Pelvis & perineum

Question 1

What does the external iliac artery give rise to?

Answer 1

inferior epigastric artery immediately above the inguinal ligament and deep iliac circumflex (behind inguinal ligament) and anastomosasing with lateral femoral circumflex

Question 2

What are the branches of the inferior epigastric artery?

Answer 2

external spermatic (cremasteric), pubic (anastamose with obturator), and muscular (ab muscles, + anastomoses with superficial epigastric)

Question 3

What does the femoral artery give rise to?

Answer 3

superficial epigastric artery to anastamose with inferior epigastric and superficial external pudendal (skin of lower abdomen, penis, scrotum, labium majorus)

Question 4

What is the venous drainage of the pelvic area?

Answer 4

lumbar veins -> IVC
deep circumflex -> external iliac
inferior epi, superficial epi, superficial external pudendal drain into great saphenous vein

Question 5

What’s the inguinal canal?

Answer 5

4 cm long, parallel to inguinal ligament that has a multitude of things that travel through the canal (testis, ductus deferens, blood, lymph, nerves)

Question 6

How is the inguinal canal formed?

Answer 6

aponeuroses of 3 ab muscles - external oblique, internal oblique, tranversus abdominis/ tranversilas fascia that begins at deep (internal) inguinal ring and ends at superficial (external) ring

Question 7

What does the inguinal canal transmit?

Answer 7

spermatic cord, round ligament of uterus, ilioinguinal nerve

Question 8

What is the superficial ring mostly made of?

Answer 8

external oblique

Question 9

What is the internal ring mostly made of?

Answer 9

transversalis fascia

Question 10

What is the inguinal ligment?

Answer 10

thick enrolled lower border of external oblique muscle

Question 11

What is the inguinal region?

Answer 11

area between anterior superior iliac spine and pubic tubercle Between ASIS and pubic tubercle

Question 12

What is the deep (internal) inguinal ring?

Answer 12

where the transversalis fascia pouches out creating an opening above the inguinal ligament, lateral to inferior epigastric artery

Question 13

What’s the floor of the internal inguinal ring?

Answer 13

lower margin of the inguinal ligament

Question 14

What’s the roof of the inguinal ring?

Answer 14

internal oblique and transversus

Question 15

Where is the superficial (external) inguinal ring?

Answer 15

above pubic tubercle, lateral crus attaches there and medial crus attaches to rectus sheath

Question 16

What is processus vaginalis?

Answer 16

outpouching of peritoneum in fetus at 12 weeks, passing through fascia and adding layers of ext, oblique to scrotum

Question 17

When do the testes start to move behind processus vaginalis in the embryo?

Answer 17

7th month

Question 18

How are testes formed?

Answer 18

posterior wall deep to transversalis fascia and peritonium where they migrate to inguinal region, pass through wall and to scrotum

Question 19

What is the gubernaculum?

Answer 19

what becomes the scrotal ligament

Question 20

Do the ductus deferens/testis and processus vaginalis have the same coverings?

Answer 20

yes, all the way to the scrotum

Question 21

What is an ovary in embryo?

Answer 21

never leaving the abdomen, the round ligament passes through inguinal canal behind processus vaginalis to end in labium majus

Question 22

What happens if part of the processus vaginalis fails to obliterate at birth?

Answer 22

more likely to have a congenital inguinal hernia

Question 23

What are the layers that make up the testes?

Answer 23

inner to outer: tunica vaginalis (visceral and parietal), internal spermadic fascia, cremaster muscle, external spermadic fascia, dartos muscle

Question 24

What are the layers that form to make the layers of the testes?

Answer 24

inner to outer: peritoneum, transversalis fascia, internal oblique, external oblique, scarpa’s fascia

Question 25

What does the camper’s fascia (protective fat) of the abdomen turn into in the peritoneum?

Answer 25

dartos smooth muscle (cold)

Question 26

What does the Scarpa’s fascia (deep to camper’s) in the abdomen turn into in the peritoneum?

Answer 26

colle’s fascia (membranous)

Question 27

What does the spermatic cord consist of?

Answer 27

ductus deferens, testicular artery, pampiniform plexus, testicular lymphatics, genital branch of genitofemoral nerve, artery of the ductus deferens, sympathetic nerves

Question 28

What layers does the spermatic cord pick up as it travels?

Answer 28

internal spermatic fascia from transversalis fascia, mantle of looped muscle fibers from the internal oblique, cremaster muscle/fascia, and external spermatic fascia from external oblique

Question 29

What does the cremastic reflex do?

Answer 29

elicited by stroking the skin of medial thigh (if genitofemoral nerve is intact = retraction)

Question 30

What is an inguinal hernia?

Answer 30

pressure and weak point in wall leading to protrusion

Question 31

When is a hernia sac formed?

Answer 31

when hernia goes through the abdominal wall and has peritoneum holding it (often bringing abdominal content)

Question 32

What happens if the hernia passes through the external ring?

Answer 32

travel down to scrotum or labium majus

Question 33

How is the inguinal canal structured to prevent hernias?

Answer 33

oblique pushes posterior abdominal wall against anterior muscle which reduces the capacity of canal and protected by pressure of conjoint tendon and rectus abdominus pressing against the canal

Question 34

How can you check for a hernia?

Answer 34

finger over internal ring (a bit above femoral artery palpation), have patient cough and a direct hernia will pop out

Question 35

What types of inguinal hernias are there?

Answer 35

indirect (lateral to inferior epigastric arteries and through ring, common on right side)
and direct (defect in wall, medial/inferior to epigastric, common in old man with weak muscle)

Question 36

What does the transversalis fascia in the abdomen become in the pelvis?

Answer 36

internal spermatic fascia

Question 37

What does the internal oblique become in the pelvis?

Answer 37

cremasteric fascia

Question 38

What does the external oblique become in the pelvis?

Answer 38

external spermatic fascia

Question 39

How is the inguinal triangle defined?

Answer 39

RIP
rectus abdominis
inferior epigastric vessels
Poupart’s ligament (inguinal ligament)

Question 40

What are the layers of the scrotum?

Answer 40

skin, superficial fascia (continuous with membranous layer), smooth muscle (dartos)
spermatic cord is deep to superficial fascia from testes

Question 41

What is the accumulation of fluid from inflammation or trauma that may fill the space in the scrotum?

Answer 41

hydrocele

Question 42

What do the seminiferous tubules do?

Answer 42

produce sperm

Question 43

What are the inner/peritoneal layers of the testis?

Answer 43

covered by tunica vaginalis (except postmedial) and tunica albuginea is deep to vaginalis

Question 44

What produces testosterone?

Answer 44

interstitial cells

Question 45

What is the coiled structure that receives the efferent ductules?

Answer 45

epididymis – mature sperm are stored here until ejaculated

Question 46

Where does testicular cancer spread?

Answer 46

abdomen - can produce large abdominal wall mass if spread to aortic lymphnodes

Question 47

What is an undescended testicle?

Answer 47

failure of migrating; may be fixed by surgical means, no spermatagenesis will not occur, but needs to be taken care of young (3-4), “empty, cold, frightened”

Question 48

Why does the testis need to be 2-3 degrees cooler?

Answer 48

normal spermatogenesis