Lecture 1: Inguinal Canal Flashcards
What part of abdominal wall do the testes and ovaries develop from; what ‘derm?
Posterior Abdominal Wall in Lumbar region; Intermediate Mesoderm
What is the gubernaculum?
A structure that assists in the descent of the testicles
The gonads descend into the future scrotum with an out-pocketing known as?
Processus vaginalis
During testicular descent, what is the order of muscles/structures they take with them from innermost to outermost?
Peritoneum
Transversalis Fascia
Transversus abdominus m.
Internal abdominal oblique m.
External abdominal oblique m.
Scarpa’s fascia
Skin
The scrotum is comprised of two layer, what are they from outer to inner?
Skin (outer)
Dartos
From outermost to innermost what are the testicular fascial layers and what part of the abdomen to they arise from?
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)
Dartos is what kind of muscle and is innervated by?
Smooth muscle innervated by the sympathetics
Cremasteric muscle is innervated by?
Under voluntary control, innervated by Genital branch of Genitofemoral n.
What is Hydrocele and how is it detected?
Scrotal swelling + Serous fluid in persistent processus vaginalis; detected by transilumination
What is hematocele and how does detection differ from that of hydrocele?
Blood in persistent processus vaginalis; will not iluminate like serous fluid does.
The parietal and visceral layer of the tunica vaginalis come from?
Processus vaginalis (peritoneum)
What are the contents of the spermatic cord?
Vas deferns
Testicular a
Testicular vein –> Pampiniform plexus
Cremasteric a and v
Genital branch of genitofemoral n
Sympathetics and visceral afferents
Lymphatics
Lymphatics: which nodes do scrotum and testes go to?
Scrotum –> Superficial inguinal LN’s
Testes –> Aortic/lumbar/cavel LN’s
Which nerve is responsible for motor to abdominal muscles and skin over pubis?
Iliohypogastric nerve (L1)
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?
Ilioinguinal n (L1)
The inguinal ligament is derived from and what are its attachment points?
Aponeurosis of external oblique m.; ASIS and pubic tubercle
What forms the conjoint tendon (inguinal falx); where does it insert?
Fused aponeurosis of internal oblique and transversus abdominis; inserts pectineal line of pubis
At the superficial inguinal ring, what is the difference in men and women?
Men: Spermatic cord
Females: Round ligament of the uterus
What forms the posterior wall, anterior wall, and the floor (middle 1/3 and superficial ring) of the inguinal canal?
Posterior wall: Transversalis fascia
Anterior wall: External Oblique
Floor: Inguinal ligament (middle 1/3) and Lacunar lig. (Superficial ring)
What makes up the lateral 1/3 (deep ring), middle 1/3, and medial 1/3 (superficial ring) of the roof of inguinal canal?
Lateral 1/3 (deep): Transversalis fascia
Middle third: Internal oblique and Transversus abdominus
Medial third (superficial): Aponeurosis of external oblique
Function of the intercrural fibers?
Reinforce and provide strength to the superficial ring
Location and function of lacunar ligament?
Ligament between pubic rami and inguinal ligament; connects the inguinal ligament to pectineal ligament at the pubic tubercle
What is the Pectineal ligament?
Continuation of fibers from lacunar ligament running along pectin pubis
What are the medial and lateral crus; where does each attach?Fi
Fibers of the external obliques
Lateral crus: Pubic tubercle
Medial crus: Pubic crest
What gives rise to the superficial and deep inguinal ring, respectively?
Superficial ring (exit): External oblique aponeurosis
Deep ring (entrance): Transversalis fascia
What are the borders of Hesselbach’s (inguinal) triangle ?
Medial: Rectus Abdominis
Lateral: Inferior epigastric V.
Base: Inguinal ligament
Most common type of inguinal hernia; found where; location in relation to spermatic cord?
Indirect; lateral to epigastric a (outside triangle); enters deep inguinal ring and is found within the spermatic cord
Where is direct inguinal hernia found; location in relation to spermatic cord?
Medial to inferior epigastric a. (inside triangle); outside of spermatic cord; inferior to conjoint tendon
Path of Ilioinguinal n. thru inguinal canal?
Does not enter deep ring, but goes thru canal and exits superficial ring.
Which hernia is most common in women and where is it found?
Femoral hernia; inferior to Inguinal L.
40% of femoral hernia cases present as?
Emergencies with incarceration or strangulation
What are Cryptorchid testis; increases risk of?
Undescended testis (increase risk of developing testicular cancer)
What is testicular variocele?
- Varicosities (swollen/dilated veins) of pampiniform plexus
- Swelling in scrotum w/ dull and recurring pain in scrotum
