Lecture 1 - Inguinal

Question 1

Layers of the abdominal wall

Answer 1

1) skin 2) Superficial fascia (campers fascia, scarpas fascia) 3) External oblique 4) Internal oblique 5) transversus abdominus 6) transversalis fascia 7) extraperitoneal layer 8) parietal peritoneum

Question 2

3 Layers of Scarpa’s fascia

Answer 2

1) scarpa’s fascia 2) Darto’s fascia (penis and scrotum) 3) Colle’s fascia (perineum region aka “gooch”)

Question 3

What 3 layers does the spermatocord pick up on the way through the inguinal canal?

Answer 3

Internal spermatic fascia - from the transversalis fascia in the deep inguinal ring
Cremasteric fascia - from the internal oblique
External spermatic fascia - from the external oblique

Question 4

How is the inguinal ligament created?

Answer 4

It is just folded over external oblique. The non folded over part will make the inguinal canal. The internal oblique then attaches to the lateral 2/3s of it.

Question 5

Falx Inguinalis

Answer 5

lower arching free edge of the internal oblique attaches to the inguinal ligament at the lateral 2/3. At the medial 1/3 it does not attach, so a hole is made. The internal oblique at this point is termed the falx inguinalis

Question 6

Conjoint Tendon

Answer 6

aponurosis of the IO and transversis abdomen fuse here. Continuation of falx inguinalis.

Question 7

Thermoregulation of the testis

Answer 7

1) Countercurrent mechanism with the pampiniform plexus and testicular artery
2) Cremaster muscle - skeletal muscle that is responsible for pulling up on the testis
3) Dartos muscle - smooth muscle responsible for pulling up the scrotum to make less surface area

Question 8

What layers are the deep and superficial inguinal rings in

Answer 8

Deep - transversalis fascia - picks up internal spermatic fascia here
Superficial - external oblique - picks up external spermatic fascia here

Question 9

Direct vs. Indirect inguinal hernias

Answer 9

Indirect - follows the path already made through the inguinal canal. It goes in the deep inguinal ring and out the superficial ring. Will have all 3 layers of fascia covering it.
Direct - Makes a whole elsewhere and then comes out of the superficial inguinal ring. Will only have 1 layer of fascia covering it. Usually the whole is made in an area called “Hasselbach’s Triangle” - lateral border is inferior epigastric artery, medial is rectus abdominus, and inferiorly is the inguinal canal.

Question 10

2 ways to tell what kind of hernia patient has?

Answer 10

1) You put your finger up and feel for a pulse. The inferior epigastric artery is the landmark. If the pulse of this artery is felt on the lateral side of your finger then it is a direct inguinal hernia, if the pulse is felt on the medial side of your finger then it is an indirect inguinal hernia.
2) Palpation - First you put your finger up the superficial inguinal ring and ask the patient to cough. If you feel the bowel on top of your finger then you know there is a hernia. You then leave your finger there and cover up the deep inguinal ring. If it is an indirect hernia, this will stop the bowel from hitting your finger, if it is direct then it will have no impact.

Question 11

Tunica Vaginalis

Answer 11

Double layer of fascia that covers the testis. Prior to the descent of the testis the processes vaginalis descends from the peritoneum down through the inguinal canal. After this, the proximal part fuses and dissapears while the other part remains - this is the tunica vaginalis.

Question 12

Persistent Processus Vaginalis

Hydrocele of the Spermatic Cord

Answer 12

PPV - When there is not a fusion of the processus vaginalis it will cause an increased liklihood of congenital hernias.
HSC - Partial fusion of proximal portion, which creates a fluid-filled cyst.

Question 13

Male vs. Female

Answer 13

Gonads: M - Testis F - Ovaries
Caudal Genital Ligament: M - Gubernaculum F - Round Ligament
Gonadal Artery: M - In spermatic cord F - In suspensory ligament
Labioscrotal fold: M - Scrotum F - Labia Majora

Question 14

Region of the abdomen

Answer 14

epigastric, umbilical, hypogastric

R and L hypochondrium, R and L lumbar, R and L inguinal

R and L midclavicular line
subcostal line (L3) and intertubercular line (L5)

Question 15

what are the contents of the spermatocord?

Answer 15

Vas defrens, testicular artery, genital branch of genitofemoral nerve, ilioinguinal (runs outside of spermatocord but inside of canal), lymphatics, tunica vaginalis

Question 16

What innervates tthe cremaster muscle?

Answer 16

genital branch of the geenitofemoral nerve. It is skeletal muscle.

Question 17

The dartos muscle is sympathetic or parasymathetic?

Answer 17

Sympathetic fibers of the genital branch of the genitofemoral nerve