1118 



SURGICAL AXD TOPOGRAPHICAL ANATOMY 



the right lobe of the Uver, and having the quadrate lobe to its left, lies oi)i)osite to 

 the right ninth costal cartilage, close to the outer edge of the rectus. It is in 

 contact with the hei)atic flexure of the colon and the first piece of the duodenum. 

 Stomach (figs. 566-569, p. 960). — This organ varies in position more than any 

 other, owing to its mobility, save at the cardiac orifice, and to its varying disten- 

 sion. \\'hen empty and contracted, it lies far back in the abdomen, under the left 

 lobe of the liver, and in front of the pancreas. AMien much distended, its pyloric 

 end moves to the right, and the organ comes forwards, pushing against the liver 

 and alidominal wall; and upwards, against the diaphragm, and thus against the 

 heart and left lung. If moderately distended, the cardia will be found under the* 

 seventh left chondro-sternal joint, about one inch beyond the sternum. The pylorus 

 is very moV)ile, liut a spot near the end of the cartilage of the eighth rib will denote 

 it with sufficient accuracy. It is on a deeper plane than the cardia. By joining 

 these two points with lines representing the lesser and greater curvatures, the 

 stomach can be marked out (figs. 708, 709). The usual inaccuracies committed in 

 delineating the stomach are as follows: The viscus is marked too horizontally — 

 students forget its oblique position. The greater curvature and fundus are not 



Fig. 688.— Diageam showing Relation of Kidney to Capsule. 



TRANSVERSE COLON 



DESCENDING COLON 



PERITONEUM 



FATTY CAPSULE 



KIDNEY ^ 

 PERITONEAL CAVITY 



Diaphragmatic 

 fascia 



Parietal muscle 



Muscular fibre in 

 subperitoneal 



Sup. mesenteric vein 

 DUODENUM 



LYMPHATIC GLAND 



LUMBAR VERTEBRA 



SUBPERITONEAL TISSUE FATTY CAPSULE 



bedded in snipe 



marked high enough on the left side. They are placed high up under the left arch 

 of the dia])hragm, well to the left of the middle line, as high as the sixth chondro- 

 sternal joint. The lesser curvature is usually made too curved and too horizontal 

 (Sheild). 



The pancreas. — This lies a little obliquely behind the stomach, crossing the 

 aorta, inferior cava, and spine about the junction of the first and second luml)ar 

 vertebrae, or three inches above the umbilicus (fig. 587, p. 987, and fig. 710, p. 

 1147). A little lower is the third piece of the duodenum, reaching to within 

 an inch of the umbilicus (Godlee). 



Intestines — (A) Small. — The only parts of these that can be localised at all 

 definitely are the duodenum and its junction with the jejunum and the ending of the 

 ileum in the cax-um. The first piece of the duodenum lies in the right hyi)Ochon- 

 drium. usually near the gall-bladder (vide ■•mprd)^ reaching from the pylorus 

 upwards, backwards, and to the right. This is the most mobile of the three parts. 

 The second, or descending, is in relation with the head of the pancreas, and reaches 

 the right lumbar region, descending as low as the second or third lumbar vertebra. 

 The third, or oblique, portion passes from the third lumljar vertebra ol)liquely from 

 right to left across the second, and, ascending, ends in the jejunum on the left side 



