1202 



THE DIGESTIVE SYSTEM. 



of the liver, except on its antero-superior aspect, which is united to the fossa for the 

 gall-bladder by areolar tissue. Sometimes, but rarely, this surface also is covered, 



and the gall- 

 bladder is 

 suspended 



Round ligament 



Quadrate lobe 

 Hepatic duct 

 Gall-bladder 

 Cystic duct 



Duodenal 

 impression 



Omental tuberosity 



Gastric impression 

 Posterior layer of 

 sser omentum 

 Esophagus 



Free edge 



of lesser 



omentum 



Bile-duct 



Duodenui 



tal vein 

 Hepatic artery 

 Pylorus 



Right gastro-epiploic artery 

 s. Superior pancreatico-duodenal artery 

 Pancreatic duct 



FIG. 944. STRUCTURES BETWEEN THE LAYERS OF THE LESSER OMENTUM. 



the transverse colon in front, and behind, near 



then 

 from 

 the liver by a 

 short peritoneal 

 ligament. The 

 fundus usually 

 lies in contact 

 with the anterior 

 abdominal wall, at 

 or immediately be- 

 neath the point 

 where the right 

 vertical lateral 

 plane meets the 

 lower margin of 

 the ribs (i.e. in 

 the angle between 

 the lateral border 

 of the right rectus 

 muscle and the 

 inferior margin of 

 the ribs). Above, 

 the gall - bladder 

 lies against the 

 liver ; and below, 

 its neck, on the 



it rests on 

 duodenum. 



In some cases the fundus of the gall-bladder does not reach the anterior border of the liver 

 or the abdominal wall. In others it may be moved considerably to the right of the vertical 

 lateral plane possibly as a result of distension of the stomach and colon or as a result of tight- 

 lacing, it may b6 moved to the left, and may then lie near the median plane and far below the 

 ribs (Fig. 918, p. 1167). 



Its total absence, as well as the presence of two distinct gall-bladders, and several other 

 irregularities in form, have been recorded. 



Its size is usually about 3 inches (75 mm.) in length, and 1 to 1^ inches (25 to 31 mm.) in 

 diameter. Its capacity varies between 1 and 1^ fluid ounces. 



Structure of Gall-bladder. The wall of the gall-bladder is composed of an outer 

 coat of peritoneum, the tunica serosa, usually incomplete ; a middle coat of unstriped 

 muscle intermixed with fibrous tissue, the tunica muscularis ; and an inner coat of mucous 

 membrane, the tunica mucosa, which is covered with columnar epithelium, and is raised into 

 a number of small ridges, the plica tunicas, mucosce, which confer on it a reticulated 

 appearance. The mucous membrane is always deeply stained with bile when the gall- 

 bladder is opened after death. 



The cystic artery which supplies it with blood arises from the hepatic artery itself, or its right 

 division, and divides into two branches, which run on the sides of the gall-bladder. The veins 

 join the vena portae, and the nerves come from the sympathetic plexus on the hepatic artery. 



Ductus Cysticus. The cystic duct, about half the diameter of the hepatic duct 

 (3 mm.), but usually slightly longer (1J to 1 \ inches : 31 to 37 mm.), begins at the 

 neck of the gall-bladder, and running an irregular course backwards and medially 

 joins the hepatic duct at the mouth of the porta hepatis, to form the bile-duct. 

 The spiral constriction found in the neck of the gall-bladder is continued into 

 the beginning of this duct. Sometimes the cystic duct joins the right hepatic duct 

 instead of the hepatic duct proper. 



Ductus Choledochus. The bile-duct (O.T. common bile-duct) begins at the 

 mouth of the porta hepatis, where it is formed by the union of the hepatic and cystic 

 ducts. From this it passes downwards, anterior to the foramen epiploicum, lying 

 between the two layers of the lig. hepato-duodenale, with the portal vein behind 



