THE ABDOMINAL CAVITY 311 



disturbance. Serum transudation occurs (i) into the stomach,, 

 giving rise to the morning sickness of alcoholic cirrhosis ; (2) into 

 the intestines, causing diarrhoea; and (3), .into the peritoneal 

 cavity, giving rise to ascites. 



Certain channels of anastomosis exist between the portal and 

 the systemic circulation, (i) At the lower end of the oesophagus, 

 the left gastric veins communicate with the cesophageal veins. 

 In portal obstruction these veins become varicose and may 

 rupture, causing hsematemesis. (2) At the lower end of the 

 rectum the superior, middle, and inferior haemorrhoidal veins 

 communicate freely. They become varicose in portal obstruction 

 and give rise to internal haemorrhoids, which may act as a 

 " safety valve " to the venous congestion. In cases of internal 

 haemorrhoids the possibility of portal obstruction must be 

 excluded before operation is advised. (3) The connections of 

 the para-umbilical vein have been discussed on p. 243. (4) The 

 lumbar veins on the posterior abdominal wall communicate 

 with the mesenteric veins. (5) The veins on the " bare area " 

 of the liver communicate with those on the inferior surface of 

 the diaphragm. 



These natural routes seldom suffice to establish compensation, 

 and the Talma- M orison operation aims at the production of 

 artificial anastomoses between the portal and the systemic 

 veins. The opposing peritoneal surfaces of the liver, spleen 

 (portal circulation), diaphragm, and anterior abdominal wall 

 (systemic circulation) are greatly irritated to encourage the 

 formation of adhesions. In addition, the greater omentum 

 (portal circulation) is fastened to the peritoneum of the anterior 

 abdominal wall (systemic circulation) by a series of stitches. 



Development of the Liver. The liver is developed from a hollow 

 bud which grows upwards from the duodenum into the septum transversum 

 (the forerunner of the diaphragm). The bud subdivides into two, of which 

 one forms the gall-bladder and cystic duct and the other gives rise to the liver 

 substance. The liver grows downwards with great rapidity into the ventral 

 mesentery of the stomach, which it subdivides into the falciform ligament 

 and the lesser omentum. The proximal end of the original outgrowth 

 remains as the bile-duct and retains its connection with the duodenum. 



The Gall-Bladder lies in a fossa on the inferior surface 

 of the right lobe of the liver. It is covered on its inferior surface 

 by peritoneum which binds it closely to the liver, but its fundus 

 may project beyond the lower margin of that organ and it then 

 receives a complete investment. The long axis of the gall- 



