THE STOMACH. 1003 



what below the ziphoid process between the sternal and parasternal lines on a 

 level with the upper edge of the first lumbar vertebra. This may extend into the 

 right hypochondriurn. In an empty, fasting stomach these relations are all 

 changed and the surfaces of contact are small. In a well-filled stomach a 

 twist of the organ occurs, so that the anterior surface comes to be more superior 

 and the posterior surface more inferior. The lesser curvature is more directed 

 toward the vertebral column and the greater curvature toward the anterior abdomi- 

 nal wall. The pylorus also moves more to the right. 



Relations of Stomach in Detail. 



Cardia. opposite left 7th chondro-sternal junction. 



Fundus reaches left 6th costal cartilage and left cupola of diaphragm. 



Pylorus reaches upper border of 1st L. vertebra to the right of the median 

 line. 



Lowest edge of greater curvature in median line reaches to within two fingers' 

 breadth of the umbilicus. 



Anteriorly : 



Diaphragm ; . 



Thoracic wall formed by anterior parts of 7th, 8th, and 9th ribs ; 



Quadrate and left lobes of liver; 



Anterior abdominal wall. 



Posteriorly, or "bed:" 

 Diaphragm ; 



Left crus of diaphragm ; 

 Aorta and vena cava inferior ; 

 1st lumbar vertebra; 

 Coeliac axis ; 



Bursa omentalis (lesser sac) ; 

 Splenic flexure_of colon; 

 Transverse colon ; 



Transverse mesocolon (upper layer) ; 

 Gastric surface of spleen ; 

 Left kidney and capsule ; 

 Pancreas ; 

 Splenic vessels; 

 4th part of duodenum. 



Right End : 



Junction of transverse colon and under surface of liver. 

 Left End: 



Spleen ; 



Diaphragm. 



The peritoneal relations of the stomach have in general been described. It 

 presents double "peritoneal lines" on both curvatures and fundus, showing the 

 cut edges of peritoneum. Above, in front of the cardia is the attachment of the 

 gastro-phrenic ligament running down along the lesser curvature as the anterior 

 layer of the lesser omentum. Behind it, separated by a linear space where the 

 stomach is uncovered, is the line for the posterior layer of the lesser omentum. 

 Larger triangular spaces are left uncovered at either end of the stomach. On 

 the greater curvature is the double line indicating the two layers of the anterior 

 lamella of the great omentum running on the left into the two lines of the gastro- 

 splenic omentum. 



Points of Fixation of the Stomach. It is a part very well secured, especially 

 by the oesophagus fastened to the diaphragm and by the duodenum firmly bound 



