THE LIVER. 



741 



and appendix vermiformis ; but are irregularly scattered also over the rest of 

 the intestine. They are small, prominent, flask-shaped bodies, of a whitish 

 color, perforated upon the central part of their free surface by a minute orifice, 

 which, in the majority, is permanent. 



Fig. 406. Minute Structure of Large Intestine. 



Aptrtotres ffTutuJf 



free Stnfac* 



THE LIVER. 



The Liver is a glandular organ of large size, intended mainly for the secre- 

 tion of the bile, but effecting also important changes in certain constituents 

 of the blood in their passage through the gland. It is situated in the right 

 hypochondriac region, and extends across the epigastrium, into the left hypo- 

 chondrium. It is the largest gland in the body, weighing from three to four 

 pounds (from fifty to sixty ounces avoirdupois). It measures, in its transverse 

 diameter, from ten to twelve inches ; from six to seven in its antero-posterior ; 

 and is about three inches thick at the back part of the right lobe, which is the 

 thickest part. 



Its upper surface is convex, directed upwards and forwards, smooth, covered 

 by peritoneum. .It is in relation with the under surface of the Diaphragm and 

 below, to a small extent, with the abdominal parietes. The surface is divided 

 into two unequal lobes, the right and left, by a fold of peritoneum, the suspen- 

 sory or broad ligament. 



Its under surface is concave, directed downwards and backwards, and in rela- 

 tion with the stomach and duodenum, the hepatic flexure of the colon, and the 

 right kidney and suprarenal capsule. The surface is divided by a longitudinal 

 fissure into a right and left lobe. 



The posterior border is rounded and broad, and connected to the Diaphragm 

 by the coronary ligament ; it is in relation with the aorta, the vena cava, and 

 the crura of the Diaphragm. 



The anterior border is thin and sharp, and marked, opposite the attachment 

 of the broad ligament, by a deep notch. In adult males, this border usually 

 corresponds with the margin of the ribs ; but in women and children, it usually 

 projects below the ribs. 



The right extremity of the liver is thick and rounded ; whilst the left is thin 

 and flattened. 



Changes of Position. The student should make himself acquainted with the different circum- 

 stances under which the liver changes its position, as they are of importance in determining the 

 existence of enlargement, or other disease of the organ. 



Its position varies according to the posture of the body ; in the upright and sitting postures, 

 its lower border may be felt below the edges of the ribs ; in the recumbent posture, it usually 

 recedes behind the ribs. Its position varies, also, with the ascent or descent of the Diaphragm. 

 In a deep inspiration, the liver descends below the ribs ; in expiration, it is raised to its ordinary 

 level. Again, in emphysema, where the lungs are distended, and the Diaphragm descends very 

 low, the liver is pushed down ; in some other diseases, as phthisis, where the Diaphragm is much 

 arched, the liver rises very high up. Pressure from without, as in tight lacing, by compressing 

 the lower part of the chest, displaces the liver considerably, its anterior edge often extending as 

 low as the crest of the ilium ; and its convex surface is often, at the same time, deeply indented 



