#KATHMANDU UNIVERSITY
University Examination
January/February 2026
Level: MBBS
Paper: V Gastrointestinal and Hepatobiliary System
Time: 2 hours 30 minutes
Marks: 50
Date: February 13, 2026
#INSTRUCTION TO THE CANDIDATE
Answer each section in a separate answer book.
Write brief, relevant and legible answers.
Illustrate your answer with well labelled diagrams wherever required.
All questions are compulsory.
#SECTION “B”
#Short Answer Questions
a. Describe the formation, contents and clinical importance of inguinal canal. [3]
b. Explain the internal features of anal canal with its applied anatomy. [3]a. Outline the sequence of reactions involved in the formation of glucose during gluconeogenesis process. [4]
b. Explain the digestion and absorption of lipid from the gastrointestinal tract. [2]a. Enlist the helminths parasitizing GI tract of human. Differentiate between the adult and larval stage of Taenia solium and Taenia saginata. [1+2=3]
b. List the causative agents of dysentery. Outline the different steps from specimen collection to identification in the laboratory diagnosis of dysentery. [2+2=4]a. Discuss the pathogenesis of peptic ulcer. [3]
b. Write short note on Hepatoblastoma. [3]Write down the composition of oral rehydration solutions. Mention specific role of each component. [2]
Describe the regulation of secretion of pancreatic juice. [3]
#SECTION “C”
#Problem Based Questions
#Problem – I
A 62-year-old presents to the clinic with complaints of epigastric pain, belching, and intermittent nausea for the past three months. His pain worsens at night or several hours after meals and sometimes improves after eating. He reports mild tenderness in the upper abdomen and takes over-the-counter antacids occasionally. There is no history of weight loss, vomiting, or changes in bowel habits.
On examination, the patient appears in moderate distress due to pain but is otherwise well-nourished. His vital signs are stable, and abdominal examination reveals mild tenderness in the epigastrium without guarding or rebound tenderness. Stool antigen test for H. pylori was positive.
a. Mention two virulence factors responsible for gastric mucosal damage. Write two diagnostic tests to detect this organism. (Microbiology) [1+2=3]
b. Describe the regulation of secretion of hydrochloric acid in gastric phase of gastric secretion. In health, reflux of gastric content is prevented by lower esophageal sphincter (LES). How? (Physiology) [3+1=4]
c. Write down the treatment regimen for eradication of H. pylori in the above case. (Pharmacology) [3]
#Problem – II
A 58-year-old male was admitted in ICU with a history of abuse of alcohol for 10 years and yellowish discoloration of eyes for one year. On examination he is comatose, with slurred speech. Biochemical investigation showed increase in ammonia and decrease in urea levels. Ultrasonography of abdomen showed shrunken liver. The doctor diagnosed him as a case of cirrhosis of liver with hepatic encephalopathy.
a. Draw a well labelled diagram of histological structures of the affected organ. (Anatomy) [4]
b. Why there is decrease in urea and increase in ammonia levels in this case? Give biochemical basis of ammonia toxicity. (Biochemistry) [3]
c. Write down the gross and microscopic features seen in cirrhosis of liver. (Pathology) [3]
