aloe A 
7 Ay 
| THE STOMACH. 100] 
or fundus directed backwards towards the diaphragm, its long axis lying almost 
in a horizontal plane, and its pyloric portion running to the right to join the 
duodenum. In this state the whole organ 18 narrow and attenuated, particularly 
the pyloric portion, which is contracted, and resembles a piece of thick-walled small 
intestine. 
When distended, the organ assumes the form of an irregular pear, and both 
the cardiac and pyloric portions become full and rounded (Fig. 674). It still lies 
within the hypochondriac and epigastric regions; but in extreme distension, or in 
exceptional cases, it may pass down below the subcostal plane and reach into the 
wmbilical and left lumbar regions. As a result of the general increase in leneth 
which takes place during distension, the pylorus is moved a variable distance to 
| —Stomach 
Spleen (anterior basal 
Attachment of {f 4 j ie: 
{vias 5 j angle) 
falciform. ligament — 
——Spleniec flexure 
Transverse mesocolon 
with stomach resting 
on it 
Tenth rib— 
\ 
Gall-bladder —_=== 
i 
( 
Terminal part of 
duodenum 
Hepatic flexure 
Third part of _— 
duodenum — Descending colon 
Root of mesentery (cut) 
Apex of vermiforimn 
appendix ‘ : é 
MM Pelvic (sigmoid) 
mesocolon 
Terminal part of ileum 
Cecum VY Li Pelvic colon (sigmoid 
\ flexure) 
\ i 
5 10 4 
: 1 | | | o | o | | l o | 1 | 1 i | 
SCALE IN INCHES SCALE IN CENTIMETRES 
Bladder 
Fic. 675.—THE ABDOMINAL VISCERA AFTER THE REMOVAL OF THE JEJUNUM AND ILEUM (from a photograph 
of the same body as Fig. 670). The transverse colon is much more regular than usual. Both the liver 
and cecum extend lower down than normal. The subdivisions of the abdominal cayity are indicated 
by dark lines. 
the right beneath the quadrate lobe of the liver, and at the same time the lone 
axis of the whole organ becomes much more oblique, running forwards, downwards, 
and to the right. Finally there is developed a special dilatation of the pyloric 
portion, known as the antrum pylori, which in extreme distension is carried so far 
to the right that it may even reach into the hypochondrium. 
In brief, it may be said that the stomach when empty is contracted, not 
collapsed ; that it assumes a narrow, attenuated shape, its cavity being practically 
obliterated, and its pyloric portion contracted to the size of small intestine ; and in 
addition, that its long axis lies in an almost horizontal plane. With distension 
there comes a general enlargement of the various diameters, an elongation of the 
whole organ, with a consequent passage of its pyloric portion to the right beneath 
the liver, the development of the antrum pylori, and an inclination of its axis from 
behind downwards and forwards, without any rotation. 
