Lecture 2: Inguinal Canal Flashcards
Where is the inguinal ligament found?
ASIS to pubic tubercle
-base of the inguinal canal
What makes up the conjoint tendon?
Aponeurosis of internal oblique muscle and transversus abdominis muscle inserting into pubis
Describe the superficial ring.
External opening of inguinal canal within the aponeurosis of external oblique muscle
- Spermatic cord or round ligament exits from here
- closer to pubis (exit for inguinal canal)
What crural fibers make up superficial ring?
Medial crus
Lateral crus
Intercrural fibers
Describe the lacunar ligament.
Ligament between pubic rami and inguinal ligament
-helps attach inguinal ligament to pbus
Describe the pectineal ligament.
Fibers from lacunar ligament running along pectin pubis
Where is the femoral ring found?
Lateral to lacunar ligament
Describe the deep ring.
Entrance to inguinal canal
-beginning of invagination of peritoneum into the transversalis fascia
What makes up the roof of the inguinal canal?
Transversalis fascia
Aponeurosis of transverse abdominis muscle
Aponeurosis of internal oblique muscle
What makes up the anterior wall of the inguinal canal?
Aponeurosis of external oblique muscle
Internal oblique muscle
What makes up posterior wall of the inguinal canal?
Transversalis fascia
What makes up the foor of the inguinal canal?
Inguinal Ligament
Lacunar Ligament
What is the iliopubic tract a thickening of?
Transversalis fascia
Where is the genitofemoral nerve found?
L1 and L2
What is the motor and sensory function of the genitofemoral nerve?
Motor: Cremasteric muscle
Sensory: small part of medial thigh and scrotal/labial fascia
Where are gonads formed?
near T10 axial level
What attaches gonads to future scrotal swellings?
Gubernaculum
During testicular descent, there is an outpocketing of the peritoneal cavity into the future scrotum. What is this called?
What is remnant called?
Processus vaginalis
Tunica vaginalis: evagination of peritoneal cavity and remains of processus vaginalis around testes
What are cryptorchid testis?
Patients with cryptorchid testis have an increased risk of developing what?
Undescended testes
-increased risk of developing testicular cancer
What abdominal layers undergo testicular migration?
What do they become?
1) Skin
2) Scarpa’s fascia –> Dartos fascia
3) External abdominal oblique muscle –> External spermatic fascia
4) Internal abdominal oblique muscle –> Cremasteric muscle
5) Transversalis fascia —> Internal spermatic fascia
6) Peritoneum —> parietal and visceral tunica vaginalis
Which abdominal layer does not undergo testicuar migration?
Transversus abdominis muscle
What innervates external spermatic fascia?
Sympathetic NS
What innervates cremasteric muscle?
Genital Branch of Genitofemoral nerve
What structures are found in the spermatic cord?
Vas deferens
Testicular artery and veins (Pampiniform Plexus)
Gonadal nerves
Gonadal lymphatics
What is a testicular varicocele?
Enlargement of veins in scrotum
-varicosities of pampiniform plexus
Describe persistent processus vaginalis.
Patent connection between tunica vaginalis and abdomen
What is a hydrocele?
Peritoneal serous fluid accumulation within tunica vaginalis
What is a hematocele?
Accumulation of blood in tunica vaginalis
In females, describe what happens to the gubernaculum.
1) Attaches to developing uterus
2) Forms ovarian ligament and round ligament of uterus
What does the round ligament of the uterus enter and exit?
Enters deep inguinal ring
Exits superficial inguinal ring, attaching to labial swellings
What structures are found in the female inguinal canal?
- Round ligament of uterus
- Ilioinguinal nerve
- Genitofemoral nerve (genital branch)
What are the boundaries of Inguinal (Hesselbach’s) Triangle?
Medial: lateral border of the rectus abdominis muscle (linea semilunaris)
Lateral: inferior epigastric vessels
Inferior: inguinal ligament
Describe a direct hernia.
Hernia found in Hesselbach’s Triangle
- medial to inferior epigastric artery
- exits superficial ring
Describe an indirect hernia.
Hernia enters scrotum
- lateral to inferior epigastric artery
- enters deep ring
- exits superficial ring
Describe a femoral hernia.
Hernia below inguinal ligament
-more common in women
