THE STOMACH. 



907 



The size of the stomach varies considerably in different subjects. When mod- 

 erately distended its greatest length, from the top of the fundus to the lowest part 

 of the greater curvature, is from ten to twelve inches; and its diameter at the 

 widest part from four to five inches. The distance between the two orifices is three 

 to six inches, and the measurement from the anterior to the posterior wall three 

 and a half inches. Its weight, according to Clendinning, is about four ounces and 

 a half, and its capacity in the adult male is five to eight pints. 



Alterations in Position. There is no organ in the body the position and connections of which 

 present such frequent alterations as the stomach. When empty, it lies at the back part of the 

 abdomen, some distance from the surface. Its pyloric end is situated close to or very slightly to 

 the right of the middle line, covered in front by the left lobe of the liver, and being on a level 

 with the first lumbar vertebra. When empty, the stomach assumes a more or less cylindrical 

 form, especially noticeable at its pyloric end. When the stomach is distended, its surfaces, which 

 are flattened when the organ is empty, become convex. The greater curvature is elevated and 

 carried forward, so that the anterior surface is turned more or less upward and the posterior 

 surface downward, and the stomach brought well against the anterior wall of the abdomen. Its 

 fundus expands and rises considerably above the level of the cardiac orifice : in doing this the 



FIG. 492. The mucous membrane of the stomach and duodenum with the bile-ducts. 



Diaphragm is forced upward, contracting the cavity of the chest. ; hence the dyspnoea complained 

 of, from inspiration being impeded. The apex of the heart is also tilted upward ; hence the 

 oppression in this region and the palpitation experienced in extreme distention of the stomach. 

 The left lobe of the liver is pushed to the right side. When the stomach becomes distended 

 the change in the position of the pylorus is very considerable; it is shifted to the right, seme 

 two or three inches from the median line, and lies under cover of the liver, near the neck of the 

 gall-bladder. In consequence of the distention of the stomach the lesser cul-de-sac bulges over 

 the pylorus, concealing it from view, and causing it to undergo a rotation, so that its orifice is 

 directed backward. During inspiration the stomach is displaced downward by the descent of 

 the Diaphragm, and elevated by the pressure of the abdominal muscles during expiration. 

 Pressure from without, as from tight lacing, pushes the stomach down toward the pelvis. In 

 disease, also, the position and connection of the organ maybe greatly changed, from the accumu- 

 lation of fluid in the chest or abdomen, or from alteration in size of any of the surrounding 



