Ligaments, canals and Fossae Flashcards
What is the inguinal ligament composed of?
The aponeurosis of the external oblique muscle
Where does the inguinal ligament run?
From ASIS to the pubic tubercle
Where does the inguinal canal run from?
The deep inguinal ring to the superficial inguinal ring - superior and parallel to the medial half of the inguinal ligament
What forms the deep inguinal ring?
A deficiency in the transversalis fascia of the abdomen
What forms the superficial inguinal ring?
A triangular shaped deficiency in the aponeurosis of the external oblique muscle which attaches laterally to the pubic tubercle and medially to the pubic crest
How long is the inguinal canal?
Approximately 4cm
What is the anatomical landmark for the deep inguinal ring?
Half way between the ASIS and pubic tubercle
What is the anterior wall of the inguinal canal composed of?
Aponeurosis of external oblique and the internal oblique muscle fibres
What is the superior wall of the inguinal canal composed of?
Internal oblique and transversus abdominus muscle fibres
What is the posterior wall of the inguinal canal composed of?
The conjoint tendon (formed by the aponeurosis of the transversus abdominus and internal oblique) and transversalis fascia
What is the inferior wall of the inguinal canal composed of?
The inguinal ligament
What is the conjoint tendon composed of?
The aponeurosis of the transversalis abdominus and internal oblique muscles
Where does the conjoint tendon run?
From the superior border of the inguinal canal to the posterior border of the inguinal canal to the pectineal line and pubic crest
Where does the external iliac artery branch to form the inferior epigastric artery?
Halfway between the pubic symphysis and the ASIS (i.e. medial to the deep inguinal ring) and inferior to the inguinal ligament
Where does the inferior epigastric artery run in relation to the inguinal canal?
Medial to the deep inguinal ligament and in the posterior wall of the canal, superiorly towards the rectus sheath
What are the borders of Hasselbach’s triangle?
Lateral border = inferior epigastric artery
Medial Border = rectus abdominus
Inferior border = inguinal ligament
(note that the posterior border is only bounded by transversalis fascia and therefore is not as strong as the posterior area that is bounded by the conjoint tendon)
What is the significance of the Hasselbach’s triangle?
It is the site of direct inguinal herniation (weakness in the transversalis fascia which leads to direct herniation from the abdomen without passing through the deep inguinal ring)
What is the lacunar ligament composed of?
The aponeurosis of the external oblique
Where is the lacunar ligament?
It runs from the inferomedial border of the inguinal ligament to the pectineal line to form the medial border of the femoral ring
What are the boundaries of the femoral ring?
Superiorly - inguinal ligament
Medially - lacunar ligament
Laterally - inferior epigastric vein
Posteriorly- pectineus muscle
What does the gubernaculum in the embryo form in the female?
The round ligament
What is the processus vaginalis?
It is a section of peritoneum that descends with the testis through the inguinal canal during fetal development and eventually forms the tunica vaginalis
How does a congenital indirect inguinal hernia form?
The processus vaginalis (a section of peritoneum) descends with the gubernaculum through the abdominal wall along the inguinal canal into the scrotum to form the tunica vaginalis. The descending portion should involute but if it remains patent, it provides a weakening whereby contents of the abdomen can pass through the deep inguinal ring and out the superficial ring and end up in the scrotum
Where would a femoral hernia be located?
Inferior and lateral to the pubic tubercle
Where would an inguinal hernia be located?
Medial to the pubic tubercle
Why are femoral hernias more common in females?
They have a wider femoral ring than males
What is the femoral triangle?
A Triangular shaped depression in the thigh which lies directly below the inguinal ligament
What are the superior, medial and lateral borders of the femoral triangle?
Superior = inguinal ligament Medial = adductus longus muscle (medial margin) Lateral = Sartorius muscle
What is floor of the femoral triangle composed of?
Medially it is formed of:
Adductus longus and pectineus muscles
Laterally it is formed of:
Psoas major tendon and iliacus muscle
What is the roof of the femoral triangle composed of?
Skin, superficial fascia, lymphatics and great saphenous vein
Which nerve supplies the skin overlying the femoral triangle?
The femoral branch of the genitofemoral nerve
What structures inside the femoral triangle?
Medial = femoral vein
Middle = femoral artery
Lateral = fermoral nerve
Deep inguinal nodes
What is contained within the femoral sheath?
The femoral artery, vein and canal
What does the femoral canal contain?
Lymphatics, node of cloquet
What is the clinical significance of the femoral canal?
It communicates directly with the femoral ring and therefore a femoral hernia can travel though the femoral canal
What are the contents of the inguinal canal?
Round ligament and ilioinguinal nerve + spermatic cord in males
Which artery does the femoral artery arise from?
External iliac artery
What is the node of Cloquet?
Lymphatic drainage for the clitoris and glans of the penis which is found in the femoral canal.
Where is the node of cloquet found?
Femoral canal
What are the fascial layers of the spermatic cord?
External spermatic (coming from the external oblique) Cremasteric muscle and fascia (coming from the internal oblique Internal spermatic (coming from the transversalis fascia)
What are the contents of the spermatic cord?
1) Vas deferens + Vas artery (from inferior vesicle artery)
2) Supply to the Testes = testicular artery (a branch of the aorta), pampiniform plexus (to testicular vain and IVC), lymphatics (drain to the paraaortic lymph nodes
3) sympathetic (ejaculation) and parasympathetic (erection) nerve supply
4) Supply to the cremasteric muscle = cremasteric nerve (genital branch of genitofemoral nerve) + cremasteric artery (branch of the inferior epigastric artery
5) Ilioinguinal nerve
Where does the testicular artery run from?
From abdominal aorta to the testes in the spermatic cord via the inguinal canal
Where does the testicular vein run to and from?
From the pampiniform plexus serving the testes in the spermatic cord via the inguinal canal to the testicular vein which drains to the IVC
Where do testicular lymphatics run?
In the spermatic cord via the inguinal canal to the para-aortic lymph nodes
Where does the cremasteric nerve arise from?
Genital branch of the genitofemoral nerve
Where does the cremasteric artery arise from?
The inferior epigastric artery
Which arteries run in the spermatic cord?
Vas
Testicular
Cremasteric
Which veins run in the spermatic cord?
Pampiniform plexus arising from the testicular vein
Which nerves run in the spermatic cord?
Ilioinguinal
Cremasteric
Sympathetic
Which vessels exit the greater sciatic foramen?
Inferior, superior gluteal arteries and veins
Internal pudendal artery and vein
Which muscles exit the greater sciatic foramen?
Only the piriformis
