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AGRS > 2 Inguinal Region and Hernias > Flashcards

2 Inguinal Region and Hernias Flashcards

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1
Q

What anatomical landmarks define the inguinal region (groin)?

A

From the ASIS (anterior superior iliac spine) to the pubic tubercle. it is the region where structures exit and enter the abdominal cavity.

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2
Q

why is the inguinal ligament important?

A

The inguinal region, sometimes called the groin, is the lower part of the anterolateral abdominal wall. It’s a small area of great importance, as it serves as a passageway for structures such as the spermatic cord, vessels, and nerves to enter or leave the abdominal cavity.

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3
Q

what is the inguinal ligament

A

The inguinal ligament is the thickened, under-turned and inferior margin of the aponeurosis of the external
oblique, forming a retinaculum that bridges the subinguinal space. This space allows muscles (flexors of the
hip) and neurovascular structures supplying the lower limb to pass through.

A retinaculum is a band of thickened deep fascia (often from a tendon or aponeurosis) that holds structures in place as they pass over joints or through spaces.

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4
Q

Why is the inguinal region clinically important?

A

It is a site where abdominal structures enter/exit and hernias commonly occur.

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5
Q

Which region overlaps with the inguinal region despite traditional definitions?

A

The pubic region is also included bilaterally as part of the inguinal region.

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6
Q

What is the inguinal ligament derived from?

A

it is a thickened underturned inferiormost part of the external oblique aponeurosis.

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7
Q

What does the inguinal ligament form and span?

A

The inguinal ligament is not just a simple cord—it is the inferior margin of the external oblique aponeurosis that has folded under itself. It plays a structural role in both muscle attachment and anatomical organization

📍What it forms:
It forms a retinaculum—which is a band that holds structures in place.

In this case, it forms the roof of the subinguinal space.

📍What it spans:
From the ASIS (Anterior Superior Iliac Spine) → to the *pubic tubercle.

This span creates a tunnel-like space underneath the ligament known as the subinguinal space.

A retinaculum bridging the subinguinal space between ASIS and pubic tubercle.

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8
Q

What passes through the subinguinal space?

A

Hip flexors and neurovascular structures to the lower limb.

This space is crucial because important structures pass through it from the abdomen to the lower limb:

Hip flexor muscles (e.g., iliopsoas)

Femoral nerve, artery, and vein

Lymphatics

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9
Q

Where do most fibres of the inguinal ligament insert?

A

Into the pubic tubercle.

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10
Q

Where does the lacunar ligament attach?

A

The lacunar ligament is formed by some fibres of the inguinal ligament that turn medially and attach to the superior pubic ramus.

To the superior pubic ramus.

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11
Q

What ligament extends from the lacunar ligament along the pecten pubis?

A

The pectineal ligament.

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12
Q

What is the reflected inguinal ligament?

A

Fibres that bypass the pubic tubercle and cross to the opposite external oblique.

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13
Q

how is the inguinal canal formed?

A

it is a short oblique tunnel in the lower abdomen to the external genitalia
- forms during fetal development when testis descent from the abdomen to the scrotum
- it contains the spermatic cord in males and round ligament of the iterus in female
- in both sexes it cotaines the ilioinguinal nerve and supplies sensation to the upper inner thigh and parts of the gentalia

formed in relation to the reocation (decent) of the testis during fetal development

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14
Q

What is the orientation and location of the inguinal canal in adults?

A

An oblique inferomedial passage superior and parallel to the medial inguinal ligament.

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15
Q

What does the inguinal canal contain in males?

A

The spermatic cord.

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16
Q

What does the inguinal canal contain in females?

A

The round ligament of the uterus.

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17
Q

What structure passes through the inguinal canal in both sexes?

A

The ilioinguinal nerve.

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18
Q

What is the deep inguinal ring?

A

An opening in the transversalis fascia, lateral to inferior epigastric vessels.
think of it as the starting point of the canal

transversalis fascia is a thin, fibrous membrane lining the inner surface of the abdominal wall, located between the transversus abdominis muscle and the peritoneum.

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19
Q

What is the superficial inguinal ring?

A

An opening above the pubic crest with medial/lateral crura.

an opening in the external oblique aponeurosis (outer most layer)

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20
Q

What reinforces the superficial inguinal ring?

A

Intercrural fibres prevent the crura from spreading.

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21
Q

What are the anterior and posterior boundaries of the inguinal canal?

A

Anterior: external oblique aponeurosis; Posterior: transversalis fascia, conjoint tendon.

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22
Q

What forms the roof of the inguinal canal?

A

Musculoaponeurotic arches of internal oblique and transversus abdominis.

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23
Q

name the coverings of the spermatic cord form superficial to deep

A
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24
Q

name the content of the spermatic cord

A

3 arteries, 3 nerves, 3 other

📦 Contents of the spermatic cord
✅ 3 Arteries:
Testicular artery – from the abdominal aorta (supplies testis and epididymis)

Artery to ductus deferens – usually from the inferior vesical artery

Cremasteric artery – from the inferior epigastric artery

✅ 3 Nerves:
Genital branch of genitofemoral nerve (L1–L2) – motor to cremaster

Sympathetic nerve fibres – on arteries and ductus deferens

Ilioinguinal nerve – note: travels alongside, not inside the cord (still sometimes grouped here in this mnemonic)

✅ 3 Other structures:
Ductus (vas) deferens – muscular tube transporting sperm

Pampiniform venous plexus – thermoregulatory venous network

Vestige of processus vaginalis – fibrous remnant of embryonic peritoneum

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25
What forms the floor of the inguinal canal?
The inguinal ligament.
26
What does the transversalis fascia become in the spermatic cord?
The internal spermatic fascia.
27
What does the internal oblique fascia form in the spermatic cord?
The cremasteric fascia.
28
What muscle layer becomes the cremaster muscle?
Internal oblique.
29
What forms the external spermatic fascia?
External oblique aponeurosis and fascia.
30
What is the function of the cremaster muscle?
Elevates the testis in response to cold; relaxes in warmth.
31
What nerve innervates the cremaster muscle?
Genital branch of the genitofemoral nerve (L1–L2).
32
Does the round ligament in females have distinct spermatic coverings?
No, they are indistinct.
33
What is a hydrocele testis and what causes it?
A hydrocele testis is an accumulation of fluid in the tunica vaginalis of the scrotum, caused by a patent processus vaginalis that allows peritoneal fluid to flow into the scrotal sac. ## Footnote 🧠 Bonus facts (optional back of card): The tunica vaginalis is the remnant of the processus vaginalis, a peritoneal extension that normally closes. A non-obliterated processus vaginalis leads to a communicating hydrocele. Commonly presents as a painless, transilluminating scrotal swelling. More frequent in infants and young boys.
34
What is the processus vaginalis?
An extension of peritoneum during testis descent. normally, it closes/obliterates leaving only tunica vaginalis around the testis, but if it stays open, fluid from the peritoneal cavity leaks down into the tunica vaginalis creating a hydrocele, seen as scrotal swelling ( a water balloon around the testicle)
35
What forms the tunica vaginalis?
The terminal part of the processus vaginalis.
36
What causes a hydrocele testis?
A patent processus vaginalis allowing fluid accumulation.
37
What is the ductus deferens?
A muscular tube that conveys sperm to the ejaculatory duct.
38
Where does the testicular artery originate?
From the abdominal aorta.
39
What is the pampiniform plexus?
A venous network draining into the testicular veins.
40
What is the function of the pampiniform plexus?
Thermoregulation of the testis.
41
What is the artery of the ductus deferens a branch of?
Inferior vesical artery.
42
What is the cremasteric artery a branch of?
Inferior epigastric artery.
43
What nerve fibres are found in the spermatic cord?
Sympathetic fibres on arteries and ductus deferens.
44
What lymph nodes do testicular lymphatics drain to?
Lumbar lymph nodes.
45
What is a hernia?
A bulge (Greek) or rupture (Latin) of tissue through a containing structure.
46
name the different types of hernias
47
What is an abdominal hernia?
Protrusion of peritoneum (and possibly viscera) through the abdominal wall.
48
Where do abdominal hernias most commonly occur?
Inguinal, umbilical, and epigastric regions.
49
Where do most abdominal hernias occur?
In the inguinal region (75%).
50
Why are inguinal hernias more common in males?
Due to the larger inguinal canal from the passage of the spermatic cord.
51
What are the two types of inguinal hernias?
Direct and indirect.
52
Which is more common: direct or indirect inguinal hernia?
Indirect (over two-thirds of cases).
53
What is the most common symptom of an inguinal hernia?
A lump in the groin.
54
What is a cough impulse in hernia examination?
Palpable pressure felt when the patient coughs.
55
What is the inguinal triangle also known as?
Medial inguinal fossa.
56
What are the borders of the inguinal triangle?
Medial: rectus abdominis (linea semilunaris) Lateral: inferior epigastric vessels Inferior: inguinal ligament
57
What structures lie within the femoral sheath?
Femoral artery and vein.
58
What is the femoral canal?
The space within the femoral sheath.
59
What is the femoral ring?
The proximal opening of the femoral canal; a weak spot.
60
Where is the saphenous opening located?
Below the inguinal ligament, where superficial veins/lymphatics enter deep vessels.
61
What passes through the saphenous opening?
Superficial veins and lymphatics.
62
What is a femoral hernia?
A protrusion through the femoral canal and saphenous opening.
63
Where does a femoral hernia present?
As a bulge in the femoral triangle, inferolateral to the pubic tubercle.
64
Why are femoral hernias more common in females?
Wider hips = wider femoral canals.
65
What are the borders of the femoral triangle?
Superior: inguinal ligament Medial: adductor longus Lateral: sartorius
66
Where is an inguinal hernia located relative to the pubic tubercle (PT)?
Above and medial.
67
Where is a femoral hernia located relative to the PT?
Below and lateral.
68
Which fascia forms the deep inguinal ring?
Transversalis fascia.
69
Which fascia forms the superficial inguinal ring?
External oblique aponeurosis.
70
What is the conjoint tendon?
Fusion of internal oblique and transversus abdominis tendons.
71
What muscle creates the cremasteric reflex?
Cremaster muscle.
72
What condition results from fluid-filled tunica vaginalis?
Hydrocele.
73
What is the clinical importance of the pampiniform plexus?
Can become varicose → varicocele.
74
What artery supplies both the testis and epididymis?
Testicular artery.
75
Where do indirect hernias pass in relation to the inferior epigastric vessels?
Lateral.
76
Where do direct hernias pass in relation to the inferior epigastric vessels?
Medial (through the inguinal triangle).
77
What is the processus vaginalis a remnant of in adults?
Embryonic peritoneum extension.
78
Which nerve is sensory in the inguinal region and also travels through the canal?
Ilioinguinal nerve.
79
What tissue is found deep to the skin and superficial fascia in the inguinal region?
External oblique aponeurosis.
80
What fascia lines the abdominal cavity and is involved in hernia formation?
Transversalis fascia.
81
What creates the obliquity of the inguinal canal?
The offset between the deep and superficial inguinal rings.
82
Which hernia type commonly enters the scrotum?
Indirect inguinal hernia.
83
What can an untreated femoral hernia lead to?
Strangulation due to narrow canal.
84
What is a typical presentation of a strangulated hernia?
Painful, irreducible lump with signs of bowel obstruction.
85
What happens to the testis during cold exposure?
Cremaster contracts and pulls it upwards.
86
What is the tunica vaginalis?
A peritoneal sac surrounding the testis.
87
how can you tell the difference between an inguinal and femoral hernia?
👉 If it's above and medial to the pubic tubercle → think inguinal 👉 If it's below and lateral to the pubic tubercle → think femoral
88
What is the inguinal region?
The lower part of the anterolateral abdominal wall, serving as a passageway for structures entering or leaving the abdominal cavity.
89
What landmarks define the inguinal region?
Superior to the thigh, lateral to the pubic tubercle, inferomedial to the ASIS.
90
What forms the inguinal ligament?
The inferior border of the external oblique aponeurosis.
91
Where does the inguinal ligament run?
From the ASIS to the pubic tubercle.
92
What reinforces the inguinal ligament medially?
The lacunar ligament and pectineal ligament.
93
What does the lacunar ligament attach to?
The superior pubic ramus.
94
What is the subinguinal space and what passes through it?
A space below the inguinal ligament; it transmits psoas major, iliacus, femoral nerve, artery, vein, and lateral cutaneous nerve of the thigh.
95
What is the inguinal canal?
A passage running inferomedially through the anterolateral abdominal wall.
96
What causes the formation of the inguinal canal in males?
Descent of the testes during development, guided by the gubernaculum.
97
What is the processus vaginalis?
A peritoneal outpouching that pulls abdominal wall layers into the scrotum during testis descent.
98
What enters the inguinal canal in males?
Ilioinguinal nerve and spermatic cord (which includes the genital branch of the genitofemoral nerve).
99
where does the inguinal canal start?
the deep inguinal ring, which is an opening in the transversalis fascia and is located at the midpoint of the inguinal ligament, just lateral to the inferior epigastric vessels.
100
where does the inguinal canal end?
The inguinal canal ends at the superficial inguinal ring, which is an opening in the external oblique aponeurosis.
101
What does the inguinal canal contain in females?
Ilioinguinal nerve, genital branch of the genitofemoral nerve, and round ligament of the uterus.
102
Where is the deep inguinal ring located?
In the transversalis fascia, lateral to the inferior epigastric vessels.
103
What forms the superficial inguinal ring?
An opening in the external oblique aponeurosis.
104
Which structure enters the inguinal canal distal to the deep ring?
The ilioinguinal nerve.
105
what is the conjoint tendon?
* Union of the transversus abdominis and internal oblique aponeuroses. ## Footnote The anterior wall is made up of the external oblique aponeurosis, while the posterior wall is formed by the transversalis fascia, and is reinforced medially by the conjoint tendon, which is the union of the transversus abdominis and internal oblique aponeuroses.
106
What forms the anterior wall of the inguinal canal?
The external oblique aponeurosis.
107
What forms the posterior wall?
Transversalis fascia, reinforced medially by the conjoint tendon.
108
What forms the roof of the canal?
Laterally: transversalis fascia; centrally: internal oblique + transversus abdominis; medially: medial crus of external oblique.
109
What forms the floor of the canal?
The inguinal ligament and medially the lacunar ligament. ## Footnote consists primarily of the gutter formed by the inguinal ligament, and is supported medially by the lacunar ligament.
110
What are the 3 fascial layers of the spermatic cord (deep to superficial)?
Internal spermatic fascia, cremasteric fascia, external spermatic fascia.
111
Where is the internal spermatic fascia derived from?
Transversalis fascia.
112
Where is the cremasteric fascia derived from?
Internal oblique muscle.
113
Where is the external spermatic fascia derived from?
External oblique aponeurosis.
114
What are the 3 arteries in the spermatic cord?
Testicular artery, artery to vas deferens, cremasteric artery.
115
What are the 3 other structures in the spermatic cord?
Pampiniform plexus, vas deferens, testicular lymphatic vessels.
116
What is the tunica vaginalis?
A serous membrane covering the testis, derived from the processus vaginalis.

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