Page images
PDF
EPUB

part of the left lobe, part of the gall-bladder, stomach, middle and pyloric portions, both orifices, first two parts of the duodenum, duodeno-jejunal junction, pancreas, except the tail, upper part of the spleen, part of the kidneys, suprarenal capsules.

Umbilical, contains the transverse colon, part of the great omentum and mesentery, transverse portion of the duodenum,

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small]

FIG. 120 Regions of the abdominal cavity, anterior view (after Joessel).

and some coils of the jejunum and ileum, part of both kidneys with ureters, and the receptaculum chyli.

Hypogastric, contains coils of the small intestine, the bladder in children, or when distended in adults, ureters, the uterus during the latter months of pregnancy, often the cecum,

appendix vermiformis, sigmoid flexure of the colon, and the upper part of the rectum.

The left lateral regions from above downward are:

Left hypochondriac, contains the fundus of the stomach, greater part of the spleen, tail of the pancreas, splenic flexure of the colon, upper part of the left kidney, and part of the left lobe of the liver.

Left lumbar, contains the descending colon, part of the omentum, sigmoid flexure, lower part of the left kidney, and some coils of the jejunum.

Left inguinal (iliac), contains the sigmoid flexure of the colon and convolutions of the jejunum and ileum.

Describe it (Fig. 121).

The Peritoneum.

A serous membrane, forming a closed sac (in the male), the layer covering the walls being called the parietal, and that

[blocks in formation]

reflected over the viscera the visceral layer; it is coated with a layer of flattened endothelium, its attached surface being connected with the subjacent parts by the subperitoneal areolar tissue or fascia.

Does the peritoneum always form a closed sac?

No; in the female the Fallopian tubes open into its cavity.

How is the peritoneum divided for convenience of description?

[graphic]

Into the greater sac 15, or that covering the upper anterior portion of the liver, the stomach 6 in front and above, descending over the ileum forming the anterior layer of the great omentum 15, the under layer of the mesocolon 20, the mesentery 21, and reflections 23 upon and be

FIG. 121.-Diagram to illustrate the reflections of the peritoneum in the female body (Leidy).

13

tween the rectum ", the uterus in the female 22, and the bladder 13, then lining the antero-lateral abdominal walls to reach, from the under surface of the diaphragm ", the upper surface of the liver, the starting-point of this description (see Fig. 121).

17

, passes

The lesser cavity, or cavity of the great omentum 16, starting from the diaphragm behind, passes over the Spigelian lobe of the liver 18, then covers the back and under surface of the stomach, forms the inner layer of the great omentum 16, over the colon completing the mesocolon 20, and thence passes over the pancreas 10 and great vessels to line the posterior abdominal wall, reaching the point started from; the two cavities communicate through the foramen of Winslow.

Describe the foramen of Winslow 18.

It is the orifice of communication between the greater and the lesser sacs, admitting two fingers; bounded above by the caudate lobe of the liver, below by the first part of the duodenum and hepatic artery, in front by the right free border of the lesser omentum, containing the hepatic artery, common bileduct, and vena portæ; behind by the inferior vena cava.

What are the omenta?

They are folds of peritoneum connecting the stomach with the other viscera, four in number, viz. the

18

[ocr errors]

Gastro-hepatic, or lesser omentum extending between the transverse fissure of the liver, lesser curvature of the stomach, and beginning of the duodenum, consisting of two layers, the anterior belonging to the greater, the posterior to the lesser sac, which enfold at the right free border of the omentum, the hepatic artery, common bile-duct, portal vein, lymphatics, and hepatic nerve-plexus; this border is called the hepatoduodenal ligament.

The great omentum 19 is formed of four layers, two descending, one from the anterior, the other from the posterior wall of the stomach, and uniting below to pass as low as the pelvis, when they ascend to the transverse colon, separate and embrace this part of the bowel, and pass to the pancreas as the transverse mesocolon.. At about the age of two years the two anterior layers of the great omentum become adherent to the transverse colon; the part between the stomach and colon is then called the gastro-colic omentum.

Gastro-splenic omentum is a double fold connecting the spleen with the stomach, contains the vasa brevia of the splenic artery, and is continuous below with the great omentum.

What are the mesenteries?

Double layers of peritoneum embracing various portions of the intestinal tube connecting them to the vertebral column or posterior abdominal walls; between the folds run the vessels of the part attached. They are called the

Mesentery, mesocecum, mesocolon 20, mesorectum, mesogas

trium.

What are the ligaments?

Ligament is a term applied to the folds connecting the viscera usually not belonging to the intestinal canal and abdominal walls, such as

The gastro-phrenic to the cardia of the stomach from the diaphragm.

The longitudinal, two lateral", and coronary ligaments of the liver.

The vesical, five so-called false ligaments.

Two vesico-uterine 23, two recto-uterine 22, two broad ligaments of the uterus.

Suspensory ligament of the spleen connecting this organ with the diaphragm; also the supporting ligament or phreno-colic.

Mention the viscera wholly (1) and partially (2) covered with peritoneum, and those totally deficient (3) in such in

vestment.

(1) The spleen, small intestine, cecum, transverse colon1, sigmoid flexure, ovaries, uterus, stomach and liver practically, duodenum (first part), rectum" (first part).

(2) Duodenum (descending ⚫ and transverse), Ascending colon,

Descending colon,

(3) Rectum" (lower part), Bladder 13 (base, ante

rior surface),

Rectum (second part "),
Vagina 12 (upper part),
Bladder 13 (posterior surface).

Pancreas 10,

Kidneys,

Suprarenal capsules,

Vagina (lower and anterior portion).

ORGANS OF VOICE AND RESPIRATION.

The Larynx.

What is the larynx1 (Fig. 122)?

The voice-organ, formed of cartilages united by ligaments, the segments enjoying movement upon one another, which is effected by numerous muscles.

Mention the component cartilages.

There are nine, three being single and three in pairs:

Thyroid cartilage1,

Cricoid cartilage,

Epiglottis,

Two arytenoid cartilages",

Two cuneiform cartilages,
Two cornicula laryngis.

Describe the thyroid (shield-like) cartilage.

It consists of two ala2, or lamellæ, united at an acute angle in front, forming a vertical ridge, whose more prominent upper portion is called the pomum Adami1, or Adam's apple; the

Inner surfaces of the alæ are smooth, giving attachment in front, at the receding angle formed by their junction, to the epiglottis, true and false vocal cords, thyro-arytenoid and thyroepiglottidean muscles.

The outer surface affords attachment along an oblique ridge to the sterno-thyroid and thyro-hyoid muscles, below and behind. to the inferior constrictor muscle.

The upper border presents a deep, median notch', and is slightly concave on either side.

The lower border is connected medianly with the cricoid cartilage by the crico-thyroid membrane, and on each side by the crico-thyroid muscle.

3

The posterior borders are thick, rounded, and terminate above and below on each side in cornua, the two superior having attached to their apices the lateral thyro-hyoid ligaments, while the inferior articulate internally by an oval facet with the cricoid cartilage; to this border are also attached the stylopharyngeus and palato-pharyngeus muscles.

4

Describe the cricoid (ring-like) cartilage.

It is placed with its narrow portion, annulus, in front and the broad lamina5 behind, has on each side two articular facets,

« PreviousContinue »