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Genitourinary MBCHB2 > Lecture 4: Inguinal canal and spermatic cord > Flashcards

Lecture 4: Inguinal canal and spermatic cord Flashcards

1
Q

Are the inguinal canal and spermatic cord the same thing?

A

Yes

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2
Q

Whats the origin and insertion of the inguinal ligament and whats it formed from?

A

Origin: ASIS
Insertion: Pubic tubercle

Formed from rolled edge of external oblique aponeurosis

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3
Q

What does the lacunar ligament connect?

A

Joins inguinal and pectineal ligament

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4
Q

Where is the pectinal ligament located?

A

Pectineal line of the pubic bone

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5
Q

What is the inguinal canal and its function?

A

Oblique passage through lower part of abdominal wall, the oblique nature helps prevent herniation of abdominal contents

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6
Q

What two structures does the inguinal canal extend between?

A

Extends from deep inguinal ring to the superficial inguinal ring

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7
Q

What is the inguinal canal used for in males?

A

Carries structures to and from the testis and abdomen via the spermatic cord (+Ilioguinal nerve)

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8
Q

What is the inguinal canal used for in females?

A

Carries round lig. of uterus and genitofemoral nerve from pelvis to the labia majora (+Ilioguinal nerve)

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9
Q

What is the superficial inguinal ring of the external oblique?

A

Triangular shaped defect in aponeurosis of external oblique

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10
Q

What is the surface landmark of the superficial inguinal ring?

A

Superior and lateral to pubic tubercle

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11
Q

What doe the external margins of the superficial inguinal ring give rise to?

A

Margins (Crura) give rise to EXTERNAL Spermatic fascia (of the spermatic cord)

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12
Q

What is the deep inguinal ring?

A

Oval opening in the transversalis fascia

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13
Q

What are the landmarks of the deep inguinal ring?

A

Landmarks:

  • Halfway b/w ASIS and pubic symphysis (mid inguinal point)
  • ~1cm above inguinal ligament
  • Lateral to inferior epigastric artery
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14
Q

What does the deep inguinal ring give rise to in men and in women?

A

Men: Internal spermatic fascia (of the spermatic cord)

Women: Round ligament fascia

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15
Q

What are two additional muscles that help form the roof of inguinal canal and spermatic cord?

A

Transversus abdominus and internal oblique

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16
Q

Describe the contribution of the transversus abdominus to the inguinal canal:

A

Origin: Lat 1/3 of inguinal lig.

DOES NOT CONTRIBUTE TO SPERMATIC FASCIA

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17
Q

Describe the contribution of the internal oblique to the inguinal lig.

A

Origin: Lat 2/3 of inguinal lig
Gives rise to cremasteric muscle of spermatic cord

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18
Q

What do the transversus abdominus and internal oblique form?

A

Form common tendon on pubic crest / pectineal line (Conjoint tendon)

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19
Q

What forms the anterior wall, floor, roof and posterior wall of the inguinal canal:

A

Ant. wall = Aponeurosis of external oblique + Internal oblique

Floor = Inf. rolled edge of external oblique aponeurosis (inguinal lig.) + Lacunar lig. (Medial)

Roof = Fibres of internal oblique and Transversus Abdominus

Post. wall = Transversalis Fascia + Conjoint tendon

20
Q

Whats the significance of the inguinal triangle?

A

Site of direct hernia (pushes through weakened abdo wall)
- Corresponds to weak ant. wall (Sup. ant. ring)

21
Q

What creates the inguinal (hesselbachs) triangle?

A

Later border of rectus abdominus
Inf. epigastric art
Inguinal ligament

22
Q

How many layers are in the spermatic cord and whats the significance?

A

3 concentric layers of fascia derived from the abdominal wall (where there are four layers….)

Begins at the deep inguinal ring, ends at testis

23
Q

How does the spermatic cord form?

A

Arises from peritoneal diverticulum called the processes vaginalis - pushes through abdo wall taking a a tubular sheath from each layer

24
Q

Describe which abdo wall layers give rise to which spermatic cord layer:

A 
Transversalis fascia (DIR) = internal spermatic fascia 
Transversus abdominus = NO CONTRIBUTION 
Internal oblique = Cremaster muscle 
External oblique (SIR) = External spermatic fascia

Layers are continuous with scotum

25
Q

What supplies the scrotum:

A
  • Internal and external pudendal arteries
26
Q

Where is the fascia of the scrotum derived from?

A

Superficial fascia continuous with abdo scarpas fascia but fat replaced with SM (Dartos fascia). Dartos fascia continuous posteriorly with deep facia of perineum

27
Q

What are the arteries found in the spermatic cord? (3s)

A
  • Testicular art. (from L2 aorta)
  • Art. of bas deferens (diferential art)
  • Cremasteric Art.
28
Q

What are the nerves found in the spermatic cord? (3s)

A
  • Genital branch of genitofemoral
  • Symp. nerves from testicular plexus
  • Ilioguinal (doesnt actually travel in cord tho)
29
Q

What other 3 structures are found in the spermatic cord?

A
  • Vas deferens
  • Lymphatics
  • Tunica vaginalis
30
Q

What is the venous supply of the spermatic cord?

A
  • Pampiniform plexus
31
Q

Where does the ilioinguinal nerve travel then?

A
  • Pierces through internal oblique (roof of canal), runs outside spermatic cord and exits SIR
32
Q

What is testicular torsion?

A

Twisting that cuts off blood supply

Emergency surgery

33
Q

Whats symptoms of testicular torsion?

A
  • Acute and severe testicular / scrotal pain
  • Absent/decreased cremasteric reflex (not infallible)

Differential = ultrasound showing lack of blood flow to testis (vs epididymitis)

34
Q

Describe the cremasteric reflex:

A
  1. Stroke superior medial thigh
  2. Stimulates sensory fibres of femoral branch of Genitofemoral n. and ilioinguinal n.
  3. This in turn simtulates motor fibres of genital branch of genitofemoral nerve
    = Cremaster muscle contracts on ipsilateral side, raising testi
35
Q

What is an indirect hernia?

A

Herniation through DIR and into the inguinal canal within the spermatic cord and possibly into testis.

LATERAL to inf. epigastric art

Often seen in juveniles b.c inguinal canal less oblique

36
Q

What is a direct hernia?

A

Hernia through inguinal triangle.

Medial to inf. epigastric art.

37
Q

Whats a femoral hernia?

A

Herniation through femoral canal
- Below inguinal lig. (Uncommon)

38
Q

What would you expect to see from a cough impulse and redcibility test for confirming a hernia?

A

Positive cough impulse/lump is reducible = hernia

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Genitourinary MBCHB2 (26 decks)

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