THE BILIARY APPARATUS. 



1721 



distance of I cm. The structure of the common duct is much the same as that 

 of the hepatic, containing but little muscular tissue and that not well defined. The 

 papilla contains a fusiform dilatation, the ampulla (of Vater), which may be i cm. 

 broad when distended. Into this the bile-duct and the duct of the pancreas usually 

 open by a common orifice. Be these orifices common or distinct, each is sur- 

 rounded by an accumulation of the circular muscular fibres which amounts to a 

 sphincter. The glands, which are found throughout the common duct, are particu- 

 larly large and numerous in the ampulla. 



Ligaments and Peritoneal Relations. The term "ligament," applied 

 to the folds of serous membrane, is entirely inappropriate. It is in part retained, 

 but the enumeration of five ligaments as separate entities is 'antiquated. The round 

 ligament (ligamentum teres hepatis) is a cord of fibrous tissue, the remains of the 

 obliterated umbilical vein, running from the umbilicus to the left end of the portal 

 fissure. Its continuation, the ductus venosus, is represented by fibrous tissue (liga- 

 mentum venosum) in the fissure of that name. The round ligament lies against the 

 abdominal wall for an inch or more above the navel and then passes backward in the 

 free edge of the falciform ligament, a peritoneal fold representing the primary ante- 

 rior mesentery, passing from the abdominal wall and diaphragm to the liver. The 



FIG. 1456. 



CEsophageal impression Vena cava 



Left coronary ligament 



V, 



Left 



triangular 

 ligament 



Fissure of ductus venosus 



Spigelian 



Portal vein / 

 Caudate lobe, left end 



Right coronary ligament 



Posterior 



non-peritoneal 



\ surface 



Right 



I triangular 

 ^-ligament 

 Suprarenal 

 impression 



.Renal 



impression 



Vena cava \ 



Colic impression 



Posterior surface of liver, showing peritoneal reflections. 



front part of the falciform ligament is appropriately described as sickle-shaped. The 

 point is in front, and it grows broader as it passes backward until it reaches the liver, 

 where, growing narrower, it extends above the liver to the spine at about the median 

 line. It contains very little tissue between its folds, which are reflected on either 

 side over the superior surface of the liver. At the notch in the anterior border the 

 round ligament passes onto the inferior surface of the liver in the umbilical fissure. 

 The coronary ligaments are differently arranged on the two sides. The right one is 

 made by the two reflections onto the diaphragm from the upper and lower borders 

 of the part of the posterior surface adherent to it. These come together at the 

 right of that surface and are continued as a fold, the right triangular ligament, on 

 the right surface, connecting it to the diaphragm in the flank by a line of attach- 

 ment some 5 cm. long. On the top of the left lobe, but not on the posterior bor- 

 der, there is a small area without peritoneal covering, enclosed by the two folds of 

 the left coronary ligament, of which the anterior is analogous to the right one, but 

 the posterior begins at the left of the upper end of the fissure of the ductus venosus. 

 They soon unite to form the left triangular ligament, which lies between the dia- 

 phragm and the top of the left lobe, being considerably longer than the right one. 



