Inguinal Regions And Hernias

Question 1

What is hernia in the abdominal wall?

Answer 1

It is a protrusion in the abdominal wall due to weakness anterior abdominal muscle

Question 2

List some of the most common hernias.

Answer 2

Inguinal
Umbilical
Femoral

Question 3

List hernias which could be caused by chronic cough, vomiting, constipation etc.

Answer 3

Epigastric

Spegelian

Question 4

From which root level do gonads descend from?

Answer 4

Posterior walls L2

Question 5

What is the position of inguinal hernia in relation to inguinal ligament and the pubic tubercle?

Answer 5

Superior to inguinal ligament

Medial to pubic tubercle

Question 6

What is the position of femoral hernia in relation to inguinal ligament and the pubic tubercle?

Answer 6

Inferior to inguinal ligament

Lateral to pubic tubercle

Question 7

What features are available in inguinal canal which prevent prolapse of abdominal viscera?

Answer 7

Inguinal canal has tight staggered opening in each layer

Also it runs obliquely, so difficult for viscera to enter the canal

Question 8

How is inguinal ligament formed?

Answer 8

It is formed by the inferior portion of external oblique muscle aponeurosis which infold to create a thick fibrous band

Question 9

What are the attachments of inguinal ligament?

Answer 9

From anterior superior illiac spine to the pubic tubercle

Question 10

What kind of opening does external inguinal ring has?

Answer 10

Slit like opening

Question 11

What is the name of the lateral and medial margins of the opening of external inguinal righ?

Answer 11

Crura

Question 12

What is the insertion of lateral crus of external inguinal ring?

Answer 12

Pubic tubercle

Question 13

What is the insertion of medial crura in external inguinal ring?

Answer 13

Pubic crest

Question 14

Intercrural fibre

Answer 14

Fibres which arise from inguinal ligament lateral to the external inguinal ring, arch superiolaterally

Question 15

What is the function of Intercrural fibres?

Answer 15

Helps prevent the crura from expanding

Question 16

What is the length of the inguinal canal?

Answer 16

Approximate 4cm

Question 17

In terms of its position, what is the relationship between inguinal ligament and inguinal canal?

Answer 17

The canal lies parallel and 2 to 4 cm superior to the medial half of the inguinal canal

Question 18

What is the position of deep inguinal ring?

Answer 18

Deep inguinal ring lies 1.25cm superior to the middle of the inguinal ligament and lateral to the inferior epigastric artery (which branch from external illiac artery)

Question 19

T/F transversalis fascia is the very first evagination to make the opening of deep inguinal ring

Answer 19

True

Question 20

Does transversalis fascia continue into the inguinal canal?

Answer 20

Yes, it continues into the canal forming interal fascia of the structure

Question 21

How is conjoint tendon formed?

Answer 21

By arching of transversus abdimjnis and internal oblique muscle which join together

Question 22

How are cremaster muscle and fascia formed?

Answer 22

It is formed when arched internal oblique muscle slips some of it muscle to the inguinal ring

Question 23

What are the insertion of conjoint tendon?

Answer 23

It inserts medially to linea alba and lateral border is free

It also inserts to the pectineal ligament along the superior ramps of the pubis

Question 24

What is gubercnaculum?

Answer 24

It is a fibrous cord which is used to guide testis into scrotum from posterior abdominal wall

Question 25

What is the fate of gubernaculum?

Answer 25

The proximal portion of gubernaculum disintegrates as gonads descends to form scrotum A small amount of gubernaculum remains after gonads reaches scrotum. This is called scrotal ligament and it attaches testis to the scrotal wall.

Question 26

T/F as gonads move from posterior abdominal wall, it creates a whole in anteriolateral abdominal wall?

Answer 26

False, gonads evaginate to create finger like processes, taking sleeves of the wall with it as it moves.

Question 27

Describe the state of each layer of anteriolateral abdominal wall as gonads make its way to the scrotum?

Answer 27

Firstly, an indentation is made in transversalis fascia (this fascia goes into the canal). Secondly, gonads pass under transversus abdiminis muscle. Thirdly, gonads pass under internal oblique muscle but it slips some of its muscle into the canal to form cremaster muscle and cremaster fascia. Lastly, gonads sleeve external oblique muscle and makes its way to the scrotum

Question 28

Name all the layers of spermatic cord? Superficial to deep

Answer 28

External spermatic fascia Cremaster muscle Cremaster fascia Internal spermatic fascia

Question 29

What is processus veginalis?

Answer 29

It is protrusion parietal peritoneum which moves along behind with gonads

Question 30

What is tunica veginalis?

Answer 30

When terminal portion of processus vaginalis bud off, it isolates a bit of parietal peritoneum called tunica vaginalis which cushions the testis. Note: cough test can detect attached processus vaginalis after birth

Question 31

What are the constituents of spermatic cord?

Answer 31

Ductus (vas) deferens Testicular artery The panini form plexus of veins Lymph vessels Sympathetic fibres of the arteries and both symp and parasymp fibres of ductus deferens Genital branch of genitofemoral nerve into spermatic cord supplying cremaster muscle

Question 32

Why do testis need to travel to scrum? Why can't it just stay in posterior abdominal wall?

Answer 32

For effective production and survival of sperms, it needs cooler environment and scrotum provides that environment

Question 33

How does scrotum gets close the the body to increase its internal temperature?

Answer 33

This action is mediated by cremaster muscle of the spermatic cord

Question 34

State what are in the medial, lateral and inferior border of the inguinal triangle?

Answer 34

Medial: lateral margin of rectus abdominis, linea semilunaris Lateral: inferior epigastric vessels Inferior: inguinal ligament

Question 35

Why does the upper half wall of inguinal triangle stronger the lower half?

Answer 35

The upper half is made of conjoint tendon whereas the lower half wall consist of inguinal ring only and no external oblique muscle thus weak

Question 36

What is direct inguinal hernia?

Answer 36

It is a protrusion of through the lower half of the inguinal triangle

Question 37

What are the body's measure to prevent herniation in inguinal triangle?

Answer 37

Conjoint tendon pulls itself like a shutter as it contracts preventing abdominal viscera to protrude any weak wall Also, obliquity of the inguinal canal prevents any easy access for abdominal viscera

Question 38

Since L1 supplies inguinal regions of the body, what could be the implication if there is any damage to L1 vertebra?

Answer 38

It may lead to direct herniation of the inguinal triangle

Question 39

What is indirect inguinal hernia?

Answer 39

It is a hernia when perietal peritoneum of the abdomen protrudes through the deep inguinal ring, travel the length of inguinal canal and exit where the wall is weaker ie the external inguinal ring