CHAPTER XXII. 

 STOMACH. 



ANATOMY. LANDMARKS. 



ULCER. DISEASES. 



REFLEX NEUROSES. OPERATIONS. 



The stomach is subject to variations with reference to 

 its size and position in accordance with the amount of dis- 

 tention present. In the empty state, this viscus lies in the 

 epigastric and left hypochondriac regions, and is irregu- 

 larly conical in shape, with a base, or fundus, to the left 

 of the vertebral column and an apex the pylorus in 

 front of, or to the right of the vertebral column. The 

 stomach does not lie vertically in the abdomen. It is so 

 situated that the fundus, which is fixed to the diaphragm 

 by the oesophagus and the gastro-phrenic ligament, is on a 

 higher level than, and is posterior to, the pylorus, with the 

 result that this organ is obliquely situated, both from 

 above downwards and forwards, and from without in- 

 wards. When distended, the fundus presses up against 

 the diaphragm, while the pylorus is shifted to the right 

 and at the same time rotated to such a degree, that it is 

 directed towards the back. This is possible, since the 

 pyloric end is the most movable part of the stomach, even 

 though it is supported by the attachment of the duodenum 

 to the posterior wall of the abdomen. This rotation of 

 the pyloric end causes the greater curvature to be applied 

 to the abdominal wall, and, in addition, alters the direction 

 of the surfaces of the stomach. These surfaces are term- 

 ed anterior and posterior, and are connected above by the 

 lesser curvature, and below by the greater curvature; 

 while at the junction of the curvatures, on the left, is situ- 

 ated the cesophageal opening, and, on the right, the pyloric 



