1002 THE ORGANS OF DIGESTION. 



vertically as Luschka puts it, unless in the infant or in the female deformed by 

 corsets. It is directed from above and the left downward and forward to the 

 right. An empty stomach may hang nearly vertically and present an anterior 

 and a posterior surface, but there is usually some obliquity. If the small intes- 

 tines are much distended it may be transverse, or if rigor mortis be rapid it may 

 be cylindrical, especially below. 



In moderate distention the cardia lies 23 cm. (1 inch) below the cesophageal 

 opening of the diaphragm (Fig. 626). 



This point is distant about 11 cm. from the anterior body-wall, is opposite the 

 sternal junction of the left seventh costal cartilage, and that corresponds to the 

 left side of the eleventh thoracic vertebra. A horizontal line drawn backward 

 from the ziphoid cartilage to the vertebral column marks the transition from cardia 

 to oesophagus. The fundus is 3-5 cm. higher than the cardia. It lies in the left 

 hypochondrium and, if distended, against the left cupola of the diaphragm, which 

 separates it from the overlying lung. Its highest point on the cadaver reaches a 

 horizontal line connecting the sternal end of the left sixth costal cartilage and the 

 vertebral end of the tenth rib. 



In its full condition the fundus lies upon the upper half of the inner surface 

 of the spleen, connected by the gastro-splenic omentum. A full stomach there- 

 fore may intrude upon respiration, or it may touch the left part of the central 

 tendon and exert an influence on the heart's action, or may compress the big ves- 

 sel trunks on the vertebral column. 



The anterior surface of the body of the stomach touches on the left the poste- 

 rior surface of the anterior thoracic Avail, where it is covered by the anterior parts 

 of the seventh, eighth and ninth ribs. The part of the lesser curvature lying 

 next is covered by the liver. Thus one finds in the so-called gastric fossa of the 

 abdomen not only the stomach but the liver in front of it. Between the part 

 covered by the liver and that covered by the left ribs, there is a triangular section 

 of about 40 sq. cm. of the anterior wall of the stomach in contact with the 

 abdominal wall. It is bounded on the left by the cartilaginous ends of the 

 seventh, eighth and ninth ribs, on the right by the anterior margin of the liver, 

 and below by the transverse colon. This is the only part of the stomach to be 

 actually seen when the subject is opened. This is the part which the surgeon 

 can readily approach in operation. In the new-born the stomach is wholly covered 

 by the left lobe of the liver. 



The posterior surface of the body covers, in moderate distention, the end of 

 the transverse colon and its splenic flexure. The greater part of the posterior 

 surface of the stomach rests on a "bed " formed largely by the transverse colon 

 and its upper layer of mesocolon. If the organs are hardened in situ, the trans- 

 verse mesocolon Avill be found to present a concavity directed upward, correspond- 

 ing to the convex shape of the stomach, and thus the latter receives great support. 

 Still in this bed are the pancreas with the splenic vessels running along its upper 

 border, the upper part of the left kidney, the left suprarenal capsule, spleen, 

 bursa omentalis, duodenum, and left crus of diaphragm .(Fig. 680). Cases are 

 known where ulcers on this surface of the stomach have perforated branches of 

 the splenic artery and caused fatal haemorrhage. 



The lesser curvature, with its concavity directed to the right and upward toward 

 the under surface of the liver, descends in front of the vertebral portion of the 

 diaphragm at first quite obliquely along the left side of the eleventh and twelfth 

 thoracic vertebrae, then crosses the vertebral column at the level of the first lumbar 

 vertebra, and then ascends into the pylorus. The greater curvature forms a con- 

 vex arch directed below. In moderate distention it crosses the epigastrium in a 

 line which connects the cartilages of the two ninth or tenth ribs. This line 

 usually lies two fingers' breadth above the umbilicus. In great distention the 

 great curvature can reach it, and in pathological cases can descend far below it. 

 The portio pylorica, bent backward and outward, lying in the epigastrium, is 

 covered by the quadrate lobe of the liver. The pylorus is to the right and some- 



