Gall-stones and diseases of the bile-ducts . hepatic ducts becomedistended with pus. Another rare condition is rupture of the hepaticduct in consequence of ulceration caused by thestone. In a case of this kind described by Freeland,the accident was quickly fatal, and at the fost-mortemexamination the belly was full of blood and pus. Gall-stones in the intrahepatic ducts.—Large calculiin the intrahepatic ducts are uncommon, but theyoccur, and are sometimes very numerous. They aregenerally of the bilirubin-calcium kind, and areusually of irregular shape, like fragments of coral. There is a remar
Gall-stones and diseases of the bile-ducts . hepatic ducts becomedistended with pus. Another rare condition is rupture of the hepaticduct in consequence of ulceration caused by thestone. In a case of this kind described by Freeland,the accident was quickly fatal, and at the fost-mortemexamination the belly was full of blood and pus. Gall-stones in the intrahepatic ducts.—Large calculiin the intrahepatic ducts are uncommon, but theyoccur, and are sometimes very numerous. They aregenerally of the bilirubin-calcium kind, and areusually of irregular shape, like fragments of coral. There is a remarkable specimen in the museum ofthe Pathologic Institute in Berlin. The liver islarge, and the cut surface shows the calculi asthick as plums in a cake. The Museum of West-minster Hospital possesses a slice of a liver withdilated intrahepatic dncts containing black coral-like gall-stones. To my mind these rounded and INTRAHEPATIC CALCULI 91 slightly curved intrahepatic calculi resemble largewoodlice lying under the bark of a decaying EERJEAU Fig. 30.—A section of liver with dilated ducts containing gall-stones (from a photograph supplied to the author by Stevens). In this specimen the dilatation of the ducts wasattributed to pressure exerted on the hepatic duct 92 DISEASES OF THE BILE-DUCTS by an echinococcous cyst in the transverse fissure ofthe liver. It was pointed out in Chap. IV that in their earlystages gall-stones are soft and plastic ; this is cer-tainly true of those which arise in the intrahepaticducts, and except in those cases where the ductbecomes so widely dilated as to accommodate manystones like eggs in a nest (Fig. 30) the calculi takethe form of the duct in which they lie, and as thelarge bile-ducts follow meandering courses in theliver, the gall-stones mould themselves to the variouscurves; the small nodules on their contour corre-spond to the oscula of the bile canals which openinto the dilated channels which lodge the fact
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