THE LIVER. 



933 



(3) The Internal oblique. (4) The lumbar fascia and the external border of the Quadratus lum- 

 borum. The edges of the wound are now to be held apart with retractors, and the transversalis 

 fascia will be exposed. This is to be opened with care, commencing at the posterior angle of 

 the incision. If the bowel is distended, it will bulge into the wound, and no difficulty will be 

 found in dealing with it. If, however, the gut is empty, this bulging will not take place, and 

 the colon will have to be sought for. The guides to it are the lower end of the kidney, which 

 will be plainly felt, and the outer edge of the Quadratus lumborum. The bowel having been 

 found, is to be drawn well up into the wound, and it may be opened at once and the margins 

 of the openings stitched to the skin at the edge of the wound ; or, if the case is not an urgent 

 one, it may be retained in this position by two harelip pins passed through the muscular coat, 

 the rest of the wound closed, and the bowel opened in three or four days, when adhesion of the 

 bowel to the edges of the wound has taken place. 



THE LIVER. 



The Liver is the largest gland in the body, and is situated in the upper and 

 right part of the abdominal cavity, occupying almost the whole of the right hypo- 

 chondrium, the greater part of the epigastrium, and extending into the left hypo- 

 chondrium as far as the mammary line. In the male it weighs from fifty to sixty 

 ounces ; in the female, from forty to fifty. It is relatively much larger in the foetus 

 than in the adult, constituting, in the former, about one-eighteenth, and in the 

 latter, about one thirty-sixth of the entire body-weight. Its greatest transverse 

 measurement is from eight to nine inches. Vertically, near its lateral or right 

 surface, it measures about six or seven inches, while its greatest antero-posterior 

 diameter is on a level with the upper end of the right kidney and is from four to 

 five inches. Opposite the vertebral column its measurement from before backward 

 is reduced to about three inches. Its consistence is that of a soft solid ; it is, 

 however, friable and easily lacerated ; its color is a dark reddish-brown, and its 

 specific gravity is 1.05. 



To obtain a correct idea of its shape, it must be hardened in situ, and it will 

 then be seen to present the appearance of a wedge, the base of which is directed 



Gall-bladder. 



LEFT LATERAL 

 LIGAMENT 



RIGHT LATERAL 

 LIGAMENT. 



FIG. 511. The liver. Upper surface. (Drawn from His's models.) 



to the right and the thin edge toward the left. Symington describes its shape as 

 that "of a right-angled triangular prism with the right angles rounded off." It 

 possesses five surfaces, viz., superior, inferior, anterior, posterior, and lateral. 



The superior and anterior surfaces are separated from each other by a thick 

 rounded border, and are attached to the Diaphragm and anterior abdominal wall 

 by a triangular or falciform fold of peritoneum, the suspensory or falciform liga- 

 ment, which divides the liver into two unequal parts, termed the right and left 



