504 



CAVITY. 



descends to enter the middle portion of this 

 intestine, the upper part of which is likewise 

 found in this region. Here, too, we have the 

 upper half of the head of the pancreas, the 

 right gastro-epiploic and the gastro-duodenalis 

 arteries. 



In proceeding to remove the parts which 

 lie most superficially in the epigastric region, 

 we notice on the right side the vessels and 

 nerves enclosed between the laminae of the 

 lesser omentum, viz. the hepatic artery and 

 its terminal branches, the vena portae, and 

 the hepatic and cystic ducts, with the com- 

 mencement of the ductus communis chole- 

 dochus, and entwining its filaments chiefly 

 around the hepatic arteries is the hepatic 

 plexus of nerves ; several lymphatic vessels 

 of considerable size are also found here, and 

 some lymphatic ganglions, the enlargement of 

 which latter, whether acute or chronic, may retard 

 the passage of the bile and give rise to jaundice. 

 All these parts are invested and connected to 

 each other by the dense cellular membrane 

 called the capsule of Glisson. Behind the 

 liver, and closely lodged in a groove, and 

 sometimes a canal in its posterior thick margin, 

 is the vena cava ascendens, which is still more 

 intimately connected with the liver through 

 the branches of the vena cava hepatica, which 

 open into that portion of the ascending vein 

 which is lodged in the groove. To the right 

 of the vein are the supra-renal capsule and 

 the upper part of the kidney, and to its left, 

 and closely connected with the supra-renal 

 capsule, is the semilunar ganglion. Here, 

 likewise, are the renal or emulgent vessels 

 and the renal plexus of nerves. 



In the centre of the epigastric region, on 

 removing the stomach, we open into the lesser 

 cavity of the peritoneum, of which the stomach 

 forms, in part, the anterior and superior boun- 

 dary. This cavity is bounded inferiorly and 

 posteriorly by the descending layer of the trans- 

 verse meso-colon, which covers the upper part 

 of the pancreas ; above this latter gland is the 

 coeliac axis, surrounded by the solar plexus of 

 nerves, giving off its terminal branches, of which 

 the hepatic passes towards the right side, and 

 forwards to the transverse fissure of the liver, 

 while the splenic directs itself tortuously towards 

 ihe left side, along the upper margin of the 

 pancreas. The pancreas itself is to be counted 

 among the parts contained in this region ; here 

 it is covered by the superior layer of the trans- 

 -verse mesocolon, which alone separates it 

 from the posterior surface of the stomach ; 

 hence this gland has sometimes, by contracting 

 an adhesion with the stomach, served to fill 

 up a perforation by an ulcer. Behind the pan- 

 creas are the vena portae and the conflux of 

 the splenic and superior mesenteric veins, the 

 superior mesenteric artery, and the nervous 

 plexus of the same name ; by all of which 

 the gland is separated from the aorta, which, 

 again, with the pillars of the diaphragm and 

 some lymphatic glands, separates the pancreas 

 from the spine. To the right of the aorta, and 

 intervening between it and the right cms, are 



the thoracic duct and the vena azygos, and 

 external to each crus of the diaphragm the 

 great splanchnic nerve is seen to connect itself 

 with the semilunar ganglion. 



On the left side the gastro-splenic omentum 

 contains the vasa brevia and splenic arteries, 

 the splenic plexus of nerves, and the com- 

 mencement of the left gastro-epiploic artery ; 

 the great cul-de-sac of the stomach, and the 

 spleen cover here the left supra-renal capsule, 

 the semilunar ganglion and great splanchnic 

 nerve, the upper part of the left kidney, and 

 the renal vessels and nerves. 



From the vast number and importance of 

 the parts contained in the epigastric region, it 

 cannot be a matter of surprise that it is fre- 

 quently the seat of disease, and that the most 

 serious consequences will often ensue upon 

 strong pressure or violence inflicted upon it. 

 It is universally known that syncope may be 

 induced or even sudden death occasioned by 

 a blow upon the epigastrium, even in a healthy 

 individual ; and it seems to be the favourite 

 opinion that such results arise from the influence 

 exerted upon the immense nervous plexus 

 which is found here. Sometimes, however, 

 one or more of the viscera have experienced 

 injury, and cases of rupture of the spleen, 

 liver, gall-bladder, or duodenum from violence 

 inflicted on this region are not uncommon.* 

 Every practitioner is familiar with the existence 

 of epigastric pulsatitms, which, as they arise 

 from a variety of causes, form a subject of 

 great interest. Dr. Copland thus enumerates 

 these causes, and, indeed, most of them may 

 be deduced a priori from a knowledge of the 

 anatomy of the region : a, nervous suscepti- 

 bility ; b, inflammation of the aorta ; c, aneu- 

 rism of the aorta ; d, adhesion of the pericar- 

 dium to the heart; e, tumours at the root of 

 the mesentery ; J\ tumours of the stomach or 

 scirrhus of the pylorus ; g, enlargement of the 

 pancreas ; h, hypertrophy of the heart, parti- 

 cularly of its right side; i, enlargement of the 

 inferior vena cava; /r, hepatisation of the lower 

 portion of the lungs ; /, enlargement of, or 

 abscess in, the liver, f 



Umbilical region. This region is distinctly 

 and naturally separated from the epigastrium 

 by the transverse arch of the colon and the 

 transverse mesocolon. It is almost entirely 

 occupied in the centre by the small intestines, 

 and on each side by the colon, either ascending 

 or descending. Deep seated and at the upper 

 part of the region, we notice the inferior portion 

 of the duodenum, which is covered by the infe- 

 rior lamina of the transverse mesocolon, and ter- 

 minates on the left side of the spine, just where 

 the mesentery commences. The superior me- 

 senteric artery crosses above and in front of 

 the duodenum, a few lines to the right of its 

 termination, and when the body is laid on the 

 back the intestine seems to suffer a constriction 

 from the artery. Such a constriction can hardly 



* See an interesting paper by Dr. Han, in the 

 Dub. flosp. Reports, vol. v. 



t Diet. Pract. Mcd. art. Epigastrium. 



