Book - An Atlas of Topographical Anatomy 14

From Embryology

XIV. Transverse section of the same body through the liver, stomach, and spleen, at the level of the eleventh dorsal vertebra

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Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.

Plates: 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term
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Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)


THIS plate represents a section through the epigastrium, exposing the liver, stomach, and spleen. No more is to be seen of the lungs ; the black line immediately internal to the ribs represents the pleural cavity, whilst close to it is the diaphragm, appearing as a muscular ring. The structures lying external to it belong to the thorax, and internal to the diaphragm is the abdominal cavity.


The plate is taken from the upper surface of a section two inches thick from the same body as the preceding and the following.


The body of the eleventh dorsal vertebra is seen divided near its under surface, so that a small piece of the interarticular fibro-cartilage is shown. The arch lying behind it also belongs to the eleventh dorsal vertebra : the joint spaces in front belong to the articular processes of the twelfth : and on either side are the sections of the eleventh, tenth, ninth, eighth, seventh, and sixth ribs ; the seventh and sixth ribs being divided twice, but not the xiphoid cartilage, since the section passes below it. It appears strange, at first sight, that the section of the right half of the body should have a larger area than the left, the transverse diameters differing by about half an inch; the cause of this is, however, in some measure, owing to a want of symmetry, and also to the fact that the sawblade diverged somewhat from the horizontal plane.


The liver occupies the greatest amount of space, and is perfectly normal in structure and weight. The left lobe of the liver is prolonged into a thin lamina, which is stretched over the stomach almost as far as the spleen. This explains the great extent of the liver in the left cupola of the diaphragm, in the preceding plate. At the point of junction of the right and left lobes, in the left longitudinal fossa, is the ligamentum teres in a fold of peritoneum ; and posteriorly, lying on the diaphragm, the lobulus Spigelii with the omentum. Close to it on the right is the inferior vena cava ;. and in front of this are the transverse fissure, the portal vein, and the hepatic duct.


The stomach contained some frozen food, which was removed so as to show its walls. It was ascertained subsequently that the fundus of the stomach had attained its highest position, and that beyond the distended portion in the commencement of the stomach, there was contraction where the folds of the mucous membrane were most marked, and that subsequently the cavity became again distended further to the right side and below. It appears, therefore, that Luschka is quite correct in disputing the entire approximation of the anterior and posterior walls of the organ in its empty condition. Here also, where completely normal conditions existed, the stomach was contracted like intestine in its empty portions, and was not flat, as represented in some plates.


The cut edges of peritoneum behind the stomach belong to its lesser sac. Further back is the spleen, normal, with its blood-vessels ; it corresponds with the course of the ninth, tenth, and eleventh ribs, and in its greatest diameter follows their direction. The left supra-renal capsule is not seen, whereas the right is evident between the liver and diaphragm.


Concerning the relations of the peritoneum, it must be remarked that transverse sections are not adapted for displaying it. The cavities can only be represented by black, and the cut edges by fine white lines, which easily mislead the eye.


In order to render any representation advantageous, views of surfaces must be given, or longitudinal or oblique sections taken as the bases of the drawings, by which, semi-diagramatically, the cavities of the peritoneum appear enlarged. Luschka and Henle have excellent plates of this kind.


On the other hand, representations of such transverse sections, here shown true to nature, are of great value surgically. They show what localities are free of peritoneum, and what not, and the surgeon consequently can plan an operation. It is of the first importance to avoid this membrane, and in this, as in the following plates, the boundaries of the cavities and points of investment of the peritoneum have been represented with the greatest fidelity ; and hence the cavity of the omentum between the lobulus Spigelii, and the posterior wall of the stomach, was not drawn as contracted, although both cavities are connected immediately below the surface of the section. The portion of the stomach which lies close to the diaphragm shows the end of the posterior cardiac region free, and uncovered by peritoneum.


An examination of the peritoneum shows that it has two functions to perform, especially mechanical, which are (1) that it fixes the several organs in the abdominal cavity in definite places; and (2), like a colossal, sinuous, mucous membrane, allows of their movements upon one another in their various conditions of distension. These changes of position can occur, where the black lines in the plate, like joint spaces, represent the cavities of the peritoneum ; at points, on the other hand, where the peritoneum is reflected, and leaves a free space for the entrance of blood-vessels, the viscera are fixed to their surroundings.


In order to show the relations as they exist in the extremes of age, I have here introduced two woodcuts. Fig. 1 is taken from a man, get, 50, who had enlargement of the liver and spleen. Fig. 2 from a recent body of a female infant, at full period, born dead.


The body of the old man is the same which furnished Plate IX in the large coloured atlas. Death resulted from hanging, and the stomach and intestines were empty.


The section passed through the tenth dorsal vertebra, and anteriorly through the xiphoid cartilage. The stomach was empty, with the exception of a little frozen mucus. The lung structure was normal and absolutely empty of air. The liver large and fatty. Supra-renal capsules and spleen large.


The well-developed body of the child showed no irregularities.


The great resemblance between Figs. 1 and 2 is singularly remarkable, also the fatty livers of the old and young subjects ; moreover, the relations correspond wonderfully accurately.


In both cases the liver fills up almost the whole interspace internal to the diaphragm, and spreads over a large portion of the spleen, which lies in relation to the spinal column, as in Plate XIV. The stomach alone shows any important change of position. In both cases it is empty; has the same position between the left lobe, of the liver and the spleen ; has a portion of the diaphragm for a covering ; and is not overlaid by peritoneum. On the other hand the shape is different in the two subjects.


FIG. 1. Male, set. 50. . 1. Liver. 2. Stomach. 3. Spleen. 4. Left lung.


Whilst in the former case the stomach is contracted like intestine, in the latter it is an oblique chink ; so that the anterior wall lies relaxed on the posterior a condition I have never observed in the adult.


In front of the right supra-renal capsule is, in the child, the inferior cava, lodged somewhat deeper under the lobulus Spigelii than in the other instance, where the capsules are not seen, notwithstanding that the section lies passed three vertebrae lower, On the other hand, corresponding with the slight power of contraction of the lungs in the old man, they are still visible at the level of the first lumbar vertebra ; whilst in the youth of twenty-two years in Plate XIV the pleural cavities are empty at the eleventh dorsal, and in the new-born child, Fig. 2, at the tenth.


In the new-born child the thorax is fixed at extreme expiration, to which it can never return after the first inspiration. The entire contents of the upper portion of the abdomen must therefore be depressed as soon as the diaphragm, during the first inspiration, leaves its high position ; and the figure, which here lies three vertebrae higher than in the old man, would then take a considerably deeper level.


FIG. 2. Child, at full period. Born dead, Natural size. 1. Liver. 2. Stomach. 3. Spleen. 4. Supra-renal capsule.


As in Plate XIV the space between the liver and the spleen appears to be completely filled up by the stomach, which, however, presents only a slight degree of distension, the question arises, what would be the condition of things if this viscus were more distended ? It is easily seen that, apart from a considerable protrusion of the anterior wall of the abdomen, which is observable after each full meal, the lower ribs also must give way a circumstance which, under a continued swelling of the abdomen, leads even to permanent prominence of the thoracic segment, as may be proved in many ways, and is especially seen in children. The left lobe of the liver must follow more or less the movements of the stomach, since it forms a species of covering to that organ ; it is lifted up by the distended stomach, pushing the pericardium up with it, and sinks down with the contracting stomach, the place of which is taken partially by the left flexure of the colon. The mesentery -like left coronary ligament of the liver renders possible such movements of its left lobe, which are associated either with a turning of the entire liver (the axis of which is to be sought in the right lobe, corresponding with the strong, firm attachments to the right half of the diaphragm), or arise from the yielding or distension of the soft tissues.


Fig. 3 reduced from Pirogoff will make this relation clear, even if one does not obtain an entirely correct idea of the form and position of the left lobe of the liver.


From this cut it is clear that the spleen lies so far back that any determination of its posterior limits by percussion is impossible. It is true that by percussing in a horizontal direction around the thorax towards the spine, at the level of the spleen, we obtain a different sound as we approach the spine ; but from the present plates one would not be warranted in assuming the existence of an air-containing organ between the spleen and the spine. We must look for the cause in the alteration of the elasticity of the ribs at this point. Further, we always find, if we percuss in a vertical direction on the back and in the axilla from above downwards, that the commencement of the dulness is in a horizontal line, corresponding with the limit of the base of the lung, and covering the superior portion of the spleen, which is directed obliquely downwards and forwards. One can easily convince oneself of the firm position of the spleen, which is especially owing to the reflexion of the peritoneum, under the name of phenico-splenic ligament, if the upper portion of the thorax be removed on the dead body, and the sac of peritoneum preserved, so that the liver, stomach, left flexure of the colon and upper wall of the spleen are seen through it. The stomach can be inflated and again allowed to collapse, and the descending colon filled and again emptied, when it will be always found that the upper border of the spleen is unchanged in position.


Fig. 3. Youth, set. 15. Stomach distended with air. Pirogoff, iii, 3, l-$. 1. Liver. 2. Stomach. 3. Spleen. 4. Abdominal aorta. 5. Vena cava inferior.


On laying the subject on the abdomen the spleen does not sink forwards, but remains in its original position. The relations are, however, different when the attachments of the spleen to the diaphragm are sparse or easily lacerable, or drawn out into long bands. This might account for the so-called movable spleen.



Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)
Braune Plates (1877): 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term

Reference

Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.


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Cite this page: Hill, M.A. (2019, September 19) Embryology Book - An Atlas of Topographical Anatomy 14. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_14

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© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G