THE LIVER. 611 



and Gall Bladder (Cholecystitis). The walls of the ducts may be covered or 

 infiltrated with a fibriuous or a purulent exudate; they may ulcerate. 



These lesions occur most frequently in connection with obstruction of 

 the bile ducts by gall stones or otherwise, and in typhoid and typhus 

 fever, pyaBmia, and cholera ; or they may be due to the extension of 

 inflammatory processes from without. They also occur under unknown 

 conditions. 



In many cases of inflammation of the gall ducts, the Bacillus coli 

 commuuis, in fewer, the pyogenic streptococcus and staphylococcus are 

 apparently concerned. 



Suppurative inflammation may lead to perforations of the ducts or 

 bladder, with escape of bile and peritonitis; or fistulous openings be- 

 tween the gall bladder and the duodenum, colon, and stomach, or through 



FIG. 373. SCPPCRATIVE INFLAMMATION OF THE GALL DUCTS ix THE LITER CHOLANGITIS. 



The suppurative foci are almost coalescent in the infected region. This lesion was secondary to suppura- 

 tive inflammation in the larger gall passages with the presence of gall stones. 



the abdominal wall. Or the inflammation may extend to the liver tissue 

 and produce abscesses. Under the latter conditions we may find a series 

 of small abscesses ranged along the walls of the suppurating gall ducts 

 (Fig. 373). In. more advanced stages the abscesses may bec'ome large 

 and communicate with with one another, so that a considerable portion 

 of the liver may be occupied by a series of communicating cavities with 

 ragged walls, containing pus and detritus of liver tissue more or less 

 tinged with bile. 



Such abscesses may become more or less completely enclosed by con- 

 nective-tissue walls. The portal vein may also become inflamed, and 

 perforations may be formed between it and the bile ducts. The excitants 



