268 ABDOMEN 



case its apex will be observed projecting above the pubes. 

 Lastly, in pregnant females the gravid uterus will be visible, 

 reaching a height which varies with the period of gestation. 



Raise the greater omentum and turn it upwards over the 

 inferior margin of the thorax. By that proceeding the coils of 

 the small intestine will be exposed, and a part of the large 

 intestine, the transverse colon, which extends across the cavity 

 of the abdomen will also be brought into view. It is 

 attached to the posterior part of the greater omentum. 



Note that all the viscera which have been seen are covered 

 by a smooth glistening membrane, the peritoneum. That 

 membrane forms the immediate boundary of a space, the 

 peritoneal cavity, which has been opened into by the reflection 

 of the anterior wall of the abdomen. The dissector should 

 recognise that under normal circumstances the peritoneal 

 cavity is merely a potential cavity, and that it becomes an 

 actual cavity only when the surgeon or dissector pulls its walls 

 apart when opening into it, or when its walls are forced apart 

 by abnormal collections of fluid or gas. 



Replace the greater omentum and commence a fuller 

 consideration of the general position, relations, and connec- 

 tions of the viscera by examining the general position of the 

 liver. 



Hepar. The liver is the large, reddish-brown organ which 

 occupies a large part of the upper portion of the abdomen, 

 where it lies in the epigastric region and both hypochon- 

 driac regions. A very large portion of its surface is in contact 

 with the diaphragm, which separates it from the contents of the 

 lower part of the thorax. The inferior border of its anterior 

 surface crosses the subcostal angle from above downwards 

 and to the right, and continues to the right, either along or 

 immediately below the right costal arch. Opposite the tip 

 of the ninth right costal cartilage the fundus of the gall- 

 bladder projects from beneath it. Pass the hand over the 

 anterior and upper surfaces of the liver, and note that they are 

 connected to the anterior abdominal wall and to the diaphragm, 

 respectively, by a fold of the peritoneal lining of the abdomen 

 which is called the falciform ligament Raise the inferior 

 margin of the liver and note that the lower and posterior 

 surfaces of the liver are connected to the stomach by a 

 fold of peritoneum called the lesser omentum. A more detailed 

 account of the attachments of the liver is given on p. 365. 



