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ANTERIOR ABDOMINAL WALL Part 3

    SPERMATIC CORD – COVERINGS AND CONTENTS (SE)     
    Coverings of spermatic cord :
      From within outwards,
           Internal spermatic fascia – derived from fascia transversalis
      Cremasteric fascia – derived from the internal oblique muscle
            External spermatic fascia – derived from external oblique aponeurosis
                              

    Contents of spermatic cord:
    Vas deferens
    Artery to vas deferens & sympathetic plexus around it
    Cremasteric artery
    Testicular artery
    Pampiniform plexus of veins
    Lymphatics from testis
    Genital branch of Genitofemoral nerve
    Remains of processus vaginalis

                                                      


    PROTECTIVE MECHANISM OF INGUINAL CANAL (SE)                  
         Obliquity of inguinal canal
            Superficial & Deep inguinal ring don’t lie opposite to each other
            When intra abdominal pressure rises, anterior & posterior walls of canal approximate with each     other like a flap valve & obliterates the passage
         Guarding of inguinal rings
             Superficial inguinal ring is guarded from behind by conjoint tendon
             Deep inguinal ring is guarded from front by internal oblique muscle
         Shutter mechanism of internal oblique muscle
            Tmuscle forms the anterior wall, roof, floor of inguinal canal
            When the muscle contracts, the roof approximates to the floor like a shutter
         Ball valve mechanism
            Contraction of cremaster pulls the testis upwards & superficial inguinal ring is plugged by spermatic cord
         Slit valve mechanism
            Contraction of external oblique results in approximation of  2 crura of superficial inguinal ring like a     slit valve






    INGUINAL HERNIA – TYPES & COVERINGS                     
              Protrusion of any of the abdominal contents through the inguinal wall or inguinal canal is called inguinal Hernia
    Types of inguinal hernia:
          Direct inguinal hernia
      Indirect inguinal herni
                                                     
                                          


    Direct inguinal hernia
    Indirect inguinal hernia
    1.
    Definition
    protrusion of abdominal contents occurs through the weak posterior wall of inguinal canal 
    (Hesselbach’s triangle)
    protrusion of abdominal contents occurs through the deep inguinal ring
    2.
    Congenital / Acquired
    Acquired
    Congenital or
    Acquired
    3.
    Etiology
    Weakness of Abdominal wall muscles, factors increasing intra abdominal pressure like chronic cough, constipation
    Persistence of patent processus vaginalis
    4.
    Age
    Old
    Children ,Young age
    5.
    Unilateral / bilateral 
    Bilateral
    Unilateral / bilateral
    6.
    Relation to inferior epigastric artery
    Medial
    Lateral
    7.
    Enters inguinal canal  through
    Inguinal triangle
    Deep inguinal ring
    8.
    Hernial sac neck
    wider
    Narrow
    9.
    Coverings
    From within outwards,
    Peritoneum
    Extra peritoneal tissue
    Fascia transversalis
    Cremasteric fascia
    External spermatic fascia
    Skin
    From within outwards,
    Peritoneum
    Extra peritoneal tissue
    Internal spermatic fascia
    Cremasteric muscle & fascia External spermatic fascia
    skin
                                                           
     Coverings of indirect inguinal hernia         
    fascia
    fascia
                                            
                                                            

    Coverings of direct inguinal hernia
    fascia
                                                             
            

       

    6.INDIRECT INGUINAL HERNIA (SE)
    Indirect inguinal hernia is protrusion of abdominal contents through the deep inguinal ring
    may be congenital/ acquired
                  congenital – due to patency of processus vaginalis
                  acquired – due to increased intra abdominal pressure
    occurs in children ,young adults
    predisposing factor is partial or complete patency of processus vaginalis.
    may be unilateral or bilateral
    hernia sac neck is narrower
    lies lateral to inferior epigastric artery
    Coverings:
          From within outwards,
    Peritoneum
    Extra peritoneal tissue
    Internal spermatic fascia
    Cremasteric muscle & fascia
    External spermatic fascia
    skin
    fascia
    fascia
                                          
             
      

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