Anatomy
Abdomen
A 40 year old man is undergoing a vasectomy. During the procedure the various layers of the spermatic cord are separated to expose the ductus deferens. The internal spermatic fascia is derived from which of the following:
Answer:
The internal spermatic fascia arises from the transversalis fascia and is attached to the margins of the deep inguinal ring.Spermatic Cord
Anatomy / Abdomen / Male Reproductive System
Last Updated: 11th April 2019
The spermatic cord begins to form proximally at the deep inguinal ring and consists of structures passing between the abdominopelvic cavities and the testes, and the three fascial coverings that enclose these structures.
Fascial Coverings
The structures of the spermatic cord enter the deep inguinal ring, proceed down the inguinal canal, and exit from the superficial inguinal ring, having acquired the three fascial coverings during their journey. Of the three fascial layers:
- the internal spermatic fascia arises from the transversalis fascia and is attached to the margins of the deep inguinal ring
- the cremasteric fascia, with the associated cremasteric muscle, arises from the internal oblique muscle
- the external spermatic fascia arises from the aponeurosis of the external oblique muscle and is attached to the margins of the superficial inguinal ring
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/02/Spermatic-cord.png)
Structure of the Spermatic Cord. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Contents
The structures in the spermatic cord include:
- the ductus (vas) deferens
- the artery to the ductus deferens (from the inferior vesical artery)
- the testicular artery (from the abdominal aorta)
- the pampiniform plexus of veins (testicular veins)
- the cremasteric artery and vein (associated with the cremasteric fascia)
- the genital branch of the genitofemoral nerve (innervation to the cremaster muscle)
- sympathetic and visceral afferent nerve fibres
- lymphatics
- remnants of the processus vaginalis.
![Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/02/Testes.png)
Contents of the Spermatic Cord. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
