Inguinal Region and Descent of the Gonads Flashcards by Joel Glotfelty

What are the 8 layers of the anterolateral abdominal wall?

) Skin
) Superficial Fascia
) External oblique
) Internal oblique
) Transverse abdominus
) Transverse Fascia
) Extraperitoneal
) Parietal Peritoneum

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What are the two layers of the superficial fascia?

) Camper’s Fascia

2. ) Scarpa’s Fascia

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The outer fatty layer of superficial fascia

Camper’s Fascia

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The inner fibrous layer of superficial fascia

Scarpa’s Fascia

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What are the three parts of the external oblique layer?

) External oblique muscle
) External oblique Aponeurosis
) External oblique Fascia

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What are the three parts of the internal oblique layer?

) Internal oblique muscle
) Internal oblique Aponeurosis
) Internal oblique Fascia

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What are the three parts of the transverse abdominis layer?

) Muscle
) Aponeurosis
) Fascia

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The transversalis fascia is also known as the

Endoabdominal fascia

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The Scarpa’s fascia of the anterior abdomnal wall is continuous inferiorly as the

) Dartos fascia of scrota and penis

2. ) Colle’s fascia of perineum

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In the anterior midline, and covered by anterior and posterior rectus sheaths

Rectus Abdominis muscles

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Splits at the lateral border of the rectus abdominus, above the arcuate line (upper three fourths)

Internal oblique aponeurosis

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Formed by the external oblique aponeurosis and the anterior lamina of the internal oblique aponeurosis

Anterior rectus sheath

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Formed by the posterior lamina of the internal oblique

aponeurosis and the transversus abdominis aponeurosis

Posterior rectus sheath

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Below the arcuate line (lower one-fourth) the internal oblique aponeurosis does not split at the lateral border of the muscle and all three aponeuroses pass

Anterior to the rectus abdominus

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Below the arcuate line (lower one-fourth) the internal oblique aponeurosis does not split at the lateral border of the muscle and all three aponeuroses pass anterior to the rectus abdominis to form the

Anterior sheath

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There is no posterior sheath, and the muscle lies directly against the

Transversalis fascia

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The inferior epigastric vessels lie between the

Posterior rectus sheath and the rectus abdominis muscle

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The inferior epigastric vessels gain entrance to the rectus sheath at the

Arcuate line

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Below the arcuate line, the inferior epigastric vessels lie between the

Transversalis fascia and rectus abdominis

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The inferior epigastric vessels anastomose with the

Superior epigastric vessels

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The downward continuation of the internal thoracic vessels

Superior epigastric vessels

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Thus, there is an anastomotic pathway between

branches of the subclavian vessels (internal thoracic) and branches of the

External illiac vessels (inferior epigastric)

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The external oblique aponeurosis inserts onto the

Illiac crest and pubic crest

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The external oblique aponeurosis has no bony attachment between the

Anterior superior illiac spine and the pubic tubercle

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The external oblique aponeurosis folds under on itself between the

Anterior superior illiac spine and the pubic tubercle

The edge of this fold is the

Inguinal ligament

The lateral 2/3 of the folded under portion of the aponeurosis serves as an attachment for the

Internal oblique muscle

Has no muscle attached to it

Medial 1/3 of folded under portion

The medial 1/3 of the folded under portion of the external oblique aponeurosis has no muscle attached to it. This leaves a gap for what to pass through?

Spermatic cord (males) or round ligament of the uterus (females)

This gap (intermediate inguinal ring) is between the inguinal ligament and the lower edge of the internal oblique muscle, called the

Falx inguinals

The medial portion of the internal oblique aponeurosis and the transversus abdominis aponeurosis are fused into a single tendon called the

Conjoint Tendon

The conjoint tendon is the medial continuation of the

Falx inguinals

The pathway through which the testes descends in the male

Inguinal canal

What does the inguinal canal contain in 1. ) Males 2. ) Females

1. ) Spermatic cord | 2. ) Round ligament of the uterus

The inguinal canal begins internally at the

Deep inguinal ring

An invagination of the transversalis fascia

Deep inguinal ring

The inguinal canal ends externally at the -A gap in the external oblique aponeurosis

Superficial inguinal ring

Form the superior wall of the inguinal canal -the lower fibers of the terminal oblique

Falx inguinalis

What makes up the following walls of the inguinal canal? 1. ) Anterior 2. ) Posterior 3. ) Superior 4. ) Inferior

1. ) External oblique aponeurosis 2. ) Transversalis fascia 3. ) Arching fibers of falx inguinalis 4. ) Inguinal ligament

What are the 6 contents making up the spermatic cord?

1. ) Ductus deferens 2. ) Testicular artery 3. ) Pampiniform plexus (testicular vein) 4. ) Genital branch of genitofemoral nerve 5. ) Autonomic nerves 6. ) Lymphatic vessels

Innervates cremaster and provides cutaneous snesation to the anterior scrotum (male) and mons pubis and labia majora (female)

Genital branch of genitofemoral nerve (L1 and L2)

The genital branch of the genitofemoral nerve (L1 and L2) innervates the

Anterior scrotum (male) and mons pubis and labia majora (female)

As the testis descends through the inguinal ring, it and the spermatic cord take on coverings that are continuous with elements of the

Anterior abdominal wall

As the testis passes through the deep inguinal ring, it is covered by the -continuous with the transversalis fascia

Internal spermatic fascia

As the testis passes through the intermediate inguinal ring, under the falx inguinalis, it is covered by some of the lower muscle fibers of the internal oblique muscle, which are called the

Cremaster muscle

The fibers covering the cremaster muscle are called the

Cremasteric Fascia

As the testis passes through the superficial inguinal ring, it is covered by an invagination of the external oblique fascia called the

External spermatic fascia

What does contraction of the cremaster muscle do?

Elevates the spermatic cord and testis

Serves a thermoregulatory function since the testes is warmer closer to the body and cooler when it is lower in the scrotum

Cremaster muscle

The cremaster will contract reflexly in response to stimulation of the skin of the lower abdominal wall or inner thigh this is called the

Cremateric reflex

The cremasteric reflex can be used to test the integrity of the

L1 spinal cord segment

In the female, the round ligament of the uterus occupies the inguinal canal and, after passing through the superficial inguinal ring, it descends to the

Labia Majus

The round ligament of the uterus ends in the

Superficial fascia

The round ligament of the uterus is derived from the

Caudal genital ligament

The round ligament of the uterus is homologous to the

Gubernaculum testis in the male

The coverings of the round ligament of the uterus are identical to the coverings of the

Spermatic cord

The gubernaculum attaches to the

Scrotum

The round ligament of the uterus attaches to the

Labia Majora

The thin scrotal skin, the absence of fat in the superficial fascia of the scrotum and the abundance of sweat glands in the scrotal skin all facilitate

Heat Loss

What are three anatomic mechanisms that allow for regulation of testicular temperature?

1. ) Cremaster muscle 2. ) Dartos muscle 3. ) Pampiniform plexus

A skeletal muscle in the covering of the spermatic cord that is innervated by the genital branch of the genitofemoral nerve -causes elevation of the testis upon contraction

Cremaster muscle

A smooth muscle in the skin of the scrotum that is sympathetically innervated

Dartos muscle

What does the dartos muscle do?

Reduces the size of the scrotal sac and thereby decreases surface area to reduce heat loss

The dartos contracts to reduce heat loss in a

Cold environment

A venous plexus that is the continuation of the testicular vein

Pampiniform plexus

Forms an elaborate network of veins that surrounds the testicular artery in the spermatic cord

Pampiniform plexus

The large amount of surface area of contact between the testicular artery and the pampiniform plexus allows for the transfer of heat from the arterial blood in the testicular artery to venous blood in the testicular vein this is called

Thermal counter-current

Allows for the reduction of temperature of testicular artery blood before it reaches the testis, thus reducing the heat increase in the testis and lowering the thermal gradient between the testis and the environment

The thermal counter-current provided by the pampiniform plexus

What are the two types of inguinal hernias?

Direct and indirect

Follow the course of the descending testis through the inguinal canal

Indirect inguinal hernias

Enter at the deep inguinal ring and exit at the superficial inguinal ring

Indirect inguinal hernias

These hernias are covered by all of the same fascial layers as is the spermatic cord and testis since they follow the identical course as the descending testis

Indirect inguinal hernias

Do not follow the pre-formed path of the inguinal canal, rather they create their own path by tearing through the abdominal wall

Direct inguinal hernias

Direct inguinal hernias typically occur where the abdominal wall is weakest, which is at the

Superficial inguinal ring

The region through which direct inguinal hernias occur is called the

Inguinal (Hesselbach's) Triangle

What are the following borders of the Inguinal (Hesselbach's) Triangle? 1. ) Lateral border 2. ) Inferior border 3. ) Medial border

1. ) Inferior epigastric artery 2. ) Inguinal ligament 3. ) Lateral border of rectus abdominus

Typically, direct inguinal hernias are covered by the

External spermatic fascia

Prior to the descent of the testis, the parietal peritoneum forms a finger-like evagination called the -descends through the inguinal canal

Processus vaginalis

The proximal portion of the processus vaginalis fuses, becomes fibrous and disappears after the

Descent of the testis

The distal portion of the processus vaginalis is within the -remains unfused following descent of the testis

Scrotum (covers most of the testes)

The distal unfused portion of the peritoneum is the

Tunica vaginalis

A double layer of peritoneum with a small cavity containing fluid

Tunica vaginalis

The layer of the tunica vaginalis that is in direct contact with the testis is called the

Visceral layer

The outer layer of the utnica vaginalis is called the

Parietal layer

The tunica vaginalis covers the anterior, lateral and medial surfaces of the testis, but not the posterior surface, which is the location of the

Epididymis

When the proximal portion of the processus vaginalis does not fuse we have a

Patent processus vaginalis

A patent processus vaginalis results in a continuous opening from the peritoneal cavity of the abdomen into the scrotum. This will predispose for a

Congenital or acquired indirect inguinal hernia

If there is incomplete fusion of the processus vaginalis, leaving a small unfused portion, this results in a

Hydrocele of the spermatic cord

Distinguished from inguinal hernias because they pass deep to the inguinal ligament

Femoral hernias

Pass superficial to the inguinal ligament after emerging from the superficial inguinal ring

Inguinal hernias

Pass through the femoral ring to enter the femoral sheath

Femoral hernias

What are the following borders of the femoral ring? 1. ) Anterior 2. ) Medial 3. ) Posterior 4. ) Lateral

1. ) Inguinal ligament 2. ) Lacunar ligament 3. ) Pectin pubis 4. ) Femoral vein

The medial reflected portion of the inguinal ligament

Lacunar ligament

Typically, femoral hernias leave the femoral sheath through the

Saphenous hiatus

Make up about 75% of abdominal hernias and occur more commonly in men than in women (10:1)

Inguinal hernias (most are indirect)

Make up about 7% of abdominal hernias and occur more commonly in women than in men (4:1)

Femoral hernias

Femoral hernias and inguinal hernias have approximately the same frequency in

Women

If a hernia can be pushed back into the abdomen, it is called a

Reducible hernia

If a hernia can not be pushed back into the abdomen, it is called an

Incarcerated hernia

If the blood supply to the herniated organ is compromised, it is a -will lead to tissue necrosis

Strangulated hernia

Have a particularly high risk (20% - 30%) of incarceration and strangulation

Femoral hernias

An outpouching of the skin and superficial fascia of the abdominal wall

Scrotum

The superficial fascia of the scrotum, the dartos fascia is continuous with

1. ) Scarpa's fascia in abdominal wall | 2. ) Colle's fascia in perineum

Is there fat in the superficial fascia of the scrotum?

Is there muscle in the superficial fascia of the scrotum?

Yes; dartos muscle (smooth muscle)

In the male, the spermatic cord (including the ductus | deferens, testicular vasculature, lymphatics and nerves) passes through the

Inguinal canal

The testis is attached to the scrotal wall by the

Gubernaculum