3 io THE ABDOMEN AND PELVIS 



The Posterior Surface of the liver is in contact with the 

 inferior vena cava and the diaphragm, and lies in front of the 

 lower thoracic vertebrae. The peritoneum on the superior 

 surface is not continued over the posterior surface, but is reflected 

 on to the diaphragm, forming the upper or anterior layer of the 

 coronary ligament. Since the peritoneum on the inferior surface 

 of the right lobe is reflected on to the kidney as the hepato-renal 

 (posterior layer of coronary) ligament, the right half of the 

 posterior surface is devoid of any peritoneal covering. It is 

 known as the " bare area " and is in direct contact with the 

 diaphragm. The bare area of the liver is the site of extra- 

 peritoneal subphrenic abscesses, which result from the upward 

 spread of .pus from retro-peritoneal abscesses on the right side 

 of the abdomen. 



The Inferior Surface of the liver is divided into a large 

 right and a smaller left lobe by the fossa for the umbilical vein, 

 which extends from the inferior border of the liver to the left 

 extremity of the porta hepatis (transverse fissure}. The porta is 

 placed transversely on the inferior surface, and its margins 

 receive the attachment of the lesser omentum. From its right 

 extremity the fossa for the gall-bladder extends forwards to the 

 inferior border of the liver. In this way a rectangular area is 

 defined, which lies in contact with the pylorus and the com- 

 mencement of the duodenum. 



The inferior surface of the left lobe is related to the antero- 

 superior surface of the stomach. The right lobe is related to 

 the right kidney posteriorly, to the right colic flexure anteriorly, 

 and to the gall-bladder and the duodenum medially. 



Tropical abscess of the liver occasionally points on the 

 inferior surface, and may rupture into the right colic flexure. 



Blood-vessels of the Liver. The liver receives its blood- 

 supply from both the hepatic artery (p. 296) and the portal vein, 

 and after circulating through the liver the blood is returned 

 to the inferior vena cava by the hepatic veins. 



The Portal Vein brings to the liver the blood which has 

 already passed through the capillaries of (i) the whole abdominal 

 alimentary canal, except the lower end of the rectum and the 

 anal canal, (2) the spleen, (3) the pancreas, and (4) the gall- 

 bladder. Portal obstruction, therefore, whether due to direct 

 pressure on the portal vein or its branches, or to backward 

 pressure from the heart, will produce venous congestion in all 

 these organs, with enlargement of the spleen and gastro-intestinal 



