Gall-stones and diseases of the bile-ducts . omentum in front of theportal vein and to the right of the hepatic passes behind the first part of the duodenum anddescending behind the second part of the duodenumcomes into close relation with the head of thepancreas to form a junction with the pancreatic confluent, but not inosculating ducts togetherpierce the duodenal wall, and after running obliquelythrough its coats for nearly 2 cm. and forming a lowrido*e beneath the mucous membrane, terminate inan ampulla (or diverticulum of Vater) ; the ampullaopens into the duodenum on t
Gall-stones and diseases of the bile-ducts . omentum in front of theportal vein and to the right of the hepatic passes behind the first part of the duodenum anddescending behind the second part of the duodenumcomes into close relation with the head of thepancreas to form a junction with the pancreatic confluent, but not inosculating ducts togetherpierce the duodenal wall, and after running obliquelythrough its coats for nearly 2 cm. and forming a lowrido*e beneath the mucous membrane, terminate inan ampulla (or diverticulum of Vater) ; the ampullaopens into the duodenum on the summit of a smallpapilla. The common bile-duct is an elongatedfunnel, narrowing gradually from the junction withthe cystic duct till it reaches the ampulla. The ampulla.—This diverticulum (of Yater) as it 8 DISEASES OF THE BILE-DUCTS is often called, occupies the base of a papilla situatedin the mucous membrane on the posterior aspect ofthe second part of the duodenum 8 cm. from thepyloric orifice of the stomach. This papilla projects. /* Fig. 4.—The ampulla with the termination of the commonbile-duct and the pancreatic duct (after Tuffier). from the duodenal mucous membrane, and resemblesvery much the lacrimal caruncle ; it is sheltered byan eyelid-like valvula of mucous membrane (Fig. 4),and opens into the duodenum by an orifice about3 mm. in diameter. This terminal orifice is thenarrowest part of the excretory apparatus. When THE BILE-DUCTS 9 distended the ampulla is ovoid, and about 6 and 4 mm. wide. The chief variations connected with the terminalsection of the duct are these: The common bile-duct and the pancreatic ductmay terminate independently. The papilla indicatingthe ampulla may be absent and the ducts open at thebottom of a depression in the mucous membrane. Evenwhen the ducts open separately the papilla may bepresent, the ducts opening independently near its base. An interesting morphologic anomaly consists inthe pancreatic duct opening on the papil
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Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
