The Liver and Gall Bladder. 199 



tion, hypertrophic cirrhosis, malignant disease, etc., 

 whereas, its upper border may be elevated by hepatic abs- 

 cess, by hydatids occupying the superior surface or by 

 malignant disease. 



The Gall Bladder. The gall bladder is conical or 

 pear-shaped, and is directed from before, backwards and 

 slightly to the left. It has a base or fundus projecting 

 on the free border of the liver; a body, underlying the 

 liver in a depression the fossa cystis fellese ; and a neck 

 which resembles the letter S in shape, and is directed in- 

 wards and to the left, to enter the cystic duct. The mucous 

 membrane o the body of the gall bladder is thrown 

 into polygonal folds, while in the neck it is arranged in a 

 spiral manner. 



Relations of the gall bladder. The fundus is in 

 contact with the abdominal parietes, especially the 

 upper end of the right linea semilunaris, and is entirely 

 surrounded, as a rule, 'with peritoneum. Above the body 

 of the gall bladder is the liver, below are the first portion 

 of the duodenum, the hepatic flexure of the colon, and 

 frequently, depending on the amount of distention of the 

 stomach, the pylorus. This portion of the gall bladder 

 has the peritoneum on its sides and inferior surface only, 

 and not, as a rule, above, where it is in contact with the 

 liver. The neck ends in the cystic duct which is directed 

 backwards and to the left as it lies in the gastro-hepatic 

 omentum. The cystic duct, according to Brewer, of New 

 York, who reported the results of the examination of the 

 biliary passages in one hundred bodies, varied from a 

 half to two and a half inches in length, the average being 

 two and one-fifth inches. It unites with the hepatic duct, 

 which is about one and a half inches in length, to form the 

 common bile duct. This latter duct, about three inches 

 long, passes downwards and to the left in the gastro- 



