Anatomy
Lower Limb
A 87 year old woman presents to the ED after her carers noted she was complaining of pain in the right groin. On examination you note a tender swelling in keeping with a femoral hernia. The femoral ring is bordered posteriorly by which of the following structures:
Answer:
The femoral ring is bordered anteriorly by the inguinal ligament, posteriorly by the pectineal ligament, medially by the lacunar ligament and laterally by the femoral vein.Femoral Canal and Femoral Ring
Anatomy / Lower Limb / Femoral Triangle
Last Updated: 13th June 2019
Femoral canal
The femoral canal lies between the femoral vein and the medial edge of the femoral sheath. The femoral canal contains loose connective tissue, lymphatic vessels, deep inguinal lymph nodes and empty space. The femoral canal allows the femoral vein to expand, for example, when venous return from the leg is increased, or when increased intra-abdominal pressure causes a temporary stasis.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Femoral-Sheath.png)
Femoral Sheath Open to Reveal Contents: Femoral Artery, Femoral Vein and Femoral Canal (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Femoral ring
Table: Anatomical Borders of the Femoral Ring
| Femoral Ring | Structure |
|---|---|
| Anterior border | Inguinal ligament |
| Posterior border | Pectineal ligament |
| Medial border | Lacunar ligament |
| Lateral border | Femoral vein |
The femoral ring is formed by the proximal abdominal opening of the femoral canal, and is important clinically, as it is a common site of hernia. It is bordered anteriorly by the inguinal ligament, posteriorly by the pectineal ligament, medially by the lacunar ligament and laterally by the femoral vein.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Femoral-Ring.png)
Femoral Ring. (Image 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 |
