. Diseases of the gall-bladder and bile-ducts, including gall-stones . etal peritoneum sutured to skin ;3, right lobe of liver, lower surface ; 4, quadrate lobe of liver; 5, suspensory-ligament of liver; 6, gall-bladder; 7, cystic duct; 8, hepatic duct; 9, commonduct; 10, branch of hepatic duct to lobus Spigelii; 11, trunk of vena porta;12, branches of vena porta to right lobe; 13, branches of vena porta to lobusSpigelii; 14, small branch of vena porta in hepatico-duodenal ligament;15, hepatic artery; 16, branches of hepatic artery to hepatico-duodenalligament; 17, lymph-glands in hepatico-duo
. Diseases of the gall-bladder and bile-ducts, including gall-stones . etal peritoneum sutured to skin ;3, right lobe of liver, lower surface ; 4, quadrate lobe of liver; 5, suspensory-ligament of liver; 6, gall-bladder; 7, cystic duct; 8, hepatic duct; 9, commonduct; 10, branch of hepatic duct to lobus Spigelii; 11, trunk of vena porta;12, branches of vena porta to right lobe; 13, branches of vena porta to lobusSpigelii; 14, small branch of vena porta in hepatico-duodenal ligament;15, hepatic artery; 16, branches of hepatic artery to hepatico-duodenalligament; 17, lymph-glands in hepatico-duodenal ligament; 18, duodenum ;19, entrance to foramen of Winslow; 20, hepatico-colic ligament; 21, trans-verse colon. munis, and the upper two-thirds of the cystic duct, are theonly convenient situations for choledochotomy. Perhapsthe diagram will enable one to appreciate these points moreclearly. 2—2 2o DISEASES OF THE GALL-BLADDER AND BILE-DUCTS In palpating the common duct for gall-stones, the surgeonfrequently feels several more or less hard nodules within the. 5 o s ffi free border of the lesser omentum, by the side, or in front of,the common duct, and unless it be borne in mind that threeor four lymphatic glands normally exist here, they may be ANATOMICAL CONSIDERATIONS 21 apt to mislead, especially as they are not unusually consider-ably enlarged where there is gall-stone irritation. Frequentlythey are as large as beans, and at times the size of 2,809 Hunterian Museum shows these glands muchenlarged and melanotic (Fig. 6). The large peritoneal pouch (Fig. 7) shown in the diagram—bounded above by the right lobe of the liver, below bythe ascending layer of the transverse meso-colon covering theduodenum internally, externally by the peritoneum lining
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Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
