360 CLINICAL APPLIED ANATOMY. 



Large secondary growths in the liver are due to infection carried 

 by the portal vein direct. 



Carcinoma of the stomach has a tendency to become adherent 

 to neighbouring parts, and invasion through the medium of the 

 adhesions may occur. The pyloric branch of the hepatic artery 

 is sometimes eroded. 



The gastric growth soon ulcerates through the mucous mem- 

 brane, and presents as a foul ulcer owing to its exposure to the 

 gastric contents. A diffuse infiltration of the stomach wall may 

 occur, giving rise to what is known as the " leather bottle 

 stomach." Growth at the pylorus is in a position to cause 

 obstruction, and so lead to dilatation, whilst growth at the cardia 

 may hinder the entry of food into the stomach, and considerable 

 atrophy of the organ result. 



Dilatation of the stomach is due to various causes. Acute 

 dilatation is a form which comes on abruptly, and is very fatal, 

 but is fortunately rare. In atonic dilatation the muscular wall is 

 at fault. Habitual over-distension with food or drink may have 

 the same result. Obstructive dilatation may be due to changes 

 in the walls of the pyloric portion, or in the duodenum or 

 to pressure from without. The pyloric sphincter involves nearly 

 an inch of the stomach wall adjacent to the pyloric orifice, and 

 is capable of great dilatation. Foreign bodies with a diameter 

 of over three-quarters of an inch have passed through it. 

 Malignant disease, cicatrices, and benign growths may narrow 

 its lumen. It is sometimes the seat of congenital hypertrophy, 

 which also obstructs the exit. 



Since the pylorus rests on the neck of the pancreas and is 

 overlapped by the liver, it is not surprising that it is occasionally 

 obstructed by tumours of these organs. It also lies in close 

 relation with the under surface of the gall bladder, and as the 

 result of cholecystitis or of pyloric ulceration the two may 

 become adherent. The pressure exerted by a movable and 

 displaced kidney upon the duodenum or pylorus may also give 

 rise to intermittent obstruction to the exit of gastric contents. 

 Obstruction may be caused by tumours of the omentum, 



