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TEXTBOOK OF ANATOMY ABDOMEN AND LOWER LIMB TEXTBOOK OF ANATOMY ABDOMEN AND LOWER LIMB Volume II Second Edition Vishram Singh, MS, PhD Professor and Head, Department of Anatomy Professor-in-Charge, Medical Education Unit Santosh Medical College, Ghaziabad Editor-in-Chief, Journal of the Anatomical Society of India Member, Academic Council and Core Committee PhD Course, Santosh University Member, Editorial Board, Indian Journal of Otology Medicolegal Advisor, ICPS, India Consulting Editor, ABI, North Carolina, USA Formerly at: GSVM Medical College, Kanpur King George’s Medical College, Lucknow Al-Arab Medical University, Benghazi (Libya) All India Institute of Medical Sciences, New Delhi ELSEVIER A division of Reed Elsevier India Private Limited Textbook of Anatomy: Abdomen and Lower Limb, Volume II, 2e Vishram Singh © 2014 Reed Elsevier India Private Limited First edition 2011 Second edition 2014 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). ISBN: 978-81-312-3728-1 e-book ISBN: 978-81-312-3626-0 Notices Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identifi ed, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Please consult full prescribing information before issuing prescription for any product mentioned in this publication. The Publisher Published by Reed Elsevier India Private Limited Registered Offi ce: 305, Rohit House, 3 Tolstoy Marg, New Delhi-110 001 Corporate Offi ce: 14th Floor, Building No. 10B, DLF Cyber City, Phase II, Gurgaon-122 002, Haryana, India Senior Project Manager-Education Solutions: Shabina Nasim Content Strategist: Renu Rawat Project Coordinator: Goldy Bhatnagar Senior Operations Manager: Sunil Kumar Production Manager: NC Pant Sr. Production Executive: Ravinder Sharma Sr. Graphic Designer: Milind Majgaonkar Typeset by Chitra Computers, New Delhi Printed and bound at Thomson Press India Ltd., Faridabad, Haryana Dedicated to My Mother Late Smt Ganga Devi Singh Rajput an ever guiding force in my life for achieving knowledge through education My Wife Mrs Manorama Rani Singh for tolerating my preoccupation happily during the preparation of this book My Children Dr Rashi Singh and Dr Gaurav Singh for helping me in preparing the manuscript My Teachers Late Professor (Dr) AC Das for inspiring me to be multifaceted and innovative in life Professor (Dr) A Halim for imparting to me the art of good teaching My Students, Past and Present for appreciating my approach to teaching anatomy and transmitting the knowledge through this book Preface to the Second Edition It is with great pleasure that I express my gratitude to all students and teachers who appreciated, used, and recommended the first edition of this book. It is because of their support that the book was reprinted three times since its first publication in 2011. The huge success of this book reflects appeal of its clear, unclustered presentation of the anatomical text supplemented by perfect simple line diagrams, which could be easily drawn by students in the exam and clinical correlations providing the anatomical, embryological, and genetic basis of clinical conditions seen in day-to-day life in clinical practice. Based on a large number of suggestions from students and fellow academicians, the text has been extensively revised. Many new line diagrams and halftone figures have been added and earlier diagrams have been updated. I greatly appreciate the constructive suggestions that I received from past and present students and colleagues for improvement of the content of this book. I do not claim to absolute originality of the text and figures other than the new mode of presentation and expression. Once again, I whole heartedly thank students, teachers, and fellow anatomists for inspiring me to carry out the revision. I sincerely hope that they will find this edition more interesting and useful than the previous one. I would highly appreciate comments and suggestions from students and teachers for further improvement of this book. “To learn from previous experience and change accordingly, makes you a successful man.” Vishram Singh Preface to the First Edition This textbook on abdomen and lower limb has been carefully planned for the first year MBBS students. It follows the revised anatomy curriculum of the Medical Council of India. Following the current trends of clinically-oriented study of Anatomy, I have adopted a parallel approach – that of imparting basic anatomical knowledge to students and simultaneously providing them its applied aspects. To help students score high in examinations the text is written in simple language. It is arranged in easily understandable small sections. While anatomical details of little clinical relevance, phylogenetic discussions, and comparative analogies have been omitted, all clinically important topics are described in detail. Brief accounts of histological features and developmental aspects have been given only where they aid in understanding of gross form and function of organs and appearance of common congenital anomalies. The tables and flowcharts summarize important and complex information into digestible knowledge-capsules. Multiple choice questions have been given chapter-by-chapter at the end of the book to test the level of understanding and memory recall of the students. The numerous simple 4-color illustrations further assist in fast comprehension and retention of complicated information. All the illustrations are drawn by the author himself to ensure accuracy. Throughout the preparation of this book one thing I have kept in mind is that anatomical knowledge is required by clinicians and surgeons for physical examination, diagnostic tests, and surgical procedures. Therefore, topographical anatomy relevant to diagnostic and surgical procedures is clinically correlated throughout the text. Further, Clinical Case Study is provided at the end of each chapter for problem-based learning (PBL) so that the students could use their anatomical knowledge in clinical situations. Moreover, the information is arranged regionally since while assessing lesions and performing surgical procedures, the clinicians encounter region-based anatomical features. Due to propensity of fractures, dislocations, and peripheral nerve lesions in the lower limb there is in-depth discussion on joints and peripheral nerves. Similarly due to high incidence of abdominal hernias and tumors involving abdominopelvic viscera, the inguinal region and abdominal viscera are described in detail. As a teacher, I have tried my best to make the book easy to understand and interesting to read. For further improvement of this book I would greatly welcome comments and suggestions from the readers. Vishram Singh