THE STOMACH. 403 



Blood Supply. The cceliac axis gives off the gastric, hepatic, and splenic 

 arteries, all of which give branches to the stomach. The gastric (or coronary) 

 gives branches to the oesophagus and cardiac end and then runs along the lesser 

 curvature to unite with the pyloric branch of the hepatic. It lies in the gastro- 

 hepatic omentum and sends branches anteriorly and posteriorly over the surface of 

 the stomach (Fig. 416). 



The hepatic artery as it nears the pylorus gives off a pyloric branch which passes 

 to the left along the lesser curvature, and a gastroduodenal branch, which divides 

 into the superior pancreaticoduodenal to supply the duodenum and head of the 

 pancreas, and the right gastro-epiploic artery which passes to the left along the 

 greater curvature of the stomach. 



The splenic artery near the spleen gives off the left gastro-epiploic artery which 

 proceeds along the greater curvature to unite with the right gastro-epiploic, a branch 

 of the gastroduodenal artery. 



The more the stomach is distended the closer do the arteries of its greater 

 and lesser curvatures lie to its walls. The fundus is supplied by the vasa brevia, 

 small branches which leave the splenic artery in the gastrosplenic omentum. 



The veins follow the course of the arteries. The right gastro-epiploic empties 

 into the superior mesenteric and the left into the splenic; they then enter the portal 

 vein. The pyloric and coronary veins empty into the portal vein direct. The latter 

 receives branches from the oesophagus which become varicose in cirrhosis of the 

 liver. 



Lymphatics. The lymphatic nodes of the stomach are found principally 

 around the regions of the pylorus inferior gastric nodes, and the lesser curvature 

 and cardiac extremity superior gastric nodes. The inferior nodes drain the greater 

 curvature toward the pylorus while the superior nodes drain the lesser curvature and 

 cardiac end. The fundus is drained by radicles which empty into the nodes which 

 accompany the splenic artery. While some nodes may be found along the greater 

 curvature toward the pyloric end, Cuno and Poirier state that it is rare to find 

 nodes in the middle portion of the greater curvature and quite exceptional to meet 

 with them in the region of the fundus. 



AFFECTIONS OF THE STOMACH. 



In disease the stomach may be contracted or dilated, and is often the seat 

 of ulcer and carcinoma. 



Contracted stomach occurs either as a normal or pathological condition; it has 

 already been alluded to on page 401. The contraction of the middle, producing the 

 hour-glass shape, results from cicatrices and adhesions due to gastric ulcer. In 

 cases of cesophageal stricture the contraction may be marked. It then embraces 

 mainly the right third of the organ and the affected portion resembles the adjoining 

 duodenum. Abstention from food in the course of an illness may also cause a 

 contracted condition which one should be prepared to encounter in case of opera- 

 tion. A normal contracted condition of the right end of the stomach, often of a 

 more or less hour-glass shape, is frequently encountered in autopsies when death 

 has been caused by disease of other organs (Fig. 417). 



Dilation results from functional diseases as well as obstructive affections, such 

 as ulcer or carcinoma, involving the pylorus. Distention causes the pylorus to pass 

 from the midline 2.5 to 7.5 cm. (i to 3 in.) to the right. The organ becomes more 

 horizontal and descends so that its lower border sinks below the umbilicus its extreme 

 normal level. Sometimes the greater curvature alone is lowered, while in others the 

 gastrohepatic omentum is stretched and the pylorus as well as the greater curvature 

 descends. This is called gastroptosis. The amount of distention is recognized by 

 percussion, as pointed out on page 402, or by administering bismuth and examining 

 by the Rontgen rays. 



Ulcer occurs most frequently along the lesser curvature; then the posterior 

 wall, the region of the pylorus, the anterior wall, cardiac end, fundus, and greater 

 curvature, in the order of frequency. The ulceration may open an artery, producing 

 hemorrhage, or there may be adhesions to neighboring organs, resulting in the 



