Lecture 2: Inguinal Canal Flashcards
Where is the inguinal ligament?
rolled under the inferior EOM aponeurosis
attached to ASIS and pubic tubercle
What is the conjoint tendon (inguinal falx)?
combined aponeurosis of the IOM and TAM inserting into pubis (inferiomedially)
What structures surround the inguinal ligament?
Be able to identify these in the image
-Lacunar, pectineal ligaments, crural fibers
Superficial ring, femoral canal
What is the deep inguinal ring? What passes here?
What is the superficial inguinal ring? What exits here?
- entrance to inguinal canal, vas deferens (M) and round ligament (F)
- exit to inguinal canal, spermatic cord (M) and round ligament (F)
What are the layers of the inguinal region?
Superficial abdominal fascia
Aponeurosis of EOM
IOM (same layer as inguinal ring and ligaments)
TAM (sam layer as inguinal ring and ligaments)
Transversalis fascia
Parietal peritoneum
What are the main nerves of the inguinal canal?
Iliohypogastric n. (L1)
Ilioinguinal n (L1)
genital branch of the Genitofemoral N. (L1-L2)
what does the genital branch of the genitofemoral n. do?
Motor to cremasteric muscle and sensory to medial thigh and scrotum/labia
How do the testes descend?
- Processus vaginalis evaginates downward and forms the scrotum pouch
- Gonad is connected to the outer abdominal muscles (TF, IOM and EOM) via the gubernaculum, so as the testes descends these also descend to “wrap” it
- spermatic cord is also formed
- PV will then close a year after birth
What is the clinical significance of cryptorchid (undescended) testes?
higher risk for testicular cancer
What is the fate of the external abdominal muscles that the descending testes carried with it?
What is the clinical significance of the abd. muscle descent?
TF - internal spermatic fascia (deepest layer of the scrotum wall)
IOM - cremasteric muscle
EOM - external spermatic fascia (superficial layer of the scrotum wall)
-area of abdominal wall weakness
What does the spermatic cord contain?
vas/ductus deferens, testicular a. and v.(pampiniform plexus), gonadal nerves and lymphatics
What is a testicular varicocele and what is its clinical significance?
varicosities of pampiniform plexus
swelling causes dull and recurring scrotal pain
What causes a hydrocele/hematocele?
(fluid/blood) buildup in the scrotum either due to persistent prcoessus vaginalis or secondary to injury
What is the classic presentation of hydrocele?
swollen scrotum
common in babies
How does the ovary descend?
Ovaries are connected to the uterus via the gubernaculum, which becomes the future ovarian l. and round l. of the uterus
What are the differing contents of the female inguinal canal?
-it has the round ligament of the uterus instead of the spermatic cord, which connects to the labia instead of the scrotum
Where does the testicular and scrotal lymph drain to?
testes: lumbar > pre-aortic nodes
scrotum: superifical inguinal > iliac > lumbar nodes
The median fold is a remnant of ?
The medial fold is a remnant of?
The lateral fold is formed by?
- urachus
- distal umbilical arteries
- course of the inferior epigastric a and v.
What is in the Inguinal (Hasselbach’s) triangle?
Inguinal l.
lateral border of the rectus abdominis
Lateral umbilical fold
Iliopubic tract
What is the difference between a direct and indirect inguinal hernia?
Direct: medial to inferior epigastric a., peritoneum/TF herniates along the spermatic cord
Indirect: hernia in the deep ring because peritoneum herniates within spermatic cord
What is a femoral hernia?
below inguinal l.
more common in females
Where are the most common ventral hernia sites?
Umbilical
Epigastric
Spigelian (LLQ)
Where are the most common groin hernia sites?
Inguinal
Femoral
What causes flank/lumbar hernias?
Posterolateral abdominal wall protrusion
