THE GALL-BLADDER AND BILE-PASSAGES. 1069 
cystic duct, and is due to a series of crescentic folds placed somewhat spirally 
round the interior of its cavity. Having arrived near the portal fissure, much 
reduced in size, 1t 
Round ligament 
passes into the Ouineacatives | wn ie 
Heoats Omental tuberosity 
evstie duet [ epatie duct | <i) e S ee 
: ; Gall-bladder Gastric impression 
AS a rule the Cyst ic duct \ Posterior layer of 
lesser omentum 
\ \ (Esophagus 
i 
} 
gall- bladder is 
covered by the peri-  jysodenal 
toneum of the in- impression 
ferior surface of the 
liver, except on its 
upper aspect, which 
is united to the 
fossa of the gall- 
bladder by areolar 
tissue. Sometimes, 
but rarely, this sur- 
face 1s covered also, 
and the gall-bladder |, nate 
is then suspended of lesser - 
irom the liver! by °°" 
a short peritoneal _ ZZ, 
liga ment. T h e Common bile-duct y 
fundus usually hes Duodenum 
in contact with the 
anterior abdominal 
wall, at or imme- 
diately beneath the 
point where the 
right Poupart line strikes the lower margin of the ribs (7c. in the angle between 
the outer border of the right rectus muscle and the lower margin of the ribs), 
Above, the gall-bladder les against the liver; and below, it rests on the transverse 
colon in front, and behind, near its neck on the duodenum. 
Portal vein 
Hepatic artery 
Pylorus 
x Right gastro-epiploic artery 
~~ 
Superior pancreatico-duodenal artery 
Pancreatic duct 
Fic. 718.—STRUCTURES BETWEEN THE LAYERS OF THE LESSER OMENTUM. 
The liver has been raised up, and the anterior layer of the omentum remoyed 
(semi-diagrammatic). 
In some bodies the fundus of the gall-bladder does not reach the border of the liver or the 
abdominal wall. In others it may be moved considerably to the right of the Poupart line— 
possibly as a result of distension of the stomach and colon—or as a result of tight lacing, it may be 
moved to the left, and may then lie near the middle line and far below the ribs (Fig. 678, p. 1006). 
Its total absence, as well as the presence of two distinct gall-bladders, and several other irre- 
eularities in form, have been recorded. 
Its size is usually about 3 inches (75 mm.) in length, and 1 to 1} inch ( 
meter. Its capacity varies between | and 13 fluid ounces. 
25 to 31 mm.) in dia- 
Structure of Gall-bladder.—The wall of the gall-bladder is composed of an outer 
coat of peritoneum, usually incomplete ; a middle coat of fibrous tissue with unstriped 
muscle intermixed ; and an inner coat of mucous membrane, which is covered by columnar 
epithelium, and is raised into a number of small ridges, which confer on it a reticulated 
appearance. The mucous membrane is always deeply stained with bile when the gall- 
bladder is opened after death. 
The cystic artery which supplies it with blood arises from the hepatic, or its right division, 
and divides into two branches, which run on the lateral surfaces of the organ. The veins join 
the portal trunk, and the nerves come from the sympathetic on the hepatic artery. 
The cystic duct (ductus cysticus), about half the diameter of the hepatie duet 
(3 mm.), but usually slightly longer (14 to 13 inch, 31 to 37 mm.), begins at the 
neck of the gall-bladder, and running an irregular course backwards and inwards, 
joins the hepatic duct at the mouth of the portal fissure, to form the common bile- 
duct. The spiral constriction found in the neck of the gall-bladder is continued 
into the beginning of this duet. 
The common bile-duct (ductus choledochus) begins at the mouth of the portal 
fissure, where it is formed by the union of the hepatic and cystic ducts. From 
this it passes downwards, in front of the foramen of Winslow, lying between the 
