RELATION OF VISCERA TO ABDOMfXAL WALLS 



1117 



eternal joint; tlic ri^ilit lialt" t<» al)()Ut tlic U'vel of the iit'lli rili, or about one inch 

 below the nij)})le; the left half not risin<i (juite so high. 



Viscera behind the linea alba. — From al)ove downwards there are the folhjw- 

 ing (tig. 686): — (1) Above the umbilicus — the left lobe of the liver, the 

 stoniach, the transverse <(iloii. part of the great omentum, the pancreas and solar 

 plexus. (2) Below the umbilicus — the rest of the great omentum, covering in 

 the small intestines and their mesentery. In the cliild, the l)ladder occupies a 

 partly abdominal position; and in tiie adult, the same viscus, if distended, may 

 rise out of the i)elvis and displace the above structures, raising the peritoneum 

 until, if distended half way to the uml)ilicus, there is an area of nearly two inches 

 safe for operations above the symphysis. The graviil uterus also rises along the 

 linea all)a. 



The liver (figs. 579, 580, and 581). — In the erect position, the ante^-ior thin 

 edge of the liver projects about half an inch below the costal cartilages, but can 

 only be made out with difhculty in this i)osition. It may also be displaced down- 

 wards by pleuritic effusion or tight lacing. The liver is also, proportionately, 

 much larger in little children. 



Fig. 687.— Sectiox of Abdomen between the Third and Fourth Lumbar 



Vertebrae. (Braune.) 



UMBILICUS 



Rectus 

 SYMPATHETIC \ 



GREAT OMENTUM 

 URETER 



TRANSVERSE COLON 



TranBversalis 



I riternal oblique 







ernal oblique 



DESCENDING COLON 

 Quadratus lumborum 



Psoas 



A orta 



ARTICULAR PROCESS OF THIRD LUMBAR 



ASCENDING COLON 



Psoas 

 Vena cai'a 



INTERVERTEBRAL CARTILAGE 



Of the three parts of the liver (according to the regions which it occupies), that 

 in the right hypochondrium corresponds to the lower margin of the thorax; but in 

 the epigastric region the anterior margin, ruiming oblicpiely across from the ninth 

 right to the eighth left costal cartilage, crosses the middle line about a hand's 

 breadth below the sterno-xiphoid articulation (Godlee). The size of the left lobe 

 varies. In infants it will occu]>y the left hypochondrium; in adults its extent to 

 tlie left will vary from a ])oint an inch and a half or two inches beyond the sternum 

 to the left nipi)le line. The level of the U}>per l)ordcr varies also with position, 

 respiration, etc. It may be rej^resented, on the right, by a line drawn about one 

 inch below the nipple, along the seventh rib, towards the middle line, the fifth 

 chondro-sternal joint, and the sterno-xiphoid articulation (or central tendon of the 

 diaphragm); on the left side it does not reach quite so high: thus its level would 

 be marked by the sixth chondro-sternal joint. Behind, the liver would be below 

 the base of the right lung, on a level with the tenth thoracic spine ( tigs. 708, 709, 

 and 710). 



Gall-bladder. — Tlie fundus of this, situated in a fossa on the under surface of 



