REMOVAL OF THE LIVER. 345 



REMOVAL OF THE LIVER 



Dissection. The liver should now be removed from the abdo- 

 men, in order that it may be more particularly examined. Begin in 

 front by cutting through the round and falciform ligaments. Then, 

 drawing the liver downwards, cut through the long left lateral liga- 

 ment and the short right one, and the upper layer of the coronary 

 ligament, taking care not to cut the diaphragm. Beyond the upper 

 layer of the coronary ligament there is an area over which the 

 posterior surface of the liver is not covered by peritoneum, but is 

 simply bound to the diaphragm by areolar tissue, and from which it 

 can be separated by the handle of the scalpel. The inferior vena 

 cava, as it leaves the liver to pierce the diaphragm, will now be 

 exposed, and it must be cut across. Finally, the lower layer of the 

 coronary ligament will be divided, and the liver will come away with 

 a portion of the inferior cava embedded in it, as that vessel had been 

 divided already before its entry into the liver. 



THE LIVER. 



The liver secretes the bile, and is the largest gland in the body. Office of the 

 Its duct opens into the duodenum with that of the pancreas. 



Dissection. Preparatory to examining the liver, the vessels at the Clean 

 under surface should be' dissected out (fig. 131, p. 346). This 

 proceeding will be facilitated by distending the vena cava and vena surface ; 

 porta? with tow or cotton- wool, and the gall-bladder with air through 

 its duct. The several vessels and the ducts are then to be defined, 

 and the gall-bladder is to be cleaned. 



On following outwards the left branch of the portal vein to the follow left 

 longitudinal or antero-posterior fissure, it will be found united ve na ports, 

 anteriorly with the round ligament (c) or the remains of the 

 umbilical vein, and posteriorly with the thin fibrous remnant of the 

 ductus venosus (d). 



The LIVER is of a red-brown colour and firm consistence, and J kteJce 

 weighs commonly in the adult from three to four pounds. Trans- . ht . 

 verse! y the gland measures from ten to twelve inches ; from front to measure . 

 back between six and seven inches ; and in thickness, at the right ments. 

 end, about three inches, but this last measurement varies much with 

 the spot examined. 



The natural shape of the liver when within the body is very Form 



,.~ . f , altered when 



dmerent from the lorm it assumes when removed and placed on a removed ; 

 flat surface, unless it has been previously hardened in situ. As 

 already described (pp. 304 et seq.) the liver has five surfaces, o f division8 - 

 which the anterior, superior and right have already been examined, 

 while the posterior and inferior can now be fully seen. The inferior 

 and posterior surfaces are farther subdivided into lobes by fissures 

 which contain vessels, and marked by fossae and impressions. 



The peritoneal ligaments are described at p. 313. 



The INFERIOR SURFACE (fig. 131) is rendered irregular by fissures 

 and fossae ; and a longitudinal sulcus separates it into a large right 



