444 ABDOMEN 



Vesica Fellea (The Gall-Bladder). Pull the liver upwards 

 and to the right and examine the position, the attachments, 

 and the connections of the gall-bladder. It is a small 

 pyriform sac, with a capacity of from one to two ounces. 

 It lies in the right hypochondriac region close to the 

 right lateral plane. Its lower extremity or fundus projects 

 below the lower margin of the anterior surface of the liver, at 

 the level of the right ninth costal cartilage, in the right 

 lateral plane and immediately to the right of the lateral 

 border of the right rectus abdominis muscle. From this 

 point the body of the organ runs upwards, backwards, and to 

 the left, to the right extremity of the porta hepatis, where a 

 constricted portion of its upper end, 

 called the neck, becomes continuous 

 with the cystic duct which connects 

 the gall-bladder with the common 

 bile-duct. The upper and anterior 

 surface of the body of the gall-bladder 

 is embedded in a sulcus on the under 

 3YST.DUCT. sur f ac e of the right lobe of the liver, 

 which is called the fossa for the gall- 

 bladder, and it is attached to the 

 COMMON liver by areolar tissue and by a 

 number of small veins which pass 

 FIG. 1 68. Diagram of the from the gall-bladder into the sub- 



stance of the liver > where th y com - 



municate with branches of the portal 

 vein. The fundus and the lower or posterior surface are 

 covered with peritoneum, and the lower surface is in contact, 

 posteriorly and above, with the first and second parts of the 

 duodenum, and below with the transverse colon. 



The cystic duct is enclosed in the right extremity of the 

 upper border of the small omentum. 



Dissection. Make a longitudinal incision through the lower surface of 

 the gall-bladder from the fundus to the neck and examine the structure of 

 its walls and its lining membrane. In addition to its partial serous cover- 

 ing it has (i) a strong coat composed of muscular and white fibrous tissue, 

 and (2) an internal mucous coat. The mucous membrane is stained 

 green by the bile and it presents a honeycombed appearance, being raised 

 into numerous ridges which surround polygonal depressions ; in the neck 

 the ridges assume a spiral form and constitute the so-called spiral valve 

 of Heister which is continued into the cystic duct. 



To obtain a satisfactory view of the lesser omentum and its contents the 

 left lobe of the liver must be removed. Cut through it from before back- 



