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B. Femoral ring
Is the abdominal opening of the femoral canal. Is bounded by the inguinal ligament anteriorly, the femoral vein laterally, the lacunar ligament medially, and the pectineal ligament posteriorly
C. Femoral canal
Lies medial to the femoral vein in the femoral sheath. Contains fat, areolar connective tissue, and lymph nodes and vessels. Transmits lymphatics from the lower limb and perineum to the peritoneal cavity. Is a potential weak area and a site of femoral herniation , which occurs most frequently in women because of the greater width of the superior pubic ramus of the female pelvis.
cc 3.20
Femoral hernia: is more common in women than in men, passes through the femoral ring and canal, and lies lateral and inferior to the pubic tubercle and deep and inferior to the inguinal ligament; its sac is formed by the parietal peritoneum. Strangulation of a femoral hernia may occur because of the sharp, stiff boundaries of the femoral ring, and the strangulation interferes with the blood supply to the herniated intestine, resulting in death of the tissues.
D. Femoral sheath
Is formed by a prolongation of the transversalis and iliac fasciae in the thigh. Contains the femoral artery and vein, the femoral branch of the genitofemoral nerve, and the femoral canal. (The femoral nerve lies outside the femoral sheath, lateral to the femoral artery.) Reaches the level of the proximal end of the saphenous opening with its distal end.
E. Adductor canal
Begins at the apex of the femoral triangle and ends at the adductor hiatus (hiatus tendineus). Lies between the adductor magnus and longus muscles and the vastus medialis muscle and is covered by the sartorius muscle and fascia. Contains the femoral vessels, the saphenous nerve, the nerve to the vastus medialis, and the descending genicular artery.
B. Deep fascia
Covers the muscles and continues over the spermatic cord at the superficial inguinal ring as the external spermatic fascia. Continues over the penis as the deep fascia of the penis (Buck's fascia) and over the pubis and perineum the deep perineal fascia.
B. Linea alba
Is a tendinous median raphe between the two rectus abdominis muscles, extending from the xiphoid process to the pubic symphysis. Is formed by the fusion of the aponeuroses of the external oblique, internal oblique, and transverse muscles the abdomen.
cc 5.2
Epigastric hernia: is a protrusion of extraperitoneal fat or a small piece of greater omentum through a defect in the linea alba above the umbilicus and may contain a small portion of intestine, which may become trapped within the hernia, leading to strangulation or incarceration. Its symptoms include nausea, vomiting, and discomfort as a result of nerves and tissue being irritated or stretched.
D. Linea semilunaris
Is a curved line along the lateral border of the rectus abdominis.
C. Inguinal canal
Begins at the deep inguinal ring and terminates at the superficial ring. P.185 Transmits the spermatic cord or the round ligament of the uterus and the genital branch of the genitofemoral nerve, both of which also run through the deep inguinal ring and the inguinal canal. An indirect inguinal hernia (if present) also passes through this canal. Although the ilioinguinal nerve runs through part of the inguinal canal and the superficial inguin ring, it does not pass through the deep inguinal ring. al Anterior wall : aponeuroses of the external oblique and internal oblique muscles. Posterior wall : aponeurosis of the transverse abdominal muscle and transversalis fascia. Superior wall (roof) : arching fibers of the internal oblique and transverse muscles.
cc 5.3
Inguinal hernia: is a condition in which a portion of intestine protrudes through a weak spot in the inguinal canal or in the inguinal triangle. Inguinal hernia occurs superior to the inguinal ligament and medial to pubic tubercle, occurs more in males than in females, and is derived from persistence of the processus vaginalis, which forms the tunica vaginalis (Figure 5-3 ). Reducible hernia is a hernia in which the contents of the hernial sac can be returned to their normal position. Incarcerated hernia is an irreducible hernia which the contents of the hernial sac are entrapped or stuck in the groin. Strangulated hernia is an irreducible hernia in which the intestine becomes tightly trapped or twisted; thus, the circulation is arrested, and gangrene (death of tissue) occurs unless relief (emergency operation) is prompt. This is life threatening, and emergency surgical repair is required.
cc 5.4
Indirect inguinal hernia: passes through the deep inguinal ring, inguinal canal, and superficial inguinal and descends into the scrotum. The hernia lies lateral to the inferior epigastric vessels. Indirect inguinal hernia is found more commonly on the right side in men and is more common than direct inguinal hernia. congenital (present at birth), associated with the persistence of the processus vaginalis, and covered by peritoneum and the coverings of the spermati cord. c Direct inguinal hernia: occurs directly through a weakened area of the abdominal wall muscles (posterior wall of the inguinal canal), lateral to the edge of the conjoint tendon, in the inguinal triangle but does not descend into the scrotum. The hernia lies medial to the inferior epigastric vessels and protrudes forward (rarely through) the superficial inguinal ring. It is acquired (develops after birth), associated with weakness in the posterior wall of the inguinal canal lateral to the falx inguinalis, and has a sac that is formed by the peritoneum and occasionally the transversalis fascia.
C. Fetal structures
Is the fetal ligament that connects the bottom of the fetal testis to the developing scrotum. Appears to be important in testicular descent (pulls the testis down as it migrates). Is homologous to the ovarian ligament and the round ligament of the uterus.
E. Transversalis fascia
Is the lining fascia of the entire abdominopelvic cavity between the parietal peritoneum and the inner surface of the abdominal muscles. Continues with the diaphragmatic, psoas, iliac, pelvic, and quadratus lumborum fasciae. P.188 Forms the deep inguinal ring and gives rise to the femoral sheath and the internal spermatic fascia. Is directly in contact with the rectus abdominis below the arcuate line.