Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

    47/116 (page 35)
    Let us take, first, the largest of the abdominal viscera— the liver. Jj. The liver lies under the right hypbchondrium, and Liver, passes across the middle line over the stomach into the left hypochondrium, generally speaking, as far as the left mammary line. The extent to which it can be felt below the edges of the ribs depends upon whether it is enlarged or not, and also upon the amount of flatus in the stomach and intestines. As a rule, in health its lower thin border projects about half an inch below the costal cartilages, and can be felt moving up and down with the action of the diaphragm ; but it requires an educated hand to feel it. An uneducated hand would miss it altogether. That part of it, however, w^hich crosses the middle line below the ensiform cartilage is much more accessible to the feel; here it lies immediately behind the linea alba, and in front of the stomach, nearly half-way down to the umbilicus. Here, therefore, is the best place to feel w^hether the liver be en- larged or pushed down lower than it ought to be. If it be much enlarged and much lower, even the most untutored hand could detect its edge. Even if the edge of the liver be felt very much lower than is normal below the ribs, it does not necessarily follow that the liver is enlarged, since it may be pressed down by other causes—for instance, the habit of wearing tight stays. To what height does the liver ascend } This can only be ascertained by careful percussion of the chest wall. The highest part of its convexity on the right side is about one inch below the nipple, or nearly on a level with the external and inferior angle of the pectoralis major. Posteriorly the liver comes to the surface below the base of the right lung, about the level of the tenth dorsal spine. Roughly speaking, the upper border of the liver corre- sponds with the level of the tendinous centre of the dia- phragm ; that is, the level of the lower end of the sternum. Thus a needle thrust into the right side, between the sixth