402 APPLIED ANATOMY. 



into the small intestine beyond. When this condition is found to exist, the stomach 

 is to be recognized by its position, its attachments, and the thickness of its walls. 

 It hangs suspended by its cardiac extremity from the oesophagus. This is beneath 

 the seventh left costal cartilage, about an inch from the edge of the sternum and 

 10 cm. (4 in.) from the surface; this brings it opposite the eleventh dorsal vertebra 

 immediately in front of the aorta. The pylorus lies just under the. edge of the liver, 

 either in the median line when the stomach is empty or, as is more often the case, 

 2.5 cm. (i in. ) or more to the right of the median line a little higher up than the 

 gall-bladder or opposite the eighth right costal cartilage and on a level with the first 

 lumbar vertebra. The pylorus is usually a little higher in women than in men. If the 

 liver is contracted the pylorus and adjacent portion of the stomach may be in direct 

 contact with the anterior abdominal wall. The lesser curvature is 7.5 to 12.5 cm. 

 (3 to 5 in.) long and passes downward, forward, and to the right. 



Relations. The stomach rests on the transverse mesocolon, which covers the 

 pancreas, solar plexus, aorta, thoracic duct, vena cava, and crura of the diaphragm pos- 



Diaphragmatic branches 

 Coeliac axis 



Cystic artery ^ jf ' "^f^S^Bfc" ^ GaStri ( r coronar y> 



. Splenic 



mam .^m^ .sv * jam, m^r %. \\ \ . \ arm 



Hepatic 



sm'i f mtmar \ ^n. vjirw> r- j ._. -f.^ - 



"lymph-nodes 



Gastroduodenal ^^^ 



Left gastro-epiploic 

 Pyloric branch 



Right gastro-epiploic 



Inferior gastric 

 lymph-nodes 



FIG. 416. Blood supply and lymphatics of the stomach, and Hartmann-Mikulicz line. 



teriorly ; farther to the left are the left suprarenal body, kidney, and spleen (Fig. 415). 



In front are the diaphragm, abdominal parietes, and liver. Above are the lesser 

 ' or gastrohepatic omentum, liver, and diaphragm. Below is the gastrocolic omen- 

 turn, transverse colon, and gastrosplenic omentum. 



Percussion. In physical diagnosis the size of the stomach is outlined by 

 percussion, it being filled with air or gas to distend it. In the median line its 

 resonance above will be limited by the edge of the liver; below, while usually 5 to 

 7.5 cm. (2 to 3 in. ) above the umbilicus, it is not considered to be dilated, especially 

 in old people, unless it reaches below the umbilicus. It leaves the left costal margin 

 opposite the ninth or tenth costal cartilage. In the left mammary line stomach 

 resonance may reach up to the fifth or sixth rib, while farther to the left it reaches 

 the spleen about in the midaxillary line. 



Traube 1 s semilunar space is limited above by the edge of the left lung, indicated 

 by the sixth interspace ; externally by the spleen, indicated by the midaxillary line; 

 and internally by the costal margin. Normally this area is resonant from the presence 

 of the stomach beneath, but pleural effusion causes it to be dull on percussion. 



