GASTKIC ULCEE. 355 



hepatic artery, in a similar manner serves to anchor the duo- 

 denum and so indirectly fixes the right end of the lesser curvature 

 of the stomach. As the stomach expands it completely fills a well- 

 defined space in the upper and left part of the abdomen known as 

 the stomach chamber. This chamber has a sloping floor on which 

 the stomach rests, a dome-like roof against which the anterior 

 surface abuts, and an anterior wall which is in contact with the 

 anterior surface and greater curvature. When the stomach is 

 empty a part of the transverse colon near the splenic flexure turns 

 up into the stomach chamber. 



The inflammation which accompanies gastric ulceration may 

 extend to surrounding structures, and the stomach thus contract 

 adhesions to different parts of the stomach chamber. Adhesions 

 readily form between the under (posterior) surface of the stomach 

 and the shelf on which it rests, since in this position they are 

 well supported and not easily disturbed by gastric or respiratory 

 movements. Adhesions between the stomach and the dome or 

 the anterior wall of the stomach chamber are formed with less 

 facility and more easily ruptured since they are constantly exposed 

 to traction in consequence of alterations in the size of the stomach 

 caused by the ingestion of food or fluid, and also by the respiratory 

 excursions of the diaphragm, liver and anterior abdominal walls. 

 Consequently, although ulcers of the posterior wall are more 

 common, ulcers of the anterior wall perforate more frequently. 

 The latter ulcers, owing to the difficulty with which firm adhesions 

 form, are sometimes spoken of as " undefended." 



The structures which form the stomach bed are the front of the 

 left kidney and its adrenal body, the gastric surface of the spleen, 

 the upper surface of the pancreas, the transverse colon and its 

 mesocolon. Interposed between these structures and the posterior 

 wall of the stomach is the lesser sac of the peritoneum, except 

 over a small area near the cardiac end, where the stomach is in 

 direct contact with the diaphragm above the left adrenal body. 

 Adhesions of the posterior surface of the stomach partly obliterate 

 the lesser sac and usually bind the stomach to the pancreas, but 

 sometimes the spleen or other structures, such as the lymphatic 



232 



