318 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



The liver. : The liver is moulded to the arch of the 

 diaphragm, and lies over a part of the stomach (Fig. 

 34). The convex surface is protected on the right side 

 by the ribs, from the seventh to the eleventh inclusive, 

 and in front by the xiphoid cartilage and the costse 

 from the sixth to the ninth inclusive, the diaphragm 

 being interposed. The diaphragm separates the liver 

 from the thin margin of the base of the right lung, 

 which descends in front of it. It extends to the leit 

 about one and a half inches beyond the left margin of 

 the sternum. In the middle line the liver lies close 

 beneath the skin in front of the stomach, and reaches 

 about half way between the xiphoid cartilage and the 

 navel. The lower edge, as it crosses the subcostal angle, 

 is represented by a line drawn from the ninth right to 

 the eighth left costal cartilage (Quain) (Fig. 30). In 

 the erect posture the lower edge on the right side is 

 about half or quarter of an inch below the margins of the 

 costal cartilages. In the recumbent position the liver 

 ascends about an inch, and is entirely covered by the 

 costse, except at the subcostal angle. It descends also 

 in inspiration and rises in expiration. " The extent of 

 the liver upwards, if traced on the surface of the body, 

 is indicated by a line crossing the mesosternum close to 

 its lower end, and rising on the right side to the level 

 of the fifth chondrosternal articulation, and on the 

 left to that of the sixth" (Quain). Behind, the liver 

 comes to the surface below the right lung, at a part 

 corresponding, both in position and width, to the tenth 

 and eleventh dorsal vertebrae. On the extreme right, 

 the liver descends to the level of the second lumbar 

 spine (Figs. 31 and 33). The fundus of the gall 

 bladder approaches the surface behind the ninth costal 

 cartilage, close to the outer border of the right 

 rectus muscle. 



The liver is more often ruptured from contusions 

 than is any other abdominal viscus. This is explained 



