Anatomy of the Inguinal region
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| The ________ is a 3-5 oblique passageway occuring in the inquinal region of the anterior body wall | Inguinal canal
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| How is the inguinal canal formed? | During fetal development the gonads (testes or ovaries) descend from the posterior abdominal wall through the inquinal canal (males-->scrotum; females-->round ligament of the uterus)
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| The spermatic cord contains vasculature and the ________ which transverse the inguinal canal and connect the testes to structures within the pelvis | spermatic cord
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| Describe the descent of the testes: initial location and position | Start in upper lumbar region (posterior abdominal wall); covered with a peritoneum (hence retroperitoneal)
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| * Describe the descent of the testes: role of the gubernaculum | ligamentous cord condenses along the posterior abdominal wall; connect the inferior surface of each testis to the bottom of the scrotum; growth of embryo causes it to shorten-->testes pulled inferiorly-->forms processus vaginalis (by peritoneum)
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| The __________ forms immediately anterior to the gubernaculum and precedes the testis as it moves toward the scrotum | processus vaginalis
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| What structures does the processus vaginalis push through? | Transversalis fascia, internal oblique muscle, and external oblique muscle; together invest layers through the inquinal canal
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| The opening by the processus vaginalis in the trasversalis fascia becomes the ___ | deep inguinal ring
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| The opening in the aponeurosis of the external abdominal oblique becomes the ___ | superficial inguinal ring
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| In the male the transversalis fascia, the internal oblique muscle and the external oblique muscle contribue layers to form the ________ | coverings of the spermatic cord and testes
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| Describe the formation of the two layers of the tunica vaginalis | The testis embeds itself into the processus vaginalis and thus obtains two layers of peritoneum, the visceral and the parietal layers of the tunic vaginalis
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| What is the ultimate fate of the processus vaginalis? | It is obliterated shortly after birth leaving only the tunica vaginalis
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| What is the ultimate fate of the gubernaculum? what is its function | Remains in the adult male as the scrotal ligament (secures testis to the most inferior portion of the scrotum)
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| What is the condition where a testis remains in the pelvic cavity or the inguinal canal? | Cryptochidism ("hidden testis" Gr.)
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| How many concentric layers of fascia cover the spermatic cord? What are they? Where are they derived from? | 3; internal spermatic fascia (from trasnversalis fascia), cremasteric muscle and fascia (from internal abdominal oblique), and the external spermatic fascia (external abdominal oblique)
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| What is the internal spermatic fascia? | It is the filmy innermost covering of the spermatic cord; forms as the processus vaginalis evaginates the transversalis fascia
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| What is the cremasteric muscle and fascia? What does it do? | middle covering of the spermatic cord which contains loops of cremaster muscle; skeletal muscles that raise the testis (in cold or due to stroking of inner thighs)
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| What is the external spermatic fascia? | Thin outermost covering of the spermatic cord, formed from the external oblique aponeurosis; attached superior to the crura of the superficial inguinal ring; continous with the fascia of the external abdominal oblique muscle
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| Describe the descent of the ovaries | Start in upper lumbar region, covered in peritoneum, gubernaculum (at 7 weeks) condenses along posterior abdominal wall and connect inferior surface of ovary to labia majora; migrate to just below pelvic brim; doesn't pass inguinal canal
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| What is the ultimate fate of the gubernaculum in the female body? | Becomes incorporated into the wall of the uterus as the round ligament of the uterus and the ovary
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| The ________ passes through the inguinal canal and continues on to the labia majora | round ligament of the uterus
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| What are the boundaries of the inguinal canal: beginning and end | deep (internal) ring opening in the transversalis fascia, superficial (external) ring opening in the aponeurosis of the external oblique muscle
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| What are the boundaries of the inguinal canal: anterior wall | external abdominal oblique over entire length (aponeurosis of); internal abdominal oblique on lateral one-third
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| What are the boundaries of the inguinal canal: posterior wall | transversalis fascia over entire length, conjoint tendon on medial one-third, reflected inguinal ligament of the external abdominal oblique on medial one third
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| What are the boundaries of the inguinal canal: roof | arched fibers of the internal abdominal oblique muscle and trasnversus abdominis muscle
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| What are the boundaries of the inguinal canal: floor | inguinal ligament of the external abdominal oblique, lacunar ligament of the external abdominal oblique
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| What is a hernia? | The potrusion of tissue (e.g. internal organ) through an abnormal opening or a weakened anterior abdominal wall (often the inguinal canal)
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| What causes an indirect inguinal hernia? | when the processus vaginalis remains patent->internal oran passes through the deep inguinal ring
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| Where are indirect inguinal hernias located? How far can they extend? | Lateral to the inferior epigastric vessels; an internal organ may pass completely through the inguinal canal (i.e. through both deep and superficial inguinal rings) and lie in the scrotum
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| What is a direct inguinal hernia and how is it caused? | When internal organ pushes directly through the superficial inguinal ring without transversing the inguinal canal; occurs medial to the inferior epigastric vessels; lies in Hesselbach's triangle
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| What are the boundaries of Hesselbach's triangle? | inferiorly by the epigastric artery; laterally by rectus abdominis muscle and inguinal ligament
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| The direct inguinal hernia produces a bulge deep to the __________ tendon. | Conjoined
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| When abdominal contents put pressure on the ____ fascia (and ____ fascia and ____), an internal organ may transverse the posterior wall of the inguinal canal. | transversalis, subserous, peritoneum
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| True or false: in a direct inguinal hernia, the contents of the hernia will enter the inguinal canal along side the spermatic cord distal to the origin of the internal spermatic fascia | True
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| The contents of a direct inguinal hernia are located between ______ and the _______ fascia layer | internal spermatic; cremasteric
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| Where is the weakness associated with direct inguinal hernia? | posterior wall of the inguinal canal
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| Which type of hernia is more common in older men? | Direct inguinal hernia
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| What structure divides the scrotum into left and right halves? | Scrotal raphe
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| What layer lies immediately deep to the skin of the scrotum? | The superficial fascia
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| What muscle is continaed ithin the superficial fascia? What does it do? What innervates it? | The dartos muscle; causes the scrotum to wrinkle when cold; sympathetic nerve fibers
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| What two fascias of the abdomen is the superficial fascia of the scrotum continous with? | The membranous layer of the superficial fascia of the abdomen (Scarpa's fascia) and the perineum (Colle's fascia)
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| The superficial fascia forms an incomplete _______ that divides the scrotum into a right and left half. | Scrotal septum
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| What are the thee primary contents of the scrotum? | The testis, the epididymis, and the vas deferens or ductus referense (vas deferens)
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| What are the (5) layers covering the testis? | external spermatic fascia, cremasteric muscle and fascia, internal spermatic fascia, tunica vaginalis testis (parietal and visceral layers), tunica albuginea
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| What two structures does the visceral layer of the tunica vaginalis testis cover? | It is adherent to the testis and the epididymis
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| Laterally, the visceral layer passes between the testis and epididymis to form the _____ of the _______ | Sinus of the epididymis
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| What is the tunica albuginea | A dense layer of connective tissue surrounding the testes which is found deep to the visceral layer of the tunica vaginalis. Extensions of the tunica albuginea form septa within the testes-->divide testes into lobules
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| Where is sperm produced? Where are these structures located? | Formed within the seminiferous tubules; within lobules formed by the septa in the testes
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| The seminiferous tubules join to form the _____ _____ | rete testis
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| What structure connects the rete testis to the head of the epididymis? | Efferent ductules (15-20)
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| What is the epididymis? Where is it located? | A tightly coiled tube which connects the efferent ducts to the vas deferens; forms on the superior and posterolateral surface of the testis
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| What three regions can the epididymis be divided into? | The body (highly convoluted duct of the epididymis), the tail (continous with the vas deferens), and the head (connects to testes efferent ductules)
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| What is the vas deferens / ductus deferens? Where is it? | transports sperm to the ejaculatory duct; sperm enters the vas deferens during ejaculation; travels through the superficial inguinal ring to the deep inguinal ring and into the abdomen
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| Where in the spermatic cord does the vas deferens run through? | Large duct of the testes runs in the posterior part of the spermatic cord.
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| What three arteries are carried by the spermatic cord? | Testicular artery, artery of the ductus deferens, cremasteric artery
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| Describe the origin, area supplied, and path of the testicular artery | From the front of the aorta; supplies testis and epididymis; runs through inguinal canal
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| Describe the origin, area supplied, and path of the artery of the ductus deferens | From the vesical artery (artery of the bladder); follows ductus deferens; anastomoses with the testicular A. near testes
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| Describe the origin, area supplied, and path of the cremasteric artery | From the inferior epigastric artery; supplies cremasteric muscle and other coverings of the cord
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| * What is the PAMPINIFORM PLEXUS? Where does it drain? | The 12 veins from the posterior surface anastomose to form this; it surrounds the ductus deferens and arteries; drains into left renal vein on left and inferior vena cava on right
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| What nerves pass through the cord and what do they supply? | Ilioinguinal nerve (skin of scrotum/labia major); sympathetic fibers on arteries; sympathetic and parasympathetic via ductus deferens; genitofemoral nerve (cremaster and skin of scrotum/labia)
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| Where do the lymph vessels that drain the testes drain into? Where do they run through? | The lumbar nodes; they pass through the spermatic cord
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