3OO Regions of Abdomen 



coils of small intestine. The bifurcation of aorta ; and bladder, or 

 stomach, when either viscus is greatly distended. 



Left lumbar. Descending colon, kidney, ureter, small intestine. 



Lowest Zone. 



Right inguinal. Caput caecum coli and vermiform appendix ; 

 small intestine, especially ileum ; ovary, ureter, spermatic vessels. 



Hypogastric. End of omentum, rectum, small intestine and 

 pregnant uterus ; fundus of the child's bladder, and that of the adult 

 when the viscus is full. 



Left inguinal. Sigmoid flexure of colon, small intestine, ovary, 

 ureter, spermatic vessels. 



In intestinal obstruction rolls of distended small intestine may 

 cause prominent elevations across the anterior wall of the abdomen. 

 These may be distinguished from the markings of the recti abdominis 

 by their irregular situation, and also by their extending beyond the limit 

 of the straight muscles ; moreover, abdominal distension effaces the 

 segmentation of the muscles. 



Tight lacing greatly disturbs the relative position of viscera. It may 

 even cause indentation of the convex surface of the liver by the ribs, and 

 may thrust up the diaphragm until inspiration is imperfectly performed 

 and the capillaries give evidence of imperfect aeration. 



The outline of an enlarged liver or spleen, a distended gall-bladder 

 or urinary bladder, may be traced upon the skin, and the upheaval 

 caused by a distended stomach may be detected by smoothing the 

 fingers gently over the abdomen. 



The better to explore a lumbar abscess or an abdominal tumour, 

 the trunk must be flexed, and the knees drawn up, so that the abdominal 

 walls may be relaxed by the ascent of Poupart's ligament. For when 

 the thighs are flat upon the bed the fascia lata drags down Poupart's 

 ligament and tightens up the abdominal aponeuroses which are at- 

 tached to it, and so renders the depths of the abdomen inaccessible. 



The pancreas crosses the aorta two or three inches above the 

 umbilicus, at the second lumbar vertebra ; pulsations may be trans- 

 mitted by it from the aorta to the fingers placed between the umbilicus 

 and the ensiform cartilage, especially in a thin subject. Pulsations 

 thus transmitted in a thin, though healthy, subject may suggest aneu- 

 rysmal or other tumour. 



The superficial arteries of the abdomen come from the superior 

 epigastric artery of the internal mammary, and from the deep epigastric 

 of the external iliac. Twigs are also derived from the lower inter- 

 costal and the lumbar arteries, and from the superficial epigastric and 

 circumflex iliac branches of the common femoral. 



The veins are tributaries of the internal saphenous, and of 

 the companion veins of the deep epigastric, lumbar, and intercostal 

 arteries. Between these surface- veins there is a free anastomosis ; 



