l620 



HUMAN ANATOMY 



Non-peritoneal area 



Cardiac orifice 



right, rises, and ends opposite the space between the ensiform and the end of the 

 eighth or ninth right costal cartilage, on a level with the first lumbar vertebra or the 

 disk below it, about 1.2 cm. ()^ in.) from the median line. The pyloric orifice is 

 affected to such an extent by changes incident to variations in distention that it 

 is manifestly impossible definitely to fix the position of the lower end of the stomach. 

 The pylorus is usually separated from the anterior abdominal wall by the over- 

 lapping liver, when the stomach is empty lying near the mid-line. According to 

 Addison, a point 12 mm. ()^ inch) to the right of the median plane midway between 

 the top of the sternum and the pubic crest will ordinarily correspond to the position 

 of the pylorus. The fuyidus is at the top of the left side of the abdomen under the 

 diaphragm, reaching the level of the sternal end of the fifth costal cartilage. The 

 anterior surface, looking upward as well as forward, is covered by the left and quad- 

 rate iobes of the iiver. A varying part of it touches the diaphragm in front of the 

 former. The extent of this must depend on the ^ize of both organs. The liver may 

 separate it entirely from that part of the diaphragm below the pericardium, or the 

 stomach may be against the diaphragm in the anterior part of this region. A small 

 triangular part of the stomach, normally in contact with the front wall of the abdo- 

 men, bounded below by the greater curvature, is seen, on opening the abdomen, 

 between the liver and the line of the left costal cartilages. This appearance gave 

 rise to the old error that the stomach is placed transversely. According to Tillaux, 



the stomach in its most con- 

 FiG. 1370. tracted state always descends to 



a line between the ends of the 

 ninth costal cartilages. The pos- 

 terior surface, forming a part of 

 the anterior wall of the lesser 

 peritoneal cavity, rests against 

 the transverse mesocolon, which 

 lies on the organs at the back of 

 that space, so as to make a part 

 of the concavity for it which Bir- 

 mingham' has well called the 

 stomach-bed (Fig. 1371). This 

 hollow is made by the diaphragm 

 on the left of the aorta, by the 

 left suprarenal capsule, the gas- 

 tric surface of the spleen, the 

 antero-superior surface of the 

 pancreas, and usually by the upper part of the left kidney, although exceptionally 

 this may be shut off from the stomach by the spleen and pancreas. The left crus 

 of the diaphragm makes a deep indentation in the stomach to the left of the car- 

 dia. The coeliac axis and the semilunar ganglia are rather to the right of the lesser 

 curvature. The transverse mesocolon continues the lower part of the stomach-bed 

 forward to the transverse colon, which lies below the stomach, following its curve 

 when the stomach is distended. The splenic flexure of the colon is close against 

 it. When free from solid contents, the stomach is usually found in dissecting-room 

 subjects hanging more or less vertically in longitudinal folds containing more or less 

 air and fluid ; but during life, as already stated, it is in a contracted and puckered 

 condition, the long axis running strongly forward as well as downward. With dis- 

 tention the stomach enlarges at first upward, backward, and to the left, then forward 

 against the abdominal walls. The upper part enlarges chiefly backward, the lower 

 forward. This does not imply a forward swing of the greater curvature such as 

 has been described. The pyloric end is rnoved to the right, it may be as far as 

 the gall-bladder. The antrum may thus, according to Birmingham, be carried to 

 the right of the pylorus. The latter rarely moves more than 5 cm. to the right of 

 the median line. Except in its last part, the lesser curvature continues essentially 

 vertical, as seen from before. The transverse colon is driven downward unless it be 

 so much distended as to offer effectual resistance. 



' Journal of Anatomy and Physiology', vols, xxxi., xxxv., 1897, 1901. 



Lesser omentum 



Pylorus 



Posterior aspect of stomach at birth, showing peritoneal relations. 



