4o 4 APPLIED ANATOMY. 



formation of abscess, or direct communication with the greater or lesser peritoneal 

 cavity may be produced. Healing of ulcers near the pylorus may cause stenosis 

 resulting in distention. Hemorrhage may occur from the vessels of the stomach 

 walls or the vessels along the lesser curvature, the splenic or hepatic arteries or even 

 the portal vein. One reason why the arteries along the curvatures are not still more 

 frequently affected is because they often lie a short distance away from and not 

 in immediate contact with the stomach walls. Adhesions to surrounding organs are 

 least liable to form when the perforation is on the anterior wall. Then the larger 

 peritoneal cavity is infected and a general peritonitis quickly ensues. A perforation 

 on the posterior wall involves the lesser cavity of the peritoneum, and the infec- 

 tion must travel first through the foramen of Winslow before a general peritonitis 

 develops. Abscesses may form between the under surface of the liver and the 

 stomach, and they have been known to penetrate the pleura, pericardium, and 

 transverse colon. 



Carcinoma. This is located in about 60 per cent, near the pylorus, in 15 per 

 cent, in the lesser curvature, in 10 per cent, at the cardiac end, and in the remaining 



- Fundus of stomach 



Contracted ri^ht end 

 of stomach 



Pylorus 



Duodenum 



FIG. 417. Showing the right end of the stomach normally contracted to near the size of the duodenum. From 



an actual specimen. 



15 per cent, in other portions of the organ. Cun6o has shown that extension 

 occurs in the lymphatic nodes along the lesser curvature, in those of the greater 

 curvature along the right third of the stomach adjacent to the pylorus, and in the 

 nodes around the pylorus and head of the pancreas. It has been noticed that there 

 is no tendency to extension to the region of the duodenum. It will thus be seen 

 that a line drawn from the junction of the right and middle thirds of the greater 

 curvature to the cardiac extremity would have nearly all the nodes to the right. It 

 is this portion which is removed in pylorectomy and partial gastrectomy; owing to 

 the extension of the disease up the lymphatics of the oesophagus, enlarged nodes 

 may sometimes be present in. the left supraclavicular fossa or even in the left 

 axilla. 



The tumor is usually felt in or near the median line, a variable distance above 

 the umbilicus ; it may drag the pylorus lower down than normal. If the stomach is 

 distended the tumor may be carried 5 to 7.5 cm. (2 to 3 in.) to the right of the 

 median line. If, as is not uncommon, the disease infiltrates the walls of the stomach, 

 the tumor can be felt passing to the left side, disappearing under the costal margin. 



