280 ABDOMEN 



that notch, between the right and left lobes, the ligamentum 

 teres, which lies in the rounded lower margin of the falciform 

 ligament, passes into the umbilical fossa on the lower surface 

 of the liver. Further to the right, in or near the right lateral 

 plane and opposite the tip of the ninth right costal cartilage, 

 the fundus of the gall-bladder projects below the liver, in the 

 majority of cases. 



Raise the lower margin of the liver and examine the 

 inferior surface. It looks downwards, backwards, and to the 

 left, and, over the whole of its extent, it is in contact with 

 other viscera ; on that account it is frequently called the 

 visceral surface. It conceals the upper and right portion of 

 the anterior surface of the stomach, the first part and the 

 upper portion of the second part of the duodenum, the lesser 

 omentum, and the greater part of the gall-bladder ; to the right 

 of the gall-bladder it is in relation, posteriorly, with a large 

 portion of the anterior surface of the right kidney, and, more 

 anteriorly, with the right flexure of the colon (see Fig. 171). 

 It is divided into right and left portions by a fossa, the 

 umbilical fossa, which contains the ligamentum teres. The 

 umbilical fossa extends from the umbilical notch in the lower 

 border of the anterior surface to the junction of the inferior 

 and posterior surfaces, where it becomes continuous with the 

 fossa for the ductus venosus. Trace the lesser omentum upwards 

 to the lower surface of the liver, and note that it is attached 

 to the margins of a fissure, called the porta hepatis, which 

 extends from the neck or uppermost part of the gall-bladder 

 on the right to the umbilical fossa on the left. The porta 

 hepatis lies immediately in front of the junction of the inferior 

 with the posterior surface of the liver. Note, further, that 

 the upper border of the lesser omentum is continued upwards 

 on the posterior surface of the liver, where it is attached to 

 the bottom of the fossa for the ductus venosus. 



The posterior surface, which is largely in relation with the 

 diaphragm, cannot be conveniently examined at present (see 

 Fig. 172). 



Vesica Fellea. The gall-bladder is a small piriform sac, 

 with a capacity of from 28.5 to 57 cc. (one to two ounces). 

 Pull the liver upwards and to the right, and examine the 

 position, attachments, and connections of the gall-bladder. It 

 lies partly in the right hypochondriac region and partly in the 

 epigastric region. Its lower extremity or fundus projects below 



