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ABDOMEN & PELVIS

1.

1.1 Describe the arterial supply of the colon.(40)


Up to right 2/3 of transverse colon-superior
mesenteric artery
Rest of large intestine Inferior mesenteric
List the histological differences in the mucosa of the ileum and colon.(30)
The type of epithelium is glandular with villi and crypts of leiberkuhn.the main cell types of
iliun are enterocytes with microvilli, globlet cells and paneth cells. But the type of epitheliumof
colon is also glangular columnar epithelium containing cell types gublet and absorptive cells.
The distinctive features of it are straight tubular glands in mucosa Teania coli
Explain the embryological basis of
a)Subhepatic caecum
(15)
b)Imperforate anus
(15)
(AL2002 main)

2.

2.1 Describe the structure of the spermatic cord and its coverings.(80)
3.Spermatic cord
Coverings (out to inwards)
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
Contents
3 arteries
Testicular artery - from abdominal aorta
Cremasteric artery - from inferior epigastric
Artery of vas - from inferior vesical
3 veins
Pampiniform plexus drain as testicular vein
Right side to IVC
Left side to left renal vein
Cremasteric vein
Vein of ductus deference
3 nerves
Genital branch of grenitofemaoral
Sympathetics T 10,11
Ilioingunal nerve not inside the cord but on the cord
3 other structures
Ductus deference
Lymphatics
Patent processes vaginalis (pathological )

Explain how the arrangement of the blood vessels in the spermatic cord assists in
spermatogenesis.(20)
(AL2002 main)
3.

3.1 Describe the relations of left kidney.(60)


anterior posterior superior
Describe the course of the ureters from its commencement to its termination.(40)

Begins within renal sinus=renal pelvis


Renal pelvis lies along medial border of kidney behind it
At lower pole it becomes ureter proper

4.

It descends in front of transverse process of L2-L5


Passes anterior to sacro iliac joint
Goes along the curvature of greater sciatic notch towards ischial spine
There it turns medially
Enters the bladder at an acute angle

Describe the anatomy of the pancreas.(100)


4 parts Head
Neck
Body
Tail
Ducts Main Major duodenal papillae, common with bile duct
Accessory Minor duodenal papillae
Relations Head Anterior
Gastroduadenal artery
Transverse colon
Loops of small intestine
Posterior
IVC
Right renal vessels
Right crus of diaphragm
Bile duct
Neck Anterior Pylorus
Peritoneum of lesser sac
Posterior
Termination of superior
mesenteric vein
Beginning of portal vein
Body - Anterior
Lesser sac & stomach
Posterior Abdominal aorta
Left crus of diaphragm
Left renal vessels
Left kidney
Inferior
Duodenojejunal flexure
Splenic flexure
Superior
Splenic artery
Clinical 1. Neoplasm of head of the pancreas, may course obstruction
of the bile duct
2. Pseudocyst of pancreas coursed by acute pancreatitis or posterior
gastric
Ulcerations
Pancreas
Exocrine componect- secretory acini and duct system
Endocrine component ilets of langherhan
Acinar cells intercalated ducts interlobular ducts interlobular
duct
(small cuboidal-stratified cuboidal)

5.

5.1 Describe the blood supply of the stomach.(50)

Explain the formation of lesser sac.(50)


is due to rotation of stomach
6.

Discuss the anatomy of the anterior abdominal wall below umbilicus and how they
contribute to their clinical importance.(100)

7.

Describe joints and ligaments between two lumbar vertebrae.

8.

8.1 Describe the relations of biliary system.(80)


Apparatus consists of Right & left
hepatic ducts
Common hepatic
duct
Gall bladder
Cystic
duct
Bile duct
Arrangement in porta hepatis
Behind forwards
Portal vein
Hepatic artery
Common Hepatic
duct
1. Gall bladder
Volume 30- 50ml
Relations Fundus Anterior Anterior abdominal wall
Posterior Transverse colon
Body Posterior Transverses colon,1st & 2nd parts of
duodenum
Superior Attached to liver,not covered by
peritoneum
Inferior Covered by peritoneum
Neck Superior Attached to areolar tissue
Inferior - 1st part of duodenum

Clinical
1. It has dual blood supply
Cystic artery
From liver bed
So gangrene is rare
Calots triangle
-cystic duct
-common hepatic duct
-inferior surface of liver

cystic artery can be located here


2.Stones in gall bladder-cholesthiasis
Spasmodic pain occur-murphys sign

3.Inflamation of gall bladder


Refered pain -in the lower border of the scapula via
sympathetics
Stomach via vagal fibers
Shoulder tip via phrenic
2.

Bile duct
diameter-6mm
relations
Spraduodenal part
Anterior-liver
Posterior-portal vein,epiploic foramen
Left-hepatic artery
Retro duodenal part
Anterior-1st part of duodenum
Posterior-IVC, left gastroduodenal artery
Infraduodenal part
Anterior-head of pancrease
Posterior-IVC

Explain the embryology.(20)


9.

9.1 Describe the anatomy of bladder.(80)


Give an account of embryological abnormalities related to bladder.(20)

10.

10.1 Describe the male urethra. (70)


Explain the embryological components that contribute to the formation of male
urethra.(30)

11. 11.1 Give an account of prostate and its relations.(80)


Anatomical features with clinical importance.(20)
12. 12.1 Describe the normal position and peritoneal relations of uterus.(60)
Explain the supports of uterus.(40)
13. 13.1 Describe superficial & deep perineal spaces including its contents.(80)
Discuss features with clinical importance.(20)
14.

Describe the anatomy of ductus deferens.(100)

15. 15.1 Name the structures that pass through the umbilicus during fetal life.
Describe the congenital anomalies that may arise in this region.
16.

Describe the relations of duodenum and its blood supply.

17.

Describe the anatomy of the extrahepatic biliary system.(100)

(AL2002 rep)

18.

Write notes on
a) Prostatic urethra.
b) Vagina

(35)
(35)

(AL2002 rep)

19.

19.1 Describe the relations of the second part of the duodenum and the microscopic
structure of its mucosa.(50)
19.2 Describe the anatomy of the Ampulla of Vater and add a note on its
development.(50)
(AL2003 main)

20.

20.1 Explain the differences between ileum and jejunum.(40)


20.2 Describe porto systemic anastamoses.(40)
20.3 Name the structures going through the umbilicus and their remnants.(20)

21.

21.1 Explain the relations of bladder.(40)


21.2Describe the male urethra.(40)
21.3Name the embryological components of male urethra.(20)

22. Write notes on


a)Paramesonephric duct (40)
b)Extrahepatic biliary system(40)
23.

23.1 A 40 year old female was admitted to the surgical casualty with severe epigastric
pain and a diagnosis of a biliary colic (pain due to stones in the gallbladder) was
made.
a. Name the region of the anterior abdominal wall ahere the gall bladder is located.
(10)
b. Why was the pain felt in epigastrium?(20)
23.2 The surgeon recommends that she should have her gallbladder removed. During
the operation an incision is made in the anterior abdominal wall over the
gallbladder.
a. List the layers of the abdominal wall which are incised.(20)
b. Draw a labeled diagram f the extra hepatic biliary system.(20)
c. Give the relations of the gallbladder to the different parts of the intestines.(20)
23.3 Following the removal of the gallbladder the specimen is sent for histology and the
report indicates a normal gallbladder wall.
Name the cells in the mucosa of the gallbladder.
(10)
(AL2004 main)

24. A 65 year old woman complained of pain in the right side of her abdomen.On
examination the attending doctor found a mass (lump) in the right iliac fossa.
Investigation revealed a cancer in the caecum.

24.1 What are the boundaries of the right iliac fossa?(15)


24.2 List the intra abdominal structures found in this region.(25)
24.3 Describe the lymphatic drainage of the caecum and the ascending colon.(30)
A plain X ray of the abdomen showed dilated small bowel loops.
24.4 What are the differences in the small & large bowel as seen in a plain X ray of the
abdomen? Give the anatomical reasons. Use diagrams as appropriate.(30)
(AL2005 main)
25. 25.1 Describe the relations of the psoas major muscle.(60)
25.2 Discuss the arrangement of the psoas fascia and its clinical significance.(40)
(AL2002 CAT2)
26. 26.1 Draw labeled diagram of the extrahepatic biliary system.
Briefly describe its development.
(50)
26.2 Describe the arrangement of blood vessels in relation to liver lobules and discuss
their functional and clinical significance.
(50)
(AL2002 CAT2)
27. 27.1 Describe the blood supply (arterial & venous) of the rectum and anal canal.(80)
27.2 State briefly the anatomical basis of haemorrhoids.(20)
(AL2002 CAT2)
28. 28.1 Describe the rectus sheath.(60)
o Rectus sheath is the aponeurotic covering around the rectus abdominis
muscle which arise from the aponeurotic fibers of external oblique, internal
oblique and transverses abdominis muscles
in the anterior abdominal wall
between the superficial facia and transversalis fascia.
o The aponeurotic fibers of external oblique are always anterior to the rectus
muscle,
fibers of internal oblique covers the both sides above the arcuate line and
the aponeurotic fibers of both internal oblique & transverse abdominis are
anterior to rectus abdominis inferior to arcuate line.
And transverse abdominis is posterior aspect of rectus abdominis above the
arcuate line.
So below the arcuate line rectus abdominis muscle isnot covered by posterior
rectus sheath.
Anterior rectus sheath is adherent with anterior surface of rectus abdominis
muscle forming tendinous intersections
but the rectus muscle is completely free behind from posterior rectus sheath.
Between two rectus muscles the anterior and posterior rectus sheaths are
attached forming linea alba.
The nerves entering the rectus sheath
lower 2 intercostal nerves, subcostal nerve and iliohypogastric nerve
lie between posterior rectus sheath and rectus abdominis and
pierce the muscle near midline.
Superior epigastric artery and inferior epigastric artery

lie between posterior rectus sheath and rectus abdominis muscle to supply it
and anastomose around umbilicus and
o superficial epigastric is between anterior rectus sheath and rectus abdominis
muscle.
28.2 Add a note on the origin and course of the inferior epigastric artery.(40)
(AL2003 CAT2)

29. 29.1 Describe the 2nd part (descending part) of the duodenum.(60)
29.2 State briefly the development of the pancreas.(40)
(AL2003 CAT2)
30. 30.1 Describe the course and relations of the left ureter.(50)
30.1 Describe the microscopy of the ureter and indicate the functional adaptations.(50)
(AL2003 CAT2)
31. 31.1 Describe the root of the mesentery of the small intestine and the arrangement of
the structures of the mesentery. (50)
31.2 Give the histological differences in the mucosa of the small intestine and the large
intestine.(30)
(AL98/99 main)

32. 32.1 Describe the relations of the head of the pancreas.(50)


32.2 Give the lymphatic drainage of the pancreas.(25)
32.3 Describe the light microscopic appearance of the pancreatic exocrine unit.(25)
(AL1996 CAT2)
33. 33.1 Describe the descent of the testis.(70)
33.2 Describe the arterial supply and the venous drainage of the testis.(30)
(AL1996 CAT2)
34. 34.1 Describe the rectus sheath.(60)
34.2 List the structures found in the umbilicus in foetus.(10)
34.3 Give the clinical significance of the structures listed in 34.2 in the adults.(30)
(AL1996 CAT2)
35. 35.1 Describe the extent and relations of the right ureter.(60)
35.2 Draw and label a transverse section of the ureter and state the special features of
its epithelium.(30)
35.3 What are the embryological structures from which the urinary bladder develops?
(10)
(AL1997 CAT2)
36. 36.1 Describe the supports of the uterus.(70)
36.2 What are the microscopic features of the endometrium in the secretory phase?(30)
(AL1997 CAT2)

37. 37.1 Describe the contents and relations of the spermatic cord below the superficial
inguinal ring.(70)
37.2 Name the structures that pass through the umbilicus in fetal life and indicate what
they form in the adults.(30)
(AL1998 CAT2)
38. 38.1 Describe the nerve supply of the transverse colon, including the arrangement of the
nerves in its wall.(60)
38.2 Describe the blood supply of t6he appendix.(40)
(AL1998 CAT2)
39. 39.1 Describe the structures that maintain the uterus in its normal position.(50)
39.2 Describe the embryological basis of an abnormal external urethral orifice in the
male.(50)
(AL1998 CAT2)
40. 40.1 Describe the arrangement of the extrahepatic biliary system.(50)
40.2 Discuss the blood flow in a liver lobule.(35)
40.3 What are the embryological components of the liver?(15)
(AL2000 CAT2)
41. 41.1 Describe the posterior relations of the left kidney.(50)
41.2 Discuss how the microscopic structure of the ureter is adapted to its function.(35)
41.3 List the adult structures derived from the intermediate mesoderm.(15)
(AL2000 CAT2)
42. 42.1 Describe the attachment ,relations and contents of the pelvic (sigmoid) mesocolon.
(40)
42.2 State the distribution of the superior rectal artery.(40)
42.3 Discuss how the distribution of the superior rectal vessel determine the position of
haemorrhidal masses in the anal canal.(20)
(AL2000 CAT2)
43. 43.1 Describe the attachment and contents of the lesser omentum.(60)
43.2 State briefly its development.(40)
(AL2001 CAT2)
44. 44.1 Describe the relations of the left kidney.(50)
44.2 Discuss the structure of renal corpuscle in relation to its function.(50)
(AL2001 CAT2)
45. 45.1 Give an account of the origin and cause of the uterine artery.(40)
45.2 Describe the microscopic structure of the uterine cervix.(40)
45.3 State briefly the development of the vagina.(20)
(AL2001 CAT2)
46. 46.1 Describe the position and relations of the duodenum.(50)
46.2 Describe the microscopic arrangement of the duodenal mucosa.(40)
46.3 List the functional adaptations of the above microscopic arrangement.(10)

47. 47.1 Describe the course and relations of the left renal vein.(50)
47.2 In a 40 year old man ultrasound scan shows multiple cysts in both kidneys.
47.2.1 Name the condition he is suffering from.(05)
47.2.2 Briefly describe the development of the excretory and collecting units of the
kidney.(25)
47.2.3 Name a similar condition affecting the kidney(05)
47.2.4 Give 5 differences (embryological & clinical) between the conditions that you
have named in 1 & 3.(15)