THE ABDOMINAL CAVITY 299 



different directions from three areas, which may be roughly 

 indicated in the following way. A line is drawn from the highest 

 point on the fundus downwards and to the right to the pylorus 

 so as to divide the organ into an upper, larger, and a lower, 

 smaller area. The latter is again subdivided by a line drawn 

 upwards from the middle of the greater curvature. 



The primary lymph glands of the upper area are (i) the 

 coronary group, and (2) the supra-pyloric lymph gland. The 

 coronary group lies between the two layers of the lesser omentum, 

 and is closely associated with the left gastric vessels, while the 

 lymph stream flows in the same direction as the coronary vein 

 as far as the cceliac artery. The supra-pyloric lymph gland lies 

 immediately above the pylorus in association with the right 

 gastric vessels, and the lymph stream in this small area follows 

 the course of the hepatic artery. From both the efferents pass 

 to the cceliac lymph glands, which therefore constitute the 

 secondary or main group for the upper area of the stomach. They 

 lie around the trunk of the cceliac (axis) artery and belong to 

 the pre-aortic group (Fig. 95). 



The primary lymph glands of the right lower area lie between 

 the two anterior layers of the greater omentum in relation to 

 the right gastro-epiploic vessels. They form the inferior gastric 

 chain, and those near the pylorus are termed the sub- and retro- 

 pyloric glands. Their efferents accompany the gastro-duodenal 

 and hepatic arteries and end in the cceliac group. 



The primary lymph glands of the left lower area lie along the 

 upper border of the body and tail of the pancreas. Their affer- 

 ents from the stomach reach them by passing through the gastro- 

 splenic ligament ; their efferents terminate in the cceliac group. 



The direction of the lymph flow from the three areas 

 described above is of great practical importance in connection 

 with malignant disease of the stomach. This condition usually 

 begins near the pylorus and spreads upwards along the lesser 

 curvature in the direction of the lymph flow. Its removal 

 therefore necessitates the excision of as much of the lesser 

 curvature as possible, and a not inconsiderable portion of the 

 greater curvature as well. 



Owing to the direction of the lymph stream, the disease 

 rarely spreads to the duodenum, and therefore only its first 

 inch or so requires to be removed. In addition, the coronary, 

 supra-pyloric, and inferior gastric lymph glands must be taken 

 away in order to minimise the chances of recurrence. 



