Lecture 1: Inguinal Canal

Question 1

What part of abdominal wall do the testes and ovaries develop from; what ‘derm?

Answer 1

Posterior Abdominal Wall in Lumbar region; Intermediate Mesoderm

Question 2

What is the gubernaculum?

Answer 2

A structure that assists in the descent of the testicles

Question 3

The gonads descend into the future scrotum with an out-pocketing known as?

Answer 3

Processus vaginalis

Question 4

During testicular descent, what is the order of muscles/structures they take with them from innermost to outermost?

Answer 4

Peritoneum

Transversalis Fascia

Transversus abdominus m.

Internal abdominal oblique m.

External abdominal oblique m.

Scarpa’s fascia

Skin

Question 5

The scrotum is comprised of two layer, what are they from outer to inner?

Answer 5

Skin (outer)

Dartos

Question 6

From outermost to innermost what are the testicular fascial layers and what part of the abdomen to they arise from?

Answer 6

External oblique –> External spermatic fascia

Internal Oblique –> Cremasteric fascia

Transversalis fascia –> Internal spermatic fascia

Tunica vaginalis (parietal) –> Processus vaginalis (peritoneum)

Tunical vaginalis (visceral) –> Processus vaginalis (peritoneum)

Question 7

Dartos is what kind of muscle and is innervated by?

Answer 7

Smooth muscle innervated by the sympathetics

Question 8

Cremasteric muscle is innervated by?

Answer 8

Under voluntary control, innervated by Genital branch of Genitofemoral n.

Question 9

What is Hydrocele and how is it detected?

Answer 9

Scrotal swelling + Serous fluid in persistent processus vaginalis; detected by transilumination

Question 10

What is hematocele and how does detection differ from that of hydrocele?

Answer 10

Blood in persistent processus vaginalis; will not iluminate like serous fluid does.

Question 11

The parietal and visceral layer of the tunica vaginalis come from?

Answer 11

Processus vaginalis (peritoneum)

Question 12

What are the contents of the spermatic cord?

Answer 12

Vas deferns

Testicular a

Testicular vein –> Pampiniform plexus

Cremasteric a and v

Genital branch of genitofemoral n

Sympathetics and visceral afferents

Lymphatics

Question 13

Lymphatics: which nodes do scrotum and testes go to?

Answer 13

Scrotum –> Superficial inguinal LN’s

Testes –> Aortic/lumbar/cavel LN’s

Question 14

Which nerve is responsible for motor to abdominal muscles and skin over pubis?

Answer 14

Iliohypogastric nerve (L1)

Question 15

Which nerve is responsible for motor to abdominal muscles and skin over upper/medial thigh and skin at root of penis/clitoris and anterior scrotum/labia?

Answer 15

Ilioinguinal n (L1)

Question 16

The inguinal ligament is derived from and what are its attachment points?

Answer 16

Aponeurosis of external oblique m.; ASIS and pubic tubercle

Question 17

What forms the conjoint tendon (inguinal falx); where does it insert?

Answer 17

Fused aponeurosis of internal oblique and transversus abdominis; inserts pectineal line of pubis

Question 18

At the superficial inguinal ring, what is the difference in men and women?

Answer 18

Men: Spermatic cord

Females: Round ligament of the uterus

Question 19

What forms the posterior wall, anterior wall, and the floor (middle 1/3 and superficial ring) of the inguinal canal?

Answer 19

Posterior wall: Transversalis fascia

Anterior wall: External Oblique

Floor: Inguinal ligament (middle 1/3) and Lacunar lig. (Superficial ring)

Question 20

What makes up the lateral 1/3 (deep ring), middle 1/3, and medial 1/3 (superficial ring) of the roof of inguinal canal?

Answer 20

Lateral 1/3 (deep): Transversalis fascia

Middle third: Internal oblique and Transversus abdominus

Medial third (superficial): Aponeurosis of external oblique

Question 21

Function of the intercrural fibers?

Answer 21

Reinforce and provide strength to the superficial ring

Question 22

Location and function of lacunar ligament?

Answer 22

Ligament between pubic rami and inguinal ligament; connects the inguinal ligament to pectineal ligament at the pubic tubercle

Question 23

What is the Pectineal ligament?

Answer 23

Continuation of fibers from lacunar ligament running along pectin pubis

Question 24

What are the medial and lateral crus; where does each attach?Fi

Answer 24

Fibers of the external obliques

Lateral crus: Pubic tubercle

Medial crus: Pubic crest

Question 25

What gives rise to the superficial and deep inguinal ring, respectively?

Answer 25

Superficial ring (exit): External oblique aponeurosis

Deep ring (entrance): Transversalis fascia

Question 26

What are the borders of Hesselbach’s (inguinal) triangle ?

Answer 26

Medial: Rectus Abdominis

Lateral: Inferior epigastric V.

Base: Inguinal ligament

Question 27

Most common type of inguinal hernia; found where; location in relation to spermatic cord?

Answer 27

Indirect; lateral to epigastric a (outside triangle); enters deep inguinal ring and is found within the spermatic cord

Question 28

Where is direct inguinal hernia found; location in relation to spermatic cord?

Answer 28

Medial to inferior epigastric a. (inside triangle); outside of spermatic cord; inferior to conjoint tendon

Question 29

Path of Ilioinguinal n. thru inguinal canal?

Answer 29

Does not enter deep ring, but goes thru canal and exits superficial ring.

Question 30

Which hernia is most common in women and where is it found?

Answer 30

Femoral hernia; inferior to Inguinal L.

Question 31

40% of femoral hernia cases present as?

Answer 31

Emergencies with incarceration or strangulation

Question 32

What are Cryptorchid testis; increases risk of?

Answer 32

Undescended testis (increase risk of developing testicular cancer)

Question 33

What is testicular variocele?

Answer 33

• Varicosities (swollen/dilated veins) of pampiniform plexus
• Swelling in scrotum w/ dull and recurring pain in scrotum