504 CAVITY. 



descends to enter the middle portion of this the thoracic duct and the vena azygos, and 



intestine, the upper part of which is likewise external to each crus of the diaphragm the 



found in this region. Here, too, we have the great splanchnic nerve is seen to connect itself 



upper half of the head of the pancreas, the with the semilunar ganglion, 



right gastro-epiploic and the gastro-duodenalis On the left side the gastro-splenic omentum 



arteries. contains the vasa brevia and splenic arteries, 



In proceeding to remove the parts which the splenic plexus of nerves, and the corn- 

 lie most superficially in the epigastric region, mencement of the left gastro-epiploic artery ; 

 we notice on the right side the vessels and the great cul-de-sac of the stomach, and the 

 nerves enclosed between the laminae of the spleen cover here the left supra-renal capsule, 

 lesser omentum, viz. the hepatic artery and the semilunar ganglion and great splanchnic 

 its terminal branches, the vena portae, and nerve, the upper part of the left kidney, and 

 the hepatic and cystic ducts, with the com- the renal vessels and nerves, 

 mencement of the ductus communis chole- From the vast number and importance of 

 dochus, and entwining its filaments chiefly the parts contained in the epigastric region, it 

 around the hepatic arteries is the hepatic cannot be a matter of surprise that it is fre- 

 plexus of nerves ; several lymphatic vessels quently the seat of disease, and that the most 

 of considerable size are also found here, and serious consequences will often ensue upon 

 some lymphatic ganglions, the enlargement of strong pressure or violence inflicted upon it. 

 which latter, whether acute or chronic, may retard It is universally known that syncope maybe 

 the passage of the bile and give rise to jaundice, induced or even sudden death occasioned by 

 All these parts are invested and connected to a blow upon the epigastrium, even in a healthy 

 each other by the dense cellular membrane individual; and it seems to be the favourite 

 called the capsule of Glisson. Behind the opinion that such results arise from the influence 

 liver, and closely lodged in a groove, and exerted upon the immense nervous plexus 

 sometimes a canal in its posterior thick margin, which is found here. Sometimes, however, 

 is the vena cava ascendens, which is still more one or more of the viscera have experienced 

 intimately connected with the liver through injury, and cases of rupture of the spleen, 

 the branches of the vena cava hepatica, which liver, gall-bladder, or duodenum from violence 

 open into that portion of the ascending vein inflicted on this region are not uncommon.* 

 which is lodged in the groove. To the right Every practitioner is familiar with the existence 

 of the vein are the supra-renal capsule and of epigastric pulsations, which, as they arise 

 the upper part of the kidney, and to its left, from a variety of causes, form a subject of 

 and closely connected with the supra-renal great interest. Dr. Copland thus enumerates 

 capsule, is the semilunar ganglion. Here, these causes, and, indeed, most of them may 

 likewise, are the renal or emulgent vessels be deduced a priori from a knowledge of the 

 and the renal plexus of nerves. anatomy of the region : a, nervous suscepti- 



In the centre of the epigastric region, on bility; b, inflammation of the aorta; c, aneu- 

 removing the stomach, we open into the lesser rism of the aorta; d, adhesion of the pericar- 

 cavity of the peritoneum, of which the stomach diurn to the heart ; e } tumours at the root of 

 forms, in part, the anterior and superior boun- the mesentery; /, tumours of the stomach or 

 dary. This cavity is bounded inferiorly and scirrhus of the pylorus ; g, enlargement of the 

 posteriorly by the descending layer of the trans- pancreas; h, hypertrophy of the heart, parti- 

 verse meso-colon, which covers the upper part cularly of its right side ; z, enlargement of the 

 of the pancreas; above this latter gland is the inferior vena cava; /c, hepatisation of the lower 

 coeliac axis, surrounded by the solar plexus of portion of the lungs ; /, enlargement of, or 

 nerves, giving off its terminal branches, of which abscess in, the liver, f 



the hepatic passes towards the right side, and Umbilical region. This region is distinctly 



forwards to the transverse fissure of the liver, and naturally separated from the epigastrium 



while the splenic directs itself tortuously towards by the transverse arch of the colon and the 



the left side, along the upper margin of the transverse mesocolon. It is almost entirely 



pancreas. The pancreas itself is to be counted occupied in the centre by the small intestines, 



among the parts contained in this region ; here and on each side by the colon, either ascending 



it is covered by the superior layer of the trans- or descending. Deep seated and at the upper 



verse mesocolon, which alone separates it part of the region, we notice the inferior portion 



from the posterior surface of the stomach ; of the duodenum, which is covered by the infe- 



hence this gland has sometimes, by contracting rior lamina of the transverse mesocolon, and ter- 



an adhesion with the stomach, served to fill miuates on the left side of the spine, just where 



up a perforation by an ulcer. Behind the pan- the mesentery commences. The superior me- 



creas are the vena portse and the conflux of senteric artery crosses above and in front of 



the splenic and superior mesenteric veins, the the duodenum, a few lines to the right of its 



superior mesenteric artery, and the nervous termination, and when the body is laid on the 



plexus of the same name ; by all of which back the intestine seems to suffer a constriction 



the gland is separated from the aorta, which, from the artery. Such a constriction can hardly 

 again, with the pillars of the diaphragm and 



some lymphatic glands, separates the pancreas * See an interesti b Dr . Harfc , in the 



from the spine. To the right of the aorta, and Dub . H OS P . Reports, vol. v. 



intervening between it and the right crus, are f Diet. Pract. Med. art. Epigastrium. 



