SURGICAL ANATOMY OF THE ABDOMEN 15 



the sixteenth and seventeenth ribs ; from here the liver 

 extends downwards, inwards, and forwards, having 

 between it and the costal walls the posterior lobe of the 

 right lung and the diaphragm, and passing across the 

 abdomen its middle lobe rests on the sternum. The 

 right lobe extends as far forwards as about opposite the 

 eleventh rib, as far back as the sixteenth or seventeenth, 

 and reaches as low down as the inferior part of the middle 

 third of the ribs. It is important to remember that, 

 excepting at one small part (between the sixteenth and 

 seventeenth ribs), the right lung and diaphragm are 

 always between us and that organ, an anatomical fact 

 which renders percussion almost useless in liver disease. 



The Spleen is situated on the left side of the abdomen ; 

 it is attached superiorly to the left kidney and prerenal 

 capsule, and anteriorly by peritoneum to the greater 

 curvature of the stomach. The base of the organ extends 

 to two or three inches behind the middle third of the last 

 rib on the left side. 



The Pancreas is situated on the double colon, to the 

 right side of the spine. At its upper part it is beneath 

 the right kidney and close against the vena cava. Its 

 anterior border is in contact with duodenum and the 

 lesser curvature of the stomach. 



The Kidneys. — The right has its anterior border 

 reaching as far forward as the sixteenth rib, where it is 

 in apposition with the liver ; its posterior extends back 

 to the first lumbar vertebra, its inferior edge as low as 

 the middle third of the last rib but one. To the posterior 

 part of this gland the base of the caecum is attached. 

 The renal artery penetrates the organ immediately under 

 the last rib. The left kidney has its anterior border 

 reaching only as far forward as the last rib, its posterior 

 to the transverse process of the third lumbar vertebra. It 



