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

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

Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

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

Roof M Posterior Anterior A T L Floor

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

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)

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)

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

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

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

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)

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

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

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!

Taken from Wikipedia!

Some sites you might find useful http://teachmeanatomy.info/abdomen/the-inguinal-canal/ http://www.instantanatomy.net/inguinal.pdf