Inguinal Region

Question 1

Inguinal Ligament

Answer 1

• the inferior margin of the aponeruosis of the external oblique that extends from the ASIS to the pubic tubercle and is folded under itself creating a thickening

Question 2

Pubic Tubercle

Answer 2

• a rounded elevation on the superior ramus of the pubic
• serves as a site of attachment for the inguinal ligament

Question 3

Inguinal Canal

Answer 3

• a canal through the abdominal wall where the testis travels from the posterior abdominal wall into the scrotum
• extends from the Deep (internal) Inguinal Ring to the Superficial (external) Inguinal Ring

Question 4

Boundaries of the Inguinal Canal

Answer 4

Inferior Aspect - portion of the inguinal ligament

Superior Aspect - arching fibers of the internal oblique and the transversus abdonimus

Anterior Wall - external oblique aponeurosis

Posterior Wall - Transversalis Fascia and conjoint tendon

Question 5

Deep Inguinal Ring

Answer 5

• internal opening of the inguinal canal
• through the transversalis fascia

Question 6

Superficial Inguinal Ring

Answer 6

• external opening of the inguinal canal
• through the apononurosis of the external oblique

Question 7

Inside the Inguinal Canal

Answer 7

Males - spermatic cord

Females - round ligament

Question 8

Spermatic Cord

Answer 8

• results from the descent of the testis into the scrotum
• during descent, testic brings its blood supply, nerves, lymphatics, and vas deferens

Question 9

Fascial Coverings of the Spermatic Cord

Answer 9

• due to the abdominal wall being “pushed” out during the descent of the testis

External Spermatic Fascia - External Oblique

Cremasteric Muscle and Fascia - Internal Oblique

Internal Spermatic Fascia - Transversalis Fascia

Question 10

Sructures within the Spermatic Cord

Answer 10

• Vas Deferens
• Testicular Artery
• Artery of the Vas
• Pampiniform Plexus of Veins
• Processus Vaginalis (obliterated peritoneum)
• Nerves
• Lymphatics

Question 11

Purpose of Pampiniform Plexus

Answer 11

• plexus of veins surrounding the testicular artery
• important counter-current thermo-regulatory function
• absorbs some of the heat from the artery so it does not go to the testes

Question 12

Hernias

Answer 12

• protrusions of structure through tissues that normally contain them

Question 13

Direct Inguinal Hernia

Answer 13

• protrude through the inguinal triangle (Hesselbach’s Triangle)

(medial to the inferior epigastric vessels)

Question 14

Indirect Inguinal Hernias

Answer 14

-pass through internal (deep) inguinal ring and thus reside in the spermatic cord coverings

(lateral to the inferior epigastric vessels)

Question 15

Tour de Testis

Answer 15

1. Transversalis Fascia → Internal Spermatic Fascia
2. Internal Oblique → Cremasteric Musle
3. External Oblique → External Spermatic Fascia

Question 16

Abdominal Wall Layers

Answer 16

(From External to Internal)

Skin → Camper’s Fascia → Scarpa’s Fascia → External Oblique → Internal Oblique → Transversus Abdominus → Transversalis Fascia → Peritoneum

Question 17

Borders of the Inguinal Triangle

Answer 17

Medial - Rectus Abdominus (semilunar line)

Lateral - Inferior Epigastric Vessels

Inferiorly - Inguinal Ligament

Question 18

Inferior Epigastric Vessels

(course)

Answer 18

• travel along the posterior aspect of the rectus abdominus
• penetrate the transversalis fascia inferior to the arcuate line

Question 19

Gonads

Answer 19

Male - testes

Female - ovaries

Question 20

Development of Gonads

(location)

Answer 20

• near posterior abdominal wall

Question 21

Testicular Arteris

Answer 21

• arise directly from the aorta in the superior portion of the abdoinal cavity (near embryonic origin of testes)
• are “dragged” into the scrotum as the testes descend

Question 22

Testicular Descent

• relationship to peritoneal cavity

Answer 22

• testes descend posterior to the periotoneal cavity

Question 23

Processus Vaginalis

Answer 23

• an outpouching of the peritoneal cavity

(inferiour portion)

• proximal portion of the tunica vaginalis obliterates
• distal portion becomes the tunica vaginalis

Question 24

Tunica Vaginalis

Answer 24

• distal portion of the tunica vaginalis that partially invaginates the testes during their descent
• cover the anterior portion of the testes

Question 25

**Layers of the Tunica Vaginalis**

Answer 25

Posterior layer - visceral tunica vaginalis Anterior layer - parietal tunica vaginalis - usually some fluid between the layers

Question 26

**Thermoregulation of Testes**

Answer 26

**Pampiniform Plexus** - takes heat from testicular artery **Cremasteric Skeletal Muscle** (in spermatic cord) and **Dartos Fascia Smooth Muscle** (in scrotum) - contract or relax to control the distance of the testes from the inguinal region to regulate temperature

Question 27

**Tunica Albuginea**

Answer 27

- thick fibrous layer surrounding the testis in the scrotum - lies directly below the visceral layer of the tunica vaginalis (on the anterior side)

Question 28

**Testis**

Answer 28

- ovoid organ that is the site of spermatozoa production and male hormones (i.e. testosterone)

Question 29

**Tour de Sperm**

Answer 29

Testis → Seminiferous Tubules → Straight Tubules → Rete Testis → Efferent Ductules → Convoluted Epididymis → Vas Deferens

Question 30

**Lymphatic Drainage of the Tested**

Answer 30

- to the para-aortic nodes | (i.e. origin of testes)

Question 31

**Lymphatic Drainage of the Scrotal Skin**

Answer 31

- to the superficial inguinal nodes

Question 32

**Hydrocele**

Answer 32

- abdnormal accumulation of fluid between the parietal and visceral layers of the tunica vaginalis

Question 33

**Greater Omentum**

Answer 33

- fatty fold of peritoneum that drapes inferiorly from the greater curvature of the stomach and lies anterior to the transverse colon and much of the small intenstines

Question 34

**Attachment of Small Intestine**

Answer 34

- attached to the posterior abdominal wall by mesentery - a double layer of visceral peritoneum (allows for mobility)