The hole in the transversalis fascia through which the spermatic cord (round ligament (f)) pass through

- deep aspect of the abdominal wall

anterior: external oblique aponeurosis & internal oblique M (more lateral)

posterior: transversus abdominis M and transversali fascia

Superior: internal oblique M and transversus abdominis M and aponeurosis

Inferior: inguinal ligament and lacunar ligament

1. Anterior superior iliac spine
2. Pubic symphysis
3. Deep inguinal ring
4. Superficial inguinal ring
5. Inguinal canal
6. Obturator foramen

- comprised of inferior fibers of the external oblique aponeurosis

- streches from the ASIS to the pubic tubercle

- forms the inferior floor of the inguinal canal

- lateral portion of the lacunar ligament

- fused to the pubic tubercle

- may include fibers from the transversus abdominis, iliopubic tract, internal oblique, and rectus abdominis

- on deep side of inguinal ligament (looking from inside out)

- begins at ASIS and inserts into the pectineal lig.

- helps form the inferior margin of the deep (internal) inguinal ring

- continues as the anterior and medial border of the femoral canal

- triangular fanning out of the inguinal ligament as it joins the pubic tubercle

- lateral edge forms medial border of femoral canal

Describe the Deep (Internal) Inguinal Ring

- entrance to inguinal canal for spermatic cord (round ligament)

- entrance for genital branch of genitofemoral N

- lateral to the inferior epigastric A

- starts as an invagination of the transversalis fascia that forms an opening for the spermatic cord to enter the inguinal canal

- inferior border formed by iliopubic tract

Describe the Superficial (external) inguinal ring

- Do things enter or exit?

- What goes through this ring?

-What is its position?

- what does it split to form?

- exit for the spermatic cord (round ligament), genitofemoral N, and ilioinguinal N from inguinal canal

- superior and lateral to pubic tubercle

- splits to form the medial and lateral crus (portion of the external oblique aponeurosis

- formed from the superficial layer of deep fascia overlying the external oblique M and aponeurosis

- runs perpendicular to the fibers of the aponeurosis to help prevent the crura from opening

- runs perpendicular to the medial and lateral crus to prevent the opening of the superficial inguinal ring

Describe the Gubernaculum

what does it do?

what does it become?

- fibrous tract connecting the primordial testes to the anterolateral abdominal wall at the site of the deep inguinal ring

- fibrous cord connecting the ovary and uterus to the developing labium majus

- becomes ovarian ligament and the round ligament

-passageway for the great vessels to the lower extremity, and for the testicle to reach the scrotum

- Site for many different hernias to occur

Borders

Superior: arch of the int. oblique M and transversus abdominis M

Lateral: iliopsoas M

Medial: lateral edge of the rectus abdominis and pubic pectin

- Iliopubic tract divides orifice into superior portion (spermatic cord) and inferior portion (iliac vessels)

- space bordered by iliopubic tract (superior) and gonadal vessels (lateral)

- contains lateral femoral cutaneous N, femoral branch of the genitofemoral N, and femoral N

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Define Triangle of Doom

- borders

- what runs through it

- space bordered by vas deferens and spermatic cord vessels

- contains external iliacs, deep circumflex iliac V, femoral N, genital branch of genitofemoral N

- cut thru the vessels in this region and pt can bleed to death

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• Direct Hernias
• go through the Hesselbach triangle
• protrude medial to the inferior epigastrics
• Indirect Hernias 
• DO NOT go through Hesselbach's triangle
• protrude laterally to inferior epigastrics

Define Hesselbach's Triangle

- borders

- superior/lateral border: inferior epigastrics

- medial border: lateral edge of rectus abdominis

- inferior border: inguinal ligament

What forms the Tunica Vaginalis?

and what does it cover?

- distal part of the processus vaginalis (the stalk degenerates)

- covers the testis and epididymis

Do the ovaries descend into the inguinal region?

How about the round ligament?

- No, the ovaries do not descend into the inguinal region because the ovarian ligament holds the ovaries up

- The round ligament however does enter the inguinal region

vas deferens A/V

cremasteric A/V

testicular A/V

vas deferens

pampiniform venous plexus

genital branch of genitofemoral N

sympathetic N

lymphatic vessels

What are the 3 fascial layers of the spermatic cord?

- include the layers origin

- external spermatic fascia - external oblique aponeurosis

- cremaster fascia - internal oblique M

- internal spermatic fascia - transversalis fascia

- layer of smooth muscle fibers responsible for wrinkled appearance of scrotum

- superior dartos fascia has no fat

- continuous anteriorly with Scarpa's fascia

-continous posteriorly with Colle's fascia

- attaches to skin and causes scrotum to contract and bring testis closer to abdominal cavity to keep warm and sperm alive

- lies on posterior surface of the testis

- is covered by tunica vaginalis

- has 3 parts head, body, tail

- the rete testis = network of canals at the termination of the seminiferous tubules

- the efferent ductules transport sperm from the rete testis to the epididymis where sperm is stored

- seminiferous tubules in testes -> rete testis -> efferent ductules -> epididymis

Name the layers covering the Testis

(from most superficial to deep)

Outer to Inner layers

- skin

- dartos fascia

- external spermatic fascia

- cremaster fascia

- internal spermatic fascia

- tunica vaginalis (parietal layer)

- tunica vaginalis (visceral layer)

- tunica albuginea

- aka ductus deferens

- continuation of the tail of the epididymis

- muscular tube that conveys sperm from the epididymis to the ejaculatory duct

- meets with seminal vesicle duct to form ejaculatory duct

Describe the Seminal Vesicles

- where is located

- what does it do

- located in between the fundus of the bladder and rectum

- DOES NOT STORE SPERM

- secretes thick alkaline fluid that mixes with sperm as they pass into the ejaculatory ducts and urethra

- superior terminal branch of the anterior ramus (L1)

-pierces transversus abdominis to course b/t 2nd and 3rd layers of abdominal M (in between transversus abdominis and internal oblique M)

- branches into lateral and anterior cut. branches, pierce internal and external oblique M above superficial inguinal ring 

- innervates skin overlying iliac crest, upper inguinal and hypogastric regions, internal oblique, and transversus abdominis M

- inferior terminal branch of anterior ramus of L1

- passes between 2nd and 3rd layer of abdominal M.

- enters the inguinal canal b/t the internal and external oblique M

- exits through the superficial inguinal ring

- innervates the skin of lower inguinal region, upper and medial thigh, inferiormost internal oblique M, transversus abdominis M, penis and upper scrotum (males), mons pubis and labium majus (female)

- arises from L1-2

- emerges on the ant. aspect of the psoas

- divides into the genital and femoral branches

- genital branch remains ventral to the iliac vessels and the iliopubic tract, as it enters the superficial inguinal canal (just lateral to inferior epigastric vessels)

- supplies the scrotum and cremaster M (males)

- supplies mons pubic and labia majora (females)

- femoral branch courses along the femoral sheath

- arises from L2-3, emerges from lateral border of psoas M at level of L4

- crosses iliacus M obliquely

- passes inferiorly to the inguinal ligament where it divides to supply the lateral aspect of the thigh

- Femoral : found in the femoral canal

- Obturator: protrude through obturator canal, more common in elderly women, present w/ Howship-Romberg sign

- Umbilical: protrude thru' umbilical ring

- Spigelian: abdominal wall hernia thru' transversus abdominis aponeurosis, b/t semilunar line and the semicircular line at the lateral edge of the rectus M

- Lumbar (Petit): protrudes thru' inferior lumbar triangle (posterior)

- Grynfelt: protrudes thru' superior lumbar triangle (posterior and superior)

- Sliding: portion of hernia sac contains an intrabdominal organ

- Pantaloon: has both direct and indirect hernia ocurring simultaneously

- Epigastric: due to congenital or acquired weakness of the linea alba above the umbilicus

Suprarenal Glands

-where are they located

- what are the measurements?

- name the fascia covering them

- describe the differences b/t the rt and lt gland

- located superiorly and medial to the kidneys at level of rib 11

- measures 5 x 3 x 1 and weights 4-5g

-Gerota's fascia covers the adrenal glands

- rt gland is more pyramid shaped, lt is more semilunar shape

- rt gland is close to liver and IVC

-lt gland is associated with aorta, spleen, and tail of pancreas

Suprarenal Cortex

- what are the 3 zones? and what do they produce?

- Glomerulosa: mineralocorticoids

- Fasciculata: glucocorticoids

- Reticularis: androgens

Suprarenal Medulla

- what % of the gland does it make up?

- Is it endodermal, mesodermal or ectodermal in nature?

- what does it produce?

- 20% of the gland (cortex makes up 80%)

- it is ectodermal in nature

- produces norepinephrine and epinephrine

Describe the blood supply to the Suprarenal Glands

(include where the A branched from)

- Suprior adrenal A : from inferior phrenic A

- Middle adrenal A: from aorta

- Inferior adrenal A: from renal A

- the Rt adrenal V is shorter b/c IVC is on the right

- rt. adrenal V drains into IVC

- the left adrenal V is longer b/c it has to travel farther

-**the left adrenal V joins the inferior phrenic V and empties into the left renal V

- at birth: glomerularis and fasciculata

- 3yo : reticularis

Fetal adrenals are 10-20 times larger than adult glands due to extensive size of the cortex.

T/F

- Renal fascia (Gerota's fascia)

- Perirenal fat (inside the renal fascia)

Pararenal fat (outside renal fascia)

pararenal fat ->renal fascia -> perirenal fat

Kidneys

- Measurements of kidneys

- Heavier in M or F?

- length: 10-14cm

- width: 5-6cm

-thickness: 2.5-3cm

- heavier in males

surface : ant and post

borders: lateral and medial

poles: superior and inferior

Kidneys have anastomotic arterial flow and are not prone to infarction when vessels are interrupted

True or False

Name the parts

[image]

- Left renal A is  shorter than right, since aorta is on left side

- Rt renal A passes posterior to IVC

Renal Veins

- describe the differences

- location

- renal V drain into IVC

- rt renal V is shorter than lt

- lt renal V passes anteriorly to aorta, but posteriorly to SMA (can be compressed)

- Lt renal V passes ant. to lt renal A

- Lt renal V is in continuity with the lt gonadal V, lt inferior adrenal V, and lumbar V

Mesonephric duct becomes the Wolffian duct --> form male reproductive system

T/F

Metanephros - will become adult kidneys

- give rise to collecting tubules, minor and major calices, renal pelvis, and ureters

During the kidneys ascent, they add segmental vessels cranially and lose them caudally as thye go up toward the suprarenal glands.

True or false

The ureter crosses anteriorly to the obliterated umbilical A.

True or False

The left ureter passes behind the sigmoid colon.

True or False?

- apex : anterior end that points toward pubic symphysis

- body: part b/t fundus and apex

- Fundus base of bladder formed by posterior wall

- Neck

- Uvula : slight projection of trigone

- smooth area within the base of the bladder

- bounded by 3 orifices : right and left ureterovesical orifices and the internal urethral meatus

males - bladder is anterior to rectum

females - bladder is anterior to vagina and uterus (bladder -> uterus & vagina -> rectum)

Lateral ligament

- divided by the urorectal septum -> doral rectum and ventral urogenital sinus

- recieves the allantois and mesonephric ducts

1. Vesical (cranial) - forms most of the urinary bladder
2. Pelvic (middle) - becomes urethra in the neck of the bladder and produces prostatic and membranous portions of the uretha in the male
3. Phallic (caudal) - forms penile urethra in male and vestibule of the vagina in the female