The =liver= may be examined in the body without removal. The left
hand is put between the diaphragm and the convex surface of the
right lobe of the organ, and the liver raised up out of the cavity.
With the long section-knife a main incision is made deep into the
organ, from left to right, about a hand’s-breadth above the lower
border. Parallel incisions to the main incision may be made. After
the examination of the cut surface the organ is dropped back into the
abdomen. When the liver is to be weighed and measured it is removed
from the body by cutting first the ligamentum hepatoduodenale,
examining, as they are cut, the _common duct_, _hepatic artery_
and the _portal vein_. The left lobe of the liver is then taken in
the left hand and raised as high as possible. The left triangular
ligament, the left half of the coronary ligament, the suspensory
ligament, the right half of the coronary ligament and the right
triangular ligament are cut from left to right. The inferior vena
cava is cut at the same time. In the case of adhesions between liver
and diaphragm these must be cut or the diaphragm itself removed
in connection with the liver. In such a case the diaphragm must
be trimmed off before the liver is weighed. The liver may also be
removed in the opposite direction, raising up the right lobe and
severing all connections as far as the median line of the spinal
column. The right lobe is then pulled upon the right edge of the
thorax-wall, and the connections with the left lobe are severed. In
separating the under surface of the right lobe care must be taken not
to damage the right adrenal. The liver is then weighed and measured,
and placed upon the board with the right lobe toward the prosector. A
long, deep cut is then made by drawing the long-section-knife across
the left and right lobes, extending the cut through to the porta.
Additional cuts may be made parallel to this chief-incision. When
occasion demands a number of sagittal incisions may be made instead.
As mentioned above, it is often best to remove the liver with
stomach, pancreas and duodenum and examine on the table.
The =gall-bladder= is opened from its fundus with the fine
probe-pointed shears; its contents are caught in a vessel and
examined. The cystic, hepatic and common ducts may be explored
from the gall-bladder, if they have not been from the intestine.
The gall-bladder may be dissected from the liver and removed in
connection with the duodenum.
The =portal vein= is opened into its radicles; the examination of the
splenic vein is of especial importance. The =portal lymphnodes= are
examined at this time.
The =mesentery= and the =mesenteric lymphnodes= are now examined. The
former may be cut off at its root and examined outside of the body.
The lymphnodes may be opened by longitudinal or transverse incisions.
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