Stomach; Pylorus 319 



colon and coils of small intestine. The left end fills in the hilnm of 

 the spleen and covers the kidney. 



The heart is separated from the stomach only by the diaphragm, 

 and their close proximity goes far towards justifying the advice * If a 

 patient complain of his " stomach " suspect heart-disease ; if he com- 

 plain of his " heart " suspect indigestion.' When the stomach is 

 excessively distended it thrusts down the transverse colon and small 

 intestine, and not only obliterates the depression below the ensiform 

 cartilage, but causes it and the left ribs and their cartilages to bulge 

 forwards ; it also thrusts upwards the liver, diaphragm, and heart. 

 Thus, flatulence may seriously interfere with the working of the heart 

 as well as of the lungs. Sometimes after a heavy meal, on account of 

 this elevation of the heart, the right side is so full of venous blood 

 that the capillaries of the brain and of the head imperfectly empty 

 themselves, the face becoming flushed and the cerebral circulation 

 disturbed ; respiration also is interfered with. The fuller the stomach, 

 the farther the liver is pushed up under the right arch of the dia- 

 phragm ; and when the stomach and the alimentary canal are empty, 

 as in cancer of the oesophagus, the liver sinks towards the epigastrium, 

 for it has lost much of its support ; the diaphragm also descends and 

 the heart is found on a very low level. 



(The exact shape and size of the stomach may be made out by 

 percussion, after the patient has swallowed first some tartaric acid 

 and then some bicarbonate of soda. This method of examination 

 must not be employed if there be a question of gastric ulcer ; nor 

 indeed, is it often needed.) 



Into the cardiac end of tJie stoinacJi the oesophagus opens without 

 any other valvular arrangement than that afforded by the muscular 

 fibres around the aperture by which the gullet passed through the 

 diaphragm. The opening is at about the level of the tenth dorsal 

 vertebra, a little to the left- behind the seventh costal cartilage. 

 The right end is continuous with the duodenum, the junction being 

 marked by a thickening of the circular fibres to form the pyloric valve 

 (TTiAj/, gateway), which, when the stomach is empty, lies behind the 

 liver, about a couple of inches below the gladiolus, and a little to the 

 right of the linea alba, at the level of the first lumbar vertebra. When 

 the stomach is distended the pylorus is thrust into the right hypo- 

 chondriac region, where it lies behind the right lobe of the liver and the 

 upper false ribs. 



The upper border of the stomach is short and concave, and is fixed 

 to the liver by the gastro-hepatic omentum, between the layers of which 

 are the coronary artery and the vessels passing through the gateway 

 of the liver. From the lower, convex, border the great omentum hangs. 

 This border may descend even into the pelvis, as in the case of dilatation 

 due to pyloric stricture. 



When a person goes to bed with an undigested meal in his stomach 



