Inguinal Region

processus vaginalis

An evagination of the peritoneal cavity called the ______________ precedes the testes as they descend through the anterior abdominal wall. N.B. - the testis descends alongside this, not within it

length , 28 weeks

Different parts of the fetus develop at different rates (differential growth). An increase in the __________ of the fetus helps to guide the descent of the testes, which descend inferiorly along the posterior abdominal wall, posterior to the parietal peritoneum. At about ____________ of gestation, the testes pass through the anterior abdominal wall, following the course of the gubernaculum, to reach their destination in the scrotum.

parietal peritoneum, transversalis fascia, acquired

Direct inguinal hernia - The hernial sac passes through a plane lying between the internal spermatic and cremasteric fascial layers, but will only be covered by _______________ and_________________. This is considered to be an ______________ type of hernia

superficial ring, inguinal triangle, medial, inferior epigastric a

Direct inguinal hernia - hernial sac directly penetrates through the abdominal wall and the ______________ through an area called the ____________ (Hesselbach's) Direct inguinal hernias protrude through the superficial inguinal ring __________ to the ___________________

femoral canal, upper thigh.

Femoral hernias - more common in females; the hernial sac passes through the ______________, posterior and inferior to the inguinal ligament and lateral to the lacunar ligament. The hernia appears as a bulge in the ____________

hernial sac

Hernia - a protrusion of a structure through an anatomical compartment. If the hernia protrudes through the abdominal wall, it may be covered by a peritoneal layer, forming a _______________. The tapered proximal portion of a hernia sac is called the neck of the hernia

Labia majora

Homologous structures in the female _______________ - homologous to the scrotum

labia majora, fascial coverings

Homologous structures in the female - the inguinal canal has the same structure as in the male, but contains the round ligament of the uterus instead of the spermatic cord round ligament of uterus - courses from the uterus to the ______________ It is a remnant of the female gubernaculum. It does not have _____________ like the spermatic cord.

inguinal ligament

INGUINAL CANAL 2. Floor - ________________

aponeurosis of external abdominal oblique, internal abdominal oblique

INGUINAL CANAL 3. Anterior wall - ______________________ a. In the lateral 1/3 of the canal, the anterior wall is reinforced by fibers of the ________________________ m

transversus abdominis, transversalis fascia

INGUINAL CANAL Openings 1. Deep inguinal ring - represents the point at which the canal opens into the abdominal cavity. The deep ring is located inferior to the inferior border of the ________________ m and is represented by a sleeve-like diverticulum of ________________ that covers the contents of the spermatic cord.

spermatic cord, round ligament of uterus, ilioinguinal n, genital branch of genitofemoral n

INGUINAL CANAL contents 1. Male - __________________ 2. Female - ____________ Both: _________________

conjoint tendon, internal oblique

Increasing abdominal pressure acts on the posterior wall, approximating it to the anterior wall. The posterior wall is further strengthened by the_______________. The position of __________________ m. fibers anterior to the deep ring also strengthens the deep ring, because the muscle contracts during any increase in intra-abdominal pressure.

lateral, inferior epigastric

Indirect inguinal hernia In this type of hernia, the hernial sac exits the abdomen ____________to the ___________________ a. The same layers that cover the spermatic cord may also cover the hernial sac in this case.

deep ring, inguinal canal, superficial ring

Indirect inguinal hernia - most common type of inguinal hernia. The hernial sac courses through the ___________, _________, and exits the __________.

autonomic, genital, genitofemoral

Spermatic cord Nerves - ___________ fibers and the ___________ branch of the ____________ n

Hydrocele

____________ - an abnormal accumulation of fluid in the scrotum, possibly caused by a failure of the processus vaginalis to close.

Testis

_____________ Function a. An endocrine gland that produces male hormones b. Also the site of spermatogenesis; spermatozoa exit via a duct system into the epididymis

inguinal

Scrotal lymphatic drainage goes through ________ lymph nodes

smooth muscle, dartos tunic

Scrotum Autonomic - sympathetic fibers to the __________ of the _____________

anterior/ posterior scrotal, pudendal

Scrotum Blood supply -_________/_______ _______ arteries (branches of the external and internal __________ aa)

ilioinguinal, genitofemoral, posterior femoral cutaneous, perineal

Scrotum Sensory - ____________ n, genital branch of the ________________ n, scrotal branches of the___________________ and _______ nn

Dartos tunic, Scarpa's fascia

Scrotum - a pendulous sac posterior to the penis that contains the testes and associated structures The scrotal wall is made up of skin and _____________ with no fat. --continuation of the __________ of the anterior abdominal wall. It contains smooth muscle that contracts in response to cold temperatures, raising the testes closer to the body.

transversalis fascia

Spermatic cord 2. Fascial coverings Internal spermatic fascia - from _______________. This fascia covers the spermatic cord through the inguinal canal.

internal oblique, middle of inguinal canal

Spermatic cord 2. Fascial coverings Cremasteric muscle and fascia - from the __________________ m and its deep fascia. This layer begins in the _____________________.

external oblique, superficial inguinal ring

Spermatic cord 2. Fascial coverings External spermatic fascia - derived from the aponeurosis and investing fascia of the _________________ m. This fascia begins at the _________________

external spermatic fascia, cremasteric muscle/fascia, internal spermatic fascia

Spermatic cord Fascial coverings - 3 layers of fascia derived from layers of the anterior abdominal wall that the testis traversed during its descent; from superficial to deep: _________,_________,_________ All three fascial layers cover the spermatic cord in the scrotum and cover the outer surface of the tunica vaginalis testis.

Ductus deferens, Testicular a, Pampiniform plexus,

Spermatic cord 1. Contents a. _______________ - carries sperm from the epididymis towards the urethra b. _____________ from the abdominal aorta ---i. Also supplies the ductus deferens (via the deferential a) c. _________________ (venous) d. Nerves - autonomic fibers and the genital branch of the genitofemoral n e. Lymphatics

tunica albuginea, seminiferous tubules

Testis Housed within a thick connective tissue capsule, the ________________. -continuous with septa that divide the testis into lobules. Lobules contain ________________ for sperm production

autonomic, testicular. abdominal aorta

Testis Neurovascular supply - reflects its abdominal developmental origin a. Nerves - ___________ fibers b. Arterial -____________ a is a branch of the __________________

pampiniform plexus

Testis Venous - _________________ is a "ladder-like" arrangement of veins surrounding the testicular a. It functions as a counter-current heat exchange mechanism to cool the blood in the testicular a before it reaches the testis. As it courses through the scrotum, it begins to coalesce into 2-3 venous structures, ultimately forming a single testicular v in the superior scrotum or inguinal canal.

processus vaginalis, tunica vaginalis testis, visceral, parietal

Testis and epididymis are covered by layers derived from the _____________________ These layers form the _______________, a sac-like covering that partially envelops the testis. -- two layers separated by a thin layer of serous fluid. ---- Inner ___________ layer is fused to the surface of testis and epididymis Cavity separates this from outer ________ layer

abdominal cavity

Testis lymphatic drainage goes into __________ lymph nodes

genital, genitofemoral, medial thigh, L1/L2

The cremasteric m is innervated by the ________ branch of the __________ n and will contract if the _______________ is stroked (cremasteric reflex). This raises the testis and is a clinical test for proper ___/___ spinal cord segment function

cryptorchidism

Undescended testes (_____________) - failure of the testes to descend into the scrotum. They may remain in the abdominal cavity or the inguinal canal and must be brought into the scrotum while the child is young or sterility will result. There is also a high incidence of testicular cancer among adults with an undescended testis.

tunica vaginalis testis

Each processus vaginalis is covered by layers of the abdominal wall that form the walls of the inguinal canal. These layers remain as a covering over the spermatic cord and testis. In the scrotum, the opening between the processus vaginalis and the peritoneal cavity obliterates, leaving a thin, non-patent cord of connective tissue. The processus vaginalis surrounds each testis, forming the ___________________

Ovary, canal of Nuck

Homologous structures in the female _________ - homologous to the testis, but does not descend as far as the testis, remaining instead in the pelvic cavity. A processus vaginalis is not normally present; an abnormal processus vaginalis in the female is called the _________________.

transversalis fascia, conjoint tendon, iliopsoas fascia

INGUINAL CANAL Posterior wall - ___________________ a. In the medial 1/3 of the canal, the posterior wall is reinforced by the _____________ b. In the lateral 1/3 of the canal, the posterior wall is reinforced by _____________

transversus abdominis, internal abdominal oblique

INGUINAL CANAL Roof - arched fibers of the _____________ and _____________ mm that originate from the inguinal ligament and inserting into the conjoint tendon

crura, intercrural, pubic tubercle, anterior pubic symphysis

INGUINAL CANAL Superficial inguinal ring - an opening in the aponeurosis of the external abdominal oblique m. The edges of the opening are called the medial and lateral __________ The crura are connected by _____________ fibers, which strengthen the opening. The lateral crus attaches to the ______________; the medial crus attaches to the _______________

transversalis fascia, aponeurosis, external oblique

INGUINAL CANAL - the path the each testis follows in its descent through the anterior abdominal wall remains as the inguinal canal and is present in both sexes. The canal runs between two openings, or rings: the deep inguinal ring (lateral opening), was made in the ______________ by the processus vaginalis, and the superficial inguinal ring (medial opening) traverses the ____________ of the ____________ muscle

processus vaginalis, congenital

Indirect inguinal hernias are commonly the result of the _______________ remaining patent, creating a channel for the herniating viscera to follow. This is considered a type of ___________ hernia.

inguinal ligament

Inguinal Canal the canal is short, only ~4 cm, and courses obliquely, superior and parallel to the _____________________ which runs between the ASIS and the pubic tubercle. The deep inguinal ring is located roughly at the midpoint of these two landmarks, on the deep surface of the anterior abdominal wall. The superficial inguinal ring is ~1.5 cm lateral to the pubic tubercle - the canal runs between these two rings

obliqueness

The presence of the inguinal canal would seem to weaken the anterior abdominal wall, but this is partly compensated for by the ____________ of the canal - the superficial and deep rings do not lie directly in line with each other.

posterior, upper lumbar gubernaculum

The testes develop along the ___________ abdominal wall in the _________ region, medial to the developing kidneys. A fibrous band of tissue, the ______________ testis, connects each testis to the area of the future scrotum

Varicocele, retrograde

_____________- congestion of the pampiniform plexus will cause the veins to dilate. This is usually caused by blood flowing __________ due to incompetent valves in the testicular vein; it is most apparent when the patient is standing

Bare area

______________ of the testis - the area left uncovered by the tunica vaginalis testis is where blood vessels enter and exit

Epididymis

_______________- a highly coiled tube that connects the testis and the ductus deferens 1. Has a head (attached to the testis), body, and a tail that is continuous with the ductus deferens. The space between the body of the and the testis is the sinus Neurovascular supply and lymphatics are the same as the testis

septum

____________divides the scrotum into two compartments with a testis, epididymis, and spermatic cord in each compartment