PRACTICAL CONSIDERATIONS : THE ABDOMEN. 



527 



through a wound, the stretching of scars, and some forms of dystocia and of uterine 

 displacement. 



The pelvic cavity — " a recess leading downward and backward from the abdomi- 

 nal cavity proper" (Cunningham) — is divided from the latter by an imaginary plane 

 extending from the promontory of the sacrum to the upper edge of the pubes. It 

 will be considered separately. 



The general shape of the abdominal cavity is described on page 161 5 as are also 

 the regions into which, for convenience, the abdomen proper may be divided by cer- 

 tain arbitrary lines (page 1615). 



The structures and organs underlying the spaces thus marked out are approxi- 

 mately as follows : 



Right Hypochondriac. 



Greater part of right lobe of 

 liver, hepatic fliexrire of colon, 

 and part of right kidney. 



Right Lumbar. 



Ascending 

 right kidney, 

 part of ileum. 



colon, part of 

 and sometimes 



Right Iliac 



Caecum with vermiform ap- 

 pendix and termination of 

 ileum. 



Epigastric 



Greater part or whole of left 

 lobe and part of right lobe of 

 liver, with gall-bladder, part of 

 stomach, including both ori- 

 fices, first and major portion 

 of the second parts of duo- 

 denum, duodeno-jejunal flex- 

 ure, pancreas, upper or inner 

 end of spleen, parts of kid- 

 neys, and suprarenal bodies. 



Umbilical. 



Greater part of transverse 

 colon, lower portion of second 

 and much of third part of duo- 

 denum, some convolutions of 

 jejunum and ileum, with por- 

 tions of mesentery and greater 

 omentum, part of right, often 

 of left, and sometimes of both 

 kidneys, and part of both 

 ureters. 



Hypogastric 



Convolutions of ileum, blad- 

 der in children, and when dis- 

 tended in adults also, uterus 

 when in the gravid state, and, 

 behind, sigmoid flexure. 



Left Hypochondriac 



Part of stomach, portion of 

 spleen, tail of pancreas, splenic 

 flexure of colon, part of left 

 kidney, and sometimes part of 

 left lobe of liver. 



Left Lumbar. 



Descending colon, part of 

 jejunum, and sometimes part 

 of left kidney. 



Left Iliac 



Sigmoid colon, convolutions 

 of jejunum and ileum. 



The contents of the various regions and the structures intersected by the different 

 planes — if the arbitrary lines are continued into planes — vary considerably within 

 normal limits and greatly in the presence of disease. 



The shape and size of the abdomen are also extremely variable. In the normal 

 adult male it is irregularly cylindrical, with a central bulging, an antero-posterior 

 flattening, and a greater width near the pelvis than near the ribs. In the adult female 

 the larger relative size of the lower abdomen is due to the greater development of the 

 pelvis, and usually to flabbiness of abdominal muscles and accumulation of fat from 

 want of exercise, and to compression of the upper segment by corsets ; it is increased 

 by the stretching of repeated pregnancies. In infancy and childhood the abdomen is 

 prominent on account of the undeveloped condition of the pelvis, the pelvic viscera 

 being then practically within the abdomen, and is broader above than below by 

 reason of the relatively great bulk of the liver. 



In obesity the weight of the intra-abdominal and subcutaneous fat carries the 

 lower part of the abdominal wall downward by gravity, stretches it, and produces a 

 pendido2is abdomen. This condition is also favored by ascites, pregnancy, etc. In 



