414 CLINICAL APPLIED ANATOMY. 



the neighbourhood of the umbilicus. Gall stones have been 

 discharged this way. 



The resistance to the passage of gall stones along the ducts is 

 greatest where the cystic duct unites with the hepatic to form 

 the common duct, and where the latter opens into the duodenum. 

 The common duct, where it lies in the edge of the lesser 

 omentum, is normally about the size of a crow quill. When 

 obstructed at its duodenal end it has become so dilated as to be 

 mistaken for the gall bladder itself. The cystic and common 

 ducts, being comparatively narrow tubes, may become the sites 

 of stricture. The stricture is more commonly found in the 

 cystic duct owing to the anatomical characters which have 

 already been described as favouring its occlusion. In cases of 

 obstruction, the liver may become honeycombed with dilated 

 ducts and much increased in size. 



The lymphatic glands which receive the lymphatics of the gall 

 bladder and bile ducts share in their inflammation, and may 

 become so enlarged and hard that they have been mistaken for 

 gall stones or malignant growths. A gland which lies on the 

 cystic duct near the neck of the gall bladder is nearly always 

 enlarged. This is the cystic gland, and it receives the lymphatics 

 from the gall bladder. Another fair sized gland is usually found 

 near the junction of the cystic and hepatic ducts, and it is 

 succeeded by a chain of glands which lie along the common 

 duct in the edge of the lesser omentum. These compose the 

 " satellite chain of the bile duct," and the lymph which they 

 transmit finally reaches the glands at the upper border of the 

 pancreas. 



Pylephlebitis may result from gall stones. The portal vein is 

 in least intimate relation with the common bile duct in the 

 middle of its course. Above and below it is in close relation and 

 in some cases is actually applied in spiral fashion to the upper 

 part of the common bile duct on the right side of the latter. 

 The portal vein may be infected by ulceration into it of a gall 

 stone, or by infection of the small radicles it derives from the 

 gall bladder. 



