- THE STOMACH. 1005 
cupola of the diaphragm; opposite the cesophageal orifice it passes into the 
body of the stomach. Its surfaces are merely prolongations of the upper and 
lower surfaces of the organ, and accordingly its relations are similar. 
Thus the upper surface lies against the left cupola of the diaphragm (and occasionally the 
left lobe of the liver, when this extends further than usual to the side) : ‘whilst the lower surface 
rests chiefly on the gastric surface of the spleen, and also on the left kidney. 
The highest part of the fundus reaches to the level of a point on the chest wall about half-an- 
inch (12 mm.) internal to the apex point of the heart. 
The narrow or pyloric end, when the stomach is empty, 1s contracted and 
cylindrical, and runs transversely to the right, lying as a rule beneath the left lobe 
of the liver. During cistension it is carried to the right beneath the quadrate lobe, 
and its terminal part is there directed backwards in order to reach the duodenum. 
Even in this condition its last inch remains comparatively undistended. 
The lesser curvature (curvatura ventriculi minor) 1s directed towards the liver, 
and corresponds to the line along which the lesser omentum is attached to the 
stomach, between the pyloric and cesophageal orifices (Fig. 674). It is connected 
to the liver by the lesser omentum, between the layers of which the gastric and 
pyloric vessels run along the curvature. : 
This curvature, when the stomach is empty, presents a sharp bend at the junction of the 
cardiac and pyloric portions, but when fully distended it forms an open curve except near its 
pyloric end, where it becomes convex, corresponding to the S-shaped form of this portion of the 
organ (see below). On viewing a distended stomach from the right side (Fig. 674, B), it will be 
observed that the line of the lesser curvature turns slightly on to the upper aspect im order to 
reach the cardia, which is situated rather on the upper surface than on the border of the stomach. 
The great curvature (curvatura ventriculi major), which is usually over three 
times as long as the lesser curvature, corresponds to a line drawn from the cardia over 
the summit of the fundus (Fig. 674), and then along the line of attachment of the 
great omentum as far as the pylorus. In general, it is directed to the left and for- 
wards, but at its beginning, near the cardia, it of course looks in the opposite 
direction. The great curvature corresponds in the greater part of its length to the 
attachment of the great omentum; and in close relation to it, but between the 
layers of the omentum, run the right and left gastro-epiploic vessels. 
Antrum Pylori.—This is a prominence of the great curvature in the distended stomach, situated 
ashort distance from the pylorus. When the stomach is distended, the pyloric portion, near its 
right extremity, becomes curved somewhat like the letter S placed horizontally. The first curve of 
the S is convex downwards and forwards, and this becoming more prominent with distension, 
forms a projection of the great curvature known as the antrum pylori. The terminal part of the 
S extends to the pylorus ; it is about one inch (2°5 em.) in length, and it appears never to become 
distended to any noticeable extent. This latter is the part described by Jonnesco as the pyloric 
canal. 
The terms cardiac and pyloric portions are often employed to indicate the wider and narrower 
portions of the stomach respectively. The cardiac portion includes about two-thirds of the 
length of the whole organ; the pyloric portion the remaining third. Except in complete dis- 
tension, the junction of the two is usually indicated by a shght constriction, and occasionally 
there is a thickening of the muscular fibres (apparently those of the oblique layer), corresponding 
in part to the constriction. 
The esophageal orifice or cardia is the aperture at which the gullet opens into the 
stomach. It is situated at the upper end of the lesser curvature, to the right of the 
fundus, and nearer the upper than the lower surface of the stomach (Fig. 674, B). 
The cardia is very deeply placed, and les about four inches behind the sternal end 
of the seventh left costal cartilage, at a point one inch from its junction with the 
sternum. Posteriorly it corresponds to the level of the eleventh. dorsal vertebra. 
Owing to the fixation of the cesophagus by its passage through the diaphragm, and the close 
connexion between the stomach and the diaphragm, near the cardia where the peritoneum is 
absent, this is the most fixed part of the whole organ. The object of this immobility is 
evidently to maintain a clear passage for the food entering the stomach. The orifice is oval 
rather than round, with its long axis very oblique ; and although the presence of a valvular 
arrangement at the cardia has been advocated by several authorities, it is difficult to find satis- 
factory proof of its existence in hardened bodies. It seems more probable, on the whole, that 
no such arrangement naturally exists here. On the other hand, the muscular margins of the 
cesophageal opening in the diaphragm, and the circular fibres of the lower end of the cesophagus, 
