962 



THE ORGAXS OF DIGESTION 



of devc'lopmeiit the orsan is certainly 

 may be maintained throughout life. 



vertical, and in rare instances this position 

 As a rule, however, the organ is placed 

 obliquely, and lies in the left hypochondriac and epigastric regions (figs. 578, 582, 

 and 58o). Its position, under normal conditions, must be liable to much 

 variation. 



The cardiac end, or fundus, reaches as high as the level of the sixth chondro- 

 sternal articulation, being a little above and behind the heart apex. The cardiac 

 orifice is opposite the seventh left costal cartilage, and is about one inch from the 

 sternum. Behind, it is about on the level Avith the body of the tenth or eleventh 

 dorsal vertebra. The pylorus is on a lower level and nearer the surface than the 

 cardiac end, and is opposite a point to the right of the middle line two to three 

 inches below the sterno-xiphoid articulation, on the level of a line drawn between 

 the bony ends of the seventh ribs (fig. 582). Behind, it is on a level with the 

 twelfth thoracic spine (fig. 583). Its position is nmch influenced Ijy the state 

 of distension of the stomach. 



Tiie posterior sxirface of the stomach looks backwards and downwards, lying on 

 the transverse meso-colon, spleen, splenic arter}^, pancreas, left kidney and supra- 

 renal capsule, and great abdominal vessels (figs. 586, 590). 



Above. 

 Liver, small omentum, diaphragm. 



Ix Feont. 



(From left to right.) 



Diaphragm, abdominal wall, 

 liver. 



GENERAL RELATIONS 



OF THE 



STOMACH 



Behind. 



Trausverse meso-colon, pancreas, 

 crura, solar plexus, great ves- 

 sels, spleeu, left kidney, and 

 capsule. 



Below. 

 Great omentum, transverse colon, gastro-splenic omentum. 



The anterior surface looks upwards and forwards. Its relations are of import- 

 ance in connection with the operation of. gastrostomy. A certain portion of this 

 surface comes into immediate contact with the abdominal wall; this portion is 

 triangular in shape, is bounded on the right by the edge of the liver, and on the 

 left by the cartilages of the eighth and ninth ribs; and below by a horizontal line 

 passing between the tips of the tenth costal cartilages (fig. 582). Besides the 

 abdominal wall, this surface is covered by the diaphragm and the under surface of 

 the left lol)e of the liver (fig. 590). 



Relations to the peritoneum, — The stomach is covered by peritoneum in its 

 whole extent, except immediately along the curvatures and upon a small triangular 

 space at the back of the cardiac orifice, where the viscus lies in direct contact with 

 the diaphragm and possibly with the upper part of the left supra-renal capsule. 

 It is enclosed between two layers. These two layers at its upper border or lesser 

 curvature come together to form the lesser omentum, and at the lower border or 

 greater curvature extend downwards, to form the great omentum (figs. 562, 563). 

 At the left of the oesophagus the two layers pass to the diajihragm, forming the 

 gastro- phrenic ligament; and at th(^ fundus they pass on to the sjileen, forming the 

 gastro-splenic omentum. 



Alteration of position. — When the stomach is em])ty the surfaces are flat 

 and the ])yl()rie end is situated near the median plane and under cover of the liver. 

 As it distends, it occupies the left dome of the diaphragm and tilts up the heart 

 apex. Moreover, it undergoes some alteration in position. The greater curvature 

 is elevated and carried forwards, the anterior surface is directed u}) wards, and the 

 posterior downwards, and the pylorus ]iasses some inches to the right. The pyloric 

 orifice, which in the empty stomach looks to the right, is so turned as to look back- 



