THE STOMACH. 40I 



sight, to reappear again above at the commencement of the transverse colon just 

 below the gall-bladder. 



The descending colon and sigmoid flexure are usually seen lying close to the 

 abdominal wall somewhere between the left iliac crest and approximately the middle 

 of Poupart's ligament. The amount visible is variable, sometimes a considerable 

 length is seen, at others only a single knuckle. Their presence and location are 

 more uncertain than are those of the caecum and ascending colon on the right side. 

 The small intestines fill the rest of the visible space. They enter the pelvis, usually 

 are found in hernial sacs, and cover both the ascending and descending colon in the 

 flanks. The coils in the upper and left portions of the abdomen are more likely to 

 be jejunum, those in the lower and right portions are more likely to be ileum. 

 Either may be found in the pelvis. 



THE STOMACH. 



When the stomach is moderately distended it is a pear-shaped organ lying 

 almost entirely to the left of the median line and occupying the epigastric and left 

 hypochondriac regions. It has an average capacity of i to 2 litres (about 2^ pints). 

 Its direction is an oblique one, being downward, forward, and to the right. The 



Cardiac end of 

 stomach 



Spleen 



Suprarenal body 

 Kidney 



~ Pancreas 



Transverse meso- 

 colon 



Pyloric end of stomach 

 FIG. 415. The bed of the stomach. The stomach has been removed showing the surrounding structures. 



upper two-thirds are more longitudinal, the lower third more transverse, the two parts 

 making an angle of 60 to 70 degrees. The part just adjoining the pylorus is slightly 

 enlarged when the stomach is distended, and is called the antrum. The stomach 

 is spoken of as having anterior and posterior walls, but they could just as truthfully 

 be called superior and inferior, especially when the organ is distended. When it is 

 relaxed it tends to hang in a more vertical position, but when it is distended it rotates 

 on a tranverse axis, the greater curvature coming forward, and the organ assumes 

 a more horizontal plane. When the stomach is empty it may not be relaxed but 

 contracted. This contraction is liable to be very marked toward the middle of the 

 organ, producing the hour-glass stomach. At other times the contraction proceeds 

 a variable distance from the pylorus toward the cardiac extremity. In such cases 

 instead of being pear-shaped the stomach becomes more or less tubular so as to 

 resemble the remainder of the intestinal canal. It then differs but little in appear- 

 ance from the duodenum, and the position of the pylorus is not readily recognized. 

 If, as may normally occur, the contraction extends well over toward the cardiac end. 

 then liquids do not lodge in the stomach but pass almost immediately through it 

 26 



