868 THE LIYEE. 



meets with the cystic duct, descending from the gall-bladder ; and the two 

 ducts uniting together at an acute angle, form the common bile-duct. 



The gall-bladder is a receptacle or reservoir for such bile as is not imme- 

 diately required in digestion. It is a pear-shaped membranous sac, three 

 or four inches long, about an inch and a half across at its widest part, 

 and capable of containing from eight to twelve fluid-drachms. It is lodged 

 obliquely in a fossa on the under surface of the right lobe of the liver, with 

 its large end or fundus, which projects beyond the anterior border of tho 

 gland, directed downwards, forwards, and to the right, whilst its neck is 

 inclined in the opposite direction. 



The upper surface of the gall-bladder is attached to the liver by areolar 

 tissue and vessels, along the fossa formed between the qimdrate lobe and 

 the remainder of the right lobe. Its under surface is free and covered by 

 the peritoneum, which is here reflected from the liver, so as to include 

 and support the gall-bladder. Sometimes, however, the peritoneum com- 

 pletely surrounds the gall-bladder, which is then suspended by a kind of 

 mesentery at a little distance from the under surface of the liver. The 

 fundus of the gall-bladder, which is free, projecting, and always covered 

 with peritoneum, touches the abdominal parietes immediately beneath the 

 margin of the thorax, opposite the tip of the tenth costal cartilage. Below, 

 it rests on the commencement of the transverse colon ; and, farther back, 

 it is in contact with the duodenum, and sometimes with the pyloriq ex- 

 tremity of the stomach. The neck of the gall-bladder, gradually narrowing, 

 forms two curves upon itself like the letter S, and then, becoming much con- 

 stricted, and changing its general direction altogether, it bends downwards 

 and terminates in the cystic duct. 



The gall bladder is supplied with blood by the cystic branch of the right 

 division of the hepatic artery, along which vessel it also receives nerves from 

 the cceliac plexus. The cystic veins empty themselves into the vena portae. 

 Beale states that two large veins always accompany one artery. 



The cystic duct is about an inch and a half in length. It runs downwards 

 and to the left, thus forming an angle with the direction of the gall-bladder, 

 and unites with the hepatic duct to form the common duct. 



The common bile-duct, ductus communis choledochus, the largest of the 

 ducts, being from two to three lines in width, and nearly three inches in 

 length, conveys the bile both from the liver and the gall-bladder into the 

 duodenum. It continues downwards and backwards in the course of the 

 hepatic duct, between the layers of the gastro-hepatic omentum, in front of 

 the vena portse, and to the right of the hepatic artery. Having reached 

 the descending portion of the duodenum, it continues downwards on the 

 inner and posterior aspect of that part of the intestine, covered by or in- 

 cluded in the head of the pancreas, and, for a short distance, in contact with 

 the right side of the pancreatic duct. Together with that duct, it then 

 perforates the muscular wall of the intestine, and, after running obliquely 

 for three quarters of an inch between its several coats, and forming an 

 elevation beneath the mucous membrane, it becomes somewhat constricted, 

 and opens by a common orifice with the pancreatic duct on the inner surface 

 of the duodenum, at the junction of the second and third portions of that 

 intestine, and three or four inches below the pylorus. 



Varieties. The liver is not subject to great or frequent deviation from its ordinary 

 form and relations. Sometimes it retains the thick rounded form which it presents 

 in the foetus ; and it has occasionally been found without any division into lobes. 

 On the contrary, Soemmerring has recorded a case in which the adult liver was 



