408 CLINICAL APPLIED ANATOMY. 



may be given as four inches in the right nipple line and four 

 and a half to five inches in the axilla. 



Abscesses of the Liver. The routes by which pyogenic in- 

 fection may reach the liver are the portal vein, the bile ducts, 

 the hepatic artery and the lymphatics. Ulceration of any part 

 of the intestinal tract from the cardiac end of the stomach to 

 the anus, or inflammation of the umbilical vein in infancy may 

 give rise to portal infection and multiple abscesses. Eadicles of 

 the portal vein may also be infected by abscesses of the spleen 

 or mesenteric glands, by inflammation of the gall bladder or 

 large bile ducts, or by retroperitoneal suppuration through their 

 communications with the subperitoneal venous plexus. 



Infections of the gall bladder and large bile ducts may extend 

 directly to the liver along the biliary passages, the retrograde 

 extension being much facilitated when biliary stasis is present. 

 Multiple small abscesses like those of portal pyaemia result. 



Liver abscesses may also be part of a general pyaemia. The 

 infection in such cases is carried by the hepatic artery. To 

 reach this vessel the infective emboli must first traverse the lung, 

 but do not necessarily lodge here on account of the large size of 

 the pulmonary capillaries compared with those of other parts 

 of the body. 



When abscesses in the neighbourhood of the liver invade it 

 from without, they probably follow the course of the lymphatic 

 spaces. 



Tropical abscess is usually solitary and situated in the upper 

 part of the right lobe. The direction in which these abscesses 

 tend to rupture is determined by their anatomical relations. 

 Owing to the common situation of the abscess, it usually bursts 

 upwards into the lung or pleural sac, for it is in close contact 

 with the dome of the diaphragm, and in addition many of the 

 lymphatics of the liver pass towards the diaphragm between the 

 layers of the coronary ligament. A considerable number of 

 abscesses burst into the peritoneum, and some, extending from 

 the under surface of the liver in the region of the right kidney 

 pouch, may open into the stomach, duodenum, colon, or even the 



