130 TOPOGRAPHIC AND APPLIED ANATOMY. 



PLATE 16. 



The position of the thymus gland, heart, liver, stomach, spleen, and intestines of a fifteen-year-old girl as seen 

 from the left. The left lung has been removed. From a Leipzig model from nature (His). 



hepatic artery also supplies the liver as it runs in the ligamentum hepatoduodenale* as the arteria 

 hepatica propria and enters the liver at the transverse fissure. The third branch of the hepatic 

 artery, the gastroduodenal, divides into the superior pancreatico-duodenal artery for the head of 

 the pancreas and the gastro-epiploica dextra, which passes to the left along the greater curvature 

 of the stomach. The splenic artery, the third terminal division of the celiac axis, runs along the 

 upper margin of the pancreas behind the stomach (see page 129 and Fig. 61) to the hilus of the 

 spleen and gives off the gastro-epiploica sinistra, which runs to the right along the greater cur- 

 vature, supplying the stomach and the great omentum and anastomosing withthe gastro- 

 epiploica dextra. 



The veins of the stomach are the gastro-epiploica sinistra and dextra, running along the 

 greater curvature, and the vena coronaria ventriculi along the lesser one. At the cardia, the 

 coronary vein anastomoses with the esophageal veins, and through these with the vena azygos 

 major (see page 123 and Fig. 55). All of the gastric veins empty into the portal system. The 

 pneumogastric nerves have been described upon page 116; the left pneumogastric passes chiefly 

 to the anterior surface, while the right one supplies the posterior surface of the stomach. 



The Liver. The relations of the liver, the largest organ of the abdominal cavity, are of 

 particular importance to the physician on account of the many diseases of this viscus, of which 

 those of the biliary passages in particular are now treated by surgical measures. The organ lies 

 chiefly in the right hypochondrium, but also extends across the epigastrium into the left hypo- 

 chondriac region (Plates 11-14 an d 16). 



The upper convex surface, divided into the right and the left lobe by the falciform ligament, 

 is in immediate relation with the diaphragm (Plates 10, 13, and 14, and Figs. 49 and 62). Since 

 this structure projects upward into the thorax, the greater portion of the liver is surrounded by 

 the ribs, but the right pleural sac (Figs. 49 and 62 and Plate 14) is interposed between the liver 

 and the thoracic wall, so that penetrating wounds which pass between the ribs and involve the 

 liver, as a rule, open this pleural cavity. The upper surface of the liver is not only in relation 

 with the right lung, the diaphragm being interposed, but also with the heart, with the pericardial 

 cavity (Fig. 62), and with a portion of the left lung. Hepatic abscesses may consequently per- 

 forate the diaphragm and rupture into the pleural cavities or into the pericardium. Such an 

 occurrence is, of course, preceded by peritoneal adhesions between the upper surface of the liver 

 and the lower surface of the diaphragm. An abscess of the liver may also perforate into a bron- 

 chus, so that pus from the liver may be expectorated ; in such a case, the inferior surface of the 

 lung must have contracted adhesions to the diaphragm. If one of the pleural cavities becomes 

 filled with an exudate or with air (pneumothorax), the diaphragm and the liver must be dis- 

 placed downward. 



The details of the inferior surface of the liver are very peculiar and best fixed upon the mind 

 when the organ has been left in place. While the inferior surface of a liver which has been 



* Free edge of lesser omentum. 



