2. Inguinal Canal

Question 1

Where is the Inguinal Ligament?

Answer 1

Basically the rolled-under inferior boarder of external oblique muscle aponeurosis

Question 2

What is the inguinal ligament attached to?

Answer 2

to the ASIS and Pubic tubercle

Question 3

What is the conjoint ligament?

Answer 3

Combined aponeurosis of inferior/medial margins of internal oblique and transverse abdominal m
-inserts into pubis

Question 4

What is the superficial Inguinal ring?

Answer 4

External opening within the aponeurosis for spermatic cord or round ligament (for ovary)

Has medial, lateral and intercrural that support and provide stability

Question 5

Lacunar Ligament

Answer 5

Ligament between pubic rami and inguinal ligament

-anchors inguinal ligament to pubis

Question 6

Pectineal Ligament

Answer 6

Continuation of fibers from lacunar ligament running along pectin pubis

Question 7

Where is the Femoral canal?

Answer 7

Lies immediately lateral to lacunar ligament, inferior to inguinal ligament

Question 8

What is the deep inguinal ring?

Answer 8

It is the entrance to the inguinal canal and beginning of the invagination of peritoneum into transversalis fascia

Where Vas deferens and gonads vessels pass through for males, while round ligament passes through for females

Question 9

Where is the deep inguinal ligament?

Answer 9

superior to inguinal ligament, lateral to inferior epigastric artery

Question 10

What are the layers of the abdomen and inguinal ring?

Answer 10

1. External oblique aponeurosis
2. Internal oblique m
3. Transversus abdominis m
4. Transversalis fascia
5. Parietal peritoneum
6. Inguinal ligament

Question 11

What is the iliopubic Tract?

Answer 11

Thickening of transversalis fascia running posterior to inguinal ligament

Question 12

Iliohypogastric N

Answer 12

L1
-motor to abdominal m (IO and TA)
-sensory to skin above pubis
—hypogastric

Question 13

Ilioinguinal N

Answer 13

L1
-transverse inguinal canal, exits superficial ring lateral to cord

• motor to abdominal m (IO and TA)
• sensory to medial thigh and penis/clit, and anterior scrotum/labia

Question 14

Genitofemoral N

Answer 14

L1, L2

• motor to cremaster m
• sensory to small part of medial thigh and lateral scrotal/labial fascia

Question 15

How do the testes descend?

Answer 15

Form near T10 and are connected to future scrotal swellings by gubernaculum
-descend along w out-pocketing of peritoneal cavity (processus vaginalis) into future scrotum
—carries vessels and nerves w

Question 16

How are layers of abdominal wall incorporated into spermatic cord?

Answer 16

As testes descend, pulls layers down with

• transversalis fascia
• internal oblique
• external oblique

Question 17

What is the embrological origin of tunica vaginalis?

Answer 17

Remnant of processus vaginalis around testes after peritoneum closes

Question 18

What is the processus vaginalis?

Answer 18

Evagination of peritoneal cavity

-usually closes w/in 1st year

Question 19

Crytorchid Testes

Answer 19

Undescended testis
-increases risk of developing testicular cancer

Tx: nothing, most resolve

Question 20

Spermatic Cord layers

Answer 20

Transversalis Fascia
-internal spermatic fascia

Internal Oblique
-cremasteric m

External Oblique
-external spermatic fascia

Question 21

What is important about the deep inguinal ring?

Answer 21

It’s where Vasculature runs to testes, but it is also a site of abdominal weaknesses
-so prone to hernias

Question 22

Spermatic Cord Contents

Answer 22

Vas deferens
Testicular A and V
-panpiniform plexus cools blood
Gonadal N
Gonadal lymph

Question 23

Testicular Varicocele

Answer 23

Varicosities of pampiniform plexus

-swelling in scrotum w dull and recurring pain in scrotum

Question 24

Persistent Processus Vaginalis

Answer 24

Patent connection between tunica vaginalis and abdomen

Question 25

Hydrocele

Answer 25

Peritoneal serous fluid accumulates within tunica vaginalis | -more common in babies, but can happen from trauma

Question 26

Hematocele

Answer 26

Accumulation of blood in tunica vaginalis

Question 27

How do the ovaries descend?

Answer 27

Begin descending but gubernaculum becomes attached to developing uterus -forms ovarian ligament

Question 28

Where does the round ligament of the uterus run?

Answer 28

Enters deep ring and exits superficial ring attaching to labial swellings

Question 29

What are the contents of the female inguinal canal?

Answer 29

Deep and superficial rings Medial/lateral crus Lucanar/pectineal ligaments Conjoint lig

Question 30

What does the female inguinal canal contain?

Answer 30

- Round ligament of uterus - Ilioinguinal N - Geniofemoral N

Question 31

Inguinal (Hasselbach’s) triangle

Answer 31

Inguinal ligament -w iliopubic tract behind Lateral boarder of rectus abdominis Lateral Umbilical ligament (fold)

Question 32

What is the iliopubic Tract?

Answer 32

Thickened transversalis fascia running behind inguinal ligament -reinforces floor of inguinal canal

Question 33

Direct hernia

Answer 33

Medial to inferior epigastric a | -peritoneum fascia alongside the spermatic cord

Question 34

Indirect Hernia

Answer 34

Enters deep ring | -peritoneum within spermatic cord

Question 35

Femoral Hernia

Answer 35

Below inguinal ligament

Question 36

Is a femoral hernia more in women or men?

Answer 36

Women

Question 37

Ventral Hernia Sites

Answer 37

Umbilical Epigastric -through wall in midline Spigelian -through fascia between the abdominal muscles but along the semilunar line of rectus abdominis —more common in obese people

Question 38

Groin Hernia Sites

Answer 38

Inguinal and Femoral

Question 39

What can cause a flank hernia?

Answer 39

Due to defects in the posterolateral abdominal wall allowing tissues inside the abdomen to protrude

Question 40

Where does lymph from gonads and scrotum/labia majora drain into?

Answer 40

Gonads drain into lumbar and pre-aortic lymph nodes along suspensory ligament Scrotum/labia Majora drains into superficial inguinal nodes