THE LIVER 



1327 



Abnormalities of the Liver. The liver may be divided into many lobules, and such lobu- 

 lation is most evident on the parietal surface of the right lobe. Lobulation is probably a patho- 

 logical change. Occasionally the right lobe is small and the left large. 



Accessory Livers are fragments of hepatic tissue or rests, which are entirely separated from 

 the liver. They are seldom met with. When they do exist their most common situation is in 

 the suspensory ligament, but they have been found in the great omentum, in the peritoneum, 

 wall of the gall-bladder, and in other situations. They may be congenital or may be due to 

 atrophy of the pedicle of an accessory lobe or of a pedunculated lobe. Tight lacing alters the 

 shape and position of the liver (Fig. 1068). It may flatten the dome and increase the length of 

 the anterior surface, this change being especially obvious in the right lobe, and a costal groove 

 may be formed by the pressure of a rib. "When the elongated right lobe passes over the right 

 kidney, there is atrophy of the hepatic substance and thickening of- the capsule, which is opaque 

 and forms a hinge-like ligament between the main part of the right lobe above the constricted 

 lower portion. This lobe is variously termed partial hepatoptosis, constriction lobe, or the 

 sustentacular formation of the right lobe (Hertz). The constriction furrow is produced by 

 the pressure of the corset in front and the resistance of the kidney behind. The constriction lobe 

 tapers to a point, so that the shape of the liver, as seen from the front, is that of a right-angled 

 triangle, with the apex downward." 1 Such a constriction lobe is known as Riedel's lobe. The 

 left lobe may also project down, but not so markedly. Tight lacing may cause the entire organ 



DIAPHRAGMATIC 

 GROOVE 



FIG. 1068. Deformed female liver. (Poirier and Charpy.) 



to occupy a level higher than normal. Such a liver is thick and excessively convex above and thin 

 below, and reaches to or laps over the spleen. In severe cases the superior surface is thrown into 

 antero-posterior creases or folds. Riedel's lobe (Fig. 1068) may be congenital, may be due to 

 tight lacing, or may arise in cholelithiasis or cholecystitis from the traction of adhesions. Such 

 a lobe comes off from the right lobe. It may be a tapering mass of liver tissue, it may have a thin 

 pedicle of liver tissue, or its pedicle may be merely a double fold of peritoneum. The gall- 

 bladder may lie upon its under surface, or may be placed to the left of it. 



Vessels. The bloodvessels connected with the liver are the hepatic artery, the portal vein, 

 and the hepatic veins. 



The hepatic artery and portal vein (Figs. 468, 469, 557, and 1069), accompanied by numerous 

 lymphatics and nerves, ascend to the transverse fissure between the layers of the gastrohepatic 

 omentum, and in front of the foramen of Winslow. The hepatic duct, lying in company with 

 them, descends from the transverse fissure between the layers of the same omentum. The rela- 

 tive position of the three structures in the' lesser omentum (Fig. 984) is as follows: The hepatic 



1 Rolleston, on Diseases of the Liver. 



