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Gross III Exam 2 > Inguinal Region > Flashcards

Inguinal Region Flashcards

0
Q

Why is the inguinal region anatomically and clinically important

A

Anatomically: important for structures passing between abdomen and lower extremity
Clinically: potential site for hernias

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1
Q

What is the inguinal region

A

region between ASIS and pubic tubercle

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2
Q

Where is the inguinal canal

A

oblique, inferomedially oriented passage along lower anterolateral abdominal wall

  • parallel and just superior to inguinal l.
  • connects extraperitoneal space of abdomen to scrotum/labia majora
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3
Q

What is contained in the inguinal canal (specific for males and females as well)

A

Male: spermatic cord
Female: round ligament of uterus
Jim: His undescended balls
Blood vessels, lymphatics, and ilioinguinal n

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4
Q

What and where is the deep (internal) inguinal ring

A
  • Internal location of evaginated transversalis fascia
  • 1cm superior to the middle portion of inguinal ligament
  • Lateral to the inferior epigastric a,v and inferior to transversus abdominis m.
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5
Q

What and where is the superficial (external) inguinal ring

A
  • Slit-like opening in inferomedial portion of external oblique aponeurosis
  • Located superolateral to pubic tubercle to pubic tubercle
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6
Q

What are the lateral margins of superficial inguinal ring called

A

Crura

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7
Q

Where does the lateral crus attach

A

pubic tubercle

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8
Q

Where does the medial crus attach

A

pubic crest

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9
Q

Where does the intercrural fibers span

A

between 2 crura to prevent separation

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10
Q

What is between the deep and superficial inguinal rings

A

muscolophrenic arches

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11
Q

How does the body resist the tendency for abdominal contents to herniates

A

collapse of the canal along with the prenatal occlusion of the peritoneal processus vaginalis and the contraction of the arches

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12
Q

What is the anterior wall of the inguinal canal

A

external oblique aponeurosis

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13
Q

What makes the posterior wall of the inguinal canal

A

Transversalis fascia

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14
Q

What reinforces the transversalis fascia of the posterior wall

A

conjoint tendon medially attaching to pubic crest and pectin crest

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15
Q

What forms the roof of the inguinal canal

A

internal oblique and transversus abdominis mm/aponeurosis

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16
Q

What forms the floor of the inguinal canal

A

inguinal ligament

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17
Q

What is the processus vaginalis

A

peritoneal diverticulum traversing the developing inguinal canal

  • carries muscular/fascial layers through the inguinal canal
  • will form fascial layers around the spermatic cord and testis
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18
Q

What does the processus vaginalis persist as

A

distal sacular portion persists as parietal/visceral tunica vaginalis

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19
Q

How is the processus vaginalis attached to the deep ring in males

A

gubernaculums

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20
Q

What does the guernaculums persist as

A

scrotal ligament

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21
Q

Where do the ovaries develop

A

endoabdominal fascia of posterior abdominal wall

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22
Q

Where does the processus vaginalis traverse in female development

A

traverse inguinal canal and protrude into labia majora

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23
Q

What does the gubernaculum connect in females

A

ovary and uterus to developing labia majora

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24
Q

What does the gubernaculum persist as in females

A

> ovarian ligament between ovary and uterus
-prevents ovary from descending through the inguinal canal
round ligament between uterus and labia majora

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25
Q

What are the fascial layers of the spermatic cord

A

External spermatic fascia
Cremasteric fascia
Internal spermatic fascia

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26
Q

Where is the external spermatic fascia derived from

A

external oblique aponeurosis and investing fascia

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27
Q

Where is the cremasteric fascia derived from

A

internal oblique investing fascia

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28
Q

Where is the cremaster muscle derived from

A

from internal oblique m and investing fascia

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29
Q

What is the cremaster muscle

A
  • raises/lowers testis in response to temperature

- helps maintain temperature to support spermatogenesis

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30
Q

What is the internal spermatic fascia derived from

A

transversalis fascia

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31
Q

What does the cremaster muscle do in response to cold

A

raise testis closer to body for warmth

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32
Q

What does Jim’s cremaster do prior to a quiz

A

raises testis because he is afraid

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33
Q

What is the cremasteric reflex

A
  • cremaster m is innervated by the genital branch of the genitofemoral n. (L1,L2)
  • contractions may be elicited by lightly stroking the skin of superomedial thigh –innervated by ilioinguinal n (L1)
  • Highly active reflexes in children may stimulate undescended testis
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34
Q

What are the contents of the spermatic cord

A 
ductus deferens
testicular artery
artery to ductus deferens
cremaster artery
pampiniform plexus
autonomic nerve fibers
genital branch of genitofemoral nerve
lympatics
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35
Q

What are the ductus deferens

A
  • muscular tube approximately 45cm in length and 3mm diameter
  • conveys spermatozoa from tail of epididymis to ejaculatory duct
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36
Q

What does the testicular artery branch from

A

abdominal aorta just inferior to renal artery

37
Q

Where is the testicular artery located

A

retroperitoneally where it crosses ureter and external iliac a

38
Q

What does the testicular artery enter and exit

A

enters inguinal canal at deep ring

exits at superficial ring

39
Q

What does the testicular artery supply

A

testis and epididymis

40
Q

What is the artery to ductus deferens

A

branches from inferior vesicle artery

–closely adhered to ductus deferens

41
Q

What is the cremaster artery

A

originates from inferior epigastric artery

42
Q

What is the pampiniform plexus

A

extensive venous network formed by 8-12 individual vv

43
Q

Where is the pampiniform plexus

A

anterior to ductus deferens and surounding testicular artery

-contributes to thermoregulation for optimal spermatogenesis

44
Q

What do the pampiniform plexus converge to form

A

form testicular vein as they pass deep to inguinal ligament

45
Q

Where does the right testicular vein drain to

A

Inferior vena cava

46
Q

Where does the left testicular vein drain

A

left renal vein

47
Q

What sympathetic fibers innervate the spermatic cord

A

T10-11 to testicular artery and ductus deferens

  • both efferent(vasomotor) and visceral afferent (pain)
  • -stimulates contraction of ductus deferens during ejaculation
48
Q

What is the parasympathetic innervation to the spermatic cord

A

vagus nerve to ductus deferens

–relaxes ductus deferens after ejaculation

49
Q

What is innervated by the genital branch of genitofemoral nerve

A

innervates cremaster muscle

50
Q

Where do the lymphatics associated with the testis and epididymis drain to

A

lumbar lymph nodes

51
Q

Where do the scrotum lymphatics drain to

A

superficial inguinal nodes

52
Q

What are the layers of the scrotum

A

skin

dartos fascia

53
Q

What is the dartos fascia continuation of

A

Scarpas fascia in anterolateral abdominal wall

colles fascia in perineum

54
Q

What does the dartos fascia form and what does it create

A

extends inward ay scrotal raphe to becoming the scrotal septum forming right and left compartments

55
Q

What is the smooth muscle of the dartos fascia attached to

A

attaches to skin –contracts when cold to wrinkle skin reducing heat loss

56
Q

What are the fascial layers of the testis

A

external spermatic fascia
cremasteric fascia
internal spermatic fascia
tunica vaginalis

57
Q

What is the external spermatic fascia

A
  • -A continuation of external oblique aponeurosis and investing fascia
  • -continuos with the spermatic cord
  • -forms the outer tunic of trilaminar sac surrounding testis
58
Q

What is the cremasteric fascia

A
  • -A continuation of the internal abdominal oblique investing fascia
  • -Continuous with the same layer of spermatic cord
  • -forms the middle tunic of trilaminar sac surrounding the testis
59
Q

What is the internal spermatic fascia

A
  • -A continuation of transversalis fascia
  • -continuous with same layer of spermatic cord
  • -forms inner tunic of trilaminar sac surrounding testis
60
Q

What are the developmental origins of the tunica vaginalis

A
  • -adult derivative of obliterated processus vaginalis

- -remnants of fetal extension of peritoneal sac into scrotum

61
Q

What does the parietal layer of the tunica vaginalis fuse with

A

fuses to internal surface of internal spermatic fascia

62
Q

What does the visceral layer of the tunica vaginalis fuse with

A

fuses with external surface testis and epididymis

–covers anterolateral sides of testis and epididymis

63
Q

What can happen if the a short mesorchium exists from extensive tunica vaginalis

A

may lead to torsion of testis, which can lead to decreased blood supply

64
Q

What is the anterior scrotal a a branch of

A

depp external pudendal a –from femoral a

65
Q

What does the posterior scrotal a. branch from

A

branch from perineal a –from the internal pudendal a.

66
Q

What are the nerve roots for the Genital Branch of Genitofemoral n

A

L1,L2

67
Q

What does the Genital Branch of Genitofemoral nerve innervate

A

anterolateral surface of the scrotum

68
Q

What does the anterior scrotal nerve branch from and what is its nerve root

A

Branch from ilioinguinal n

L1

69
Q

What does the anterior scrotal nerve innervate

A

anterior surface of the scrotum

70
Q

What does the posterior scrotal nerve branch from and what is its nerve root

A

Branch from perineal nerve

S2-4

71
Q

What does the posterior scrotal nerve innervate

A

posterior scrotum

72
Q

What are the nerve roots of the posterior femoral cutaneous nerve

A

S2, S3

73
Q

What does the posterior femoral cutaneous nerve innervate

A

inferior surface of scrotum

74
Q

What is the epididymis

A
  • -hard to type
  • -tightly coiled duct on superoposterior surface of testis
  • -covered by visceral tunica vaginalis
75
Q

What is the pattern of diameter of the epididymis

A

head=large, decreasing down to the tail

76
Q

Where does the ductus deferens begin

A

tail of epididymis

77
Q

What is stored in the epididymis

A

spermatazoa prior to ejac

–sperm undergo maturity

78
Q

What is the testis

A

ovoid organ suspended in scrotum by spermatic cord

79
Q

Which testis is suspended lower

A

left testis lower than right

80
Q

Does undescended testis occur more often in premature or full term babies

A

premature, before 37 weeks

81
Q

Where is the undescended testis usually located

A

likely in the inguinal canal, but possibly still in abdomen/pelvis

82
Q

Will an undescended testis correct itself

A

usually in the first few months of life

–if not by 4 months surgery will relocate testis back to scrotum

83
Q

What are the risks of an uncorrected undescended testis

A

risk of malignancy–even if relocated risk is increased

issues with infertility

84
Q

What is hydrocele

A

excess fluid present in a persistent processus vaginalis

–sometimes associated with indirect inguinal hernia

85
Q

What is hydrocele a result of

A

from excessive secretion by visceral tunica vaginalis

86
Q

Where might hydrocele occur

A

adjacent to testis or in spermatic cord

–congenital condition may communicate with peritoneal cavity

87
Q

What is a hematocele

A

accumulation of blood between parietal/visceral tunica vaginalis
–usually caused by trauma to blood vessels

88
Q

What is varicocele

A
  • “bag of worms”
  • tortuous dilation in pampiniform plexus
  • may be due to valve insufficiency or venus return problems
89
Q

Which side is a varicocele more common

A

more common on left side as left testicular v drains into left renal v at a 90˚ angle

90
Q

What is a vasectomy

A

bilateral excision of a segment of ductus deferens

91
Q

What does a vasectomy accomplish

A

prevents sperm from passing from epididymis to ejaculatory duct
–doesnt affect secretions from accessory glands so there will still be an ejaculate

Gross III Exam 2 (11 decks)

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