INGUINAL REGION + HERNIAS Flashcards
List the 6 regions of the abdomen in the first convention.
The right and left hypochonrium regions are below the costal margin, bordering the epigastrium. The right and left lumbar levels are near the umbilical region. The right and left inguinal levels are by the groin, bordering the hypogastrium.
Name the 4 quadrants of the abdomen by the second convention.
The right upper quadrant, left upper quadrant (containing the jejunum), right lower quadrant (with the ileum+appendix) and left lower quadrant. These use the umbilicus as a central landmark.
List the 7 layers of the anterior body wall, from superficial to deep.
Skin > Superficial Fascia (Camper’s + Scarpa’s) > External Oblique muscle > internal oblique > transverse abdominus > transversalis fascia > parietal peritoneum
Describe the significance of the extra-peritoneal layer.
The extraperitoneal layer is located between the transversalis fascia and parietal peritoneum. It is divided into 2 layers: the anterior which is thin with vessels (around the testes) and the THICK posterior which covers retroperitoneal organs (kidneys and aorta)
Describe Colles and Dartos’ Fascias. Why is there no fatty layer in the scrotum?
Colles fascia is extraperitoneum in the perineum and Dartos’ fascia is the same layer but wrinkled and located in the scrotum.
The scrotum lacks a fatty layer since it doesn’t need insulation for spermatogenesis.
After the descent of the testes, the extraperitoneal (Dartos’) layer, which covers the testes, should migrate between what two layers?
Dartos’ fascia should migrate to the position between the (2nd) superficial fascia and (3rd) external oblique layers by the 9th month of fetal development.
Describe the descent of the testes in terms of it’s original position, evaginations and path.
The testes, which were originally located by the kidneys descend and EVAGINATES the transversalis fascia it’s covered by, making it the Internal Spermatic fascia. During this process each drags down a testicular artery, veins and lymphatics into the Spermatic cord as well as the Deep Inguinal Ring.
Describe the attachments and composition of the Inguinal ligament.
The inguinal ligament is part of the external oblique that happened to fold in on itself to meet the internal oblique on the backside. It is attached to the ASIS and the pubic tubercle.
Define the cremaster muscle, in terms of what muscle layer it’s made of and its relation to the testes.
The cremastere muscle is a fold of the internal oblique muscle that functions to pull up the testes in cold weather since the scrotum does not have a fatty layer for insulation.
What is the innervation and function of Dartos’ Muscle in the scrotum?
Dartos’ muscle is innervated by sympathetics and can reduce the surface area of the scrotal skin to reduce heat loss. This functions in conjunction with the Cremaster muscle in cold weather.
Define the inguinal canal.
This canal is a “pre-formed” pathway made by the testes during its descent that starts at the deep inguinal ring and ends at the superficial inguinal ring.
Describe an Indirect inguinal hernia.
A portion of bowel that emerges through the PRE-FORMED pathway made by the descent of testes. It goes through BOTH Deep and Superficial inguinal rings. It is detected LATERAL to the epigastric artery. “Long Island”
Describe a Direct inguinal hernia.
A portion of bowel that emerges from the superficial inguinal ring by TEARING through the abdominal wall. It gets covered by the external oblique layer and passes by the Hesselbach’s triangle. The hernia can be detected MEDIAL to the artery and just lateral to rectus abdominus. “DM’s”
Define Hesselbach’s Triangle and its significance.
This triangle is bordered by the rectus abdominus (medially), inferior epigastric vessels (laterally) and the inguinal ligament (inferiorly). It is commonly the site through which a direct hernia is detected.
Describe a Femoral hernia.
The femoral hernia is a loop of bowel that emerges through the femoral canal and is more common in females than males.
