THE LIVER 261 



posterior part, to the right kidney, and, in its anterior part, to 

 the right (hepatic) flexure of the colon. Cases have been 

 recorded in which a tropical abscess has ruptured into the 

 right colic flexure and has been discharged per anum. 



The porta hepatis (transverse fissure of the liver) is placed 

 on the inferior surface, and through it the hepatic artery and 

 portal vein enter and the hepatic ducts leave the liver (PI. I.). 



The hepatic veins, which join the inferior vena cava just 

 before it pierces the diaphragm, return the blood distributed 

 not only by the hepatic artery but also by the portal vein. 

 Sudden dilatation of the right atrium of the heart dams back 

 the blood in the inferior vena cava, and this backward pressure 

 is at once communicated to the hepatic veins, causing acute 

 venous congestion of the liver. In this condition, the size of the 

 anterior surface of the liver is much increased, and the skin 

 and muscles of the upper part of the anterior abdominal wall 

 may be acutely sensitive to ordinary tactile stimuli (vide infra). 

 The enlarged liver exhibits pulsations which are identical with 

 the pulsations of the internal jugular vein, as they are brought 

 about in precisely the same way (p. 311). When the dilatation 

 of the right atrium of the heart is more gradual in its onset, 

 chronic venous congestion of the liver is brought about and may 

 cause the viscus to project for a considerable distance below 

 the costal margin. 



The Lymph Vessels of the liver are very numerous. Some 

 pass to the coeliac glands directly, or through the subpyloric 

 glands (p. 249). Others pierce the diaphragm and join the 

 lymph glands in the mediastinal space. Secondary growths, 

 therefore, may be found in the mediastinal glands in primary 

 cancer of the liver. 



The Gall-bladder forms a small reservoir for the bile 

 secreted by the liver. It occupies a fossa on the inferior 

 surface of the right lobe of the liver, to which it is connected 

 by its peritoneal covering. Its blind extremity or fundus pro- 

 jects from under cover of the inferior border of the liver and 

 comes into contact with the anterior abdominal wall, just 



