Inguinal

How does the development of the inguinal canal differ in females from males?

In females, the lower gubernaculum becomes the round ligament of the uterus and the upper gubernaculum becomes the suspensory ligament of the ovary

In males, the gubernaculum becomes the scrotal ligament.

In males the processes vaginalis becomes what

The tunica vaginalis

What is the tunica vaginalis

The serous sheath (friction free membrane -like covering) of the testis and epididymis

How does the inguinal region relate to the anterior abdominal wall in terms of muscle layers

The inguinal region is formed by contributions from the anterior abdominal wall muscles, including the external oblique, internal oblique, and transversus abdominis. These muscles help form the inguinal canal and provide structural support.

Name some ligaments that are associated with the inguinal region

Inguinal ligament (of Poupart)

Lacunar ligament

Pectineal ligament

Reflected inguinal ligament

Where does the Inguinal ligament (of Poupart) attach to

Anterior Superior Iliac Spine (ASIS)

Pubic tubercle

What is the Inguinal ligament (of Poupart) formed from

The fibrous, thickened, folded margin (inferior edge) of the external oblique aponeurosis

What part of the inguinal canal is formed by the Inguinal ligament (of Poupart)

Forms the floor of the inguinal canal

What are the boundaries of the inguinal canal

It starts deep and ends superficially

Name the 2 openings in the inguinal canal that mark it’s 2 ends

Superficial Inguinal Ring (or external inguinal ring)

Deep Inguinal Ring (or internal inguinal ring)

Where is the Superficial Inguinal Ring

Opens in the external oblique aponeurosis

• superolateral to the pubic tubercle

• medial to the inferior epigastric vessels (artery & vein)

It is the external opening of the inguinal canal

Where is the Deep Inguinal Ring

Opens in the transversalis fascia

• ½ way along the inguinal ligament

• lateral to the inferior epigastric vessels (artery & vein)

It is the internal opening of the inguinal canal

The inguinal canal passes in what direction

obliquely and inferomedially

How long is the inguinal canal

4cm

Contents of the inguinal canal in males & females

Role of spermatic cord

Suspends the testis in the scrotum

Contains the structures that run to and from the testis.

Where does the spermatic cord start, emerge from the inguinal canal & end

Start: Deep inguinal ring

Emerge from canal: Superficial inguinal ring

End: Scrotum

What layers does the scrotum invaginate through

What layers of the abdomen change their name when they are evaginated through by the scrotum

Scarpa's fascia becomes Dartos fascia

Internal abdominal oblique muscle becomes Cremaster muscle

What is the external spermatic fascia derived from

Investing fascia of external oblique

What is the Cremaster fascia and muscle derived from

the investing fascia of internal oblique muscle

Structure of the cremaster muscle = smooth/striated

striated

Innervation of the cremaster muscle

Genital branch of the genitofemoral nerve to elevate the testis (GSE)

What is the Internal spermatic fascia derived from

Transversalis fascia

Spermatic Cord: Contents

Cremasteric artery (and vein)

Remnant of obliterated processus vaginalis

Pampiniform plexus of veins

Genital branch of genitofemoral nerve (GSE)

In the pampiniform plexus of veins what does the right & the left drain into

Right drains to IVC

Left drains to Left renal vein

Describe the scrotum

The scrotum is part of the male external genitalia.

It is a cutaneous (skin), muscular sac with a variable (wrinkled) appearance

How does a scrotum have a wrinkled appearance (Rugose)

due to smooth muscle fibres known as Dartos muscle that are extremely thin and insert onto the skin

The dartos muscle is continuous with what fascia

Scarpa’s fasci (& Colle’s fascia in the perineum)

How does the scrotum protect the testes

by passively raising them towards the trunk

Possible problem that can happen with the scrotum

penoscrotodynia (chronic pain or discomfort in the penis and scrotum)(dynia = pain)

A female equivalent of the Dartos muscle may be present in females.

Where is it & what purpose does it serve

In the Labia majora

Play a functionally sexual role

(Vulvodynia may involve this layer of muscle)

Describe the testes

The testis is a firm yet mobile (paired) organ suspended within the scrotum (by the spermatic cord)

How are the testes anchored into place

Each is anchored inferiorly by the scrotal ligament.

The testes are paired ovoid reproductive glands that produce what

Sperm

Male hormones

Testes average length

5cm

At what temperature is functionality optimal in testes

Function optimally below body temperature

What is a hernia

A hernia is when part of an organ is displaced and protrudes through the wall of the cavity containing it, often involving the intestine at a weak point in the abdominal wall.

What hernia is associated with what colour dot

what type of hernia is that

umbilical hernia

What type of hernia is more common in females that males

Femoral hernia

How to differentiate between indirect & direct inguinal hernias

Where does an inguinal hernia emerge

Emerges from superficial inguinal ring

Where is Hesselbach’s inguinal triangle (between what folds)

located between the medial and lateral peritoneal (umbilical) folds

Why does herniation sometimes occur in Hesselbach’s Triangle

It is a weak area in the posterior wall of the inguinal canal

Border’s of Hesselbach’s Triangle

RIP

Direct inguinal hernia’s RIP through the triangle

Treatment for a hernia

hernioplasty or herniorrhaphy

surgical techniques that act to repair and reconstruct the posterior aspect of the anterior abdominal wall

What is the Cremasteric Muscle Reflex

The cremasteric muscle reflex causes rapid elevation of the testis

Elicited by stroking the skin of the ipsilateral thigh

What nerves are involved in the Cremasteric Muscle Reflex

What is Spermatic Cord Torsion

Testicular torsion or “twisting of the spermatic cord”

At what age is Spermatic Cord Torsion most common

can occur at any age although is most common during adolescence

What occurs in Spermatic Cord Torsion that causes a problem

The venous drainage of the testis becomes obstructed and consequently results in arterial ischemia, edema & hemorrhage

How can Spermatic Cord Torsion be tested for

using the cremasteric reflex

What are the layers under transversus abdominis from top to bottom

Transversus abdominis

Transversalis fascia

Parietal peritoneum

What are gonads

Organs that produce oocytes in females and sperm in males

Problem with testes not descending into the scrotum

The person is predisposed to testicular cancer

How many layers do the testis cut through to reach the scrotum

They don’t cut through any - they make an evagination in each wall which becomes the layers of the scrotum

What would cause the testes to raise

Fear

Outside temperature

Difference between an acquired hernia & a congenital hernia (how & where does it occurs)

Acquired

• develop over time due to factors such as heavy lifting

• pushes through the posterior wall of the inguinal canal

Congenital

• can be genetic or something like amniotic band syndrome - hand can be severed in utero

• moves through a patent (open) processus vaginalis

do both types of hernias (indirect & direct) come through the abdominal wall

yes