Henry Gray (18251861). Anatomy of the Human Body. 1918.
above the umbilicus, its upper border just below the greater curvature of the stomach.
Descending Colon.The left colic flexure is situated in the upper left angle of the intersection between the left lateral and transpyloric lines. The descending colon courses down through the left lumbar region, lateral to the left lateral line, as far as the iliac crest (see footnote p. 1181).
Iliac Colon.The line of the iliac colon is from the end of the descending colon to the left lateral line at the level of the anterior superior iliac spine.
Liver (Fig. 1223).The upper limit of the right lobe of the liver, in the middle line, is at the level of the junction between the body of the sternum and the xiphoid process; on the right side the line must be carried upward as far as the fifth costal cartilage in the mammary line, and then downward to reach the seventh rib at the side of the thorax. The upper limit of the left lobe can be defined by continuing this line downward and to the left to the sixth costal cartilage, 5 cm. from the middle line. The lower limit can be indicated by a line drawn 1 cm. below the lower margin of the thorax on the right side as far as the ninth costal cartilage, thence obliquely upward to the eighth left costal cartilage, crossing the middle line just above the transpyloric plane and finally, with a slight left convexity, to the end of the line indicating the upper limit.
According to Birmingham the limits of the normal liver may be marked out on the surface of the body in the following manner. Take three points: (a) 1.25 cm. below the right nipple; (b) 1.25 cm. below the tip of the tenth rib; (c) 2.5 cm. below the left nipple. Join (a) and (c) by a line slightly convex upward; (a) and (b) by a line slightly convex lateralward; and (b) and (c) by a line slightly convex downward.
The fundus of the gall-bladder approaches the surface behind the anterior end of the ninth right costal cartilage close to the lateral margin of the Rectus abdominis.
Pancreas (Fig. 1225).The pancreas lies in front of the second lumbar vertebra. Its head occupies the curve of the duodenum and is therefore indicated by the same lines as that viscus; its neck corresponds to the pylorus. Its body extends along the transpyloric line, the bulk of it lying above this line to the tail which is in the left hypochondriac region slightly to the left of the lateral line and above the transpyloric.
Spleen (Figs. 1217,1226).To map out the spleen the tenth rib is taken as representing its long axis; vertically it is situated between the upper border of the ninth and the lower border of the eleventh ribs. The highest point is 4 cm. from the middle line of the back at the level of the tip of the ninth thoracic spinous process; the lowest point is in the midaxillary line at the level of the first lumbar spinous process.
Kidneys (Figs. 1225,1226).The right kidney usually lies about 1 cm. lower than the left, but for practical purposes similar surface markings are taken for each.
On the front of the abdomen the upper pole lies midway between the plane of the lower end of the body of the sternum and the transpyloric plane, 5 cm. from the middle line. The lower pole is situated midway between the transpyloric and intertubercular planes, 7 cm. from the middle line. The hilum is on the transpyloric plane, 5 cm. from the middle line. Round these three points a kidney-shaped figure 4 cm. to 5 cm. broad is drawn, two-thirds of which lies medial to the lateral line. To indicate the position of the kidney from the back, the parallellogram of Morris is used; two vertical lines are drawn, the first 2.5 cm., the second 9.5 cm. from the middle line; the parallelogram is completed by two horizontal lines drawn respectively at the levels of the tips of the spinous process of the eleventh thoracic and the lower border of the spinous process of the third