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.

Laboratory Yellow Practice Tags 1-20 - Table 4P 1-10, Table 5P GI 11-20,

  1. Pelvic Splanchnic Nerve (Parasympathetic)
    • Branching from ventral ramus of S3. About 2 cm long. Ramifies into the inferior hypogastric plexus, aka pararectal plexus, aka pelvic plexus.
  2. Ventral Ramus S3
    • Passing through the S3 anterior sacral foramen. Merging with S2 to contribute to sacral plexus
  3. Obturator Nerve
    • Crossing anterior to ala of the sacrum. Converging with the obturator artery at the entrance to the obturator canal
  4. 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.
  5. 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.
  6. Vas Deferens
    • Retroperitoneal path from floor of pelvis, posterior to prostate. Converges with structures that pass into the deep ring.
  7. 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?
  8. Left Testicular Vein
    • Converges with structures that pass into the deep ring.
  9. 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.
  10. 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.
  11. Esophageal Artery
    • Branching from the left gastric artery and ascending toward the esophagogastric junction.
  12. 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.
  13. Dorsal Pancreatic Artery
    • Branches, in this case, from the base of the celiac trunk. May branch from the aorta in other cases.
  14. 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.
  15. Gastrolienal Ligament
    • Visceral ligament between fundus of the stomach and hilum of the spleen. Of the dorsal mesentery.
  16. Right Gastroepiploic Artery
    • Continuation of gastroduodenal artery entering the gastrocolic ligament part of the greater omentum.
  17. Gastroduodenal Artery
    • Terminal branch of the common hepatic artery. Passes posterior to the duodenal cap (Part I).
  18. Superior Anterior Pancreaticoduodenal Artery
    • Branch of duodenal artery that travels along the anterior surface of the head of the pancreas.
  19. Superior Posterior Pancreaticoduodenal Artery
    • Branch of duodenal artery that travels along the posterior surface of the head of the pancreas.
  20. 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.

Theme Parks for Anterior Abdominal Wall Practice Identifications - Non-Exhaustive

Scarpas and Campers Fascia

  1. Fundiform Ligament
    • Scarpas fascia converging onto dorsum of penis to become colles fascia (not to be confused with suspensory ligamnet of the penis/clitoris)
  2. Campers Fascia
    • Fatty tela subcutanea superficial to scarpas fascia
    • Paraumbilical veins
    • Superficial circumflex iliac vein
    • Superficial epagastric vein
    • Lateral thoracic vein
    • Thoracoepigastric vein

Derivatives of External Oblique Aponeurosis

  1. Linea Semilunaris
    • Lateral margin of the rectus sheath
  2. Anterior Lamina Rectus Sheath
    • Joined by internal oblique and transversus abdominis if inferior to arcuate line
  3. Linea Alba
    • Anterior midline from sternum to pubic crest
    • Relatively avascular - bloodless laparotomy. Poor wound healing.
  4. Superficial Inguinal Ring
    • 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.
  5. Medial Crural Fibers
    • Thickening of external oblique aponeurosis superomedial to path of inguinal canal.
  6. Lateral Crural Fibers
    • Thickening of external oblique aponeurosis inferolateral to path of inguinal canal.
  7. 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.
  8. 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
  9. 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
  10. 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
  11. 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

  1. Anterior Lamina Rectus Sheath
    • Combined external oblique, internal oblique and transversus abdominis if inferior to arcuate line
  2. Posterior Lamina Rectus Sheath
    • Combined internal oblique and transversus abdominis if superior to arcuate line
  3. Linea Alba
    • Fibers from external oblique, internal oblique, and transversus abdominis
  4. Superior epigastric artery
    • Terminal branch of internal thoracic artery
  5. 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.
  6. 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
  7. Thoracolumbar nerves
    • Enter the rectus sheath at the linea semilunaris
    • Relationship

Theme Parks for Inguinal Canal, Round Ligament, and Spermatic Cord Practice Identifications

Inguinal Canal

  1. 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.
  2. Transversalis Fascia
    • Posterior wall of inguinal canal
  3. Arcades
    • Superior "wall"
    • Connecting fibers between external oblique and internal oblique
  4. Deep Ring
    • Evagination of transversalis fascia
  5. Superficial Ring
    • Evagination of external oblique aponeurosis

Spermatic Cord, Testis, and Round Ligament

  1. External Spermatic Fascia
    • From superficial ring and converging onto cremasteric fascia about 3 cm inferior to superficial ring
  2. Cremasteric Fascia
    • Outer layer of spermatic cord if proximal to superficial ring
    • Derived from internal oblique
    • Genitofemoral and ilioinguinal nerves
  3. 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
  4. Visceral Tunica Vaginalis
    • Adhered to tunica albuginea of testicular capsule except for posterior region
  5. Parietal Tunica Vaginalis
    • Adhered to inside of internal spermatic fascia
  6. Efferent Ductules
    • From testis to the head of the epididymis
  7. Head of the Epididymis
    • At superior pole of testis
  8. Body of the Epididymis
    • Along posterior margin of testis
  9. Tail of the Epididymis
    • Along posterior margin of testis
    • Continues as the vas deferens
  10. Scrotal Ligament
    • Inferior pole of testis to floor of scrotal sac
  11. Scrotum Septum
    • Partition of the scrotal sac
  12. 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

Theme Parks for Umbilical Ligaments and Folds Practice Identifications

Inguinal Folds and Ligaments

  1. Median Umbilical Ligament and Fold
    • 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.
  2. 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.
  3. 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

  1. Supravesical Fossa
    • Midline region between the medial umbilical folds
    • Includes the median umbilical fold
    • Site for direct inguinal hernias
  2. Medical Inguinal Fossa
    • Paired regions between the medial and lateral umbilical folds
    • Site for direct inguinal hernias (guarded by conjoint tendon)
  3. 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

Theme Parks for Peritoneum, Visceral ligaments, Mesentery, Greater omentum, Peritoneal Sacs Practice Identifications

Visceral Ligaments

  1. Lesser Omentum
  2. Greater Omentum
  3. Gastrocolic Ligament
  4. Gastrolienal Ligament
  5. Lienorenal Ligament
  6. ligament of Treitz


  1. Intestinal Mesentery
  2. Mesoappendix
  3. Transverse Mesocolon
  4. Sigmoid Mesocolon

Greater and Lesser Sac

  1. Epiploic Foramen

Theme Parks for Celiac Trunk, Stomach, Spleen, Liver, Gall bladder Practice Identifications

Celiac Trunk




Gall Bladder

foregut, midgut, hindgut, Celiac Trunk, Stomach, Spleen, Liver, Gall bladder




key Access Control:
-- LorenEvey - 13 Oct 2019
  1. ID
    • Relationship
Topic revision: r6 - 15 Oct 2019, LorenEvey
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