300 



DISSECTION OF THE ABDOMEN. 



Position 

 and rela- 

 tions of the 



stomach : 



cardiac 

 orifice, 



surface 

 marking, 



fundus ; 



small 

 curvature ; 



pyloric end. 



Surface 

 marking. 



upper 



and lower 

 surfaces ; 



great curva- 

 ture is least 

 fixed part. 



Changes ii 

 form and 

 position ; 



empty 

 and full 

 stomach. 



RELATIONS OF THE VISCERA. 



The STOMACH (figs. 110 and 111, p. 303) intervenes between the 

 gullet and the small intestine, and is partly retained in position by 

 folds of the serous membrane. It is somewhat pyriform in shape, 

 with the larger end on the left side ; and it is placed in the left 

 hypochondriac and epigastric regions, and reaches to the upper part 

 of the umbilical. 



At its large end the stomach is joined by the oesophagus, which 

 fixes it to the diaphragm. The opening of the oesophagus into the 

 stomach, because of its nearness to the heart (from which it is only 

 separated by the diaphragm and pericardium), is named the cardiac 

 orifice, and lies behind the seventh costal cartilage of the left side, 

 about an inch from its junction with the sternum, being on a level 

 with the tenth dorsal vertebra. To the left of the orifice, the stomach 

 bulges upwards to its summit in the left vault of the diaphragm, and 

 lies behind the fifth rib in the left lateral line (fig. 111). The con- 

 cave border of the stomach to the right of the oesophagus is the 

 lesser curvature, and is attached to the liver by a fold of peritoneum 

 the small omentum. 



The right extremity leads into the small intestine (duodenum) 

 by the pyloric orifice, the situation of which is indicated externally 

 by a slight constriction of the tube, and a thickened band in the 

 wall that may be felt with the finger. The pyloric end of the stomach 

 is placed beneath the liver, a little to the right of the middle line in 

 the transpyloric plane, at the level usually of the disc between the 

 first and second lumbar vertebrae. 



The upper surface (which looks also somewhat forwards) of the 

 stomach is in contact above and to the right with the liver, on the 

 left with the diaphragm, and between these with the abdominal 

 wall. The lower surface (compare fig. Ill and fig. 112, p. 305) lies 

 over the spleen, to which it is connected by a fold of peritoneum 

 (gastro-splenic omentum), the left kidney and suprarenal capsule, the 

 pancreas, and the transverse meso-colon. This surface looks also 

 backwards. 



The convex border or greater curvature is directed to the left 

 forwards and downwards, and has the great omentum attached to 

 it ; along it lies the transverse colon. 



The form and position of the stomach vary with its degree of 

 distension. When the organ is empty, it is flattened, and the 

 pyloric end reaches but little to the right of the middle line. But 

 when full, the stomach becomes rounded, and its upper surface is 

 directed somewhat upwards and forwards, filling particularly the 

 left hypochondriac and epigastric regions ; the fundus pushes upwards 

 the diaphragm, pressing on the heart and left lung ; the great curva- 

 ture moves somewhat to the left and downwards, as well as forwards ; 

 and the pyloric extremity is carried an inch or so to the right. As 

 will, however, be pointed out later on, the full stomach is accommo- 

 dated to a great extent in a deep hollow to the left of the vertebral 



