Inguinal Region/Canal

Question 1

Why is the anatomy of the inguinal region/canal clinically important?

Answer 1

Due to the frequency of inguinal hernae.

Question 2

What forms the inguinal ligament? How?

Answer 2

The aponeurosis of the external oblique; by folding over on itself forming a taut ligament-like structure.

Question 3

To which bony structures does the inguinal ligament attach?

Answer 3

Superolaterally to the anterior superior iliac spine of the hip bone, and inferomedially to the pubic tubercle.

Question 4

A deficiency in each of the three layers on the anterolateral abdominal wall, in the region of the inguinal ligament, forms what specific passage?

Answer 4

The inguinal canal - an obliquely flattened passageway.

Question 5

In which layer is the superficial inguinal ring formed?

Answer 5

The aponeurosis of the external oblique - the outermost (superficial) layer.

Question 6

In which layer is the deep inguinal ring formed?

Answer 6

It is a slit in the fascia transversalis.

Question 7

What structure forms the floor of the inguinal canal?

Answer 7

The inguinal ligament.

Question 8

What structure forms the posterior wall of the inguinal canal?

Answer 8

The conjoint tendon (joined aponeuroses of the internal oblique and transversus abdominis).

Question 9

What passes through this inguinal canal in the neonatal male?

Answer 9

the testis

Question 10

In the adult male, what structure is found within the inguinal canal?

Answer 10

the spermatic cord

Question 11

In the adult female, what structure is found within the inguinal canal?

Answer 11

the round ligament

Question 12

Which layer(s) of the anterior abdominal wall contribute to the sheaths (layers) of the spermatic cord?

Answer 12

EO, IO, Fascia transversalis

Question 13

What does the external oblique contribute to the spermatic cord?

Answer 13

External oblique - external spermatic fascia;

Question 14

What does the internal oblique contribute to the spermatic cord?

Answer 14

internal oblique - cremasteric muscle and/or fascia;

Question 15

what does the fascia transversalis contribute to the spermatic cord?

Answer 15

fascia transversalis - internal spermatic fascia

Question 16

Which layer of the anterior abdominal wall does NOT contribute to the spermatic cord?

Answer 16

transversus abdominis

Question 17

What are the main components found within the spermatic cord?

Answer 17

The ductus deferens, testicular a., pampiniform plexus of (testicular) veins and genitofemoral n.

Question 18

What feature of embryological development allows the formation of a congenital hernia?

Answer 18

The processus vaginalis (a finger-like extension of the peritoneum that extends down into the scrotum via the inguinal canal.

Question 19

In what age groups is the formation of a congenital hernia common?

Answer 19

Up to early 30s

Question 20

What is the actual function of the processus vaginalis?

Answer 20

It provides a serous (slippery) lining for the inside aspect of the scrotal wall and the visceral surface of the testicle for friction-free movement.

Question 21

What typically extends from the body cavity in a hernia?

Answer 21

a loop of small intestine

Question 22

What is the clinical implication of an inguinal hernia?

Answer 22

The loop of bowel may become trapped in the inguinal canal, squeezed by intra-abdominal pressure on the canal walls and cause loss of blood supply - gangrene may ensue.

Question 23

How does an acquired inguinal hernia differ from the congenital type?

Answer 23

A congenital inguinal hernia slides down the oblique inguinal canal due to the presence of a patent processus vaginalis (passing through the anterior abdominal wall indirectly), the acquired inguinal hernia protrudes directly through a defect that develops in the posterior wall of the inguinal canal (the conjoint tendon) and out through the superficial inguinal ring.

Question 24

Through what component of the inguinal canal does the direct hernia protrude?

Answer 24

The superficial inguinal ring after penetrating the posterior wall (conjoint tendon).

Question 25

Where would the inferior epigastric artery pulse be found in each type of herniation?

Answer 25

In the congenital (indirect) inguinal hernia the arterial pulse is medial to the hernia whereas in the acquired (direct) inguinal hernia the pulse is felt lateral to the hernia.

Question 26

How do inguinal herniae differ in presentation form femoral herniae?

Answer 26

Inguinal hernia present above the inguinal ligament whereas a femoral hernia presents under the inguinal ligament.

Question 27

Name the boundaries of the inguinal triangle.

Answer 27

Lateral: inferior epigastric a.; medial: lateral border of the rectus abdominis; inferior: inguinal ligament.

Question 28

What structure(s) typically traverse the inguinal triangle in the normal condition?

Answer 28

The spermatic cord passes through the triangle just above the inferior boundary of the inguinal ligament.

Question 29

Where is the location of the deep inguinal ring with relation to the inferior epigastric artery?

Answer 29

The deep inguinal ring is lateral to the inferior epigastric a.

Question 30

Where is the inferior epigastric artery going?

Answer 30

Up into the posterior aspect of the rectus sheath, between it the posterior leaf of the sheath and the rectus abdominis muscle, gaining access via the arcuate line.