

Medial to inferior pigastic vessels, passes through triangle

Question 27

Boundaries of Hesselbachs Triangle

Answer 27

``` Inferior = Inguinal Ligament Lateral = Inferior epigastric vessels Medial = lateral border of rectus abdominis ```

Question 28

Femoral Hernias

Answer 28

Inferior to inguinal ligament, go through femoral ring of anterior abdomen More common in females

Question 29

Sports Hernias

Answer 29

torn muscle, ligament or tendon in lower abdominal/inguinal region - not a true herniation

Question 30

Incarcerated

Answer 30

Irreducible - cannot be manually reduced

Question 31

Strangulated

Answer 31

Blood supply is cut off

Question 32

Direct Inguinal

Answer 32

Often reducible Acquired Medial to inf epigastric a Hesselbachs triangle

Question 33

Indirect Inguinal

Answer 33

Irreducible Congenital - typically see with men at birth Lateral to inf epigastric Deep ring

Question 34

Femoral

Answer 34

Often reducible Acquired Inferior to inguinal lig Femoral ring