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Slides_Inguinal_Region.pdf
1.
Inguinal region Inguinal region Maria
Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
2.
Introduction • Inguinal region •
Inguinal canal • Boundaries • Openings • Contents • Hernias • Indirect • Direct The inguinal region is vitally important! It is a complex area of anatomy with numerous structures entering and leaving the abdomen; clinically, it is important as it is a major site of herniation. Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
3.
Surface anatomy inguinal
region The inguinal region is an area of the abdominal wall that extends from the ASIS to the pubic tubercle. The inguinal canal is found here, which contains the spermatic cord in the male and the round ligament of the uterus in the female. Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
4.
Inguinal canal Anterior Posterior 1
2 3 1 External oblique 2 oblique 3 Transversus abdominis Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
5.
Inguinal canal Remember the
layers of the anterolateral abdominal wall? They still exist in the inguinal region, but are arranged to form the inguinal canal. The inguinal canal has four boundaries: • Anterior wall • Posterior wall • Roof • Floor Also has an opening at each end: • Superficial inguinal ring • Deep inguinal ring Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
6.
Inguinal canal Observe: • The
free edge of the external oblique aponeurosis forms the inguinal ligament • The contents of the spermatic cord passing from deep layers (within the abdomen) to superficial layers (within the scrotum/labia) • SC passing through transversalis fascia lateral to inferior epigastric vessels Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
7.
Inguinal canal Observe: • SC
also passing through internal oblique • Transversus abdominis and internal oblique passing over SC • Transversus abdominis and internal oblique converge behind superficial inguinal ring = conjoint tendon Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
8.
Boundaries of inguinal
canal Boundary Level of deep ring Middle Level of superficial ring Anterior wall Internal oblique External oblique External oblique aponeurosis External oblique aponeurosis (crura) Posterior wall Transversalis fascia Transversalis fascia Conjoint tendon Roof Transversalis fascia Arching fibres of internal oblique and transversus abdominis Medial crus of external oblique Floor Inguinal ligament Inguinal ligament Lacunar ligament Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
9.
Inguinal canal -
contents Male spermatic cord • Ductus deferens • Artery of ductus deferens • Testicular artery • Cremasteric artery • Pampiniform venous plexus • Sympathetic nerve fibres • Genital branch of genitofemoral nerve • Lymphatic vessels Female • Round ligament of the uterus Due to the significant size of the spermatic cord compared to the round ligament of the uterus, the superficial inguinal ring is much bigger = increased possibility of hernias in males. Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
10.
Inguinal canal -
contents Male spermatic cord • Ductus deferens • Artery of ductus deferens • Testicular artery • Cremasteric artery • Pampiniform venous plexus • Sympathetic nerve fibres • Genital branch of genitofemoral nerve • Lymphatic vessels Female • Round ligament of the uterus Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
11.
Spermatic cord -
coverings Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
12.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
13.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
14.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
15.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
16.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
17.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
18.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
19.
Spermatic cord -
coverings These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
20.
Spermatic cord -
coverings Three layers cover the spermatic cord All of them are derived from structures in the abdominal wall 1. External spermatic fascia = External oblique 2. Cremasteric fascia/muscle = Internal oblique 3. Internal spermatic fascia = Transversalis fascia These coverings result from the testes descending from the posterior abdominal wall to the scrotum during embryological development. Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
21.
Inguinal hernias Maria Rodríguez,
ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
22.
Inguinal hernias Hernia =
the protrusion of an organ through the wall of the compartment that contains it Think about the causes: 1. Changes in intra-abdominal pressure • Lifting • Chronic cough/sneezing 2. Contents of abdomen • Intestines 3. Potential sites of weakness • Inguinal rings Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
23.
Inguinal hernias Hernia =
the protrusion of an organ through the wall of the compartment that contains it Think about: • Inguinal hernia = protrusion of the intestines through the abdominal wall in the inguinal region • 2 potential sites of weakness = superficial and deep inguinal rings • 2 different types = direct and indirect Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
24.
Inguinal hernias Indirect Direct Maria
Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
25.
Inguinal hernias Direct Indirect Maria Rodríguez,
ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
26.
Inguinal hernias Indirect Direct Direct
(acquired) • Protrusion occurs at level of superficial ring • Leaves abdomen medial to inferior epigastric vessels • Hernial sac limited by peritoneum and transversalis fascia • Does not usually enter scrotum Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
27.
Inguinal hernias Direct (acquired) •
Protrusion occurs at level of superficial ring • Leaves abdomen medial to inferior epigastric vessels • Hernial sac limited by peritoneum and transversalis fascia • Does not usually enter scrotum Indirect Direct Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
28.
Inguinal hernias Indirect (congenital) •
Protrusion occurs at level of deep ring (patent processus vaginalis; typically in young males) • Leaves abdomen lateral to inferior epigastric vessels; traverses canal and can enter the scrotum via superficial ring • Hernial sac in persistent processes vaginalis • More common than direct hernias Indirect Direct Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
29.
Conclusion • Inguinal region •
Surface landmarks • Inguinal canal • Muscles and ligaments that form the boundaries of the canal • An opening at either end: superficial and deep inguinal ring • Contents: spermatic cord in male, round ligament of uterus in female • Hernias • Indirect: congenital, lateral to inferior epigastric vessels, enters scrotum • Direct: acquired, medial to inferior epigastric vessels, rarely enters scrotum Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
30.
Dieses Dokument gehört:
Maria Rodríguez Hinweis: Dieses Dokument ist urheberrechtlich geschützt. Die Vervielfältigung, Verbreitung, Wieder- bzw. Weitergabe und sonstige Nutzung ist ohne die schriftliche Genehmigung der Lecturio GmbH nicht gestattet. Powered by TCPDF (www.tcpdf.org) Maria Rodríguez, ilenbravodiaz@gmail.com © www.lecturio.de | Dieses Dokument ist urheberrechtlich geschuetzt. Powered by TCPDF (www.tcpdf.org)
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