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1. All Abdomen and Pelvis Clinicals
Clinical Reference Info
1-Meckel's
Diverticulum
(v.imp)
BD pg. 219, 291 Persistence of proximal part of vitellointestinal Duct
Gives similar pain to appendicitis
Rules of 2s:
1. 2 inches long
2. 2 feet from ileocecal valve
3. 2 times more common in men
4. 2% of population has it
5. 2 Types of tissue present
2-Enterocoele BD pg. 219 Persistence of middle part of vitellointestinal Duct
3-Abdominal Incisions
(v.imp) (Viva)
BD pg. 227 1. Supraumbilical Median Incisions- Through
Linea Alba above umbilicus- Postoperative
weakness may cause incisional Hernia
2. Infraumbilical Median Incisions- Through Linae
Alba below umbilicus- Closeness of Rectus
prevents Incisional Hernia so Safer
3. Paramedian Incisions- Through Rectus sheath
on the sides of Linea Alba- Safest and Rectus
muscle moved laterally to protect vessels and
low chance of ventral or incisional hernia, More
Preffered
4-Types Of Abdominal
Hernias
(vvv.imp)
BD pg. 235, 265 Types of Abdominal Hernia:
1-Internal:
• Protrusion of intestinal loop into “No Entry
Zone” of peritoneum
• This is the Lesser sac
• Through Epiploic Opening/Foramen of
Winslow
2-External Hernia:
1. Umbilical-Non return of midgut loop
2. Paraumbilical-Intestinal loop protrudes through
Linea Alba
3. Incisional/Anterior- Through Antero-Lateral
Abdominal wall due to mainly supraumbilical
incisions
4. Lumbar-Through Lumbar Triangle
5. Epigastric-Through Upper part of Linae Alba

2. 6. Femoral-Femoral Ring
7. Inguinal-Deep or Superficial Rings
5-Inguinal Hernia
(vvv.imp)
BD pg. 235 2 Types:
Direct Indirect
Superficial Inguinal Ring
(Hesselbach Triangle)
Deep Inguinal Ring and
Superficial Inguinal Ring
Through Posterior Wall
and Hesselbach Triangle
Through Deep then to
Superficial to Scrotum
Cause mainly wall
weakness
Cause mainly patent
process vaginalis
Covering:
1-Extraperitonial Tissue
2-Fascia Transversalis
3-Cremesteric
Fascia/Conjoint Tendon
4-External Spermatic
Fascia
5-Skin
Covering:
1-Extraperitonial Tissue
2-Internal Spermatic
Facia
3-Cremesteric Fascia
4-External Spermatic
Fascia
5-Skin
Less liable to Blockage More Liable to Blockage
6-Hydrocoele
(vvv.imp)
BD pg. 244 Accumulation of Fluid in Process Vaginalis of
Peritoneum
Structures pierces (Layers of Scrotum) in Removing
Fluid (Some Damn Englishmen Called It The Testicle):
1. Skin
2. Dartos Muscle (superficial Fascia Camper)
3. External Spermatic Fascia
4. Cremaster Muscle
5. Internal Spermatic Fascia
6. Tunica Vaginalis
7-Varicocoele
(imp)
BD pg. 247 • Caused by Dilation of pampiniform plexus of
veins
• Common on Left Side
• As Left testicular vein is longer as it drains in
left renal vein whereas right testicular vein
drains in inferior Vena cava
8-Ascites BD pg. 255 Collection of fluid in peritoneum
Greater Omentum known as abdominal policeman as it
slows spread of infection
9-Subphrenic Abscess
(imp)(viva)
BD pg. 268 Collection of pusses in intraperitoneal subphrenic
spaces
1-Hepatorenal (Morrisons Pouch)
Puss collects in supine position

3. 2-Rectouterine/Rectovaginal (Female) - Rectovesical
(Male) (Douglas pouch in both)
Puss collects in Inclines supine position
10-Gastric/Peptic Ulcer BD pg. 279 • Gastric pain in epigastric region because of
nerve supply from T6-T9
• Ulcer more common in lesser curvature
• Common in people who Hurry, Worry and Eat
spicy Curry
• Ulceration of posterior wall may damage
splenic artery
• Cancer of stomach spreads to thoracic duct to
left supraclavicular lymph node called
Virchow’s Node this spreading is called
Troiser’s Sign
11-Appendicitis
(vvv.imp)
BD pg. 297 • Inflammation of Appendix
• Pain referred to umbilical region due to T9-T10
Nerve Supply
• Pain radiates towards appendix then
• McBurney’s Point 2/3rd
Medial and 1/3rd
Lateral on the line joining Umbilicus and
Appendix, this is location of max Tenderness
12-Nut Cracker
Syndrome
(vv.imp)
BD pg. 307 3rd
part of duodenum has Superior Mesenteric Artery
in front and Aorta at the back so this part of
duodenum can become obstructed like a nut between
two tongs
13-1Cholecystitis
(imp)
BD pg. 319 Inflammation of Gall Bladder
Referred pain to Epigastrium due to T9 nerve supply
and Right Shoulder due to C4 Phrenic nerve Supply
If fingertip placed on 9th
costal cartilage patient feels
sharp pain on inspiration known as Murphy's Sign
14-Cholelithiasis BD pg. 319 Gall stones are called cholelithiasis
Most commonly in Hartmann's Pouch of gallbladder
directed downwards and backwards
15-Courvoisier's Law
(imp)
BD pg. 319 Dilation of gall bladder only occurs in Bile Duct
Obstruction and not in Gall Stones
16-Cystic Artery
Ligation
(imp)(viva)
BD pg. 319 Ligated in Calot’s Triangle
Boundaries:
Medially: Common Hepatic Duct
Laterally: Cystic Duct
Superiorly: V segment lobe of Liver
17-Spleen BD pg. 326 Splenic Puncture: Left 9th
or 10th
intercostal space
midaxillary line
Referred Pain: Epigastrium and left shoulder (Kehr’s
Sign)
18-Pancreas BD pg. 332 Referred Pain: Epigastrium and towards the back
19-Renal Angle
(imp)
BD pg. 348 Area of weakness where kidneys are vulnerable to
trauma

4. Boundaries:
Superiorly: 12th
Rib
Medially: Erector Spinae Lateral border
20-Anomalies of
Kidneys
(imp)
BD pg. 353 1. Congenital polycystic kidney: nonunion of
excretory and secretory ducts
2. Horeshoe Kidney: Fusion of Lower poles of
kidney
3. Pelvic Position: Renal artery arise from
common iliac
21-Hypospadias BD pg. 413 Urethra opening is at the undersurface of penis or
perineum
22-Epispadias BD pg. 413 Urethra opening is at the dorsum of penis
23-Piles/Hemorrhoids
(vvv.imp)
BD pg. 451 Internal/True Piles Externa/False Piles
Painless Painful
Above Pectinate Line Below Pectinate Line
Bleed Profusely Don’t Bleed
Primary are in 3, 7, 10
position all others are
secondary
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By Bilal Safdar
NUMS-CMH Lahore
Contact Number for WhatsApp, 03114579803