Physician Assistant PAS701/2/3 and Graduate Anatomy ANAT503: Annotated Laboratory Practice Tags: Abdomen, Pelvis, and Perineum 2019
More important than being able to correctly identify a tag is to know the relationships that define the tag. The following key for practice tags in the laboratory is annotated with key relationships. Not exhaustive. Appreciating relationships applies to both the essay and the laboratory examination.
Branching from ventral ramus of S3. About 2 cm long. Ramifies into the inferior hypogastric plexus, aka pararectal plexus, aka pelvic plexus.
Ventral Ramus S3
Passing through the S3 anterior sacral foramen. Merging with S2 to contribute to sacral plexus
Obturator Nerve
Crossing anterior to ala of the sacrum. Converging with the obturator artery at the entrance to the obturator canal
Iliolumbar Artery
Ascending on the anterior surface of the ala of the sacrum toward the fifth lumbar space. Tag is distal to the iliac branch and on the lumbar branch. Main trunk was cut from internal iliac artery (stuff happens). I did not do it; I swear.
Lumbosacral Trunk
Crossing the anterior surface of the ala of the sacrum. Part of L4 and all of L5. Note relationship to superior gluteal artery. Merges with S1 to contribute to sacral plexus.
Vas Deferens
Retroperitoneal path from floor of pelvis, posterior to prostate. Converges with structures that pass into the deep ring.
Inferior Epigastric Artery
Immediately medial to the opening of the deep ring. In this case, the deep ring is large. You guys must have pulled an indirect hernia out of a patent processes vaginalis?
Left Testicular Vein
Converges with structures that pass into the deep ring.
Genital Branch of Genitofemoral Nerve
Genitofemoral nerve emerges from anterior surface of psoas major muscle. Splits into a femoral branch following the femoral artery into the femoral sheath and a genital branch entering the inguinal canal near the deep ring.
Deep Circumflex Iliac Artery
Branches from the external iliac artery at nearly the same level as the inferior epigastric artery. Travels along the iliac crest. Deep to the anterior wall muscles; thus, not the superficial circumflex iliac artery from the femoral artery.
The deep circumflex iliac artery anastomoses with the iliac branch of the iliolumbar artery and, thus, contributes to an anastomoses between the external and internal iliac arteries.
Esophageal Artery
Branching from the left gastric artery and ascending toward the esophagogastric junction.
Left Gastric Artery
One of three branches of the celiac trunk. Travels along the left margin of the lesser curvature of the stomach. Travels within the hepatogastric ligament.
Dorsal Pancreatic Artery
Branches, in this case, from the base of the celiac trunk. May branch from the aorta in other cases.
Short Gastric Artery
Branches from the splenic artery at the hilum of the spleen and traveling to the fundus of the stomach by way of the gastroleinal ligament.
Gastrolienal Ligament
Visceral ligament between fundus of the stomach and hilum of the spleen. Of the dorsal mesentery.
Right Gastroepiploic Artery
Continuation of gastroduodenal artery entering the gastrocolic ligament part of the greater omentum.
Gastroduodenal Artery
Terminal branch of the common hepatic artery. Passes posterior to the duodenal cap (Part I).
Superior Anterior Pancreaticoduodenal Artery
Branch of duodenal artery that travels along the anterior surface of the head of the pancreas.
Superior Posterior Pancreaticoduodenal Artery
Branch of duodenal artery that travels along the posterior surface of the head of the pancreas.
Inferior Anterior Pancreaticoduodel Artery (May be a common trunk)
Branch of the superior mesenteric artery. Notice that the superior mesenteric plexus was opened to show the superior mesenteric artery and the middle colic artery.
Contributes external spermatic fascia to the spermatic cord.
Boundaries: Superior - medial crural fibers, Inferior - lateral crural fibers, Anterior - communication for spermatic cord to pass from inguinal canal to scrotum and round ligament to mons pubis, Posterior - conjoint tendon, reflected inquinal ligament.
Medial Crural Fibers
Thickening of external oblique aponeurosis superomedial to path of inguinal canal.
Lateral Crural Fibers
Thickening of external oblique aponeurosis inferolateral to path of inguinal canal.
Intercrural Fibers
Orthogonal to, and bridging, medial and lateral crural fibers.
Supporting anterior wall of inguinal canal.
Contributing to lateral margin of superficial inguinal ring.
Inguinal Ligament
Thickening of external oblique aponeurosis running from anterior superior iliac spine to pubic tubercle.
Contributing support to the inferior wall of the inguinal canal
Reflected Inguinal Ligament
Fibers of the inguinal ligament that reflect off the pubic tubercle toward the pubic symphysis
Contributes to inferoposterior margin of superficial ring
Lacunar Ligament (fill a gap)
Fibers of the inguinal ligament that diverge away and fill a gap between the inguinal ligament and the pectin line.
Contributes medial border of the femoral ring
Pectineal Ligament
Fibers from the lacunar ligament blend with the periosteum along the pectineal line
Holds sutures and may be used to shore up the anterior abdominal wall during hernia repair.
Crossed by an aberrant obturator artery - disastrous to ligate if artery of the ligament of the head of the femur is functioning as an end artery.
Rectus Sheath
Anterior Lamina Rectus Sheath
Combined external oblique, internal oblique and transversus abdominis if inferior to arcuate line
Posterior Lamina Rectus Sheath
Combined internal oblique and transversus abdominis if superior to arcuate line
Linea Alba
Fibers from external oblique, internal oblique, and transversus abdominis
Superior epigastric artery
Terminal branch of internal thoracic artery
Inferior epigastric artery
Branch of external iliac artery that marks the lateral inguinal fold and crosses the anterior abdominal wall medial to the deep ring.
Tendinous Intersections
Divide the rectus abdominis muscle into a "six pack" (or an 8 pack)
Adhered to the anterior lamina of the rectus sheath, but not to the posterior lamina
Medial Crural Fibers, Lateral Crural Fibers, and Intercrural Fibers
Named parts of the external oblique aponeurosis that contribute to a
Anterior wall of the inguinal canal.
Transversalis Fascia
Posterior wall of inguinal canal
Arcades
Superior "wall"
Connecting fibers between external oblique and internal oblique
Deep Ring
Evagination of transversalis fascia
Superficial Ring
Evagination of external oblique aponeurosis
Spermatic Cord, Testis, and Round Ligament
External Spermatic Fascia
From superficial ring and converging onto cremasteric fascia about 3 cm inferior to superficial ring
Cremasteric Fascia
Outer layer of spermatic cord if proximal to superficial ring
Derived from internal oblique
Genitofemoral and ilioinguinal nerves
Internal Spermatic Fascia
Evagination of transversalis fascia
Contains structures that passed into deep ring
Vas deferens, deferent artery and vein, deferent arterial plexus, Testicular vein and artery, pampiniform plexus, testicular arterial plexus, lymphatic vessels draining to upper lumbar nodes and internal iliac nodes
Visceral Tunica Vaginalis
Adhered to tunica albuginea of testicular capsule except for posterior region
Parietal Tunica Vaginalis
Adhered to inside of internal spermatic fascia
Efferent Ductules
From testis to the head of the epididymis
Head of the Epididymis
At superior pole of testis
Body of the Epididymis
Along posterior margin of testis
Tail of the Epididymis
Along posterior margin of testis
Continues as the vas deferens
Scrotal Ligament
Inferior pole of testis to floor of scrotal sac
Scrotum Septum
Partition of the scrotal sac
Round Ligament
Fibrous ligament enters deep ring after traveling within broad ligament
Leaves inguinal canal by way of superficial ring and ramifies into the mons pubis
Accompanied by lymph vessels that may convey metastatic desease from inferior pole of the ovary and lateral margin of the fundus of the uterus toward superficial inguial nodes
Urachus (obliterated allantois) extends from apex of bladder to umbilicus as the median (unpaired) umbilical ligament
Median umbilical ligament is superficial to fold of parietal peritoneum and transversalis fascia that underlies the ligament.
Medial Umbilical Ligament and Fold
Obliterated umbilical artery extends from superior vesical arterial branches (point of obiliteration) of bladder to umbilicus as the medial (paired) umbilical ligaments
Medial umbilical ligament is superficial to fold of parietal peritoneum and transversalis fascia that underlies the ligament.
Lateral Umbilical Fold
Extends from the region of the external iliac artert to the umbilicus as the lateral (paired) umbilical folds
Inferior epigastric artery is superficial to fold of parietal peritoneum and transversalis fascia that underlies the artery.
Inguinal Fossa and Hernias
Supravesical Fossa
Midline region between the medial umbilical folds
Includes the median umbilical fold
Site for direct inguinal hernias
Medical Inguinal Fossa
Paired regions between the medial and lateral umbilical folds
Site for direct inguinal hernias (guarded by conjoint tendon)
Lateral Inguinal Fossa
Paired regions lateral to lateral umbilical folds
Site for indirect inguinal hernias
Deep ring is immediately lateral to the lateral umbilical fold and, thus, of the lateral inguinal fossa