1056 THE ORGANS OF DIGESTION. 



liver leaves the costal arch and passes obliquely from right to left, ascending to the 

 anterior end of the left eighth rib. In case of a thin abdominal wall this anterior 

 edge of the liver can be felt as it passes through the epigastrium. This part can 

 contract adhesions with the wall. 



Relations in Detail. 



Antero-swperiorly : 



Diaphragm ; 

 Right and left lungs ; 

 Pericardium and heart ; 

 Anterior abdominal wall ; 

 r\ +1 1,+ f Six or seven low r er ribs : 



ri S nt j Fifth to ninth costal cartilage. 



Inferiorty : 



Right kidney and capsule ; 



Hepatic flexure of colon ; 



Descending duodenum ; 



Gall-bladder and cystic duct ; 



Vessels at portal fissure ; 



Pyloric end of stomach ; 



Superior curve of duodenum ; 



Cardia ; 



Lesser curvature of stomach ; 



Anterior surface stomach, small part (sometimes fundus of stomach). 



Posteriorly : 



Diaphragm ; 



Tenth and eleventh dorsal vertebrae ; 



End of tenth and eleventh ribs ; 



Crura of diaphragm ; 



(Esophagus ; 



Aorta ; 



Vena cava inferior ; 



Thoracic duct ; 



Non-peritoneal impression for right suprarenal capsule. 



The Fixation of the Liver. The liver, compared Avith other intraperitoneal 

 organs, has a firm position, due to its fusion with the diaphragm. The peritoneal 

 folds aid this fixation by connecting the liver to the concavity of the dia- 

 phragm. They are the falciform, or suspensory, coronary, and right and left lateral 

 ligaments. In spite of this fixation, the liver experiences certain physiological 

 changes and variations of position. It passes downward and forward in inspira- 

 tion, and in expiration is pushed upward and backward. It moves up and down 

 1 to 1.5 cm. In inspiration Hasse finds a stretching of the liver ; in expiration, a 

 compression. - These changes exert an influence over the circulation of the liver. 

 The dilatation of the vessels accompanying the expansion of the liver during inspi- 

 ration favors the influx of portal blood ; during expiration and the accompanying 

 compression the blood in the open hepatic veins is pressed into the vena cava. 



Also the liver suffers small displacements occasioned by changes in the position 

 of the body. In the horizontal supine position it falls back upon the diaphragm, 

 and its anterior margin is more concealed behind the ribs. In the erect position 

 the liver descends a little below the costal arch. The horizontal lateral position of 

 body also has influence, displacing it a little toward the left or the right, as the case 

 may be. Furthermore, by relaxation of ligaments, sometimes in women after child- 

 birth, a "dislocation" of the liver results, or " wandering liver." Any pathological 

 displacements of the diaphragm also affect the liver, as effusions into the thoracic 

 cavity ; also ascites, tympanites, or tumors in the abdominal cavity. 



