2 S 6 PRACTICAL ANATOMY. 



capsule of Glisson the ducts : hepatic (two), cystic, and common. Follow this 

 latter, the common bile duct, three and one-half inches to its confluence with the 

 pancreatic duct, in the receding angle of the duodenum. 

 The descriptive terms used in speaking of the liver are : 



1. Tlic root, transverse fissure, or porta hepatis. This is ivhere the vessels, 

 nerves, and ducts enter, surrounded by the capsule of Glisson. 



2. The superior or plirenic surface is in relation to the inferior surface of the 

 diaphragm. It is covered by peritoneum, except a small space between the two 

 layers of the suspensory ligament. 



3. The inferior or visceral surface rests on the stomach, duodenum, colic 

 elbow, right kidney. Two places are not covered by peritoneum : the fissure in 

 which the gall-bladder rests and the transverse fissure. Surgically, this is the 

 most important part of the liver, and should be most faithfully studied by the 

 student. 



4. The posterior surface is a territory you can see only when you remove the 

 liver. It is mostly uncovered by peritoneum, and is limited by the anterior and 

 posterior layers of the coronary ligament. 



5. The anterior border is the one interrogated in physical examinations of the 

 liver. It is quite thin and is marked by two notches, one for the suspensory liga- 

 ment and one for the fundus of the gall-bladder. This latter is, in health, oppo- 

 site the ninth costal cartilage. This border is about in line with the ribs. 



6. The extremities, rig/it and left, are associated with the lateral ligaments, but 

 have no special importance in physical diagnosis. The hepatic elbow a coinage 

 will be explained when the anterior relations of the right kidney are considered. 



7. Peritoneal investment of the liver is for practical purposes complete ; never- 

 theless, on each surface we have found areas not completely covered. This has 

 been explained under the head of peritoneum on page 238. 



The relation of the liver to other organs is one of the most fascinating 

 and instructive parts of the work thus far encountered, (i) Now show on your 

 dissection that the superior surface of the liver is related to the under surface of 

 the diaphragm, and separated by the diaphragm from the bases of the lungs, base 

 of the pericardium, anterior abdominal wall, and six or seven lower ribs on the 

 right side. (2) Show that the inferior surface of the liver lies on the right kidney 

 and its adrenal ; on the hepatic flexure of the colon ; on the descending duode- 

 num ; on the gall-bladder and its duct ; on the root-structures of the liver; on 

 the right end of the stomach ; on the upper curve of the duodenum ; on the 

 anterior surface and lesser curve of the stomach ; on the lesser omentum. (3) 

 Show that posteriorly the liver is in relation with the diaphragm and its crura, 

 the tenth and eleventh thoracic vertebrae and their ribs, the oesophagus, aorta, 

 vena cava, and thoracic duct. To show these posterior relations separate the 

 liver from the diaphragm and pull it far forward, but do not injure the vena cava ; 

 you may ligate and then cut the hepatic veins. This will give you an opportu- 

 nity to study the coronary ligament also. All the above relations are to be studied 

 without cutting anything except possibly the hepatic vein, as above indicated. 



The Superior Mesenteric Artery. To make a good dissection of this 

 artery and its branches, turn the transverse colon up and pull the mass of small 

 intestine forming the jejunum and ileum far down over the left iliac region, as 

 shown in figure 180. Now, remember the mesentery contains, between its two 

 layers, all the vessels, glands, nerves, and lymphatics that go to or come from 

 the small intestine. Remember all these structures are embedded in connective 

 tissue, just as are the root-structures of the liver enclosed by Glisson 's capsule ; 

 that the function of this mesenteric connective tissue is, like Glisson 's capsule, 

 protective and supportive, and contains, in some persons, large quantities of fat, 

 technically designated mesenteric fat. 



