Part 127

As stated above, the liver is divided by fissures into three principal lobes—right, middle, and left. The right lobe is the largest in the young subject and is irregularly quadrilateral in form. On its dorsal part is the caudate lobe, which ends in a pointed process directed outward, and assists in forming the cavity for the right kidney. The middle lobe is normally much the smallest. The left lobe is oval in outline and thickest centrally. In old or middle-aged subjects it often exceeds the right one in size. In some cases the atrophy of the right lobe is so extreme that the middle lobe may exceed it in size.

The =hepatic duct= (Ductus hepaticus) is formed at the ventral part of the portal fissure by the union of right and left chief lobar ducts. It is two or three inches (ca. 5 to 8 cm.) long and about half an inch (ca. 1 to 1.5 cm.) wide. It passes between the two layers of the lesser omentum, and pierces the wall of the duodenum about five or six inches (ca. 12 to 15 cm.) from the pylorus, alongside of the pancreatic duct. The ducts pass obliquely through the wall of the duodenum for about half an inch (ca. 1 cm.) before opening into the diverticulum duodeni. The arrangement forms an effective valve, which prevents regurgitation from the intestine. There is no gall-bladder.

FIG. 276.—LIVER OF NEW-BORN FOAL, HARDENED in situ. VISCERAL SURFACE.

The differences, when compared with the organ in the adult, are very striking. ]

=Structure.=—The liver is covered by an outer serous, and an inner fibrous coat. The =serous coat= covers the gland except at the attachment of the pancreas and at the portal fossa; it is reflected from it to form the ligaments and the lesser omentum. The =fibrous capsule= is in general thin; it sends laminæ into the ligaments, and also delicate strands into the gland substance. At the portal fissure it is abundant and surrounds the vessels and ducts, which it accompanies in the portal canals of the gland substance.

The gland substance is composed of the parenchyma and the interstitial tissue. The =parenchyma= is made up of lobules, 1 to 2 mm. in diameter, which are held together by a small amount of interlobular connective tissue. On account of the very small amount of the latter, the lobulation of the horse’s liver is not usually at all distinct to the naked eye; for the same reason the organ is also quite friable.

=Vessels and Nerves.=—The =portal vein= enters at the portal fissure. It conveys blood from the digestive tract and the spleen, which contains various products of digestion and numerous white blood-cells. The =hepatic artery= also enters at the portal fissure; it may be termed the nutrient vessel. All the blood is returned from the liver to the posterior vena cava by the hepatic veins. The portal vein and the hepatic artery both divide into interlobular branches, which run together in the portal canals of the interlobular tissue. The branches of the portal vein (Venæ interlobulares) give off intralobular branches which form plexuses of capillaries in the lobules and give rise to a central vein (Vena centralis). The branches of the hepatic artery (Rami arteriosi interlobulares) are of relatively small size. They supply mainly (if not exclusively) the interlobular tissue, the capsule, and the walls of the vessels and ducts. The =hepatic veins= (Venæ hepaticæ) empty into the vena cava as it lies in the fossa of the gland. Their ultimate radicles are the central lobular veins, which emerge from the bases of the lobules and join the sublobular veins (Venæ sublobulares); the latter unite to form the hepatic veins. The largest hepatic veins, three or four in number, join the posterior vena cava just before it leaves the liver to pass through the diaphragm.

The nerve-supply comes from the =hepatic plexus=, composed of branches from the vagus and sympathetic nerves.

THE SPLEEN

The =spleen= (Lien) is the largest of the ductless glands. It is situated chiefly in the left parachondrium, in close relation to the left part of the great curvature of the stomach, to which its long axis corresponds. Its size and weight vary greatly in different subjects, and also in the same subject under different conditions, depending chiefly on the great variability of the amount of blood contained in it. The average weight is about 35 ounces (ca. 1 kg.), its length about 20 inches (ca. 50 cm.), and its greatest width about 8 to 10 inches (ca. 20 to 25 cm.). It is usually bluish-red or somewhat purple in color. In the natural state it is soft and yielding, but not friable.

The weight appears to vary ordinarily from about one to eight pounds, although in large horses the latter figure even may be exceeded without any apparent evidence of disease. There does not seem to be any constant relation to the body-weight. For example, the spleen of a colt about ten months old weighed three and a half pounds, while it often weighs less than two pounds in horses weighing 1000 to 1200 pounds. The chief variation in outline consists of increase of width, especially of the dorsal part.

It extends obliquely in a curved direction from the left crus of the diaphragm and the saccus cæcus of the stomach to the ventral third of the ninth or tenth rib. It presents for description two surfaces, two borders, and two extremities.

The =parietal= or =external surface= (Facies parietalis) is convex, and lies chiefly against the diaphragm, but is in direct contact with the upper parts of the last two ribs and to a small extent with the flank at the lumbo-costal angle.

The =visceral= or =internal surface= (Facies visceralis) is in general concave. It is divided into two unequal portions by a longitudinal ridge; on this is a groove, the =hilus=, in which the vessels and nerves are situated. The area in front of the ridge (Facies gastrica) is moulded on the great curvature of the stomach; it is about two inches (ca. 5 cm.) wide. The area behind the ridge (Facies intestinalis) is much more extensive; it is related chiefly to the small colon, the small intestine, and the great omentum. It may be marked by one or two fissures.

FIG. 277.—SPLEEN OF HORSE, HARDENED in situ. VISCERAL SURFACE.

The area marked intestinal impression is related to the first coil of the small colon. ]

The =anterior border= (Margo anterior) is concave and thin.

The =posterior border= (Margo posterior) is convex and thin.

The =base= or =dorsal extremity= is beveled, and fits into the interval between the left kidney and the left crus of the diaphragm and the psoas major. When hardened in situ, it shows an impression (Facies renalis) where it lies against the kidney. The left extremity of the pancreas touches it also. The anterior basal angle fits in between the saccus cæcus of the stomach and the left kidney; the posterior basal angle usually lies against the flank just behind the last rib.

The =apex= or =ventral extremity= is small; it lies—when the stomach is not full—between the left lobe of the liver and the left dorsal portion of the colon; when the stomach is full, the spleen is pushed further back and loses contact with the liver.

The spleen is attached by two peritoneal folds, the suspensory ligament and the gastro-splenic omentum. The =suspensory ligament= (Lig. suspensorium lienis) attaches the base to the left crus of the diaphragm and the left kidney; it contains a quantity of elastic tissue. The part which passes to the diaphragm is the ligamentum phrenico-lienale, and blends with the gastro-phrenic ligament; the part which goes to the kidney is termed the ligamentum renolienale. The =gastro-splenic omentum= (Lig. gastrolienale) passes from the hilus to the left part of the great curvature of the stomach. It is narrow above, where it joins the suspensory ligament; below it becomes much wider and is continuous with the great omentum.

Small globular or lenticular masses of splenic tissue may be found in the gastro-splenic omentum. They are termed =accessory spleens= (Lienes accessoriæ).

=Structure.=—The spleen has an almost complete =serous coat=. Subjacent to this and intimately united with it is a =capsule= of fibrous tissue (Tunica albuginea), which contains many elastic fibers and some unstriped muscular tissue. Numerous =trabeculæ= (Trabeculæ lienis) are given off from the deep face of the capsule and ramify in the substance of the organ to form a supporting network. In the interstices of this framework is the =spleen pulp= (Pulpa lienis), a dark red, soft, grumous material. This is supported by a delicate adenoid =reticulum=, and contains numerous leukocytes, the large splenic cells, red blood-corpuscles, and pigment. The pulp is richly supplied with blood. The branches of the splenic artery enter at the hilus and pass along the trabeculæ. The arteries which enter the pulp have a sheath of lymphoid tissue, which collects on the vessel wall at certain points, forming small =lymph nodules=, the so-called Malpighian corpuscles (Noduli lymphatici lienales). These are visible to the naked eye as white spots, about as large as the head of a pin. The blood passes into cavernous spaces lined by endothelium which is continuous with the cells of the reticulum of the pulp. From these the veins arise. The splenic vein runs in the hilus in company with the artery and nerves, and joins the posterior gastric vein to form a large radicle of the portal vein.

=Blood-supply.=—Splenic artery.

=Nerve-supply.=—Splenic plexus.

THE PERITONEUM

The general disposition of the peritoneum has been described, and other facts in regard to it were mentioned in the description of the viscera. It is now desirable to study it as a continuous whole. (Figs. 256, 257, 278, 279.)

We may consider the peritoneum as consisting of two sacs—a greater and a lesser. The =greater sac= lines the greater part of the abdominal cavity, and covers most of the viscera which have a peritoneal investment. The =lesser sac= is an introversion or recess of the greater sac, formed during the development of the viscera. The two sacs communicate by a relatively narrow passage, termed the =epiploic foramen= of Winslow (Foramen epiploicum). This opening is situated on the visceral surface of the liver above the portal fissure. It can be entered by passing the finger along the caudate lobe of the liver toward its root. Its dorsal (or anterior) wall is formed by the caudate lobe and the posterior vena cava. Its ventral (or posterior) wall consists of the pancreas, the gastro-pancreatic fold, and the portal vein. The walls are normally in contact, and the passage merely a potential one. It is usually about four inches (ca. 10 cm.) in length. It is narrowest at the right extremity, where it is about an inch (ca. 2.5 to 3 cm.) wide. If the finger is passed into the foramen from right to left, it enters the cavity of the lesser sac. If now an opening is made in the great omentum and the other hand introduced through it, the fingers of the two hands touch each other over the lesser curvature of the stomach. The formation and boundaries of the lesser sac should now be examined by spreading out the great omentum. It will be found that the latter now incloses a considerable cavity behind the stomach; this is termed the =omental cavity= (Bursa omentalis). Passing forward over the lesser curvature of the stomach, we enter another space, the =vestibule= of the omental cavity (Vestibulum bursæ omentalis). This space is closed on the left by the gastro-phrenic ligament, below and on the right by the lesser omentum, and dorsally by the gastro-pancreatic fold, which is attached to the dorsal border of the liver and to the posterior vena cava. Above the œsophageal notch the fingers can be passed around the border of the liver and the vena cava till the coronary ligament is encountered. Thus the vestibule is closed except (1) on the right, where it communicates with the cavity of the greater sac by the epiploic foramen; and (2) behind, where it communicates with the cavity of the omentum.