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Abdomen, pelvis and perineum is the largest anatomical domain. Applied surgical anatomy is 75 of the 180 Paper 1 questions, and this domain contributes 21 of them: abdominal wall and peritoneal cavity 6, abdominal viscera 6, abdominal vessels 3, pelvis 4 and perineum 2. It covers the layers of the abdominal wall and the inguinal canal, the peritoneal reflections, mesenteries and the lesser sac, the foregut, midgut and hindgut organs with their blood supply, the liver, biliary tree and Calot’s triangle, the pancreas and spleen, the kidneys, ureters and adrenals, the aorta and its branches, the portal system and its portosystemic anastomoses, the bony pelvis and pelvic floor, the rectum, bladder, prostate and uterus with their vessels and nerves, and the anal canal and urogenital triangle. Questions are rooted in operations — hernia repair, cholecystectomy, colectomy, nephrectomy, anterior resection — and in the relations a surgeon has to know to avoid the ureter, the common bile duct or the pelvic nerves.
Topics in this domain
From the free sample — original, referenced, with the full explanation. Rate your confidence first.
A 72-year-old woman taking apixaban develops sudden lower abdominal pain after a bout of coughing. There is a tender, non-pulsatile mass in the right lower quadrant that remains palpable and becomes more tender when she lifts her head from the pillow.
Which vessel is the most likely source of bleeding?
A 40-year-old man has painless bright-red bleeding after defaecation. Proctoscopy shows prolapsing haemorrhoids arising above the dentate line.
Into which vein do the dilated vessels principally drain?
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Also in this domain: Anterior abdominal wall (coming soon), Calot's triangle & the biliary tree (coming soon), Portal venous system (coming soon), Pelvic floor & perineum (coming soon)
Inguinal canal anatomy for MRCS Part A: walls, rings, cord coverings, indirect versus direct hernias, the femoral canal, surface landmarks and nerves at risk.
Read · 8 minCalot's triangle for MRCS Part A: hepatocystic boundaries and contents, cystic artery and duct variants, the critical view of safety and bile duct injury.
Read · 11 minFemoral triangle for MRCS Part A: boundaries, roof and floor, contents in order, the femoral sheath and canal, femoral hernia and profunda branches.
Read · 8 minAnterior: the external oblique aponeurosis, reinforced laterally by internal oblique. Posterior: transversalis fascia, reinforced medially by the conjoint tendon. Roof: the arching fibres of internal oblique and transversus abdominis. Floor: the inguinal ligament, with the lacunar ligament medially. It carries the spermatic cord or the round ligament, and the ilioinguinal nerve.
By its relation to the inferior epigastric vessels at operation: an indirect hernia enters the deep ring lateral to them and lies within the coverings of the cord; a direct hernia bulges through the posterior wall medial to them, in Hesselbach’s triangle. Clinical tests such as occluding the deep ring are unreliable, which is a favourite point for a question.
At the pelvic brim where it crosses the common iliac bifurcation, during ligation of the inferior mesenteric artery or the ovarian pedicle, where it passes under the uterine artery near the lateral vaginal fornix, and at the ureterovesical junction. It is identified by its peristalsis and its position on the medial leaf of the mesentery.
The ICBSE blueprint gives this domain 21 of the 180 Paper 1 questions: abdominal wall and cavity 6, viscera 6, vessels 3, pelvis 4 and perineum 2 — the largest anatomical domain. Hernias, the acute abdomen and colorectal disease are examined again, as clinical conditions, in Paper 2.
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