320 The Stomach 



the hard masses fall against the lesser curvature and the cardiac end, 

 and, irritating the pneumogastric, cause irregularity of the heart's action, 

 palpitation, and faintness, or, perhaps, asthma. After an attack of 

 vomiting the symptoms promptly subside. 



Structure. The stomach and intestine consist for the most part of 

 serous, muscular, submucous, and mucous coats. The muscular coats 

 consist of pale fibres arranged longitudinally, and, more deeply, in a 

 circular manner, the circular fibres being aggregated to form the 

 pyloric sphincter above and the internal sphincter ani below. 



On the stomach the longitudinal fibres (continuous above and 

 below with those of the oesophagus and duodenum) are chiefly along 

 the two curvatures. The oblique fibres are deeply placed at the cardiac 

 end and are continuous with the circular fibres of the oesophagus. 



The stomach is invested front and back by peritoneum, which 

 comes down in the gastro-hepatic omentum and is continued from the 

 lower curvature as great omentum. 



The mucous membrane from the cardiac orifice of the stomach to 

 the anal part of the rectum is lined with columnar epithelium ; columnar 

 epithelioma is, therefore, the variety of malignant disease generally 

 associated with the alimentary canal. 



When a piece of intestine is wounded, as in a stab in the abdomen, 

 the mucous membrane bulges through the wound in the serous and 

 muscular coats and so plugs the opening. 



The arteries of the stomach come from the gastric, splenic (vasa 

 brevia and left epiploic), and hepatic (pyloric and right epiploic). The 

 veins are tributaries of the portal vein and run chiefly along the greater 

 curvature. They are often found much congested after death ; such 

 venous fulness is very different from the widely-spread congestion 

 of the capillaries found after irritant poisoning, and may be recog- 

 nised on opening the stomach and holding it up to the light. The 

 nerves are the pneumogastrics, and branches of the solar plexus ; the 

 left pneumogastric passing chiefly to the anterior surface. The lym- 

 phatics end in glands along the curvatures, and are associated with the 

 mediastinal glands, and indirectly also with those of the root of the 

 neck (p. 140). 



Gastric catarrh interferes with digestion and causes a feeling of 

 fulness in the region of the stomach. The food undergoes decom- 

 position in the stomach, gas being evolved, and the patient is worried 

 with eructations, oppressed breathing, and cardiac disturbance, the 

 diaphragm being raised by the distended stomach. The inflammation 

 is chiefly along the greater curvature, so that discomfort occurs im- 

 mediately food is taken into the stomach ; whereas, in the case of 

 gastric ulcer, the lesion is probably near the lesser curvature, so that 

 pain does not come on so quickly after the meal. Though it is often 

 difficult to differentiate between catarrh and ulcer, an important sign is 

 that pain occurs only when food is in contact with the ulcer, so that 



