Fig. 132. Gail-Bladder. Bile Ducts and Surrounding Structures 



Male. 



As in Fig. i p a large window, 6 inches long and 9 inches ivide, was cut out 

 of the right Hypo-chondriac region of the corpse of a robust male. (Other 



details as in Fig. i^i.) 



The Fundus of the Gail-Bladder lies more to the side than in Fig. 131. 

 No difference dependent on sex could be made out in the position of the organ. 



All the structures are shewn of normal size, more distinctly, and somewhat 

 differently arranged from Fig. 131 e. g. the position of the Gall-Bladder is more 

 transverse, the P3dorus is at a higher le\el, tlie Hepato-duodenal fold extends 

 further on to tlie Duodenum (cf. Fig. 1 3 1 where it does not go beyond the 

 Cystic Duct), consequently the Foramen of WlXSLOW is in a .somewhat different 

 position. 



The> two lymphatic glands seen, e. g. a smaller Cystic at the neck of the (xall- 

 Bladder, and a larger Gland of the Portal Vein on the anterior aspect of the Portal 

 Vein near the Hepatic Duct, are constant. Another gland may be found lower 

 down near the Common Bile Duct at the upper border of the Duodenum. It is 

 right to know of these glands, because they become enlarged in chronic inflam- 

 mation of the Biliary passages and may become so hard as to be mistaken for 

 gaU-stones. 



The Gall-Bladder is supplied by the Cystic Artery (a branch of the Hepatic) 

 which di\-ides into two branches, one running along the free surface of, the other 

 running between, the Gall-bladder and the Liver. (Both branches need a ligature 

 in Cholecystectomy.) Considerable importance is attached to a small but constant 

 artery (cf. Figs. 131 and 132) which, derived from the Hepatic or Gastro-duodenal, 

 runs across the anterior aspect of the Common Bile-Duct and ramifies on it, on the 

 Duodenum and on the Pancreas. It sends a branch upwards to the Gall-Bladder 

 which we caU the Accessory C^^stic Artery. It reasonably follows that in per- 

 forming Choledochotom\' the operator should look out for this artery. 



Both figures shew that, when the Liver is pushed upwards, the Duodenum 

 and Pylorus drawn downwards, the Bile passages are easily accessible ; thus removal 

 of the Gall-Bladder, opening of the Cystic Duct, and other operations are rendered 

 possible. 



The Common Bile-Duct lies for a short part of its course in the Supra- 

 duodenal portion and favourable for surgical measures. Its further course behind 

 the Duodenum is covered by the Pancreas. (Cf. Fig. 133.) 



