THE PERITONEUM. 



725 



Right Hypochondriac. 



The right lobe of the 

 liver and the gall-bladder, 

 the duodenum, pancreas, 

 hepatic flexure of the 

 colon, upper part of the 

 right kidney, and the 

 right suprarenal capsule. 



Right Lumbar. 

 Ascending colon, lower 

 part' of the right kidney, 

 and some convolutions of 

 the small intestines. 



Epigastric Region. 

 The middle and pyloric 

 end of the stomach, left 

 lobe of the liver and 

 lobulus Spigelii, and the 

 pancreas. 



Left Hypochondriac. 

 The splenic end of the 

 stomach, the spleen and 

 extremity of the pancreas, 

 the splenic flexure of the 

 colon, upper half of the 

 left kidney, and the left 

 suprarenal capsule. 



Left Lumbar. 



Descending colon, part 

 of the omentum, lower 

 part of the left kidney, 

 and some convolutions of 

 the small intestines. 



Right Inguinal. 

 The caecum, appendix 

 caeci, and ureter. 



Left Inguinal. 

 Sigmoid flexure of the 

 colon, and ureter. 



Umbilical Region. 

 The transverse colon, 

 part of the great ornen- 

 tum and mesentery, trans- 

 verse part of the duode- 

 num, and some convolu- 

 tions of the jejunum and 

 ileum. 



Hypogastric Region. 



Convolutions of the 

 small intestines, the blad- 

 der in children, and in 

 adults if distended, and 

 the uterus during preg- 

 nancy. 



THE PERITONEUM. 



The Peritoneum (Atpmrlvt n>, to extend around] is a serous membrane ; and, like 

 all membranes of this class, a shut sac. In the female, however, it is not com- 

 pletely closed, the Fallopian tubes communicating with it by their free ex- 

 tremities ; and thus the serous membrane is continuous with their mucous 

 lining. 



The peritoneum partially invests all the viscera contained in the abdominal 

 and pelvic cavities, forming the visceral layer of the membrane; it is then re- 

 flected upon the internal surface of the parietes of those cavities, forming the 

 parietal layer. The free surface of the peritoneum is smooth, moist, and covered 

 by a thin squamous epithelium; its attached surface is rough, being connected 

 to the viscera and inner surface of the parietes by means of areolar tissue, 

 called the subperitoneal areolar tissue. The parietal portion is loosely connected 

 with the fascia lining the abdomen and pelvis ; but more closely to the under 

 surface of the Diaphragm, and in the middle line of the abdomen. 



In order to trace the reflections of this membrane (Fig. 397), the abdomen 

 having been opened, the liver should be raised and supported in that position, 

 and the stomach should be depressed, when a thin membranous layer is seen 

 passing from the transverse fissure of the liver to the upper border of the 

 stomach: this is the lesser or gastro-hepatic omentum. It consists of two delicate 

 layers of peritoneum, an anterior and a posterior, between which are contained 

 the hepatic vessels and nerves. Of these two layers, the anterior should first 

 be traced, and then the posterior. 



The anterior layer descends to the lesser curvature of the stomach, and covers 

 its anterior surface as far as the great curvature; it descends for some distance 

 in front of the small intestines, and, returning upon itself to the transverse 

 colon, forms the external layer of the great omentum; it thcTi covers the under 

 surface of the transverse colon, and, passing to the back part of the abdominal 

 cavity, forms the inferior layer of the transverse meso-colon. It then descends in 

 front of the duodenum, the aorta, and vena cava, as far as the superior mesen- 



