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
1
Q
What is the inguinal region
A
region between ASIS and pubic tubercle
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
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
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.
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
6
Q
What are the lateral margins of superficial inguinal ring called
A
Crura
7
Q
Where does the lateral crus attach
A
pubic tubercle
8
Q
Where does the medial crus attach
A
pubic crest
9
Q
Where does the intercrural fibers span
A
between 2 crura to prevent separation
10
Q
What is between the deep and superficial inguinal rings
A
muscolophrenic arches
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
12
Q
What is the anterior wall of the inguinal canal
A
external oblique aponeurosis
13
Q
What makes the posterior wall of the inguinal canal
A
Transversalis fascia
14
Q
What reinforces the transversalis fascia of the posterior wall
A
conjoint tendon medially attaching to pubic crest and pectin crest
15
Q
What forms the roof of the inguinal canal
A
internal oblique and transversus abdominis mm/aponeurosis
16
Q
What forms the floor of the inguinal canal
A
inguinal ligament
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
18
Q
What does the processus vaginalis persist as
A
distal sacular portion persists as parietal/visceral tunica vaginalis
19
Q
How is the processus vaginalis attached to the deep ring in males
A
gubernaculums
20
Q
What does the guernaculums persist as
A
scrotal ligament
21
Q
Where do the ovaries develop
A
endoabdominal fascia of posterior abdominal wall
22
Q
Where does the processus vaginalis traverse in female development
A
traverse inguinal canal and protrude into labia majora
23
Q
What does the gubernaculum connect in females
A
ovary and uterus to developing labia majora
24
What does the gubernaculum persist as in females
>ovarian ligament between ovary and uterus
-prevents ovary from descending through the inguinal canal
>round ligament between uterus and labia majora
25
What are the fascial layers of the spermatic cord
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
26
Where is the external spermatic fascia derived from
external oblique aponeurosis and investing fascia
27
Where is the cremasteric fascia derived from
internal oblique investing fascia
28
Where is the cremaster muscle derived from
from internal oblique m and investing fascia
29
What is the cremaster muscle
- raises/lowers testis in response to temperature
| - helps maintain temperature to support spermatogenesis
30
What is the internal spermatic fascia derived from
transversalis fascia
31
What does the cremaster muscle do in response to cold
raise testis closer to body for warmth
32
What does Jim's cremaster do prior to a quiz
raises testis because he is afraid
33
What is the cremasteric reflex
- 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
34
What are the contents of the spermatic cord
```
ductus deferens
testicular artery
artery to ductus deferens
cremaster artery
pampiniform plexus
autonomic nerve fibers
genital branch of genitofemoral nerve
lympatics
```
35
What are the ductus deferens
- muscular tube approximately 45cm in length and 3mm diameter
- conveys spermatozoa from tail of epididymis to ejaculatory duct
36
What does the testicular artery branch from
abdominal aorta just inferior to renal artery
37
Where is the testicular artery located
retroperitoneally where it crosses ureter and external iliac a
38
What does the testicular artery enter and exit
enters inguinal canal at deep ring
| exits at superficial ring
39
What does the testicular artery supply
testis and epididymis
40
What is the artery to ductus deferens
branches from inferior vesicle artery
| --closely adhered to ductus deferens
41
What is the cremaster artery
originates from inferior epigastric artery
42
What is the pampiniform plexus
extensive venous network formed by 8-12 individual vv
43
Where is the pampiniform plexus
anterior to ductus deferens and surounding testicular artery
| -contributes to thermoregulation for optimal spermatogenesis
44
What do the pampiniform plexus converge to form
form testicular vein as they pass deep to inguinal ligament
45
Where does the right testicular vein drain to
Inferior vena cava
46
Where does the left testicular vein drain
left renal vein
47
What sympathetic fibers innervate the spermatic cord
T10-11 to testicular artery and ductus deferens
- both efferent(vasomotor) and visceral afferent (pain)
- -stimulates contraction of ductus deferens during ejaculation
48
What is the parasympathetic innervation to the spermatic cord
vagus nerve to ductus deferens
| --relaxes ductus deferens after ejaculation
49
What is innervated by the genital branch of genitofemoral nerve
innervates cremaster muscle
50
Where do the lymphatics associated with the testis and epididymis drain to
lumbar lymph nodes
51
Where do the scrotum lymphatics drain to
superficial inguinal nodes
52
What are the layers of the scrotum
skin
| dartos fascia
53
What is the dartos fascia continuation of
Scarpas fascia in anterolateral abdominal wall
| colles fascia in perineum
54
What does the dartos fascia form and what does it create
extends inward ay scrotal raphe to becoming the scrotal septum forming right and left compartments
55
What is the smooth muscle of the dartos fascia attached to
attaches to skin --contracts when cold to wrinkle skin reducing heat loss
56
What are the fascial layers of the testis
external spermatic fascia
cremasteric fascia
internal spermatic fascia
tunica vaginalis
57
What is the external spermatic fascia
- -A continuation of external oblique aponeurosis and investing fascia
- -continuos with the spermatic cord
- -forms the outer tunic of trilaminar sac surrounding testis
58
What is the cremasteric fascia
- -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
What is the internal spermatic fascia
- -A continuation of transversalis fascia
- -continuous with same layer of spermatic cord
- -forms inner tunic of trilaminar sac surrounding testis
60
What are the developmental origins of the tunica vaginalis
- -adult derivative of obliterated processus vaginalis
| - -remnants of fetal extension of peritoneal sac into scrotum
61
What does the parietal layer of the tunica vaginalis fuse with
fuses to internal surface of internal spermatic fascia
62
What does the visceral layer of the tunica vaginalis fuse with
fuses with external surface testis and epididymis
| --covers anterolateral sides of testis and epididymis
63
What can happen if the a short mesorchium exists from extensive tunica vaginalis
may lead to torsion of testis, which can lead to decreased blood supply
64
What is the anterior scrotal a a branch of
depp external pudendal a --from femoral a
65
What does the posterior scrotal a. branch from
branch from perineal a --from the internal pudendal a.
66
What are the nerve roots for the Genital Branch of Genitofemoral n
L1,L2
67
What does the Genital Branch of Genitofemoral nerve innervate
anterolateral surface of the scrotum
68
What does the anterior scrotal nerve branch from and what is its nerve root
Branch from ilioinguinal n
| L1
69
What does the anterior scrotal nerve innervate
anterior surface of the scrotum
70
What does the posterior scrotal nerve branch from and what is its nerve root
Branch from perineal nerve
| S2-4
71
What does the posterior scrotal nerve innervate
posterior scrotum
72
What are the nerve roots of the posterior femoral cutaneous nerve
S2, S3
73
What does the posterior femoral cutaneous nerve innervate
inferior surface of scrotum
74
What is the epididymis
- -hard to type
- -tightly coiled duct on superoposterior surface of testis
- -covered by visceral tunica vaginalis
75
What is the pattern of diameter of the epididymis
head=large, decreasing down to the tail
76
Where does the ductus deferens begin
tail of epididymis
77
What is stored in the epididymis
spermatazoa prior to ejac
| --sperm undergo maturity
78
What is the testis
ovoid organ suspended in scrotum by spermatic cord
79
Which testis is suspended lower
left testis lower than right
80
Does undescended testis occur more often in premature or full term babies
premature, before 37 weeks
81
Where is the undescended testis usually located
likely in the inguinal canal, but possibly still in abdomen/pelvis
82
Will an undescended testis correct itself
usually in the first few months of life
| --if not by 4 months surgery will relocate testis back to scrotum
83
What are the risks of an uncorrected undescended testis
risk of malignancy--even if relocated risk is increased
| issues with infertility
84
What is hydrocele
excess fluid present in a persistent processus vaginalis
| --sometimes associated with indirect inguinal hernia
85
What is hydrocele a result of
from excessive secretion by visceral tunica vaginalis
86
Where might hydrocele occur
adjacent to testis or in spermatic cord
| --congenital condition may communicate with peritoneal cavity
87
What is a hematocele
accumulation of blood between parietal/visceral tunica vaginalis
--usually caused by trauma to blood vessels
88
What is varicocele
- "bag of worms"
- tortuous dilation in pampiniform plexus
- may be due to valve insufficiency or venus return problems
89
Which side is a varicocele more common
more common on left side as left testicular v drains into left renal v at a 90˚ angle
90
What is a vasectomy
bilateral excision of a segment of ductus deferens
91
What does a vasectomy accomplish
prevents sperm from passing from epididymis to ejaculatory duct
--doesnt affect secretions from accessory glands so there will still be an ejaculate
