906 THE ORGANS OF DIGESTION. 



The anterior surface has a somewhat flattened appearance when the stomach is 

 empty, but when it is full the surface becomes convex. It is in relation with the 

 Diaphragm ; the thoracic wall formed by the anterior parts of the seventh, eighth, 

 and ninth ribs of the left side ; the left lobe of the liver ; and the anterior 

 abdominal wall. Between the part covered by the liver and that covered by the 

 left ribs there is a triangular segment of the anterior wall of the stomach, which 

 is in contact with the abdominal wall and is the only part of the stomach which 

 is visible when the abdominal wall is removed and the viscera allowed to remain 

 in situ. It is of about 40 sq. cm. and is of great importance to the surgeon, as 

 the stomach can readily be reached in this situation. Occasionally the transverse 

 colon may be found lying in front of the lower part of the anterior surface of the 

 stomach. The whole of this surface of the stomach is covered by peritoneum. 



The posterior surface of the stomach is in relation with the Diaphragm, the 

 gastric surface of the spleen, the left supra-renal capsule, the upper part of the left 

 kidney, the anterior surface of the pancreas, the splenic flexure of the colon, and 

 the ascending layer of the transverse mesocolon. These structures form a .shallow 

 concavity or bed on which this surface of the stomach rests. The transverse 

 mesocolon intervenes between the stomach and the duodeno-jejunal junction and 

 commencement of the ileum. Its greater curvature is in relation with the trans- 

 verse colon and has attached to it the anterior two layers of the great omentum. 

 Almost the whole of this surface is covered with peritoneum, but behind the 

 cardiac orifice there is a small portion of the stomach which is uncovered by 

 peritoneum and is in contact with the Diaphragm and frequently with the upper 

 portion of the left supra-renal capsule. 



The lesser curvature of the stomach extends between the cardiac and pyloric 

 orifices along the right border of the organ. It descends in front of the left crus 

 of the Diaphragm, along the left side of the eleventh and twelfth dorsal vertebrae, 

 and then turning to the right it crosses the first lumbar vertebra and ascends to 

 the pylorus. It gives attachment to the two layers of the gastro-hepatic omentum, 

 between which blood-vessels and lymphatics pass to reach the organ. 



The greater curvature is directed to the left, and is four or five times as long 

 as the lesser curvature. Starting from the cardiac orifice, it forms an arch to the 

 left with its convexity upward, the highest point of which is on a level with the 

 costal cartilage of the sixth rib of the left side. It then passes nearly straight 

 downward, with a slight convexity to the left, as low as the costal cartilage of 

 the ninth rib and then turns to the right to end at the pylorus. As it crosses the 

 median line the lowest edge of the greater curvature is about two fingers' breadth 

 above the umbilicus. The lower part of the greater curvature gives attachment to 

 the two anterior layers of the great omentum, between which layers, vessels and 

 lymphatics pass to the organ. 



The cardiac orifice is the opening by which the oesophagus communicates with 

 the stomach. It is therefore sometimes termed the oesophageal opening. It is 

 the most fixed part of the stomach, and is situated about two inches below the 

 highest part of the fundus on a level with the body of the tenth or eleventh 

 dorsal vertebra to the left and a little in front of the aorta. This would correspond 

 on the anterior surface of the body to the articulation of the seventh left costal 

 cartilage to the sternum. 



The pyloric orifice communicates with the duodenum, the aperture being 

 guarded by a valve. Its position varies with the movements of the stomach. 

 When the stomach is empty the pylorus is situated just to the right of the median 

 line of the body, on a level with the upper border of the first lumbar vertebra. 

 On the anterior surface of the body its position would be indicated by a point one 

 inch below the tip of the ensiform cartilage and a little to the right. As the 

 stomach becomes distended the pylorus moves to the right, and in a fully distended 

 stomach may be situated two or three inches to the right of the median line. 

 Near the pylorus the stomach frequently exhibits a slight dilatation, which is 

 named the antrum pylorus. 



