Inguinal Region Flashcards
What is the inguinal ligament?
The rolled under inferior border of the EOM aponeurosis
Attached to ASIS and pubic tubercle
What is the conjoint tendon (inguinal falx)?
Combined aponeurosis of inferior/medial margins of IOM and TA muscle inserting onto pubis
What is the superficial ring?
External opening within aponeurosis for spermatic cord (male) or round ligament of uterus (female) to exit from the inguinal canal
What are the three types of crural fibers of the inguinal region?
Medial crus, lateral crus and inter crural fibers
Medial and lateral are boundaries for the superficial ring
What is the lacunar ligament?
Ligament between pubic rami and inguinal ligament
Anchors inguinal ligament to pubis
What is the pectineal ligament?
Continuation of fibers from lacunar ligament running along the pectin pubis (used in hernia repairs)
What is the femoral canal (subinguinal space)?
Lies immediately lateral to lacunar ligament
What is the deep ring?
Entrance to inguinal canal and beginning of the invagination of peritoneum into transversalis fascia
Superior to inguinal ligament and lateral to inferior epigastric A
What passes through the deep ring?
Vas deferens and gonadal vessels/nerves in males and round ligament in females
What nerves are near the inguinal ligament, canal and ring?
Iliohypogastric nerve, ilioinguinal nerve and genitofemoral nerve
Describe the Iliohypogastric nerve
L1
Motor to abdominal muscles (IO and TA)
Sensory to skin above pubis (hypogastric region)
Describe the ilioinguinal nerve
L1
Traverses inguinal canal, exits superficial ring lateral to cord
Motor to IO and TA muscles
Sensory to skin over upper/medial thigh and skin to root of penis/clitoris and anterior scrotum/labia
Describe the genital branch of the genitofemoral nerve
L1-2
Motor to cremasteric muscle
Sensory to small part of medial thigh and scrotal/labia fascia
What are the borders of the inguinal (Hasselbach’s) triangle?
Inferior epigastric vessels (lateral umbilical ligament), inguinal ligament and the lateral edge of the RA
What is the clinical significances of the inguinal triangle?
An area of abdominal weakness
Direct hernia can occur inferior to conjoint tendon and medial to lateral umbilical ligament
What is the iliopubic tract?
Thickened transversalis fascia running posterior to inguinal ligament
Reinforces floor of inguinal canal
What is a direct hernia?
Medial to inferior epigastric A
Peritoneum/transversalis fascia alongside the spermatic cord (exit superficial ring)
What is an indirect hernia?
Enters deep ring
Periosteum within spermatic cord
What is a femoral hernia?
Below inguinal ligament
More common in women
40% present as emergencies with incarceration or strangulation
Where do gonads form?
Near T10 axial level
Gonads are connected to future scrotal swellings by what structure?
Gubernaculum
What are cryptorchid testes?
Undescended testis
Increase risk of developing testicular cancer
What is the processus vaginalis?
Evagination of peritoneal cavity
Communication usually closes within 1st year postnatally
Describe testicular descent
Descent along with an out-pocketing of peritoneal cavity (processus vaginalis) into future scrotum carrying vessels and nerves with them (future suspensory ligament)
Connection to peritoneum closed; tunica vaginalis represents the remains of processus vaginalis around testes
Layers of abdominal wall carried as spermatic cord develops such as transversalis fascia, internal and external oblique muscles
Describe the spermatic cord layers
As gonad herniates out along with its blood supply and vas deferens it carries layers of abdominal wall with it forming the spermatic cord
-Transversalis fascia: internal spermatic fascia
-Internal oblique: makes cremasteric muscle
-External oblique: external spermatic fascia
Site of abdominal wall weakness
What are the contents of the spermatic cord?
Vas deferens (ductus deferens), testicular A and veins (pampiniform plexus), gonadal nerves and lymphatics
What is a persistent processus vaginalis?
Patent connection between tunica vaginalis and abdomen
What is hydrocele?
Peritoneal fluid accumulation within tunica vaginalis
More common in babies
In adults, inflammation or injury in the scrotum, testis or epididymis
Communicating and non-communicating types
Detected with transillumination
What is hematocele?
Accumulation of blood in tunica vaginalis
Describe lymph drainage of the testes and scrotum
From scrotum drains into superficial inguinal nodes and eventually travel into iliac and lumbar LNs
Testes drain into lumbar and pre-aortic LNs
Describe ovarian descent
Begins descending but gubernaculum becomes attached to developing uterus
Gubernaculum forms ovarian ligament and round ligament of the uterus
Round ligament of the uterus enters deep ring and exits superficial ring attaching to labial swellings
Describe the female inguinal canal
Deep and superficial rings Medial/lateral crus Lacunar/pectineal ligaments Conjoint tendon (inguinal falx) Scrotal/labia relationship
What are the contents of the female inguinal canal?
Round ligament of uterus, ilioinguinal nerve and genitofemoral nerve (genital branch)
The inferior epigastric A runs anterior to what?
Posterior rectus sheath
What is the median umbilical fold?
Due to obliterated urachus
What is the medial umbilical fold?
Due to obliterated umbilical A
What is the lateral umbilical fold?
Fold due to inferior epigastric A
