Serrat - Inguinal Region Flashcards
A defect or opening in fascia that permits the passage of structures thru the inguinal canal. There are superficial and deep found in external oblique aponeurosis and transversalis fascia, respectively.
Inguinal ring
The deep inguinal ring is found in the region of the ___________
Lateral inguinal fossa
The folded lower border of the aponeurosis of the external oblique muscle. Dense band of aponeurosis extends from the ASIS to the pubic tubercle.
Floor of inguinal canal
Aka Poupart’s ligament
Inguinal ligament
Medial extension of the inguinal ligament attaches to the pectineal line on the pubis. Its sharp free edge forms the medial border of the femoral ring. Continuous w/ the pectineal ligament
Lacunar ligament.
The inguinal canal is larger in _____ than in _______
Males
Females
The inguinal canal transmits
Genitofemoral nerve
Ilioinguinal nerve
Spermatic cord (male)
Round ligament of uterus (females)
Describe the course of the ilioinguinal nerve through the inguinal canal
Enters canal laterally by piercing the transversus abdominus and internal oblique muscles, travels through the canal and then exits through the superficial ring.
The beginning of the inguinal canal
Deep inguinal ring
The deep ring protrudes thru the abdominal wall ________ to the inferior epigastric vessels
Lateral
The two sides of the triangle that is the superficial inguinal ring, are called the medial and lateral crus. They are help together by ___-__ which prevent widening of the superficial ring
Crossing intercural fibers
The medial crus attaches to the ________
Pubic symphysis
The lateral crus connects to the __———
Pubic tubercle
Anterior wall of the inguinal canal
Aponeurosis of external oblique muscle (thru/o length of canal)
Aponeurosis of internal oblique muscle (lateral 1/3 of canal)
Posterior wall of the inguinal canal
Transversalis fascia thru/o length of canal
Conjoint tendon in medial 1/3 of canal
Roof of the inguinal canal
Muscle fibers and aponeurosis of the internal oblique muscle and the aponeurosis of the transversus abdominis muscle as they arch from anterior to posterior
Floor of the inguinal canal
Inguinal ligament (thru/o length of canal)
Lacunar ligament (medial 1/3 of canal)
What is the cremasteric reflex and what nerves does it test?
Stroking the medial aspect of thigh produces a reflex contraction of cremaster muscle and ipsilateral elevation of the testis and scrotum
Tests; ilioinguinal (L1) which is sensory to inner thigh
Genitofemoral (genital branch) (L1-L2) - motor to cremaster muscle that retracts testis
An evagination of peritoneum into ventral abdominal wall that occurs independent of tests descent.
Process vaginalis
The evagination of the ____- ______ forms the inguinal canal and is normally obliterated between the deep inguinal ring and superior aspect of the testes during the first postnatal year.
Processus vaginalis
A condensed band of mesenchyme that extends from the lower pole of the developing gonad thru the inguinal canal to the labioscrotal swelling
Gubernaculum
In the adult male, the gubernaculum is :
The fibrous cord connection the testes to the scrotum
In the adult female, the gubernaculum is :
The round ligament of the uterus
Testis enter the deep ring of the inguinal canal at about -_____ months gestation
3
Gonadal development begins where ?
High in the lumbar region (L1) on the posterior abdominal wall, deep to the transversalis fascia
The testis descend thru the inguinal canal at about ______ months gestation, carrying layers of the abdominal wall in its descent into the scrotum
7 mos gestation
When does the stalk of the processus vaginalis degenerate?
About within the first year
Layers of the scrotum
Skin
Fascia - dartos fascia and muscle
The outer capsule around the testis is called the ?
Tunica albuginea
Site of sperm production
Seminiferous tubules
Network of canals that conduct sperm
Rete testis
Sperm storage and maturation
Head - coiled ends of efferent ductules
Body - convoluted ducts
Tail - continuous w/ ductus deferens
Epididymis
Transport sperm to ejaculatory duct
Ductus (vas) deferens
Arteries of the testis
Cremasteric (from inferior epigastric)
Testicular (from abdominal aorta)
Artery of ductus deferens (from inferior vesicle artery)
Function of testis
Sperm production in seminiferous tubules
Androgen production in Leydig cells
The white fibrous capsule that surrounds the testis like the rind of an orange. Covered by the visceral layer of the tunica vaginalis
Tunica albuginea
Derived from parietal peritoneum, has two layers
A shiny visceral layer, immediately covering the tunica albuginea and a parietal layer that is separated from the visceral layer by a cavity of the tunica vaginalis
Tunica vaginalis
Genital branch of genitofemoral nerve provides motor innervation to ?
Cremaster muscle
Pampiniform plexus does what?
Drains nuts, converges as testicular vein, empties into inferior vena cava
Component of spermatic cord
What are the components of the spermatic cord?
Ductus deferens and artery
Testicular artery
Genital branch of genitofemoral nerve (L1, L2)
Pampiniform plexus (goes into testicular vein)
Lymphatics from testis and epididymis
Cremaster A. And V.
Plexus of autonomic nerves
Fascia contributions of the inguinal canal from the external oblique aponeurosis (x7)
Inguinal ligament
Lateral crus
Medial crus
Lacunar ligament
Intercrural fibers
External spermatic fascia
Superficial inguinal ring
Fascia contributions to the inguinal region from the internal abdominal oblique aponeurosis (x2)
Conjoint tendon
Cremasteric layer of muscle and fascia
Fascia contributions to inguinal region and canal from transversus abdominis aponeurosis
Conjoint tendon
What abdominal muscle aponeurosis has no layer contributed to coverings of spermatic cord?
Transversus abdominis aponeurosis
What are the fascia contributions to the inguinal region from the transversalis fascia?
Deep inguinal ring
Internal spermatic fascia
Fascia contributions to the inguinal region from peritoneum
Embryo; processus vaginalis
Mature; tunica vaginalis testis
What layer of testis and spermatic cord corresponds with skin
Skin
What layer of testis and spermatic cord corresponds with fatty layer of superficial fascia
Dartos muscles
What layer of testis and spermatic cord corresponds with membranous layer of superficial fascia
Membranous layer of superficial fascia of perineum (colle’s layer)
What layer of testis and spermatic cord corresponds with aponeurosis of external abdominal oblique
External spermatic fascia
What layer of testis and spermatic cord corresponds with internal abdominal oblique muscle and its aponeurosis
Cremaster muscle and fascia
What layer of testis and spermatic cord corresponds with transversus abdominis muscle
No contribution
What layer of testis and spermatic cord corresponds with transversalis fascia
Internal spermatic fascia
What layer of testis and spermatic cord corresponds with extraperitoneal fat
Loose connective tissue including fat
What layer of testis and spermatic cord corresponds with parietal peritoneum
Tunica vaginalis (obliterated processus vaginalis)
Incomplete testes descent such that one or both testes remain in body cavity or inguinal canal
Cryptorchidism
What is the cause of indirect inguinal hernia?
Congenital . From incomplete obliteration of processus vaginalis
What is cause of direct inguinal hernia ?
Weakness of posterior wall of inguinal canal
Type of hernia:
Occurs in adults
Common in older men
Neck of hernia passes thru medial inguinal fossa in hesselbach’s triangle
Enters inguinal canal medial to inferior epigastric vessels
Transverses only medial 1/3 of inguinal canal.
May transverse superficial inguinal ring but won’t enter scrotum.
Cause is weakness of posterior wall of inguinal canal
Direct inguinal hernia
Type of hernia;
Most common type in both children and adults.
Males > females
Neck of hernia thru deep inguinal ring in lateral inguinal fossa
Enters inguinal canal lateral to inferior epigastric vessels
Usually transverses entire inguinal canal and may extend into scrotum
Cause - congenital, incomplete obliteration of processus vaginalis
Indirect inguinal hernia
_______ umbilical folds contain the inferior epigastric vessels
Lateral
How do you distinguish a femoral hernia from an inguinal hernia?
The neck of a femoral hernia is always below and lateral to the pubic tubercle
Collection of fluid in testes or spermatic cord that can result from persistent processus vaginalis
Hydrocele
What layers must you pierce in order to tap a hydrocele?
Skin Dartos Colle’s fascia External spermatic fascia Cremaster muscle and fascia Internal spermatic fascia Parietal layer of tunica vaginalis
Why are most varioceles in the left testicular veins?
The right veins empty into the inferior vena cava which are lower pressure than the left renal vein which is where the left testicular vein empties into
Rotation of the testis around the spermatic cord w/in the scrotum
Severe pain
Obstructed blood flow can lead to necrosis of an entire testicle
Often occurs in active young men and children and is accompanied by severe pain
Torsion of the testis
Surgical ligation of ductus deferens so that no sperm are contained in ejaculated fluid
Vasectomy
