1172 



THE DIGESTIVE SYSTEM. 



and to the right to join the pylorus, which is often placed quite superficially below the 

 liver. As a result of the displacement, the left extremity of the pancreas is pushed 

 downwards from the horizontal until it almost assumes a vertical position. The narrowing 

 and inversion of the inferior margin of the thoracic framework at the same time constri 

 the stomach about its middle, and may lead to a bilocular condition. 



'icts 



Hour-glass or Bilocular Stomach. This is a condition of the organ, by no means rare, 

 in which the stomach is more or less completely separated into two divisions a cardiac and 

 a pyloric the normal arrangement in certain rodents and other animals. As a rule the former 

 division is the larger, but occasionally the two are nearly equal, or the pyloric portion may 

 exceed the cardiac in size. Sometimes the condition is temporary, and the result of a vigorous 

 contraction of the circular muscular fibres at the seat of constriction. In other cases it is 



FIG. 923. 



A. Empty stomach in vertical position as denned by the X-rays. 



B. Filled stomach in vertical position as seen with the X-rays. 



C. Half-filled stomach in vertical position as seen with the X-rays. 



D. Half-filled stomach in horizontal position as seen with the X-rays. 



permanent, and may be due to cicatricial contraction after gastric ulcer, or to some other patho- 

 logical condition. The condition is more frequent in the female than the male, and is rarely 

 found in the fo3tus or child. 



Position of the Stomach. When empty, or nearly so, the stomach lies in the 

 left hypochondrium and left part of the epigastrium, with its fundus directed 

 posteriorly towards the diaphragm, its long axis lying almost in a horizontal 

 plane and its pyloric part running to the right to join the duodenum. In 

 this state the whole organ is narrow and attenuated, particularly the pyloric part, 

 which is contracted, and resembles a piece of thick-walled small intestine. 



When distended, both the cardiac and pyloric parts become full and rounded 

 (Fig. 923). It still lies within the hypochondriac and epigastric regions ; but in 

 exceptional cases, or in extreme distension, it may pass down below the subcostal 

 plane and reach into the umbilical and left lumbar regions. As a result of the 



