Henry Gray (18251861). Anatomy of the Human Body. 1918.
does not imply that the hernia existed at birth, but merely that a condition is present which may allow of the descent of the hernia at any moment. As a matter of fact, congenital herniæ frequently do not appear until adult life.
Where the processus vaginalis is occluded at the lower point only, i.e., just above the testis, the intestine descends into the pouch of peritoneum as far as the testis, but is prevented from entering the sac of the tunica vaginalis by the septum which has formed between it and the pouch. This is known as hernia into the funicular process or incomplete congenital hernia; it differs from the former in that instead of enveloping the testis it lies above it.
2i. The Liver
The liver, the largest gland in the body, has both external and internal secretions, which are formed in the hepatic cells. Its external secretion, the bile, is collected after passing through the bile capillaries by the bile ducts, which join like the twigs and branches of a tree to form two large ducts that unite to form the hepatic duct. The bile is either carried to the gall-bladder by the cystic duct or poured directly into the duodenum by the common bile duct where it aids in digestion. The internal secretions are concerned with the metabolism of both nitrogenous and carbohydrate materials absorbed from the intestine and carried to the liver by the portal vein. The carbohydrates are stored in the hepatic cells in the form of glycogen which is secreted in the form of sugar directly into the blood stream. Some of the cells lining the blood capillaries of the liver are concerned in the destruction of red blood corpuscles. It is situated in the upper and right parts of the abdominal cavity, occupying almost the whole of the right hypochondrium, the greater part of the epigastrium, and not uncommonly extending into the left hypochondrium as far as the mammillary line. In the male it weighs from 1.4 to 1.6 kilogm., in the female from 1.2 to 1.4 kilogm. It is relatively much larger in the fetus than in the adult, constituting, in the former, about one-eighteenth, and in the latter about one thirty-sixth of the entire body weight. Its greatest transverse measurement is from 20 to 22.5 cm. Vertically, near its lateral or right surface, it measures about 15 to 17.5 cm., while its greatest antero-posterior diameter is on a level with the upper end of the right kidney, and is from 10 to 12.5 cm. Opposite the vertebral column its measurement from before backward is reduced to about 7.5 cm. Its consistence is that of a soft solid; it is friable, easily lacerated and highly vascular; its color is a dark reddish brown, and its specific gravity is 1.05.
To obtain a correct idea of its shape it must be hardened in situ, and it will then be seen to present the appearance of a wedge, the base of which is directed to the right and the thin edge toward the left. Symington describes its shape as that of a right-angled triangular prism with the right angle rounded off.
Surfaces.The liver possesses three surfaces, viz., superior, inferior and posterior. A sharp, well-defined margin divides the inferior from the superior in front; the other margins are rounded. The superior surface is attached to the diaphragm and anterior abdominal wall by a triangular or falciform fold of peritoneum, the falciform ligament, in the free margin of which is a rounded cord, the ligamentum teres (obliterated umbilical vein). The line of attachment of the falciform ligament divides the liver into two parts, termed the right and left lobes, the right being much the larger. The inferior and posterior surfaces are divided into four lobes by five fossæ, which are arranged in the form of the letter H. The left limb of the H marks on these surfaces the division of the liver into right and left lobes; it is known as the left sagittal fossa, and consists of two parts, viz., the fossa for the umbilical vein in front and the fossa for the ductus venosus behind. The right limb of the H is formed in front by the fossa for the gall-bladder, and behind by the fossa for the inferior vena cava; these two fossæ are separated from one another by a band of liver substance, termed the caudate process. The bar connecting the two limbs of the H is the porta (transverse fissure); in front of it is the quadrate lobe, behind it the caudate lobe.