Lecture 2: Inguinal Canal

Question 1

Where is the inguinal ligament?

Answer 1

rolled under the inferior EOM aponeurosis

attached to ASIS and pubic tubercle

Question 2

What is the conjoint tendon (inguinal falx)?

Answer 2

combined aponeurosis of the IOM and TAM inserting into pubis (inferiomedially)

Question 3

What structures surround the inguinal ligament?

Be able to identify these in the image

Answer 3

-Lacunar, pectineal ligaments, crural fibers

Superficial ring, femoral canal

Question 4

What is the deep inguinal ring? What passes here?

What is the superficial inguinal ring? What exits here?

Answer 4

• entrance to inguinal canal, vas deferens (M) and round ligament (F)
• exit to inguinal canal, spermatic cord (M) and round ligament (F)

Question 5

What are the layers of the inguinal region?

Answer 5

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

Question 6

What are the main nerves of the inguinal canal?

Answer 6

Iliohypogastric n. (L1)
Ilioinguinal n (L1)
genital branch of the Genitofemoral N. (L1-L2)

Question 7

what does the genital branch of the genitofemoral n. do?

Answer 7

Motor to cremasteric muscle and sensory to medial thigh and scrotum/labia

Question 8

How do the testes descend?

Answer 8

• 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

Question 9

What is the clinical significance of cryptorchid (undescended) testes?

Answer 9

higher risk for testicular cancer

Question 10

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?

Answer 10

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

Question 11

What does the spermatic cord contain?

Answer 11

vas/ductus deferens, testicular a. and v.(pampiniform plexus), gonadal nerves and lymphatics

Question 12

What is a testicular varicocele and what is its clinical significance?

Answer 12

varicosities of pampiniform plexus

swelling causes dull and recurring scrotal pain

Question 13

What causes a hydrocele/hematocele?

Answer 13

(fluid/blood) buildup in the scrotum either due to persistent prcoessus vaginalis or secondary to injury

Question 14

What is the classic presentation of hydrocele?

Answer 14

swollen scrotum

common in babies

Question 15

How does the ovary descend?

Answer 15

Ovaries are connected to the uterus via the gubernaculum, which becomes the future ovarian l. and round l. of the uterus

Question 16

What are the differing contents of the female inguinal canal?

Answer 16

-it has the round ligament of the uterus instead of the spermatic cord, which connects to the labia instead of the scrotum

Question 17

Where does the testicular and scrotal lymph drain to?

Answer 17

testes: lumbar > pre-aortic nodes
scrotum: superifical inguinal > iliac > lumbar nodes

Question 18

The median fold is a remnant of ?
The medial fold is a remnant of?
The lateral fold is formed by?

Answer 18

• urachus
• distal umbilical arteries
• course of the inferior epigastric a and v.

Question 19

What is in the Inguinal (Hasselbach’s) triangle?

Answer 19

Inguinal l.
lateral border of the rectus abdominis
Lateral umbilical fold
Iliopubic tract

Question 20

What is the difference between a direct and indirect inguinal hernia?

Answer 20

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

Question 21

What is a femoral hernia?

Answer 21

below inguinal l.

more common in females

Question 22

Where are the most common ventral hernia sites?

Answer 22

Umbilical
Epigastric
Spigelian (LLQ)

Question 23

Where are the most common groin hernia sites?

Answer 23

Inguinal

Femoral

Question 24

What causes flank/lumbar hernias?

Answer 24

Posterolateral abdominal wall protrusion