Inguinal Canal, Testes, and Scrotum
name the parasympathetic (rest and digest) functions in testis
--erectile tissues of the penis and prostate gland receive parasympathetic innervation from pelvic splanchic nerves --promotes sexual arousal
name the sympathetic (fight or flight) functions in testes
--promotes ejaculation --increases glandular secretions
what are the things entering the testicular mediastinum
--testicular artery --Pampiniform plexus of veins
what are the contents of the spermatic cord
1) Artery to ductus deferens 2) Ductus vas deferens 3) Lymphatics 4) Testicular artery 5) Cremasteric artery and vein 6) Remnant of obliterated processus vaginalis 7) Pampiniform plexus of veins 8) Genital branch of genitofemoral nerve (GSE) **All Doctors Love Taking Care Of Patients Genitals
what are the three coverings of the spermatic cord (from superficial to deep)
1) External spermatic fascia 2) Cremaster fascia and muscle 3) Internal spermatic fascia
what are the two repairs for a hernia and describe them
1) Hernioplasty --this is a no-tension technique where you put a mesh around the hernia and create this sort of fake abdominal wall 2) Herniorrhaphy --This is where you suture it and put tension on the area but there is no mesh or anything involved
what are the 6 testes coverings (from superficial to deep)
1) Skin 2) Tunica Dartos (Dartos muscle fascia) 3) External spermatic fascia 4) Cremaster muscle and fascia 5) Internal spermatic fascia 6) Tunica vaginalis
indirect inguinal herniated content is covered by __________1________ which makes it ___2___ likely to enter the scrotum
1) all 3 layers of the spermatic cord plus periotneum 2) more
the inguinal ligament extends from ________1_____ to ______2_____
1) anteior superior iliac spine 2) pubic tubercle
the inguinal region of the abdominal wall is the area between the ___________1________________ and _________2_______
1) anterior superior iliac spine 2) pubic tubercle
Again for review, the opening of the inguinal canal is the ________1____________ and the exit of the inguinal canal is the _________2____________
1) deep inguinal ring 2) superficial inguinal ring
the conjoint tendon is formed from what two things
1) fibers from the intenal oblique 2) fibers from the transversus abdominis aponeurosis
Again to review, what are the three things that are in the inguinal canal that males and females have in common
1) ilioinguiinal nerve 2) genital branch of the genitofemoral nerve 3) blood and lymphatic vessels
what are the other four contributions to the descent of the testis and coverings ( in descending order-from deep to superficial) of the spermatic cord and scrotum
1) internal abdominal oblique muscle 2) external abdominal oblique muscle 3) Scarpa's fascia 4) skin
So the venous drainage differs for the right and left testis. The left testicular vein drains into _____1_______. The right testicular vein is lazy and drains into ________2________.
1) left renal vein 2) inferior vena cava
what are the contents of the female inguinal canal
1) round ligament of the uterus 2) ilioinguinal nerve 3) genital branch of genitofemoral nerve 4) blood and lymphatic vessels
the scrotum develops from which two labioscrotal swellings that eventually fuse to form a pouch
1) scrotal septum 2) scrotal raphe
what are the 5 scrotum coverings (superficial to deep)
1) skin 2) Dartos muscle and superficial fascia 3) External spermatic fascia 4) Cremaster fascia and muscle 5) Internal spermatic fascia
name the general contents of the inguinal canal. You will be quizzed on the different male and female contents later on in the deck
1) spermatic cord 2) round ligament of the uterus 3) inguinal nerve 4) blood and lymphatic vessels
what are the contents of the male inguinal canal
1) spermatic cord 2) ilioinguinal nerve 3) genital branch of genitofemoral nerve 4) blood and lymphatic vessels
Cremaster muscle is _____1___ and innervated by the ___________________2____________________ to elevate the testis
1) striated 2) genital branch of the genitofemoral nerve
the _____1____ jumps on the ______2_____, and ends up in the scrotum which hangs outside the male body and is the optimum temperature for sperm production since being inside the body is not the best for sperm production because that temperature is too high
1) testis 2) gubernaculum
the herniated content in a direct inguinal hernia is covered by _________________1__________________ which makes it ___2___ likely to enter the scrotum
1) transversalis fascia and parietal peritoneum 2) less
name the veins in the anterior portion of the scrotrum and what they drain into
Anterior scrotal veins draining into external pudendal veins
the testicular arteries branch directly from the abdominal aorta at approximately ____
L2
Lymph from the testis drains into which lymph nodes
Para-aortic (lumbar) lymph nodes
where is dartos muscle and superficial fascia derived from
Scarpa's fascia
where is tunica dartos (dartos muscle fascia) derived from
Scarpa's fascia
name the flow of the neurovascular structures enter and leave the testis
Seminiferous tubule---->straight tubule---->Rete testis----->efferent ductules---->head of epididymis---->ductus (vas) deferens
the anterior portion of the scrotum is supplied by which artery
anterior scrotal artery
the testes are visceral organs and therefore receive _____________ innervation
autonomic
testis function optimally ________ body temperature
below
which muscle helps elevate the testis
cremaster muscle
what works in conjuction with the striated cremaster muscle
dartos muscle
where does the spermatic cord begin
deep inguinal ring
what are the two types of inguinal hernias
direct inguinal hernia and indirect inguinal hernia
the tail of the epididymis is continuous with what and what does that mean
ductus deferens, so the sperm goes from the ductus deferens up to the penis so it could be expelled during sex
describe the epididymis
elongated and tightly coiled
where is external spermatic fascia derived from
external oblique muscle fascia
femoral hernia is more common in __________
females
name the pathway that the anterior scrotal artery comes from
femoral artery------>external pudendal artery-------->anterior scrotal artery
what are the three parts of the epididymis
head, body and tail
explain where the hernia pushes through depending on whether it is acquired or congenital
if it is acquired, it pushes through the posterior wall of the inguinal canal and if it is congenital, it moves through a open processus vaginalis
what is the anterior scrotal nerve
ilioinguinal nerve
the inguinal canal starts deep and lateral to the ____________ _______________ artery
inferior epigastric
the ____________ ______________ is a passageway from the abdominal cavity through the anterior abdominal wall
inguinal canal
where does the spermatic cord travel through
inguinal canal
what does the inguinal ligament sit on (what is on the floor of the inguinal canal)?
inguinal ligament
where is cremaster fascia and muscle derived from
internal oblique muscle fascia
one really important thing to remember is that the lymph surrounding the skin of the scrotum initially drains where?
into the superficial inguinal lymph nodes
external spermatic fascia is derived from what
investing fasica of external oblique muscle
what is the inguinal ligament made from
it is basically the fibrous, thickened, folded margin of the external oblique aponeurosis
what is Hesselbach's triangle
it is located between the medial and lateral peritoneal (umbilical) folds and is a weak area in the posterior wall of the inguinal canal
where does a direct inguinal hernia originate from and where is it located
it orginates from Hesselbach's triangle and is located MEDIAL to the inferior epigastric artery
where does an indirect inguinal hernia originate from and where is it located
it originates from the deep inguinal ring, so it is LATERAL to the inferior epigastric artery
describe how the inguinal canal starts and ends
it starts deep and ends superficially
what does the spermatic cord do
it suspends the testis in the scrotum and contains the structures that run to and from the testis
Again just for review, the deep inguinal ring is ____________ to the inferior epigastric vessels (vein and artery)
lateral
Again, just for review, the superficial inguinal ring is __________ to the inferior epigastric vessels (artery and vein)
medial
the inguinal canal ends _________ superficial
medially
Let's talk about the carcinoma of the skin of the scrotum. Where is metastatic spread most likely and be specific
metastatic spread is most likely via the lymphatic system and in the superficial inguinal lymph nodes first!!
the inguinal canal in females is ___________
narrower
in what population is a direct inguinal hernia common
older males
the epididymis is located wher
on the posterior surface and superior pole of the testis
the deepest layer of the testes covering is the Tunica Vaginalis. Name the two layers of the tunica vaginalis
parietal layer and visceral layer
the posterior portion of the scrotum is supplied by which artery
posterior scrotal artery
name the veins in the posterior portion of the scrotum and what they drain into
posterior scrotal veins that drain into internal pudendal vein
what is the posterior scrotal nerve
pudendal nerve
Each testis is anchored inferiorly by the __________________
scrotal ligament
where does the spermatic cord completely end
scrotum
what type of muscle is Dartos musce
smooth
tell me about how the carcinoma of the testis like where it spreads first and where it could eventually reach
so carcinoma of the testis is metastatic spread that is mainly spread by the lymphatic system but could also be spread by the vascular system. It spreads to the lumbar (para-aortic) lymph nodes first but cancer of the testes could eventually reach the lungs and if spread by the vascular system, it could eventually reach the spine and liver and brain
explain why an indirect inguinal hernia originates at the deep inguinal ring
so there is already an opening at the deep inguinal ring which is normal because the opening transmits the ductus deferens or round ligament of the uterus so this opening can make it easier for a hernia to occur here at the deep inguinal ring
what two things do testis product
sperm and male hormones
what suspends the testis within the scrotum
spermatic cord
what is the function of the epididymis
stores spermatozoa until maturation occurs
what type of inguinal rings are there in terms of the formation of the inguinal canal
superficial and deep inguinal rings
where does the spermatic cord emerge
superficial inguinal ring
the scrotum can protect the testes by regulating _____________
temperature
arterial supply for the epididymis is provided by which artery
testicular artery
the ____________________ is where the neurovascular structures enter and leave the testis
testicular mediastinum
the arterial supply for the testis is provided by which artery
testricular arteries
the exit of the inguinal canal is located on which wall with which aponeurosis
the anterior wall with external oblique aponeurosis
what is superior (on the roof) of the inguinal canal
the conjoint tendon
what forms the inguinal canal
the inguinal canal is formed by folds of the external abdominal oblique aponeurosis
describe how the inguinal rings are formed in terms of the formation of the inguinal canal
the inguinal rings are made from the initial folds formed by the external abdominal oblique aponeurosis
cremaster fascia and musce are derived from what
the investing fascia of internal oblique muscle
the testicular mediastinum is NOT covered by what
the tunica vaginalis layers
what contributes to the wrinkled appearance of the scrotum
the wrinkled appearance is due to smooth muscle fibers known as Dartos muscle that are extemely thin and insert into the skin
the internal spermatic fascia is derived from what
transversalis fascia
what is the first and closest fascia that contributes to the descent of the testes and coverings of the spermatic cord and scrotum
transversalis fascia
where is internal spermatic fascia derived from
transversalis fascia
at what fascia does the inguinal canal start
transversalis fascia on the posterior wall (since the inguinal canal starts deep)
the ______________________ muscle does NOT contribute to the descent of the testes and converings of the spermatic cord and scrotum
transversus abdominus muscle
the visceral layer of the tunica vaginalis continues on to become this white layer that is the deepest layer of the testis
tunica albuginea
the inguinal canal in males is ___________
wider
in what population is an indirect inguinal hernia common
young males
