. Diseases of the gall-bladder and bile-ducts, including gall-stones . opsy of the gall-bladder and gall-stones. In some instances the gall-bladder projects beyond theapex of the linguiform projection, as in a case described byDr. Hellier* (Fig. 8). In Case 234 the gall-bladder and linguiform process of theliver reached the caecal region, and the recurrent attacks of * British Medical Journal^ May 4, 1895. ANATOMICAL CONSIDERATIONS pain associated with local peritonitis and unaccompanied byjaundice much resembled recurring appendicitis, the point ofgreatest tenderness being situated midway bet
. Diseases of the gall-bladder and bile-ducts, including gall-stones . opsy of the gall-bladder and gall-stones. In some instances the gall-bladder projects beyond theapex of the linguiform projection, as in a case described byDr. Hellier* (Fig. 8). In Case 234 the gall-bladder and linguiform process of theliver reached the caecal region, and the recurrent attacks of * British Medical Journal^ May 4, 1895. ANATOMICAL CONSIDERATIONS pain associated with local peritonitis and unaccompanied byjaundice much resembled recurring appendicitis, the point ofgreatest tenderness being situated midway between theumbilicus and anterior superior spine of the ilium, in whichposition the incision for the operation was made. In others the projection is external to the gall-bladder,which is then found lying on its inner side (Fig. 9). In a case of this kind, where the gall-bladder is contracted,and calculi are impacted in the cystic duct, there may be thegreatest difficulty in extracting them, owing to the limitationof the space for manipulation caused by the Fig. 9.—Linguiform Process of Liver. Professor Riedel has described it, and the projection issometimes known as Riedels lobe. It is said to be uniformlydue to cholelithiasis, but that it is not always associated withgall-stones our experience in several cases demonstrates. The liver is sometimes displaced vertically, as in Case 268,where the incision had to be prolonged quite up to the ensi-form cartilage in order to reach the shrunken gall-bladder,lying under cover of the liver, the under surface of whichfaced to the left side. In this case the left lobe was muchsmaller than the right, which formed the great bulk of theliver. CHAPTER IL INFLAMMATORY AFFECTIONS. Inflammatory affections may be conveniently consideredclinically under the following headings : 1. Catarrhal Inflammation. (a) Acute catarrhal cholangitis. (b) Chronic catarrhal cholangitis. (c) Chronic catarrhal cholecystitis. 2. Croupous Inflammation of
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