358 CLINICAL APPLIED ANATOMY. 



tumour may exhibit considerable mobility or contract adhesions. 

 The adjacent aorta may communicate pulsation to it. Being 

 muscular it may sometimes be felt to harden and relax, and 

 at times gastric contents are felt to bubble through it. The 

 peristalsis of the stomach may be distinguished from peristalsis 

 of the transverse colon by the fact that the wave of the former 

 passes from left to right, whilst that of the latter passes from 

 right to left. In some cases the direction of gastric peristalsis is 

 reversed. 



The arrangement of the lymphatic vessels and glands of the 

 stomach has an important bearing on the spread of gastric 

 carcinoma. The lymphatics commence in the submucous coat 

 and follow the track of the vessels in the subserous tissue. Three 

 distinct lymphatic areas may be recognised, the superior gastric, 

 the inferior gastric, and the area of the fundus. The superior 

 gastric lymphatics drain the upper halves of both surfaces of the 

 stomach from the pylorus to the junction of the central third 

 with the fundus. Their efferent trunks follow the coronary vein 

 along the lesser curvature, lying between the two layers of the 

 lesser omentum ; they traverse the superior gastric glands which 

 lie in this situation, and near the cardiac orifice turn backwards, 

 in the pancreatico-gastric fold, to enter the glands of the coeliac 

 group. They leave the stomach where the coronary artery reaches 

 the lesser curvature. The inferior gastric lymphatics drain the 

 lower halves of the pyloric and central regions. They traverse the 

 inferior gastric glands of the greater curvature, and their trunks, 

 accompanying the right gastro-epiploic vessels, pass below the 

 pylorus into the pancreatico-duodenal fold to reach the coeliac 

 glands. The lymphatics of the fundus accompany the vasa brevia 

 of the splenic artery in the gastro-splenic omentum, and pass to 

 the glands near the hilus of the spleen. These glands in turn 

 discharge into the cceliac glands. In the lesser omentum a few 

 lymphatic trunks pass directly from the pylorus to the glands in 

 the portal fissure. 



Carcinoma of the pylorus involves both upper and lower 

 lymphatic areas. It extends chiefly along the lesser curvature, 



