REFLECTIONS OF PERITONEUM. 435 



of the peritoneum ; it lies on the large vessels (aorta and cava) and on the 

 pillars of the diaphragm. 



The liver changes its situation with the ascent and descent of the dia- 

 phragm in respiration ; for in inspiration it descends, and in expiration it 

 regains its former level. In the upright and sitting postures, too, this 

 viscus descends lower than in the horizontal condition of the body ; so 

 that when the trunk is erect, the anterior border may be felt underneath 

 the edge of the ribs, but when the body is reclined it is withdrawn within 

 the margin of the thorax. 



The connections of the liver with the surrounding parts may be changed 

 by the growth of tumors, by collections of fluid in the chest or in the 

 abdomen, or by constricting the space for its lodgment, as in tight lacing. 



The spleen (fig. 142, m) lies deeply in the left hypochondrium, between 

 the stomach and the ribs, and is connected by peritoneum to the great end 

 of the stomach on the one side, and to the diaphragm on the other. Its 

 position is almost vertical. 



The outer surface is convex, and touches the diaphragm opposite the 

 ninth, tenth, and eleventh ribs. At the inner surface, which is concave, 

 the vessels enter (p. 465), and to it is attached a process of peritoneum, 

 the gastro-splenic omentum : the part in front of the vessels touches the 

 stomach ; and the part behind them is in contact with the tail of the pan- 

 creas, the suprarenal capsule, and the left crus of the diaphragm. 



Below the spleen is a transverse piece of the peritoneum (pleurocolic 

 fold), the kidney, and the beginning of the descending colon. When the 

 stomach is distended the spleen is somewhat behind it. 



The kidney should be examined on the left side of the body, so that the 

 duodenum may not be displaced. In order that it may be seen, the de- 

 scending colon and the peritoneum must be separated from the abdominal 

 wall, and its casing of fat should be torn through. 



This viscus is surrounded with fat, and is situate in the lumbar region 

 opposite the last dorsal, and the upper two or three lumbar vertebrae. Its 

 position is somewhat oblique, and the upper end is nearer than the lower 

 to the spinal column. 



In front of the kidney are the peritoneum and the colon ; and behind 

 it are the quadratus lumborum and psoas muscles, with the diaphragm and 

 the last rib. Above each kidney and resting on it, is the suprarenal cap- 

 sule. The inner border looks to the spine and receives the vessels. 



Difference on opposite sides. The right kidney is placed rather lower 

 than the left ; it reaches as high as the lower border of the eleventh rib, 

 whilst its fellow is opposite the upper border of the corresponding rib. In 

 front of the right, besides the common connections before specified, is the 

 duodenum : and before the left one is the lower end of the spleen. Abov<? 

 the right is the liver, and above the left the spleen. 



The connections of the pancreas may be omitted for the present. This 

 viscus is described at page 446. 



THE PERITONEUM. 



This is the largest serous membrane in the body. Like other mem- 

 branes of the kind it is a closed sac in the male, but in the female its 

 cavity is continuous with the canals of the Fallopian tubes. One part of 

 it lines the wall of the abdomen (parietal layer), and another is reflected 

 over the different viscera (visceral layer), except where the vessels enter. 



