THE LIVER 



1183 



is crossed by the falciform ligament. The posterior surface is separated from the 

 superior and inferior surfaces by ill-defined postero-superior and postero-inferior 

 borders. 



Surface outline. — The average position of the Uver may be outlined upon the anterior 

 surface of the body as follows (fig. 914): Locate one point on the right mid-clavicular (mid- 

 Poupart) line opposite the fifth rib; a second point on the left mid-clavicular line about 2 cm. 

 lower, in the fifth interspace; and a third point about 2 cm. below the costal arch (10th rib) 

 on the right lateral wall. A line slightly concave upward, joining the first and second points 

 defines the uppermost aspect of the lever. A line, strongly convex laterally, joining the first 

 and third points, defines the right side of the liver. Finally, a third line, joining the second and 

 third points, corresponds to the anterior border and defines the lowermost portion of the liver. 

 This line is subject to many individual variations. In general, it is usually shghtly convex 

 downward as it crosses the epigastric region. It usuall.y presents a slight umbilical notch, as 

 before mentioned, and frequently a notch for the fundus of the gall-bladder, which is placed near 

 the right mammary (mid-Poupart) line. The lower and right portion of the anterior border of 

 the liver runs somewhat parallel with the infracostal margin. In the upright position, and in 

 livers larger than usual, it extends about 2 cm. below the hypochondrium into the right lateral 

 abdominal (lumbar) region (fig. 914). In the supine position, however, the liver recedes about 

 2 cm. toward the head. The liver of course participates also in the respiratorj' movements of 

 the diaphragm. 



Fig. 945. — Cross-section of Body at Level of the Eleventh Thoracic Vertebra. 



(Poirier-Charpy.) 

 Caudate lobe of liver 

 Suprarenal gl. 

 Vena cava inf. 



Spleen 



Lesser 

 omentum 



Falciform lig 



Lig. teres 



Lobes and fissures. — The superior surface is divided by the falciform ligament 

 into two areas, corresponding to a larger right and a smaller left lobe (fig. 941). 

 On the posterior and inferior surfaces of the liver (figs. 942, 943), an H-shaped 

 arrangement of fossae and fissures completes the demarcation of lobes. The left 

 upright of the H [fossa sagittalis sinistra] corresponds to the prolongation of the 

 line of attachment of the falciform ligament. It is made up of the umbilical 

 fissure [fossa venae umbilicalis], containing the round ligament, on the inferior 

 surface; and of the fossa ductus venosi, containing the ligamentum venosum 

 (obliterated ductus venosus) and the upper part of the lesser omentum, on the 

 posterior surface of the liver. This left sagittal fossa separates the left lobe of the 

 liver from the right lobe (in the wider sense of the term) . The right lobe is further 

 subdivided by the right upright and cross-bar of the H. The right upright [fossae 

 sagittales dextrae] is made up of the broad fossa for the gall-bladder [fossa vesicae 

 felleae] on the inferior surface, and the broad fossa vencB cavce on the posterior sur- 

 face (fig. 943. These two fossae are not continuous, but are separated by a narrow 

 strip of liver, the caudate process of the caudate lobe (fig. 942). The cross-bar 

 of the H is formed by the transverse or portal fissure [porta hepatis], which encloses 

 the root structures of the liver, within the lower part of the lesser omentum (fig. 

 942). The area anterior to the cross-bar of the H corresponds to the quadrate 



