612 THE LIVER. 



of these inflammatory processes iu the gall ducts and gall bladder are 

 probably usually bacteria. Those which have been most frequently 

 found are the "pyogenic cocci," ' the colon and typhoid bacilli, and the 

 pneurnococcus. It should be borne in rniud that post-mortem invasion 

 of the gall bladder and passages by bacteria may take place early. 



Constriction and Occlusion of the Bile Ducts. This may be produced by 

 inflammation of the ducts themselves, by new growths in their walls, by 

 calculi or parasites in their luinina, by changes in the hepatic tissue in 

 chronic and acute hepatitis, by aneurisms, or by pressure on the duct 

 from without, as by tumors in the head of the pancreas, etc. 



The obliteration of the smaller bile ducts produces no marked lesions. 

 When the ductus communis or the hepatic duct is obstructed, the ducts 

 throughout the liver are frequently dilated and the liver tissue is bile- 

 stained. The liver may undergo atrophy and the whole Jbody be in- 

 tensely jaundiced. When the cystic duct is obstructed the gall bladder 

 is dilated. 



Dilatation of the Bile Ducts is usually produced by strictures in the 

 ways just mentioned, or by calculi. When calculi have produced the 

 dilatation this condition may sometimes continue after they have found 

 their way into the intestines. Sometimes, however, we meet with very 

 marked dilatation of the bile ducts without being able to make out any 

 present or past obstruction. The dilatation may affect only the common 

 and hepatic ducts, or it may extend to the smaller ducts in the liver, 

 which are then dilated uniformly or in sacculated forms. They may con- 

 tain bile, mucus, or calculi. The liver is at first enlarged, but may after- 

 ward atrophy. The gall-bladder may be dilated in consequence of obstruc- 

 tion of the common or the cystic duct. In the latter case it may reach an 

 immense size and form a large tumor in the abdominal cavity. The 

 dilatation is generally uniform, the bladder retaining its normal shape ; 

 sometimes, however, there are diverticula, which are usually produced 

 by calculi. If the obstruction to the hepatic duct is incomplete or mov- 

 able the gall bladder may contain bile, and often calculi. If the obstruc- 

 tion is complete the contained fluid may gradually lose its biliary char- 

 acter and become a serous or mucus fluid of a light-yellow color liydrops 

 cystidis fellece. The walls of the bladder may be of normal thickness, or 

 thinned, or thickened, or calcified. If the obstruction is due to a cal- 

 culus, this may pass into the intestine and the gall bladder be suddenly 

 emptied. Usually the bladder fills again, owing to its loss of contractile 

 power. 



TUMORS OF THE GALL BLADDER AND LARGER GALL DUCTS. 



Small fibromata have been described in the gall bladder and in the 

 common duct, but they are very rare. The most common tumors are 



1 For a study of gall-bladder infections consult Gushing, Johns Hopkins Hosp. Bull., 

 x., p. 166, 1899, bibliography. Als 

 Soc. Biol., November 8th, 1902, p. 1189. 



, . 



vol. x., p. 166, 1899, bibliography. Also Gilbert and Lippmann, Comptes rend, de la 

 , 1902, 





