THE LIVER. 1053 



elongated it may reach the spleen or even be hooked around it or inseparably fused 

 with it. The papillary tubercle may be so developed as to form a separate lobule. 

 An accessory lobe may be attached to the left one, united by peritoneum and blood- 

 vessels. Many times the number of lobes are diminished and the form becomes 

 square or spherical. More often the number of lobes increases, separated by short 

 deep clefts called rimce ccecce. 



Besides congenital changes, others may be acquired by pressure. By excessive 

 lacing in women the superficial part of the liver will become atrophic and the peri- 

 toneal coat will become thicker. On the convex surface of the liver a transverse 

 furrow will be established dividing off an anterior portion, especially of the right 

 lobe. This part will be pushed down into the abdominal cavity, and may become 

 almost separated from the rest the "corset liver." If the liver be more resistant, 

 its surface may show the flat, stripe-like impressions occasioned by the ribs. 



Ligaments and Peritoneal Relations. The liver is connected in part by peri- 

 toneum to the roof of the abdominal cavity, to the anterior wall, to the stomach, 

 duodenum, right kidney, and hepatic flexure of colon, whereby the following peri- 

 toneal folds or ligaments are to be distinguished. With one exception they are 

 peritoneal folds. 



The coronary ligament connects the posterior surface of the liver to the dia- 

 phragm. Its two layers surround the rough triangular surface seen on the pos- 

 terior part of the right lobe, which is connected directly to the diaphragm by 

 areolar tissue. These layers are reflections from the parietal peritoneum descending 

 from the diaphragm. This ligament has three portions (Fig. 668). The right 

 part is much the bigger and its layers are far apart, enclosing the posterior rough 

 surface of the right lobe. The two layers are derived from the peritoneum of the 

 greater sac. A middle portion is seen above the Spigelian lobe. The two layers 

 are close together ; the anterior one belongs to the greater sac, and the posterior 

 one to the lesser. Farther to the left is a third narrow portion continued into the 

 left lateral ligament. Both layers here belong to the greater sac. On either end 

 of the coronary ligament the two layers of peritoneum gradually approach, and 

 finally unite, thus forming the right and left lateral ligaments as prolongations of 

 the coronary. As they enclose a triangular space, they are also called triangular 

 ligaments ; the left is the longer, and lies in front of the ossophagus. The right is 

 often imperceptible. 



The suspensory, longitudinal, falciform, or broad ligament is a part of the old 

 anterior mesentery of the stomach and duodenum. The liver was developed in it, 

 budding out from the duodenum, where its duct is still attached. This is a thin 

 membrane which passes antero-posteriorly above the liver and below it. Above it 

 meets the coronary ligament at right angles. By one of its margins it is connected 

 with the posterior layer of the sheath of the right Rectus abdominis muscle as far 

 as the umbilicus, and above to the under surface of the diaphragm, where it spreads 

 out to the right and left. By its other margin it is attached along the upper sur- 

 face of the liver, its left layer passing over the left lobe and continuing into the 

 left part of the coronary and left lateral ligament. Its right layer passes over the 

 right lobe and corresponding ligaments. The remaining margin is free and 

 rounded, and passes from the interlobular notch to the transverse fissure of the 

 liver. It contains between its two layers the intra-abdominal part of the umbilical 

 vein of the foetus, now a fibrous cord, the round ligament (lig. hepato-umbilicalis), 

 which is lodged in the umbilical fissure. Also between the two layers run some 

 branches of the epigastric veins anastomosing with the portal system, little twigs 

 of the phrenic arteries, numerous lymphatics, and branches of the phrenic nerve 

 which are destined for the serosa of the liver and for the peritoneum of the anterior 

 abdominal wall. In its natural position the falciform ligament forms a pocket, 

 which, with the diaphragm and abdominal wall, enclose the convex upper part of 

 the left lobe of the liver. This ligament has no function of suspension. 



Besides these there are others hardly less marked which we have noted in the 

 study of the peritoneum. The lesser omentum (lig. gastro-hepaticum) with its 



