Inguinal Canal, Scrotum, & Testis
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True / False: fetal testes are retroperitoneal in the posterior abdominal wall before they descend into the scrotum
Components of the superficial inguinal ring
- Intercrural fibers
- Lateral crus
- Medial crus
Forms the medial border of the femoral canal
Contents of inguinal canal
- Spermatic cord / Round ligament of uterus
- Cremasteric fascia / muscle
- Ductus (vas) deferens
- Artery of ductus deferens
- Testicular a./v.
- Pampiniform plexus
- Ilioinguinal n.
- Genital branch of genitofemoral n.
Round ligament of the uterus attachment
Attach within labia majora
Landmark - Deep inguinal ring
- Superior to inguinal ligament
- Medial to femoral a.
- Lateral to inferior epigastric vessels
- Midway between ASIS / pubic symphysis
Landmark - Superficial inguinal ring
- Superior to the pubic tubercle
- Medial to the femoral canal
Forms deep inguinal ring
Transversus abdominis m.
Forms superficial inguinal ring
External oblique aponeurosis
Innervates upper medial thigh and anterior scrotum
Ilioinguinal n. (L1)
How does the ilioinguinal n. enter the inguinal canal?
Enters between transversus abdominus / internal oblique mm.
Contraction of inguinal canal
- Occurs w/ increased abdominal pressure
- Prevents herniation of bowel
Origins of inferior epigastric vessels
- Artery arises from external iliac a.
- Vein drains into external iliac v.
Blood supply to the ductus deferens
Artery to ductus deferens (branch of inferior epigastric a.)
Origin of testicular a/v
Branch of lumbar aorta (supplies testicles)
- Ilioinguinal n. (L1)
- Genitofemoral n. (L2)
Innervates cremasteric muscle and lateral scrotum
Genital branch of Genitofemoral n. (L1-L2)
Which muscle does not contribute anything to inguinal canal?
Contributes fibers to the cremasteric muscle / fascia
Contributes fibers to internal spermatic fascia
Contributes fibers to external spermatic fascia
external oblique m.
What is the round ligament of the uterus a remnant of?
Floor of inguinal canal
- Medial 1/2 of inguinal ligament
- Lacunar ligament
Roof of inguinal canal
Arching fibers of transversus abdominis / internal oblique mm. on their way to form conjoint tendond
Anterior wall of inguinal canal
- External oblique aponeurosis
- Reinforced laterally by internal oblique
Posterior wall of inguinal canal
- Transversalis fascia
- Reinforced medially by conjoint tendon
What is the processes vaginalis? How do testes descend in relation to it?
- Evagination of peritoneum into scrotum
- Testes descend from posterior body wall posterior to processes vaginalis
- (behind two layers of peritoneum)
Gubernaculum in adult testes
- Gubernaculum guides testes as it descends
- Remnant will help attach testes to scrotal wall
Remnants of the processes vaginalis
Obliterates except for visceral / parietal layers around the testes (tunica vaginalis)
Contents of spermatic cord
- External spermatic fascia
- Cremasteric fascia
- Genitofemoral n.
- Internal spermatic fascia
- Testicular a.
- Pampiniform plexus
- Ductus deferens (w/artery)
- Lymphatics & ANS
Innervation of the testis
- Testis innervated by ANS (T10 - L1/2)
- Vagal parasympathetics! (nausea)
- Visceral afferents (sympathetics) from T7
- Pain fibers travel w/ sympathetics
Why is tunica vaginalis present only on anterolateral surface of testes?
Testes descended behind both layers of processes vaginalis
- "White tunic"
- Thick CT deep to visceral layer of tunica vaginalis
What type of muscle makes the dartos muscle
What type of muscle makes the cremasteric muscle
Site of direct hernias
Hesselbach's traingle (medial to epigastric vessels)
Hernial coverings: direct vs. indirect
- Direct: covered by peritoneum
- Indirect: covered by peritoneum and layers of spermatic cord
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