STOMACH AND INTESTINE. 



309 



with the more fixed duodenum and oeso- 

 phagus. The former tube is connected with 

 the posterior wall of the belly, the latter 

 perforates the crura of the diaphragm a 

 little to the left of the median line, so as to 

 enter the abdomen about one inch in front of 

 the left border of the aorta, by an aperture 

 which is everywhere muscular*, although 

 close to the posterior border of the tendon. 

 The fixation of the stomach is also aided 

 by certain processes of peritoneum. To 

 the left of the oesophagus, the short phreno- 

 gasfric amentum passes from the diaphragm 

 to the cardiac pouch, which it reaches some- 

 what posteriorly. Still lower down, the 

 stomach is united to the spleen by the gaslro- 

 splcnic on/t'iitiim. The lower border of the 

 organ gives oft' the great omentum ; this de- 

 scends for some distance towards the bottom 

 of the belly, and is then reflected upwards to 

 the anterior border of the transverse colon, 

 which it splits to enclose. The upper border 

 of the stomach is attached by means of the 

 gastro-hepatib or small omentum, which de- 

 scends from the transverse fissure of the liver. 

 All of these folds are double; though the four 

 layers of the reflected omentum majus are 

 often inseparably united to each other. They 

 are more particularly described in the article 

 PERITONEUM. 



Situation. The stomach is placed almost 

 transversely in the upper part of the abdo- 

 minal cavity, in which it passes from the left 

 to the right side, as well as downwards, and 

 slightly forwards. This direction results from 

 its situation relatively to the oesophagus and 

 duodenum : since it is joined by the former 

 at its highest part, and near its left extremity ; 

 while the latter is immediately prolonged 

 from its right or pyloric end. In this course 

 from left to right, the stomach successively oc- 

 cupies the left hypochondriac and the epi- 

 gastric regions ; and, just at its termination, 

 it reaches the right hypochondrium. Its an- 

 terior surface is therefore in contact with the 

 diaphragm, where this muscle lines the car- 

 tilages of the left false ribs ; and with the ante- 

 rior wall of the abdomen. Its posterior surface 

 lies upon the pancreas, the aorta, and the crura 

 of the diaphragm, where these parts cover the 

 spine. Its left extremity is in contact, above, 

 with the diaphragm, below, with the spleen ; 

 and, posteriorly, it touches the left supra- 

 renal capsule and kidney. Its upper border 

 is in apposition to the liver: viz. to its 

 left lobe, to the lobulus Spigclii, and to part 

 of the lobulus quadratus. Its lower border is 

 parallel, and close to, the transverse colon. 



* The muscularity of this aperture led Haller 

 and some other anatomists to regard it as a kind 

 of sphincter to the cardiac orifice of the stomach. 

 But we may point out that, though the contraction 

 of its fibres reduces the elliptical opening to a 

 circular one, yet as this apparent constriction coin- 

 cides with the descent of the diaphragm, the oblique 

 plane of this muscle is at the same instant becoming 

 transverse. Hence this ellipse and circle merely 

 represent an oblique and a transverse section of 

 the same cylinder. The diameter of the oesophagus 

 may therefore remain unchanged. 



Unusual size or distention chiefly affects the 

 situation of the organ by causing it to ex- 

 tend downwards; so as to overlap or cover 

 the transverse colon, and thus reach the 

 umbilical, the left lumbar, or even the iliac 

 region. Under similar circumstances, its leit 

 extremity also passes deeply into the corre- 

 sponding hypochondrium ; so as to be co- 

 vered, not only by the cartilages of the ribs, 

 but by these bones themselves. Its extension 

 upwards diminishes the size of the thorax, 

 but is rarely sufficient to be felt as a serious 

 hindrance to the descent of the diaphragm 

 in the ordinary tranquil inspiration of health. 

 Its right extremity may reach the gall-bladder. 



It may be useful to trace the effect of its 

 usual progressive distention upon the form, 

 site, and fixation of the stomach. When 

 void of food, and not distended (as it often is) 

 by gases, the flattened stomach hangs almost 

 vertically in the epigastrium. In this state 

 of the organ, the pulpy food that enters it 

 from the oesophagus drops at once into the 

 cardiac pouch, which forms its most depend- 

 ing part. The reception of further quantities 

 effaces its upper and lower borders, and gra- 

 dually changes them, from almost straight lines, 

 into the curves above mentioned ; at the same 

 time that it separates the previously apposed 

 surfaces, and converts the whole organ into a 

 bent cone, which is convex below and in front. 

 The latter of these two flexures chiefly occupies 

 the pyloric extremity, and is often very sudden. 

 Both result from the increased length of the 

 organ, and the proximity of its comparatively 

 fixed orifices. But both are greatly assisted 

 by the muscular coat : since the distention 

 of the separated stomach tolerably imitates, 

 though it scarcely equals, the curves taken by 

 the organ when moderately expanded in situ. 

 The delicate and yielding omenta above men- 

 tioned allow the stomach to expand be- 

 tween their elastic and extensible laminae, 

 without undergoing any disturbance of its ner- 

 vous and vascular connections, or any loss of 

 its serous covering. Finally, although the 

 stomach itself enlarges pretty equally in all di- 

 rections, still, after filling the hypochondrium, 

 the mobility of its bent middle directs it 

 towards that part of the enclosing cavity where 

 it meets with the least resistance : namely, 

 towards the yielding anterior wall of the belly. 

 Hence, should the distended intestines not 

 allow it any great descent downwards, it comes 

 forwards; so that what was its vertical anterior 

 surface now looks obliquely upwards ; while 

 its inferior border touches the lower part of 

 the wall of the epigastrium, where its artery 

 has even been felt pulsating in very thin sub- 

 jects. 



The serous coat of the stomach is conti- 

 nuous with the double laminae of peritoneum 

 above mentioned, which split to enclose it 

 where they reach its various borders. Here 

 they are very loosely connected to each other, 

 and to the subjacent coat, by an abundance of 

 highly elastic areolar tissue. But towards the 

 middle of the gastric surfaces, the peritoneum, 

 though still elastic, is closely united to the 



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