The Heart.

The surface markings of the heart are already given on p. 137The Abdomen.

The abdomen is most prominent in the region of the umbilicus, which is situated normally below the mid-point between the infrasternalj notch (formed by the seventh costal cartilage and lower border of sternum) and the symphysis pubis, a little below the level of the highest part of the iliac crest and opposite the fourth lumbar vertebra; in obese or pendulous abdomens it may be considerably below this level.

The anterior abdominal wall is limited above by the infra-sternal notch and costal margin, and below by the fold of the-groin and crest of the pubes.

In a spare subject the recti and supra-umbilical portion of the linea alba are easily seen; if the outline of the rectus is-obscured by fat, the outer border is indicated by a line drawn from the tip of the ninth costal cartilage down as far as the umbilicus, then curving forward to the pubic spine. In the angle between the outer border of the rectus and the ninth costal cartilage on the right side lies the gall-bladder.

The abdomen is arbitrarily divided into nine regions, by twa vertical and two horizontal planes.

The mid-clavicular lines, continued downwards, cut Poupart's ligament in the mid-point between the anterior superior iliac spine and the pubic symphysis. (Note that this point is not the mid-point of Poupart's ligament.) In the abdomen these are-called the Poupart planes.

The upper [infracostal) plane is at the level of the lowest part of the tenth costal cartilage, and passes through the third lumbar vertebra.

The lower {intertubercular) plane is at the level of the tubercles-of the iliac crests, and passes through the fifth lumbar vertebra.

The subdivisions of the upper zone are called the epigastric and right and left hypochondriac regions; of the middle zone, the umbilical and right and left lumbar regions; of the lower zone, the hypogastric and right and left iliac regions.

The transpyloric plane is midway between the suprasternal notch and the symphysis pubis; it passes through the first lumbar vertebra and almost always through the pylorus; hence its name.

Fig. 73. - Plane of Abdomen.

The Liver

In front the lower border of the liver can readily be felt as it crosses the costal angle; it passes from the eighth costal cartilage on the left side to the tip of the tenth on the right, and in the mid-line crosses the transpyloric plane. In the mid-axillary line it is a little below the level of the lowest part of the tenth right costal cartilage. The upper border reaches from the fifth interspace on the left side to the fourth interspace on the right (both points in the mid-clavicular line).

The Stomach

The stomach lies almost entirely in the left half of the epigastric and the left hypochondriac regions. The cardiac orifice lies 4 inches from the surface at a point over the seventh left costal cartilage, 1 inch from the sternum ; the pylorus is generally about 1 inch to the right of the mid-line in the transpyloric plane; its position varies slightly according to the state of distension of the stomach. The highest part of the fundus of the stomach lies under the left cupola of the-diaphragm, and reaches the fifth interspace in the mid-clavicular line, a little above and behind the apex of the heart; the lowest part of the great curvature lies between the transpyloric and infracostal planes.