i 
THE LIVER. 1063 
triangle it comes into direct relation with the anterior wall of the abdomen, for a distance 
usually of two or three inches below the xiphi-sternal articulation. It has a complete peritoneal 
covering, and gives attachment as far down as the umbilical notch, at the inferior border, to the 
falciform ligament, which connects it to the anterior abdominal wall. 
The anterior passes gradually into the upper and right areas, but it is distinctly separated 
from the visceral surface by the sharp inferior border of the organ. The umbilical notch is 
often continued upwards for some distance on this surface as a slit-like fissure. 
The right area of the parietal surface is convex and extensive, and lies in contact with the 
diaphragm, which separates it from the inner surface of the lower ribs, and also from the lower 
margin of the lung and pleura above. Though sharply marked off by the inferior border from 
the visceral surface, it passes without distinct limits into the other areas of the parietal surface. 
It is completely covered by peritoneum. 
Visceral or Inferior Surface.—This surface of the liver is an wregular, 
obliquely sloping surface (Fig. 716), which looks downwards, backwards, and to 
the left, and rests upon the stomach, intestines, and right kidney—all of which 
leave impressions upon it. The division into right and left lobes is indicated on 
this surface by the umbilical fissure, which passes from the umbilical notch at the 
anterior border, back to the portal fissure. 
The visceral surface of the left Jobe is directed downwards and backwards, and 
rests on the upper surface of the stomach, in front of the cardia; also on the lesser 
curvature with its attached lesser omentum. The part which rests upon the upper 
surface of the stomach is rendered concave by the pressure of that organ (Fig. 716), 
and is known as the gastric impression (impressio gastrica); whilst the portion to 
the right of this, being free from the pressure of the stomach, projects backwards 
over the lesser curvature against the lesser omentum, and is known as the omental 
tuberosity (tuber omentale). 
The visceral surface of the right lobe may be divided into two portions by the line 
of the gall-bladder, which extends forward in its fossa to the lower sharp margin 
of the liver (Fig. 716). 
(a) To the left of the line of the gall-bladder are found from before backwards :— 
The quadrate lobe, portal fissure, and caudate lobe. (1) The quadrate lobe (lobus 
quadratus) is placed at the anterior part of the under surface, between the gall- 
bladder and the umbilical fissure, extending to the inferior margin of the liver in 
front, and to the portal fissure behind: it rests upon the pylorus or the beginning 
of the duodenum. (2) The portal or transverse fissure is a wide cleft through which 
the portal vein, hepatic artery, and hepatic duct enter the liver, and to the margins 
of which are attached the two layers of the lesser omentum (Fig. 716). (5) The 
caudate lobe or process (processus caudatus) consists of a narrow ridge of liver 
substance which runs across behind the portal fissure, and connects the lower end 
of the Spigelian lobe with the rest of the right lobe. It forms the upper boundary 
of the foramen of Winslow, and is felt when the finger is introduced into that 
passage. It is often very small, and occasionally can scarcely be distinguished. 
(b) The surface to the right of the gall-bladder, which is more extensive than 
that on its left, is entirely occupied by three impressions produced by the under- 
lying viscera—namely: (1) The colic impression (impressio colica) hes in front and 
to the right of the gall-bladder. It rests upon the hepatic flexure and the 
beginning of the transverse colon. (2) Behind this is the renal impression (im- 
pressio renalis), larger than the preceding, which corresponds in size and form to 
the upper half or two-thirds of the right kidney, against the anterior or visceral 
surface of which it lies. It is placed behind the colic impression just as the kidney 
itself is placed behind the colon. (3) To the inner side of the renal impression, and 
near the neck of the gall-bladder, is placed the narrow duodenal impression (im- 
pressio duodenalis) which lies in contact with the duodenum (the second part, down 
to the point at which it is crossed by the colon). 
The quadrate lobe is of an oblong shape, the antero-posterior diameter being the greatest. Its 
surface is generally concave, and is related to the pylorus and the adjacent parts of the stomach 
and duodenum, when the former is distended. When the stomach is empty, however, the 
pylorus usually lies beneath the right portion of the left lobe, and the first part of the duodenum 
lies beneath the quadrate lobe, the transverse colon also coming in contact with it anteriorly 
(Fig. 716). 
The upper end of the renal impression is frequently uncoyered by peritoneum (Fig. 716), that 
