1. Peer Support 10/08/2012 Rachel Edgar & Amrit Sandhu
Inguinal Region
Peer Support
10/08/2012
Rachel Edgar & Amrit Sandhu

2. What we are going to cover!
Inguinal canal Hernias Borders of a direct hernia Differentiating between a direct and indirect hernia Differentials for a lump in the groin

3. Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

4. The Inguinal Canal
What is it? Oblique passage through lower part of abdominal cavity Runs between deep and superficial Inguinal rings What goes through it? Transmits spermatic cord in males Transmits round ligament of uterus in females

5. Roof M
Posterior
Anterior A T L
Floor

6. Roof M
Posterior
Arching MUSCLE fibres of the Internal Oblique and Transversus Abdominus
Anterior A T
TRANSVERSALIS fascia & Conjoint TENDON
APONEUROSIS of the External Oblique and Internal Oblique
Inguinal LIGAMENT
Lacunar LIGAMENT L
Floor

7. It pulls a fold of peritoneum with it that forms the tunica vaginalis
The testicle is retroperitoneal and descends through the anterior abdominal wall
It pulls a fold of peritoneum with it that forms the tunica vaginalis
Ductus deferens
Parietal Peritoneum
Transversalis fascia
Processus vaginalis
This region is the developing inguinal canal
Tunica vaginalis
(part covering testicle)

9. Midpoint of the inguinal ligament The inguinal ligament runs from the pubic tubercle to the anterior superior iliac spine, so the midpoint is halfway between these structures. The opening to the inguinal canal (deep inguinal ring) is located just above this point. Mid-inguinal point Halfway between the pubic symphysis and the anterior superior iliac spine. The femoral artery crosses into the lower limb at this anatomical landmark. Deep Inguinal Ring Lies between the midpoint of inguinal ligament & the midinguinal point (1cm above the inguinal ligament) Superficial Ring Lies supero-lateral to the pubic tubercle. Point of emergence of spermatic cord (male) or round ligament and coverings (female)

10. Hernias
Define hernia The protrusion of a structure from its normal cavity through an abnormal opening How can they be described? Reducible Contents easily put back Incarcerated: Cannot be reduced Strangulated Contents are stuck, and there is constriction of the tissues at the neck of the hernia, leading to reduced venous drainage and arterial occlusion

11. Direct Indirect Medial to inferior epigastric vessel
Direct goes directly through Hesslebach’s Triangle
Lateral to inferior epigastric artery
Passes through processus vaginalis via deep & superficial inguinal rings
Travels into scrotum
Congenital type
Common in males

13. Dr, Dr there is a lump in my groin, what on earth could it be?!

14. DDx
Hernias Very Much Like To Swell Hernias (inguinal & femoral) Vascular (femoral aneurysm, sapheno varyx) Muscle (psoas abscess) Lymph nodes Testicle (ectopic, undescended) Spermatic cord (lipoma, hydrocele)

15. Quick Fire Quiz
How can you differentiate a hydrocele? Trans illuminate Where is fluid collecting in a hydrocele? Between the visceral and parietal tunica vaginalis A lump lateral and below the pubic tubercle is likely to be what kind of hernia? Femoral hernia An inguinal hernia is above/above and medial to the pubic tubercle

16. Who are femoral hernias more common in
Who are femoral hernias more common in? Females Who are indirect hernias more common in? Males An indirect hernia is due to the failure of what? Failure of complete obliteration of the process vaginalis

17. Thank you!
If you notice any mistakes on this presentation please let us at Peer Support know! If you have any questions about this topic feel free to ask us, you’re not in it alone!

18. Taken from Wikipedia!

19. Some sites you might find useful