2OO Anatomy Applied to Medicine and Surgery 



hepatic omentum. It is about the size of a goose-quill, is 

 situated about half an inch from the right or free margin 

 of the omentum and lies to the right of the hepatic artery 

 and in front of the portal vein. This duct passes behind 

 the descending part of the duodenum and between it and 

 the head of the pancreas to about a little below the middle 

 of the inner side of this portion of the intestine, where it 

 meets with the pancreatic duct, and, becoming dilated 

 ampulla of Vater opens into this descending part of the 

 duodenum. There would be no trouble in rinding the situ- 

 ation of this part of the duct, if it were occupied by a 

 calculus, but to do so, in the cadaver, is very difficult. 

 Brewer suggests that, if, after an incision is made in 

 the first part of the duodenum, the finger of the left hand 

 be introduced into the wound, it feels a sharp crescentic 

 fold corresponding to the junction of the first and second 

 parts. If this fold be opposite to the middle of the second 

 phalanx, then the tip of the finger touches the opening of 

 the duct. 



Landmarks for the gall bladder. It lies opposite 

 the right linea semilunaris, i.e., along the outer border of 

 the right rectus muscle, or about opposite to the cartilage 

 of the ninth rib near its junction with the bony portion of 

 the rib. 



Diseases. Pain associated with disease of the liver 

 may be due to stretching of the peritoneal capsule, or to 

 the direct involvement of this coat. It may be felt at the 

 point of the shoulder, or over the clavicle, or down the 

 arm on either side, and may be explained (Luschka) by 

 the branches of the phrenic nerve that pass from the dia- 

 phragm, between the folds of the "suspensory ligament, to 

 the liver, and, since the phrenic is derived from the third, 

 fourth and fifth cervical, and, since from the third and 

 fourth cervical, the superficial cervical plexus arises 



