THE STOMACH. 



1619 



Fig. 1368. 



PyloruSi 



Outline of stomach with 

 constricted and greatly elon- 

 gated pylorus. 



stomach is necessarily oblique, although the lesser curvature is vertical until near its 

 end. The axis slants downward and to the right as well as forward, the pyloric 

 portion being disregarded. The stomach is sometimes comparatively tubular, the 

 fundus being but little developed, although the cardiac opening is always on the 

 right side. This is a continuation of the foetal form, and is more often seen in 



women. There is often (possibly normally) a hint of a con- 

 striction about the middle. 



The foregoing conventional description is that of a dis- 

 tended stomach. The shape of the stomach during life, 

 when not distended, is probably much more tubular, the 

 greater part of the organ being often reduced to almost the 

 diameter of the duodenum. Based on the divisions of the foetal 

 organ (Fig. 1369), Schwalbe recognizes three chief segments 

 in the adult stomach : {\) saccus cardiaciis , the upper part which 

 remains saccular even during contraction ; {2) tubiis gastriciis, 

 the lower part which, when contracted, resembles the intes- 

 tine; and {^^^ pars pylorica, subdivided into the pyloric vestibule and canal. Local 

 contractions of the muscular coat account for many irregular forms of the stomach. 

 Weight and Dimensions. — Not only is the normal development of the 

 stomach very variable, but it is impossible to define the limits between the normal 

 and the pathological ; naturally, therefore, statements differ widely and are of little 

 value. According to Glendinning, the weight is 127 gm. (4^ oz. ) for man and a 

 little less for woman. The greatest length, directed nearly vertically, is some 25 cm. 

 (10 in. ),the greatest breadth from 10-12 cm. (4-5 in.), and its diameter from before 

 backward from 7.5-10 cm. (3-4 in.). The average adult capacity is said to range 

 from 600-2000 cc. (1.25-4.25 pints), with an average of 1200 cc. (2.50 pints). 



Peritoneal Relations. — The greater omentum, the original posterior mesentery, 

 passes to the back of the stomach just to the left of the oesophagus, where its layers 

 diverge so as to leave a small triangular part behind it attached to the diaphragm with- 

 out peritoneal covering. The lower of the diverging lines runs to the lesser omentum. 

 The line of attachment then passes across the posterior surface of the fundus near the top, 

 but posterior to the greater curvature; At the left of the stomach the line of insertion is 

 at the greater curvature, and 



continues so till it reaches the Fig. 1369. 



pylorus. The fold passing to 

 the diaphragm at the begin- 

 ning is the gastro-phrenic lig- 

 ament. This is joined by the 

 gastro-pancreatic fold on the 

 posterior abdominal wall which 

 conveys the coronary artery to 

 the right of the cardiac open- 

 ing. This last fold is impor- 

 tant in relation to the typog- 

 raphy of the peritoneum, but 

 not to the stomach. The lesser 

 omentum is attached along the 

 whole of the lesser curvature, 

 except that its posterior layer 

 may leave it below the cardia 

 to join on the back of the 

 stomach the layer of the greater omentum which forms the inferior border of the non- 

 serous triangle. With the exception of this triangle, and of the trifling interval be- 

 tween the lines of attachment of the omenta, the whole organ is invested by peritoneum. 

 Position and Relations. — The cardiac opening is opposite the tenth thoracic 

 vertebra and not far from the level of, but from 8-10 cm. (3-4 in. ) behind, the sixth 

 left costal cartilage, about 12 mm. (^ in.) to the left of the median line. The 

 lesser curvature descends vertically in an antero-posterior plane, parallel to the left 

 border of the ensiform, but slanting strongly forward, until it suddenly turns to the 



Duodenum 



(Esopha^S 



(Esophagus 



Fundus 



ecus cardiacus 



Fundus 



Tubus ^astricus 



Duodenum 



_ Pars in loricy 



Tubus 



gastricus 



Anterior (A) and posterior (B) aspects of stomach of human fcetus ot 

 205 mm. (Schwalbe.) 



