Atlas of Applied Internal Liver Anatomy

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Considering the sources of error which result from the relations in the dead body, an exact definition of the position of the parts must be given up. This viscus when full pushes the left lobe of the liver outwards, and lies for the most part covered by it. The portion of the diaphragm that supports the pericardium indicates the position of the heart. If the left ventricle, when full, exceeds the margin on the left side, it is clear that the heart lies, not on the stomach, but on the liver, and only its apex reaches the region of the stomach, and a transverse section would be similar to that represented on Plate XIII.

The left cupola of the diaphragm is distended, therefore, by the left lobe of the liver, stomach, and spleen.

Inferior vena cava. Pericardial portion of diaphragm. Lobulus Spigelii. By simple inspection of the form of the circumference of the liver, it is evident that the figure was taken from another body, and that a body was used in which there was considerable distension of the stomach. The stomach, which was distended with food, did not extend as far as the left side, but still had against it the fatty portion of the peritoneum, which drags on the left end of the transverse colon, and which is continuous with the greater sac. The left lobe has a different form from that in Fig.

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From observations that I instituted on different subjects, after filling the colon from the anus, or the stomach from the oesophagus, in order to demonstrate the variation in position of the organs in one and the same individual, I was convinced that even by carefully lifting the peritoneum, I obtained no condition of things from which a plate of any value could be made.

It appeared in the highest degree remarkable that in a portion of the trunk, to which merely the under half of the thorax was attached, one could inject a large quantity of water through the oesophagus, and leave it any length of time without its escaping. On introducing the finger through the oesophagus into the stomach one could feel its wall between the cardiac extremity and the fundus jutting out so sharply as to form a distinct valve.

It must remain for further investigations how far these relations on the subject can be applied to the living body.

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Great oinentum. The other relations are similar to the preceding. It appears in these plates that the heart always has the left lobe of the liver between it and the stomach, and lies on the stomach by only a portion of its apex, which may vary greatly in size. Vena cava interior. Left flexure of colon. It will also be seen that, according to the condition of the stomach, the position of the viscera in the left cupola of the diaphragm will be altered.

The following woodcuts are taken from Pirogoff's atlas to demonstrate the change in the position of the apex of the heart as occasioned by pleuritic or pericardial exudation. The section is taken at the same level as mine, and the apex of the heart is pushed strongly backwards and somewhat to the left side. Male thorax. Lungs healthy. Pirogoff, ii, 15, 2. Vena cava inferior. The pleurse approach each other in front, leaving only a narrow space at the left edge of the sternum. One would expect a greater separation of the pleurae from each other as the quantity of fluid in the pericardium took up greater space.

It is therefore the place to choose for puncture of the pericardium, as has been stated before, so as not to open the pleural cavity. It was made on the body of a man of middle age, who died in hospital, and passes deeper than my section by a vertebra. Notwithstanding the mass of exudation, very little of the liver is divided. As regards the position of the apex of the heart, it is dislocated backwards and to the right.

The distension of the left pleura is so considerable that it extends forwards to the middle line and posteriorly beyond it. Left pleurisy. Pirogoff, ii, 22, 2. Yena cava inferior. Of the ribs of the left side almost the same are divided as in my case, from which it is evident that the effusion was more considerable, causing a tilting up of their anterior extremities.

Atlas Of Applied Internal Liver Anatomy

On the right side, on the other hand, which, according to PirogofTs account, contained very little fluid, the ribs lie wider apart, so that the fourth rib is sawn through. The description is to be found in Pirogoff's atlas, ii, p. The section, which has passed a vertebra deeper, divided the fifth, sixth, seventh, eighth, and ninth ribs of both sides, and shows almost the same relations of the skeleton as Plate XIII, both halves of the thorax being symmetrical. The man had an encysted empyema of the right side. The right lung was strongly compressed, and appeared polygonal in section.

Partial cystic empyema of right side. Pirogoff, ii, 15, 4. The left pleura was thickened and very adherent. The heart, it will be observed, is dislocated and drawn to the left. The left lung lies far back, and its pleural sac is firmly adherent for its whole length in front of the heart, so that puncture of the pericardium could be performed without danger of the pleura at the sides.

With regard to dislocation and hypertrophy of the heart, some authors have frequently observed a bending in of the inferior vena cava.

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Compare Luschka, ' Anat. In my opinion the question is not yet decided, and can only be definitely settled by allowing a body to be frozen, and to expose the right auricle with the venae cavaa from behind with hammer and chisel. Researches on animals, which I have instituted in Ludwig's laboratory, and published in the reports of the Academy, show that ligature of the inferior vena cava does not set up any considerable disturbance of the circulation, as the blood finds a ready path collaterally by means of the azygos veins and spinal plexus, thus getting into the superior vena cava.

Cite this page: Hill, M.

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