18 



DISEASES OF THE DIGESTIVE APPARATUS 



abdominal wall, but between that and the wall lies the left lobe of the 

 liver. This left lobe extends as far as the pelvis, coming close to the left 

 kidney; the left or cardiac end of the stomach extends as far as the ninth 

 rib and posteriorly as far as the thirteenth rib and the anterior border of 

 the left kidney. The right or pyloric end of the stomach is directed on 

 the median line to the right. The larger part of the stomach is enclosed 

 by the liver and the diaphragm coming in contact with the anterior side. 

 The cardiac end of the stomach is directed toward the median line and 

 the pyloric toward the right. The empty stomach (Fig. 8) extends 

 anteriorly as far as the left pillar of the diaphragm and toward the chest 

 as far forward as the tenth rib and posteriorly as far as the twelfth rib, 



Fig. 7. — Section through centre of abdomen. 



and is completely covered by the liver on the left side. Only a very small 

 part of it comes in contact with the diaphragm and the inferior face of the 

 ninth and tenth dorsal vertebra. The pyloric opening is directed toward 

 the right and very slightly forward (Fig 9). When the stomach is 

 very much distended with gas or food, it comes almost directly in contact 

 with the abdominal walls, and when greatly distended it extends as far as 

 the umbilical region and lies against the ribs and the left abdominal wall 

 and the left and ventral lobes of the liver being pushed almost entirely 

 away from the surface of the stomach, depending on the amount of the 

 distention. 



From the above anatomical details it can be readily seen that it is 

 nearly impossible to make a reliable examination of the stomach when it 

 is empty or even when it is fairly well distended. The cardiac and pyloric 



