470 ABDOMEN 



In both cases, it occupies more space within the abdomen by 

 the displacement of neighbouring viscera, and the pylorus 

 moves to the right, but not as a rule more than an inch and 

 a half, or at most two inches, from the medial plane. The 

 pylorus does not alter in a vertical direction ; it main- 

 tains the same level within the abdomen. The position of 

 the cardiac opening is only slightly affected by the emptying 

 or the distension of the stomach. It is placed opposite the 

 body of the tenth dorsal vertebra, and on the surface of the 

 body its situation may be indicated by placing the finger on 

 the seventh costal cartilage of the left side about one inch 

 from the median plane. 



As the stomach fills it becomes more rounded in general 

 outline, and should it assume the oblique position when full 

 the fundus is directed upwards whilst the surfaces look 

 forwards and backwards ; further, the part of the greater 

 curvature opposite the incisura angularis takes a medial 

 position and occupies a lower level than any other part of 

 the stomach. It follows from this that the pyloric part 

 of the organ courses upwards and to the right to reach its 

 termination. 



In considering the various conditions which determine the position and 

 form of the full stomach it is necessary to take into account the state of the 

 movable, and as a rule yielding, floor of the stomach chamber. It is 

 possible that the easiest and most natural way for the stomach to expand, 

 under ordinary circumstances, is in a downward direction by intestinal 

 displacement, and when this occurs the oblique portion of the organ is the 

 result. But when the intestines are distended the stomach cannot acquire 

 the necessary space in this manner, and the liver, which forms so large a 

 part of the roof of the stomach chamber, has to give way before it. The 

 obvious result of such a change in the position and form of the pliant liver 

 is that the full stomach retains the horizontal position. 



The dissector must remember that the above description 

 refers to the appearance presented by the stomach fixed and 

 hardened after death when the body is lying on its back. It 

 probably has a very similar form and similar relations during 

 life when the body is recumbent, but when the body is erect 

 the oesophageal orifice and the fundus retain their close 

 relationships to the diaphragm and the pylorus remains at 

 the level of the transpyloric plane, but the lowest part of the 

 great curvature descends to or below the level of the 

 umbilicus, and the upper two-thirds of the organ becomes 

 more tubular and lies more in a vertical plane. 



The Abdominal Part of the (Esophagus. The abdominal 



