Inguinal Canal

Question 1

What makes up the deep inguinal ring? What passes through it?

Answer 1

Invagination of the peritoneum into transversalis fascia creates it

Contents - spermatic cord (males), round ligament (females), genital branch of genitofemoral n.

Question 2

What makes up the superficial inguinal ring? What passes through it?

Answer 2

Aponeurosis of the external oblique forms it

Contents - spermatic cord (males) round ligament (females) ilioinguinal n.

Question 3

What are the boundaries of the inguinal canal?

Answer 3

Posterior wall - transversalis fascia laterally, conjoin tendon medially
Anterior wall - internal oblique m. laterally, aponeurosis of external oblique medially
Roof - internal oblique and transversus abdominis m.’s

Question 4

How do the testes descend? (Where do they form, what are they connected to, what do they descend along)

Answer 4

Form around T10
Are connected to future scrotal area by gubernaculum
Descend along processus vaginalis into future scrotum, dragging nerves/vessels/abdominal wall layers with them

Question 5

How do the ovaries descend? (Where do they form, what are they connected to, what do they descend along)

Answer 5

Form around T10
Are connected to developing uterus by gubernaculum (forms ovarian ligament and round ligament)
Descend along processus vaginalis until they reach the area

Question 6

Which abdominal fascia/muscle layers make up which testicular layers?

Answer 6

transversalis fascia - makes internal spermatic fascia
internal oblique - makes cremasteric m.
external oblique - makes external spermatic fascia

Question 7

The inguinal canal is derived from what?

Answer 7

Made of transversalis fascia (deep ring) and aponeurosis of external oblique (superficial ring)

Question 8

The tunica vaginalis is derived from what?

Answer 8

Peritoneum

Question 9

What are the contents of the spermatic cord?

Answer 9

3 arteries - artery to vas deferens, testicular a., cremasteric a.
3 fascia layers - external spermatic, cremasteric, internal spermatic fascia
3 other structures - pampiniform plexus, vas deferens, testicular lymphatics
3 nerves - genital branch of genitofemoral n., ilioinguinal n., sympathetic and visceral afferent fibers

Question 10

What is the lacunar ligament connected to?

Answer 10

The ligament between the pubic rami and inguinal ligament, anchors inguinal ligament to pubis

Question 11

What is the pectineal ligament connected to?

Answer 11

It’s the continuation of fibers from lacunar ligament running along pectin pubis

Question 12

What is a testicular varicocele?

Answer 12

It’s swelling in the scrotum caused by varicosities of the pampiniform plexus, causes dull and recurring pain

Question 13

What is a persistent processus vaginalis? What can it cause?

Answer 13

A connection remains tunica vaginalis (testicles) and abdomen - can lead to a hydrocele, where peritoneal fluid accumulates in tunica vaginalis
Can be communicating or non-communicating
More common in babies, but can happen in adults that injure the area

Question 14

How do you detect a hydrocele?

Answer 14

Aside from obvious scrotal swelling, using trans-illumination

Question 15

Which LN’s would infection in scrotum spread to?

Answer 15

to the superficial inguinal LN’s, then to iliac and lumbar LN’s

Question 16

Which LN’s would infection in testes spread to?

Answer 16

To lumbar and pre-aortic LN’s

Question 17

What are the boundaries of Hasselbach’s triangle?

Answer 17

inguinal ligament (inferior)
lateral border of rectus abdominis (medial)
lateral umbilical ligament (superior) - though google says inferior epigastric vessels
Iliopubic tract - reinforces floor of inguinal canal

Question 18

Where does a direct hernia usually occur? What is it caused by?

Answer 18

Usually occurs medial to inferior epigastric a., in the peritoneum/transversalis fascia alongside spermatic cord

Usually caused when the wall of the abdominal m. becomes weak

Question 19

Where does an indirect hernia usually occur? What is it caused by?

Answer 19

Occurs when viscera/peritoneum enters deep ring of inguinal canal
Usually caused by birth defect

Question 20

Where does a femoral hernia usually occur? What is it caused by?

Answer 20

Happens below the inguinal ligament

Caused by weakness in abdominal wall, more common in females

Question 21

What folds/ligaments are present on posterior aspect of anterior abdominal wall? (3)

Answer 21

median fold
medial fold
lateral fold

Question 22

What is the median fold?

Answer 22

A remnant of the urachus

Question 23

What is the medial fold?

Answer 23

Remnant of distal-most portion of umbilical a.’s

Question 24

What is the lateral fold?

Answer 24

Fold due to inferior epigastric arteries and veins

Question 25

What are cryptorchid testis?

Answer 25

Where one or both testicles fail to descend from the abdomen into the scrotum. Needs to be surgically corrected or else can cause infertility, increases risk of cancer.

Question 26

How is a hematocele different than a hydrocele?

Answer 26

Its a collection of blood in tunica vaginalis. Usually caused by trauma, or a complication of surgery. Transillumination will show non-translucent fluid (as opposed to hydrocele which is clear)

Question 27

What are common sites for abdominal hernias? (6)

Answer 27

ventral - umbilical, epigastric, spigelian (along semilunar line)
groin - inguinal, femoral
flank - lumbar