Inguinal Region

Question 1

what is the difference between direct and indirect hernias

Answer 1

direct enters inguinal canal via posterior wall through haseslbach’s triangle due to weakened conjoint tendon
indirect enters inguinal canal via deep inguinal ring outside haseselbach’s triangle due to patent process vaginalis

Question 2

is there an inguinal canal in females

Answer 2

yes

Question 3

why is the cremater reflex tested

Answer 3

to test that the iliogenital and iliofemoral nerves are working

Question 4

how do layers of the spermatic cord relate to the layers of the anterior abdominal wall

Answer 4

skin is the same as the skin of the abdominal wall
campers and scarpas fascia fuse to form the darts- fat lost from campers fascia
external spermatic fascia comes from the external obliques
cremaster muscle comes from internal oblique
internal spermatic fascia comes from transversus abdominis

Question 5

what is the difference between the deep and superficial inguinal rings

Answer 5

superficial inguinal ring- formed by the external oblique

deep inguinal ring- formed by transversus abdominis

Question 6

what is the origin of tunica vaginalis in the testis?

Answer 6

process vaginalis disappears, but stays to form the layers around the testis

Question 7

what is the origin of the tunica vaginalis in females

Answer 7

no tunica vaginalis, the process vaginalis regresses in females
if it doesn’t forms the canal of nuck

Question 8

what are clinical implications of the gubernaculum

Answer 8

guides the testis into the scrotum

if it doesn’t develop fully testis does not descend fully

Question 9

what does the gubernaculum become in the male

Answer 9

lower part connects the testis to the scrotum

upper part degenerates

Question 10

what does the gubernaculum become in the female

Answer 10

round ligament of uterus and round ligament of ovary

Question 11

where do the testis travel during development

Answer 11

through the inguinal canal

Question 12

what happens if the wall of the inguinal canal is weakened

Answer 12

hernia

Question 13

what is a hernia

Answer 13

visceral protrusion beyond normal boundaries

Question 14

what level do gonads develop at and in what space

Answer 14

T12 in retroperitoneal space

Question 15

what is in the spermatic cord

Answer 15

nerves
vessels
lymphatics
ductus deferens

Question 16

describe week 6 of testis development

Answer 16

testis in retroperitoneal space with caudal ligament attached to the skin in the scrotal swelling

Question 17

what becomes the gobernaculum ligament

Answer 17

caudal ligament

Question 18

describe week 10 of development

Answer 18

testis travels anteriorly in subserous fascia, taking the nerves, vessels and lymphatics with it from T12

Question 19

describe 7 month development

Answer 19

process vaginalis forms
testis moves into the deep inguinal canal taking wall layers with it
exit through superficial ring
testis pushes into the processes vaginalis which forms the parietal and visceral layers and cavity of tunica vaginalis

Question 20

describe testis at birth

Answer 20

testis is in scrotum surrounded by tunica vaginalis and the process vaginalis is closed off

Question 21

what is the role of the gobernaculum

Answer 21

guides the testis into scrotum

Question 22

what happens if the gobernaculum is incompletely formed

Answer 22

incomplete testis descent

Question 23

what is cryptorchidism

Answer 23

undescended testis- usually in the inguinal canal

Question 24

what are consequences of undescended testes

Answer 24

decreased fertility

increased risk of testicular cancer

Question 25

what part of the process vaginalis remains

Answer 25

tunica vaginalis- lining testes and the cavity

Question 26

what is patent process vaginalis

Answer 26

failure of close, leaving a communication between the peritoneal cavity and the scrotum can lead to an indirect hernia

Question 27

what is a hydrocele

Answer 27

fluid filled sac in the spermatic cord from a weird closing of the process vaginalis

Question 28

how is a hydrocele distinguished from an undescended testis

Answer 28

light- hydroceles let light through

Question 29

what does the gubernaculum become in females and where is it attached

Answer 29

round ligament of uterus attached to the labia major distally and ovary proximally middle is attached to the uterus

Question 30

round ligament of the uterus

Answer 30

gobernaculum between the uterus and labia majora

Question 31

round ligament of the ovary

Answer 31

gobernaculum between the uterus and ovary

Question 32

what is significant about the lymphatics associated with the round ligament in females

Answer 32

acts as a communication between the uterus and labia major so cancer cells from the uterus can migrate inferior and result in enlarged superficial inguinal lymph nodes

Question 33

what happens to the process vaginalis in females

Answer 33

regresses

Question 34

what is the canal of nuck

Answer 34

failure of the process vaginalis to regress in females | results in abcess and indirect hernia potential

Question 35

what are the 3 muscles layers involved in the formation of the inguinal canal

Answer 35

external oblique internal oblique transversus abdominis

Question 36

what is the inguinal ligament

Answer 36

thickened inferior edge of the external oblique going from the anterior superior ishial spine to the pubic tubercle

Question 37

what is the lacunar ligament

Answer 37

triangular ligament next to the pubis | forms medial floor of inguinal canal

Question 38

what is the pectinal ligament

Answer 38

ligament below the lacunar ligament, on top of the pectinate muscle, right up next to the bone

Question 39

what is the conjoint tendon

Answer 39

internal oblique + transverses abdominis | strenghten posterior wall of inguinal canal

Question 40

what forms the deep inguinal ring

Answer 40

transversalis abdominis lateral to inferior epigastric vessels

Question 41

where does the conjoint tendon move when it weakens

Answer 41

medially

Question 42

where is an indirect inguinal herina

Answer 42

bowel comes out lateral to inferior epigastric vessels

Question 43

where is a direct inguinal hernia

Answer 43

bowel enters inguinal canal medial to inferior epigastric vessels

Question 44

what forms the roof of the inguinal canal

Answer 44

transversus abdominis and the internal oblique muscles

Question 45

what forms the posterior boarder of the inguinal canal

Answer 45

trasversali fascia and conjoint tendon (transversus and interal)

Question 46

what forms the anterior wall of the inguinal canal

Answer 46

external oblique

Question 47

what forms the floor of the inguinal canal

Answer 47

inguinal ligament and the lacunar ligament (both from external oblique)

Question 48

what is in the male inguinal canal

Answer 48

``` ductus deferens testicular artery and vein sympathetic innervation ilioinguinal nerve genitofemoral nerve ```

Question 49

what is in the female inguinal canal

Answer 49

round ligament of the uterus | ilioinguinal nerve

Question 50

what contributes to the spermatic cord

Answer 50

internal spermatic fascia- transversalis fascia cremaster muscle- internal oblique external spermatic fascia- external oblique

Question 51

what is a vasectomy

Answer 51

surgical disruption in the ductus deferens as a form of birth control

Question 52

what is testicular torsion

Answer 52

spermatic cord twisting resulting in loss of blood supply to the testis

Question 53

what is the cremaster reflex and what does it test

Answer 53

scratch medial thigh (iliofemoral nerve) to make the cremaster muscle contract (genitofemoral nerve)

Question 54

what i varicocele

Answer 54

varicosities in the pampinform plexus of the scrotum due to obstruction of the left renal vein affecting the testicular vein

Question 55

what is a hydrocele

Answer 55

fluid filled process vaginalis remant

Question 56

what does a patent process vaginalis cause

Answer 56

indirect inguinal hernia in men, canal of nuck in females

Question 57

what is a canal of nuck

Answer 57

patent process vaginalis in female

Question 58

what is a hematocele

Answer 58

accumulation of blood in the tunica vaginalis

Question 59

which hernia enters hesselbach's triangle

Answer 59

direct- bowel enters scrotum due to weakening of conjoint tendon which strengthens the posterior wall of the inguinal canal

Question 60

where is a indirect hernia palpable

Answer 60

on the tip of the finger

Question 61

where is a direct hernia palpable

Answer 61

side of finger

Question 62

what causes an indirect inguinal hernia

Answer 62

congenital latency of process vaginalis

Question 63

describe a indirect inguinal hernia

Answer 63

bowel enters deep inguinal ring outside hasselbach's triangle

Question 64

describe a direct inguinal hernia

Answer 64

bowel enters posterior wall of inguinal canal inside hasselbach's triangle

Question 65

what are the boarders of hasselbach's triangle

Answer 65

inferior epigastric vessels inguinal ligament lateral rectus sheath

Question 66

what is seen on inspection with hernia preseent

Answer 66

buldge in inguinal region

Question 67

what is felt on palpation with hernia

Answer 67

pain/discomfort | eversion of skin with finger- feel buldge

Question 68

what is heard on auscultation of a hernia

Answer 68

bowel sounds

Question 69

what type of hernia is more common in females

Answer 69

femoral

Question 70

which type of inguinal hernia is more common

Answer 70

indirect