432 ABDOMEN 



may also chance that the bladder is full, in which case its 

 apex will be observed projecting above the pubes. Lastly, 

 in pregnant females the gravid uterus will be visible, reaching 

 a height which corresponds with the period of gestation. 



Raise the great omentum and turn it upwards over the 

 lower margin of the thorax. By this proceeding the coils of 

 the small intestine are exposed and a part of the great intestine, 

 which extends across the cavity of the abdomen, will be seen 

 attached to the posterior part of the great omentum. This 

 is the transverse colon. 



Note that all the viscera which have been seen are covered 

 by a smooth glistening membrane, the peritoneum. This 

 membrane forms the immediate boundary of a space, the 

 peritoneal cavity, which has been opened into by the reflection 

 of the anterior wall of the abdomen. The dissector should 

 recognise that under normal circumstances the peritoneal 

 cavity is merely a potential cavity, and that it only becomes 

 an actual cavity when the surgeon or dissector pulls its walls 

 apart in opening into it, or when its walls are forced apart by 

 abnormal collections of fluid or gas. 



Replace the great omentum and commence a fuller 

 consideration of the general position, relations, and connec- 

 tions of the viscera by examining the general position of the 

 liver. 



Hepar (Trie Liver). The liver is the large, reddish-brown 

 organ which occupies a large part of the upper portion of the 

 abdomen, where it lies in the epigastric and both hypochon- 

 driac regions. A very large portion of its surface is in contact 

 with the diaphragm which separates it from the contents of the 

 lower part of the thorax. The lower border of its anterior 

 surface is seen crossing the subcostal angle from above 

 downwards and to the right, and continuing to the right either 

 along or immediately below the right costal arch. Opposite 

 the tip of the ninth right costal cartilage the fundus of the gall- 

 bladder projects from beneath it. Pass the hand over its 

 anterior and upper surfaces and note that they are connected 

 to the anterior abdominal wall and to the diaphragm re- 

 spectively, by a fold of the peritoneal lining of the abdomen 

 which is called the' falciform ligament. Raise the lower 

 margin of the liver and note that the lower and posterior 

 surfaces of the liver are connected to the stomach by a 

 fold of peritoneum called the small omentum. 



