THE LYMPHATICS OF THE ABDOMEN. 981 



around the opening for the vena cava. From the more lateral portions of each 

 lobe, however, the collecting stems take a different course, those from the right lobe 

 uniting to form a single stem which passes backward between the layers of the right 

 lateral (triangular) ligament, and then passes medially over the surface of the right 

 crus of the diaphragm to terminate in the nodes surrounding the coeliac axis. Those 

 from the lateral portions of the left lobe pass backward between the layers of 

 the left lateral (triangular) ligament and terminate in the nodes of the superior 

 gastric group which are situated in the neighborhood of the cardiac orifice of the 

 stomach. 



The collecting stems of the anterior portion of the stiperior surface are relatively 

 small and are more conspicuous on the right lobe than on the left. They pass 

 forward and downward to curve around the anterior border of the liver, and join with 

 the stems arising from the quadrate lobe and gall-bladder to pass with these to the 

 hepatic nodes situated in the transverse fissure. Finally, much more important "than 

 these, is a group of vessels which arise from a rich subserous net-work situated along 

 the line of attachment of'the suspensory (falciform) ligament. Some of these vessels 

 take a backward course toward the vena cava and accompany the other vessels of 

 the superior surface which terminate in the caval diaphragmatic nodes, and others 

 pass forward until they meet the upper portion of the round ligament, which they 

 follow to reach the nodes situated in the transverse fissure.- The remaining stems of 

 the group, from three to ten in number, pass forward and upward, between the layers 

 of the suspensory ligament, toward the under surface of the diaphragm, traverse^ 

 that structure near its anterior attachment, and come into connection with a* 

 number of small nodes situated behind the xiphoid process of the sternum. From 

 these they are continued upward along the course of the internal mammary vessels 

 to terminate in the lower nodes of the inferior deep cervical group, usually upon the 

 left side, rarely upon the right. This path is of importance as furnishing a direct route 

 by which the metastasis of the left supraclavicular nodes, frequently induced by 

 abdominal carcinomata, may be produced. It must, furthermore, be noted that 

 both these vessels and others which arise from the superior surface of the liver com- 

 municate somewhat extensively with the net-work occurring on the under surface of 

 the diaphragm, and since this net-work communicates abundantly with that of the 

 thoracic surface of the diaphragm, and this again with the vessels of the pleurae, 

 opportunity is afforded for the development of pleuritis, especially upon the right 

 side, as a result of a subdiaphragmatic infection. 



Turning now to the stems arising from the superficial net-work of the inferior 

 surface of the liver, it will be found that they pass principally to the hepatic nodes 

 situated in the transverse fissure, at least these nodes form the termination for the 

 vessels passing from the left and quadrate lobes, the left half of the Spigelian and 

 the anterior and middle portions of the right lobe. Those, however, which take 

 their origin toward the posterior part of the right lobe and from the right half of 

 the Spigelian pass to the vena cava and, ascending along it, terminate in the dia- 

 phragmatic nodes surrounding its opening into the thorax. 



The lymphatics of the gall-bladder and common bile-duct have their origin 

 in two net-works, one of which is situated in the mucosa and the other in the muscular 

 coat. Efferents from both net-works pass to the surface to form a superficial 

 net-work, from which collecting stems pass, in the case of the gall-bladder to the 

 nodes situated in the transverse fissure, and in the case of the duct for the most 

 part to a chain of nodes belonging to the hepatic group, which occurs along the line 

 of the duct in the edge of the gastro-hepatic omentum ; those from the lower portion 

 of the duct, however, associate themselves with stems from the duodenum and head 

 of the pancreas which open into the uppermost nodes situated along the course of • 

 the superior pancreatico-duodenal vessels. 



Stated in brief, the destinations of the hepatic lymphatics are principally the 

 hepatic nodes situated in the transverse fissure and the diaphragmatic nodes which 

 surround the opening of the inferior vena cava. A vessel from the right lobe also 

 passes to the coeliac nodes, some from the left lobe to the superior gastric nodes, 

 and an important group passes up in the suspensory ligament to communicate with 

 some of the anterior diaphragmatic nodes and terminate in the lower inferior deep 



