CHAPTER XXI. 

 THE LIVER AND GALL BLADDER. 



LIVER. GALL BLADDER. 



Anatomy. Anatomy. 



Relations. Relations. 



Landmarks. Landmarks. 



DISEASES OF LIVER AND GALL BLADDER 



CLINICAL EXAMINATION OF LIVER AND GALL 

 BLADDER. 



OPERATIONS ON LIVER AND GALL BLADDER. 



The liver is situated in the right hypochrondiac, in the 

 epigastric and in the inner portion of the left hypochron- 

 diac regions, and measures about twelve inches in its 

 transverse diameter and about six inches in its antero- 

 posterior diameter. It is somewhat wedge-shaped, from 

 side to side, as well as from before backwards, the thick 

 part of the wedge in the former instance being opposite 

 the right ribs, and the thin end at the left extremity, while 

 in the latter, i.e., from before backwards, the posterior 

 surface is the deeper, and the anterior border the thin end 

 or point of the wedge. The liver is divided into two lobes 

 on its upper surface by the suspensory or broad ligament, 

 and on its lower surface by the umbilical fissure. The 

 posterior surface is triangular in shape, with the base to 

 the right and the apex to the left, and the portion of the 

 left lobe that forms this surface is covered with periton- 

 eum, while the back of the right lobe is devoid of it ; and, 

 as the posterior surface of the right lobe passes obliquely 

 across the body, the lobulus Spigelii, which forms a part 

 of this surface, is opposite the tenth and eleventh verte- 

 brae. There are five fissures connected with the liver, 

 viz. : The umbilical, the fissure for the vena cava and the 

 one for the gall bladder, that for the ductus venosus, and 



