Liver

Upper Border. - The highest point of the liver is on the right side just to the inner side of the nipple where it rises to the middle of the fourth interspace. To the left it crosses the xiphosternal articulation to follow the lower border of the heart to a little beyond its apex, but hardly to the nipple line, where it reaches the lower border of the sixth rib. Its highest point on the left side is under the fifth rib posteriorly. On the right side it reaches the upper border of the fifth rib in the mammary line, the eighth rib in the midaxillary line, and the tenth rib in the scapular line (Tyson,"Physical Diagnosis," p. 51). In the median line it is about opposite the tenth thoracic spine (Fig. 386).

Lower Border

From just below and to the inner side of the left nipple the lower border of the liver passes across the left eighth costal cartilage, then across the median line midway between the xiphoid articulation and the umbilicus to reach the right ninth costal cartilage, and then follows the edge of the ribs posteriorly. In the upright position, and in women, the liver may project a centimetre or two below the edge of the chest. In the aged it may be slightly retracted.

Liver Dulness

On percussion the liver dulness in the right mammary line extends from the upper border of the sixth rib to the lower edge of the chest. In the axillary line it reaches the upper border of the eighth and in the scapular line the upper border of the tenth rib. From these limits it extends downward to the edge of the ribs.

Gail-Bladder

The gall-bladder reaches the surface at the anterior end of the right ninth costal cartilage, just to the outer edge of the rectus muscle. This is the upper end of the right linea semilunaris.

Stomach

The cardiac end lies under the cartilage of the seventh rib, 2.5 cm. (1 in.) from the edge of the sternum and about 10 cm. (4 in.) from the surface. When the stomach is empty the pylorus lies in the median line 2.5 to 5 cm. (1 to 2 in.) below the tip of the xiphoid or ensiform cartilage; when distended the pylorus moves 3 to 5 cm. to the right. The fundus rises in the left nipple line to the lower edge of the fifth rib. The lower border of the stomach crosses the median line 5 to 7.5 cm. (2 to 3 in.) above the umbilicus. In the old it may reach as low as the umbilicus, and when dilated may go far below it.

Pancreas

The pancreas lies beneath the stomach and transverse colon, stretching across from the duodenum on the right of the spine to the spleen on the left. Its body lies over the first and second lumbar vertebrae. This would bring its lower edge about 5 cm. (2 in.) above the umbilicus and its upper edge about 10 cm. (4 in.) above it.

Fig. 386.   Surface anatomy of the abdomen, showing the outlines of the viscera.

Fig. 386. - Surface anatomy of the abdomen, showing the outlines of the viscera.