Loiver Surface of Liver 



335 



niatory thickening, the respiratory movements give rise to a friction 

 sound, just as in the case of pleurisy. 



On account of the liver occupying the arch of the diaphragm, it is 

 overlapped in front, laterally, and behind by the sharp border of the 

 base of the lung. A horizontal stab may, therefore, pass through four 

 layers of pleura and two of peritoneum before the liver is wounded. 

 In a case of hydatid tumour of the upper surface of the liver, which I 

 was recently treating with Dr. Broadbent, 1 we opened the pleura 

 through the seventh intercostal space, traversing also the diaphragm ; 

 we then fixed the hydatid cyst to the edges of the skin-wound by 

 hare-lip pins for a couple of days before incising and draining it, and 

 with an excellent result. The lung collapsed on the pleural cavity 

 being opened, but, the wound being sealed by adhesive inflammation, 

 it soon expanded again. (See figure on p. 192.) 



The lower surface of the liver is mapped out by five fissures, arranged 

 in the shape of the letter H, into five lobes. In relation with this surface 

 are the right kidney and supra-renal capsule posteriorly, and the ascend- 

 ing part of duodenum and colon more to the front ; this surface also 



R.L 



L.L 



R L, L L, right and left lobes ; L s, Spigelian ; L c, caudate ; LQ, quadrate ; p, portal fissure ; 

 uf, umbilical ; fdv, for ductus venosus ; gbl, gall-bladder ; vci, cava ; ig, gastric im- 

 pression ; c, position of cardia ; ic, impressio colica ; ir, impressio renalis ; id, impressio 

 duodenalis ; x, surface destitute of peritoneum. (From QUAIN.) 



Transactions of the Clinical Society, 



