THE ABDOMEN. 



373 



Stomach. The cardiac end lies under the cartilage of the seventh rib, 2.5 cm. 

 (i in.) from the edge of the sternum and about 10 cm. (4 in.) from the surface. 

 When the stomach is empty the pylorus lies in the median line 2.5 to 5 cm. (i to 

 2 in. ) below the tip of the xiphoid or ensiform cartilage ; when distended the pylorus 

 moves 3 to 5 cm. to the right. The fundus rises in the left nipple line to the lower 

 edge of the fifth rib. The lower border of the stomach crosses the median line 

 5 to 7.5 cm. (2 to 3 in.) above the umbilicus. In the old it may reach as low as the 

 umbilicus, and when dilated may go far below it. 



Pancreas. The pancreas lies beneath the stomach and transverse colon, 

 stretching across from the duodenum on the right of the spine to the spleen on the 

 left. Its body lies over the first and second lumbar vertebrae. This would bring its 



Fir,. 386. Surface anatomy of the abdomen, showing the outlines ot the viscera. 



lower edge about 5 cm. (2 in. ) above the umbilicus and its upper edge about 10 cm. 

 (4 in. ) above it. 



Spleen. The spleen lies under the ninth, tenth, and eleventh ribs of the left 

 side. Its long axis follows the tenth rib. Its anterior end is at the midaxillary line, 

 while its posterior end reaches to within 4 cm. ( i y 2 in. ) of the median line. 



Kidneys. The lower edge of the right kidney reaches to within an inch of the 

 level of the umbilicus; this is about opposite the level of the third lumbar spine. 

 The left is 1.25 to 2 cm. (^ to ^ in. ) higher. This leaves about 4 cm. (i^ in.) 

 between the lower edge of the kidneys and the highest point of the iliac crests. 

 Their upper edge is almost or quite up to the level of the tip of the xiphoid cartilage. 

 The pelvis of the kidney and commencement of the ureter are 5 cm. (2 in. ) from the 

 median line, about on the level of a line joining the upper ends of the lineae semi- 

 lunares. Posteriorly the right kidney rises to the lower border of the eleventh rib, 

 the left kidney to the upper border. The outer edge of the kidney is a little beyond 

 the outer borders of the erector spinae and quadratus lumborum muscles. 



