THE LIVER. 675 



more numerous, and placed in much closer apposition than those of the small 

 intestine ; and they open by minute rounded orifices upon the surface, giving it a 

 cribriform appearance. 



The solitary glands in the large intestine are most abundant in the ca3cum and 

 appendix vermiformis, being irregularly scattered over the rest of the intestine ; 

 they are small, prominent, flask-shaped bodies, of a whitish color, perforated upon 

 the central part of their free surface by a minute orifice, which, in the majority, 

 is permanent. 



THE LIVER. 



The Liver is a glandular organ of large size, intended mainly for the secretion 

 of the bile, but effecting also important changes in certain constituents of the blood 

 in their passage through the gland. It is situated in the right hypochondriac 

 region, and extends across the epigastrium into the left hypochondrium. It is the 

 largest gland in the body, weighing from three to four pounds (from fifty to sixty 

 ounces avoirdupois). It measures, in its transverse diameter, from ten to twelve 

 inches; from six to seven in its antero-posterior ; and is about three inches thick 

 at the back part of the right lobe, which is the thickest part. 



Its upper surface is convex, directed upwards and forwards, smooth, covered 

 by peritoneum, and is in relation with the under surface of the Diaphragm ; and 

 below, to a small extent, with the abdominal parietes. This surface is divided 

 into two unequal lobes, the right and left, by a fold of peritoneum, the suspensory 

 or broad ligament. 



Its under surface is concave, directed downwards and backwards, and in rela< 

 tion with the stomach and duodenum, the hepatic flexure of the colon, and the 

 right kidney and supra-renal capsule. This surface is divided by a longitudinal 

 fissure, into a right and left lobe. 



The posterior border is rounded and broad, and connected to the Diaphragm by 

 the coronary ligament ; it is in relation with the aorta, the vena cava, and the 

 crura of the Diaphragm. 



The anterior border is thin and sharp, and marked, opposite the attachment of 

 the broad ligament, by a deep notch. In adult males, this border usually corre- 

 sponds with the margin of.'the ribs ; but in women and children, it projects usually 

 below this point. 



The right extremity of the liver is thick and rounded ; whilst the left is thin and 

 flattened. 



Changes of Position. The student should make himself acquainted with the different circum- 

 stances under which the liver changes its position, as they are of importance as a guide in deter- 

 mining the existence of enlargement, or other disease of that organ. 



Its position varies according to tbe posture of the body; in the upright and sitting postures, 

 its lower border may be felt beneath the edges of the ribs ; in the recumbent posture, it usually 

 recedes beneath the ribs. 



Its position varies with the ascent or descent of the Diaphragm. In a deep inspiration, the 

 liver descends below the ribs ; in expiration, it is raised to its ordinary level. Again, in emphy- 

 sema, where the lungs are distended, and the Diaphragm descends very low, the liver is pushed 

 down ; but in some other diseases, as phthisis, where the Diaphragm is much arched, the liver 

 rises very high up. 



Pressure from without, as in tight lacing, by compressing the lower part of the chest, dis- 

 places the liver considerably, its anterior edge often extending as low as the crest of the ilium ; 

 and its convex surface is often, at the same time, deeply indented from pressure of the ribs. 



Its position varies greatly, according to the greater or less distension of the stomach and 

 intestines. When the intestines are empty, the liver descends in the abdomen ; but when they 

 are distended, it is pushed upwards. Its relations with surrounding organs may also be changed 

 by the growth of tumors, or from collections of fluid in the thoracic or abdominal cavities. 



LIGAMENTS. The ligaments of the liver (fig. 341) are five in number : four 

 are formed of folds of peritoneum ; the fifth, the ligamentum teres, is a round, 

 fibrous cord, resulting from the obliteration of the umbilical vein. The ligaments 

 are the longitudinal, two lateral, coronary, and round. 



