inguinal region and hernias Flashcards
What anatomical landmarks define the inguinal region?
The inguinal region extends between the ASIS (anterior superior iliac spine) and the pubic tubercle.
Why is the inguinal region clinically significant?
It is a key area where structures exit and enter the abdominal cavity, making it a potential site for herniation.
What is another name for the inguinal region?
The groin.
How does the definition of the inguinal region contradict the nine abdominal regions?
The pubic region is also included as part of the inguinal region bilaterally in some classifications.
What is the inguinal ligament?
The inguinal ligament is the thickened, under-turned, and inferior margin of the aponeurosis of the external oblique muscle.
What structure does the inguinal ligament form?
It forms a retinaculum that bridges the subinguinal space.
What is the function of the subinguinal space?
It allows the passage of muscles (hip flexors) and neurovascular structures that supply the lower limb.
What is the lacunar ligament?
Some fibers of the inguinal ligament attach to the superior pubic ramus, forming the lacunar ligament.
What is the pectineal ligament?
Some fibers of the lacunar ligament continue along the pecten pubis, forming the pectineal ligament.
What is the reflected inguinal ligament?
Some fibers of the inguinal ligament bypass the pubic tubercle, cross the linea alba, and blend with the contralateral external oblique aponeurosis to form the reflected inguinal ligament.
What is the inguinal canal?
The inguinal canal is an oblique passage in the lower abdominal wall, formed in relation to the descent of the testes during fetal development.
what direction do the inguinal canal run?
It runs inferomedially, parallel and superior to the medial half of the inguinal ligament.
What structures pass through the inguinal canal in males and females?
In males, the inguinal canal contains the spermatic cord.
In females, it contains the round ligament of the uterus.
In both sexes, it contains the ilioinguinal nerve.
What are the two openings of the inguinal canal?
The inguinal canal has:
The deep inguinal ring
The superficial inguinal ring
where is the opening of the deep inguinal ring located
The deep inguinal ring – an opening in the transversalis fascia.
where is the opening of the superficial inguinal ring located
The superficial inguinal ring – an opening located just superior and lateral to the pubic crest.
Where is the deep inguinal ring located?
The deep inguinal ring is located superior to the midpoint of the inguinal ligament and lateral to the inferior epigastric vessels.
Where is the superficial inguinal ring located?
The superficial inguinal ring is located just superior and lateral to the pubic crest.
What structures form the margins of the superficial inguinal ring?
The margins of the superficial inguinal ring are:
Medial crus – attaches to the pubic crest.
Lateral crus – attaches to the pubic tubercle.
What is the function of the intercrural fibers?
Intercrural fibers help prevent the crura from spreading apart
What are the three divisions of the inguinal canal based on boundaries?
The inguinal canal is divided into three sections:
Lateral third
Middle third
Medial third
memorise this table of boundaries of the inguinal canal
What are the layers of the spermatic cord derived from?
Transversalis fascia → Internal spermatic fascia
Fascia of internal oblique muscle → Cremasteric fascia
Internal oblique muscle → Cremaster muscle
External oblique aponeurosis and fascia → External spermatic fascia
What is the function of the cremaster muscle?
The cremaster muscle controls the reflexive movement of the testis:
Contracts in response to cold, drawing the testis superiorly.
Relaxes in a warm environment, allowing the testis to descend.
What nerve innervates the cremaster muscle?
The genital branch of the genitofemoral nerve (L1-L2) innervates the cremaster muscle.
What is the internal spermatic fascia derived from?
The internal spermatic fascia is derived from the transversalis fascia.
How do the coverings of the spermatic cord relate to the round ligament of the uterus?
Coverings corresponding to those of the spermatic cord are indistinct along the round ligament.
What is the processus vaginalis?
The processus vaginalis is an extension of the peritoneum that descends with the testis during development
the terminal portion forms what
The terminal portion forms the tunica vaginalis, which cushions the testis.
What happens to the processus vaginalis after birth?
The processus vaginalis normally degenerates after birth, leaving behind the vestige of processus vaginalis in the spermatic cord.
What is a patent processus vaginalis, and what condition can it cause?
A patent processus vaginalis occurs when the processus vaginalis fails to close, allowing fluid to move into the tunica vaginalis from the peritoneal cavity. This results in a hydrocele testis (scrotal hydrocele).
What is a hydrocele testis?
A hydrocele testis (or scrotal hydrocele) is an abnormal accumulation of fluid within the tunica vaginalis, leading to swelling of the scrotum.
How is a hydrocele different from a hernia?
A hydrocele involves the accumulation of fluid in the tunica vaginalis, while a hernia involves the protrusion of abdominal contents (such as intestines) through the inguinal canal.
What are the 9 contents of the spermatic cord?
- Ductus (vas) deferens
- Testicular artery
- Artery of ductus deferens
- Cremasteric artery
- Pampiniform venous plexus
- Sympathetic nerve fibers
- Genital branch of the genitofemoral nerve
- Lymphatic vessels
- Vestige of processus vaginalis
What is the ductus (vas) deferens, and what is its function?
The ductus deferens is a muscular tube that conveys sperm from the epididymis to the ejaculatory duct.
What is the testicular artery, and what does it supply?
The testicular artery is a branch of the abdominal aorta, supplying blood to the testis and epididymis.
What is the pampiniform venous plexus, and what is its function?
The pampiniform venous plexus is a network of up to 12 veins that surrounds the testicular artery and helps with temperature regulation by cooling the arterial blood before it reaches the testis
What is the cremasteric artery, and where does it originate?
The cremasteric artery is a branch of the inferior epigastric artery that supplies the cremaster muscle.
Which nerve provides innervation to the cremaster muscle?
The genital branch of the genitofemoral nerve (L1-L2) innervates the cremaster muscle.
What is the function of lymphatic vessels in the spermatic cord?
The lymphatic vessels drain the testis to the lumbar lymph nodes.
What is the vestige of processus vaginalis, and where is it located?
The vestige of processus vaginalis is a fibrous thread found in the anterior part of the spermatic cord, representing a remnant of the embryonic processus vaginalis.
What is the definition of a hernia?
A hernia is a bulge caused by the rupture of a containing structure, leading to the protrusion of tissues through a weakened area.
What does the term “hernia” mean in Latin and Greek?
In Latin, “hernia” means rupture.
In Greek, “hernia” means bulge.
What is an abdominal hernia?
An abdominal hernia is the protrusion of the peritoneum (and possibly abdominal viscera) through weakened abdominal boundaries.
Where do most abdominal hernias occur?
Most abdominal hernias occur in:
Inguinal region
Umbilical region
Epigastric region
What causes a hernia to form?
Hernias occur due to weakness in the abdominal wall, allowing tissues to protrude through.
What percentage of abdominal hernias occur in the inguinal region?
75%
Why are inguinal hernias more common in males?
Inguinal hernias are more common in males because they have a wider inguinal canal due to the passage of the spermatic cord.
What are the two types of inguinal hernias?
- Indirect (congenital) inguinal hernia
- Direct (acquired) inguinal hernia
Which type of inguinal hernia is more common?
Indirect inguinal hernia is more common, accounting for more than 2/3rds of inguinal hernia cases.
What is the most common presenting symptom of an inguinal hernia?
A lump in the groin that disappears with minimal pressure or when the patient lies down.
What is a cough impulse, and how is it related to hernias?
A cough impulse occurs when an examiner feels a bulge against their fingers while palpating the hernia as the patient coughs.
What is the inguinal triangle, and why is it clinically significant?
It is also called the medial inguinal fossa, which is a potential site for direct inguinal hernias.
What are the borders of the inguinal triangle?
Medial: Lateral margin of the rectus abdominis (linea semilunaris)
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament
What is the femoral canal, and what does it contain?
The femoral canal is a space within the femoral sheath that contains lymphatics, fat, and connective tissue.
What 3 structures are enclosed within the femoral sheath?
The femoral artery, femoral vein, and femoral canal
What is the femoral ring, and why is it clinically significant?
The femoral ring is the proximal opening of the femoral canal in the abdominal region. It is a weak spot where femoral hernias can occur.
What type of hernia can occur through the femoral ring?
A femoral hernia, where abdominal contents protrude through the femoral canal.
What is the saphenous opening, and what drains through it?
The saphenous opening is an opening in the femoral sheath where superficial veins and lymphatics drain into the deep vessels.
What is a femoral hernia?
A femoral hernia is a protrusion of abdominal contents through the femoral canal, passing through the saphenous opening, and creating a bulge in the femoral triangle.
Where does a femoral hernia appear in relation to the pubic tubercle?
A femoral hernia appears inferolateral to the pubic tubercle.
Why are femoral hernias more common in females?
Females have a wider pelvis and a wider femoral canal, making them more prone to femoral hernias
How can you differentiate an inguinal hernia from a femoral hernia based on location?
Inguinal hernia (IH): Appears above and medial to the pubic tubercle (PT).
Femoral hernia (FH): Appears below and lateral to the pubic tubercle (PT).
