Anatomy of the inguinal canal (part 2)

what is the inguinal ligament formed from

thickening of the inferior free border of the external oblique muscle

where does the inguinal ligament attach laterally

ASIS

where does the inguinal ligament attach medially

pubic tubercle

what is the lacunar ligament

increases medial attachment point of the inguinal ligament formed greater stability

where does the lacunar ligament come from

extension of external oblique aponeurosis

what is the inguinal canal

an oblique passageway through the anterior abdominal wall, connecting the abdominal cavity to the external genitalia

how long is the inguinal canal

4cm

where does the inguinal canal course

parallel and superior tot he inguinal ligament formed greater from the deep inguinal ring to the superficial inguinal ring

what is the superficial inguinal ring

an aperture in the external oblique aponeurosis

exit point of the inguinal canal

where is the superficial inguinal ring located

1cm supero-lateral to the pubic tubercle

what are the layers which are involved in the inguinal canal

external oblique aponeurosis

internal oblique aponeurosis/muscle

conjoint tendon

transversalis fascia

what is the conjoint tendon

aponeurosis of both internal oblique and transversus abdominis

what is the deep inguinal ring

aperture in the external oblique aponeurosis

entry point of the inguinal canal

what is the deep inguinal ring the midpoint between

between the attachments of the inguinal ligament

what does the deep inguinal ring lie lateral to

inferior epigastric vessels

what is the anterior wall of the inguinal canal

external oblique aponeurosis

internal oblique aponeurosis/muscle - reinforces lateral 1/3

what is the roof of the inguinal canal

transversalis fascia

arching fibres of transversus abdominis and internal oblique aponeurosis (conjoint tendon)

external oblique aponeurosis

all layers of the abdominal wall contribute to the roof of the inguinal canal

what is the posterior abdominal wall of the inguinal canal

internal oblique aponeurosis - medial 1/3

conjoint tendon - medial 1/3

transversalis fascia - lateral 2/3

what is the floor of the inguinal canal

inguinal ligament

iliopubic tract - laterally

lacunar ligament - medially

what are the contents of the female inguinal canal

round ligament of uterus

genital branches of the genitofemoral nerve

ilioinguinal nerve

blood vessels and lymphatics

what is the round ligament

forms lateral border of uterus to labia majora

where does the genital branch of the genitofemoral nerve course

enters at deep inguinal ring and exits at superficial inguinal ring

what is the innervation of the genital branch of the genitofemoral nerve

sensory only to the skin around pubis area and the labia majora

where does the ilioinguinal nerve course

within abdominal wall muscles

where does the ilioinguinal nerve pierce

internal oblique aponeurosis to enter inguinal canal - it does not enter at the deep inguinal ring

where does the ilioinguinal nerve enter

pierces the internal oblique aponeurosis

where does the ilioinguinal nerve exit

superficial inguinal ring

what is the innervation of the ilioinguinal nerve

motor and sensory for external genitalia and proximity medial thigh

what are the contents of the inguinal canal in the male

spermatic cord

ilioinguinal nerve

what does the spermatic cord require

requires larger aperture

what are the contents of the spermatic cord

ductus deferens

genital branch of genitofemoral nerve

blood vessels

where does the ductus deferens run and what will it connect with

runs through inguinal canal in the spermatic cord and connect with urethra in the pelvic cavity

what is the function og the genital branch of genitofemoral nerve in males

motor and sensory, it will cause the testes to lift higher for temperature control

what is an inguinal hernia

the protrusion of an abdominal organ through the peritoneal wall which is usually a loop of small intestines

why is an inguinal hernia more likely to occur in men

due to having a larger superficial inguinal ring to accomodate for the spermatic cord - the larger it is then there will be a greater point of weakness

what % of inguinal hernias will occur in males

85%

what is a direct hernia

it will occur later in life

where does a direct hernia travel through

only through the superficial inguinal ring

what is the origin of a direct hernia

medial to inferior epigastric vessels through posterior abdominal wall through superficial inguinal ring

what is an indirect hernia

born with it

where does an indirect hernia travel

though both the deep and superficial inguinal ring

how can an indirect hernia end up in the scrotum

because it enters through deep inguinal ring it is within spermatic cord and can end up in the scrotum

what is the origin of the indirect hernia

lateral to inferior epigastric vessels

what is the cause of an indirect hernia

caused by the processus vaginalis not fully closing in development, usually the processus vaginalis would get smaller and become deep inguinal ring, if this fails to occur then there is a larger aperture

what is strangulation

when the blood supply has been cut off

what type of hernia is strangulation more likely

indirect

what is the visible presentation of an inguinal hernia

visual protrusion superior and medial to pubic tubercle

when might an inguinal hernia enlarge

exertion of anterolateral abdominal wall or an increase in pressure such as coughing

what is the treatment of an inguinal hernia

surgically, hernia mesh is placed over the weakened aperture

A patient presents with an inguinal hernia.

Concerning the inguinal canal, the inguinal ligament forms which of the following?

floor

The anterior wall of the rectus sheath is formed by an aponeuroses of which muscles?

external oblique and part of the internal oblique