The Inguinal Region

Question 1

Which part of the abdomen do the gonads descend during fetal development to give rise to the inguinal canal?

Answer 1

Descend from the posterior abdominal wall

Question 2

What traverses the inguinal canal in males and in females?

Answer 2

In males, the ductus deferens traverses the inguinal canal.

In females, the round ligament of the uterus traverses the inguinal canal

Question 3

Are the testes peritoneal or retroperitoneal?

Answer 3

They are covered with peritoneum and are termed retroperitoneal

Question 4

What causes the downward pull of the testes during development?

Answer 4

Starts in the posterior abdominal wall, where the gubernaculum condenses. The gubernaculum shortens as the embryo develops, pulling the testes inferiorly and forms process vaginalis

Question 5

What is the role of the process vaginalis during the descend of the testes?

Answer 5

The process vaginalis preceeds the testis as it moves toward the scrotum, forms anterior to the gubernaculum. Pushes through transversalis fascia, the internal oblique, and external oblique to form inguinal canal and picks up these layers eventually forming covering of spermatic cord and testes

Question 6

What is the name of the opening of the processus vaginalis in the transversalis fascia?

Answer 6

Deep inguinal ring (beginning of inguinal canal)

Question 7

What is the name of the opening in the aponeurosis of the external abdominal oblique?

Answer 7

Superficial inguinal ring (end of inguinal canal)

Question 8

What is the name of the processus vaginalis after the testes are embedded into it?

Answer 8

Tunica vaginalis (two layers, visceral and parietal)

Question 9

What are the three layers of covering of the spermatic cord? And from which muscles do they form?

Answer 9

Internal spermatic fascia (forms as processus vaginalis evaginates transversalis fascia)
Cremasteric muscles and fascia (forms as processus vaginalis evaginates the internal abdominal oblique)
External spermatic fascia (thin outer covering from the external abdominal oblique aponeurosis, which also forms the superficial inguinal ring)

Question 10

What is the cremasteric reflex?

Answer 10

Contraction of cremasteric muscle after stroking inner thigh causing the scrotum to lift via the genitofemoral nerve and the cremasteric artery (a branch of the inferior epigastric artery)

Question 11

What are the remnants of the gubernaculum in the female?

Answer 11

Round ligament of the uterus and the ligament of the ovary

Question 12

Which ligament in females passes through the inguinal canal?

Answer 12

The round ligament of the uterus; continues on to the labia majora

Question 13

What are the boundaries of the inguinal canal?

Answer 13

Starts the deep inguinal ring, ends at the superficial inguinal ring
Anterior Wall: The aponeurosis of the external abdominal oblique plus the lateral 1/3 by internal abdominal oblique
Posterior Wall Transversalis fascia plus the conjoint tendon on medial 1/3, plus the reflected inguinal ligament on external abdominal oblique
Roof: Internal abdominal oblique muscles and transversus abdominis
Floor: Inguinal ligament and lacunar ligament of the external abdominal oblique

Question 14

What is an indirect inguinal herina? Does it occur medial or lateral to the inferior epigastric vessels?

Answer 14

Occurs when processus vaginalis remains patent, and an internal organ passes through the deep inguinal ring. Occurs lateral to the inferior epigastric vessles.

Question 15

What is a direct inguinal hernia? Does it occur medial or lateral to the inferior epigastric vessels?

Answer 15

Occurs when an organ pushes directly through the superficial inguinal ring without traversing the inguinal canal. Occurs medial to the inferior epigastric artery and lies in the Hesselbach’s triangle

Question 16

What are the boundaries of Hesselbach’s triangle?

Answer 16

Inferior epigastric artery, the lateral border of rectus abdominis, and the inguinal ligament

Question 17

Which is acquire and which is congenital for hernias (indirect, direct) (congenital, acquired)

Answer 17

Indirect is congenital

Direct is acquired due to weakening of walls

Question 18

What are the layers of the scrotum?

Answer 18

Some Damn Englishmen Called it The Testes

Skin
Dartos muscle (involunary muscle)
External spermatic fascia
Cremasteric muscle and fascia
Internal spermatic fascia
Tunica vaginalis
Tunica albuginea

Question 19

What are the 3 parts of the epididymis?

Answer 19

The body (highly convoluted duct of epididymis)
The tail (continuous with vas deferens)
The head (connects to testes efferent ductules)

Question 20

Where does the ductus deferens travel?

Answer 20

Travels through the superficial inguinal ring to the deep inguinal ring and into abdomen

Question 21

What are the efferent ductules?

Answer 21

Connected rete testis to the head of epididymis

Question 22

What are the rete testis?

Answer 22

The joining together of the seminiferous tubules

Question 23

What are contained within the spermatic cord?

Answer 23

“3 arteries, 3 nerves, 3 other things”
Arteries: Testicular artery, artery of ductus deferens, cremasteric artery
Nerves: Ilioinguinal nerve, autonomic nervous system nerves, and genitofemoral nerve
3 other things: pampiniform plexus (forming of 12 veins on posterior surface), the vas deferens, and lymph vessels

Question 24

Which artery gives rise to the artery of ductus deferens?

What artery gives rise to cremasteric artery?

Answer 24

Artery of ductus deferens arises from inferior vesical artery (males only)
Artery of cremasteric artery arises from inferior epigastric artery