chap. xvii.] ABDOMINAL VISCERA, 353 



costal cartilages. In the recumbent position the liver 

 ascends about an inch, and is entirely covered by the 

 costae, except at the subcostal angle. It descends also 

 in inspiration and rises in expiration. " The extent of 

 the liver upwards, if traced on the surface of the body, 

 is indicated by a line crossing the meso-sternum close 

 to its lower end, and rising on the right side to the 

 level of the fifth chondro-sternal articulation, and on 

 the left to that of the sixth " (Quain). Behind, the 

 liver conies to the surface below the right lung, at a 

 part corresponding, both in position and width, to the 

 tenth and eleventh dorsal vertebrae. On the extreme 

 right the liver descends to the level of the second 

 lumbar spine (Figs. 31 and 33). The under surface of 

 the liver is in contact with the stomach, the first and 

 second parts of the duodenum, the small omenturn, 

 the right kidney, and the beginning of the transverse 

 colon. 



The fundus of the gall - bladder approaches the 

 surface behind the ninth costal cartilage, close to the 

 outer border of the right rectus muscle. 



The liver is more often ruptured from contusions 

 than is any other abdominal viscus. This is explained 

 by its large size, its comparatively fixed position, and 

 its great friability of structure. Death, in such in- 

 juries, usually ensues from haemorrhage, since the walls 

 of the portal and hepatic veins, being incorporated 

 with the liver substance, are unable to retract or to 

 collapse. The hepatic veins also open direct into the 

 vena cava, and, being unprovided with valves, could 

 allow of the escape of an immense quantity of blood, 

 if any retrograde current were established. It is pos- 

 sible for the liver to be ruptured without the peritoneal 

 coat being damaged. - Such injuries may be readily 

 recovered from. The liver presents, behind, a fairly 

 extensive non-peritoneal surface, at which rupture or 

 wound may occur without extravasation into the 

 x 4 



