1320 SURFACE ANATOMY AND SURFACE MARKINGS 



above the umbilicus, its upper border just below the greater curvature of the 

 stomach. 



Descending Colon. The left colic flexure is situated in the upper left angle or! 

 the intersection between the left lateral and transpyloric lines. The descending 

 colon courses down through the left lumbar region, lateral to the left lateral line, 

 as far as the iliac crest (see footnote p. 1181). 



Iliac Colon. The line of the iliac colon is from the end of the descending colon 

 to the left lateral line at the level of the anterior superior iliac spine. 



Liver (Fig. 1223). The upper limit of the right lobe of the liver, in the middle 

 line, is at the level of the junction between the body of the sternum and the xiphoid 

 process; on the right side the line must be carried upward as far as the fifth costal 

 cartilage in the mammary line, and then downward to reach the seventh rib at. 

 the side of the thorax. The upper limit of the left lobe can be defined by continuing 

 this line downward and to the left to the sixth costal cartilage, 5 cm. from the 

 middle line. The low r er limit can be indicated by a line drawn 1 cm. below the 

 lower margin of the thorax on the right side as far as the ninth costal cartilage, 

 thence obliquely upward to the eighth left costal cartilage, crossing the middle 

 line just above the transpyloric plane and finally, with a slight left convexity, to 

 the end of the line indicating the upper limit. 



According to Birmingham the limits of the normal liver may be marked out 

 on the surface of the body in the following manner. Take three points: (a) 1.25 

 cm. below the right nipple; (6) 1.25 cm. below the tip of the tenth rib; (c) 2.5 cm. 

 below the left nipple. Join (a) and (c) by a line slightly convex upward ; (a) and 

 (6) by a line slightly convex lateralward; and (6) and (c) by a line slightly convex 

 downward. 



The fundus of the gall-bladder approaches the surface behind the anterior 

 end of the ninth right costal cartilage close to the lateral margin of the Rectus 

 abdominis. 



Pancreas (Fig. 1225). The pancreas lies in front of the second lumbar vertebra. 

 Its head occupies the curve of the duodenum and is therefore indicated by the same 

 lines as that viscus; its neck corresponds to the pylorus. Its body extends along 

 the transpyloric line, the bulk of it lying above this line to the tail which is in the 

 left hypochondriac region slightly to the left of the lateral line and above the 

 transpyloric. 



Spleen (Figs. 1217, 1226). To map out the spleen the tenth rib is taken as 

 representing its long axis; vertically it is situated between the upper border of the 

 ninth and the lower border of the eleventh ribs. The highest point is 4 cm. from 

 the middle line of the back at the level of the tip of the ninth thoracic spinous 

 process; the lowest point is in the midaxillary line at the level of the first lumbar 

 spinous process. 



Kidneys (Figs. 1225, 1226). The right kidney usually lies about 1 cm. lower 

 than the left, but for practical purposes similar surface markings are taken for 

 each. 



On the front of the abdomen the upper pole lies midway between the plane of 

 the lower end of the body of the sternum and the transpyloric plane, 5 cm. from 

 the middle line. The lower pole is situated midway between the transpyloric 

 and intertubercular planes, 7 cm. from the middle line. The hilum is on the 

 transpyloric plane, 5 cm. from the middle line. Round these three points a 

 kidney-shaped figure 4 cm. to 5 cm. broad is drawn, two-thirds of which lies medial 

 to the lateral line. To indicate the position of the kidney from the back, the 

 parallellogram of Morris is used; two vertical lines are drawn, the first 2.5 cm., 

 the second 9.5 cm. from the middle line; the parallelogram is completed by two 

 horizontal lines drawn respectively at the levels of the tips of the spinous process 

 of the eleventh thoracic and the lower border of the spinous process of the third 





