THE LIVER. 421 



it had a distinct mesentery. The tip (fundus) of the gall-bladder lies in contact with 

 the abdominal wall at the tip of the ninth costal cartilage, where the right linea 

 semilunaris strikes the costal margin, and just at the outer edge of the rectus muscle, 

 which is about 7.5 cm. (3 in.) from the median line (Fig. 431). 



Hepatic, Cystic, and Common Ducts. The hepatic duct is formed by the 

 union of the right and left branches in the portal fissure. It is about 2.5 cm. (i in.) 

 long and 6 mm. ( % in. ) wide. . The cystic duct is smaller in diameter than the hepatic 

 and 3 to 4 cm. (i^ to 1^/2, in.) long and joins it as it emerges from the portal fissure. 

 Both the neck of the gall-bladder and the cystic duct contain constrictions of the 

 mucous membrane Robson and Moynihan call them valves which obstruct the 

 passage of a probe or stone. Hence gall-stones are frequently found impacted or 

 lodged in the neck of the gall-bladder or somewhere in the course of the duct. The 

 cystic artery lies above the duct. The common duct is formed by the union of the 

 hepatic and cystic ducts at the edge of the portal fissure, and empties into the duo- 

 denum about the middle of its second portion on its inner wall. It is 7.5 cm. (3 in.) 

 long and 6 mm. (^ in.) or more in width. It passes almost directly downward. 



Gall-bladder 



Cystic duct 



Foramen of Winslow 



Cut end of duodenum 



Kidney 



Ampulla of Vater ' 



Pancreatic duct 



.Opening of the ducts into the 

 second portion of the duodenum 



FIG. 431. The biliary passages. The edge of the liver has been raised, exposing its under surface; the first 

 portion of the duodenum and anterior surface of the pancreas has been removed, exposing the common bile-duct 

 and blood-vessels. 



inclining a little to the right, between the folds of the lesse'r omentum, in front of the 

 foramen of Winslow, behind the first portion of the duodenum, and then between 

 the pancreas and the inner wall of the second portion of the duodenum. It is, at 

 this part, in two-thirds of the cases, completely surrounded by pancreatic tissue. As 

 it passes through the duodenum, which it pierces obliquely, it expands into the 

 ampulla of Vater and receives the pancreatic duct, or duct of Wirsung. Above, it 

 lies directly on the portal vein, with the hepatic artery to its left. About half of the 

 duct, 3 to 4 cm. (i % to i*4 in.), is above the duodenum and half behind it. 



The hepatic artery passes along the upper edge of the pancreas, to which it 

 gives branches; it then gives off the superior pyloric to the lesser curvature of the 

 stomach, the gastroduodenal (see page 403), and finally right and left terminal 

 branches. The left supplies the left lobe of the liver, the right crosses usually 

 behind but sometimes in front of the bile-ducts and terminates in the right iobe, after 

 first giving off the cystic artery. This runs between the cystic and hepatic ducts and 

 has superficial branches which ramify on the surface of the gall-bladder and deep 

 branches which run up the grooves on each side between the gall-bladder and liver. 



