THE STOMACH 243 



The pyloric canal, which leads to the pylorus, is the 

 narrowest portion of the stomach. 



The anterior surface of the stomach lies in the posterior 

 wall of the supra- colic compartment of the peritoneal cavity, 

 and is therefore related to the great sac (Fig. 88). This 

 area lies in contact with (i) the left lobe of the liver, (2) the 

 left half of the diaphragm, and (3) the anterior abdominal 

 wall. The hepatic area consists of a strip along the lesser 

 curvature, while the diaphragmatic area consists of the fundus 

 and adjoining portion. The diaphragm separates this part of 

 the stomach from the apex of the heart, the base of the left 

 lung and the pleura. Great distension of the stomach may 

 act mechanically upon the heart, causing palpitation and 

 cardiac irregularity, and, in debilitated bed-ridden patients, it 

 may cause some collapse of the lower lobe of the left lung by 

 direct pressure. 



It is impossible to state accurately the size of a normal 

 stomach, since it is constantly undergoing changes of shape 

 which depend upon its physiological condition at the time of 

 examination. When the patient is lying on his back, the 

 positions of the cardiac orifice and the pylorus can be 

 determined with sufficient accuracy for practical purposes. 

 The cardiac orifice is placed behind the seventh left costal 

 cartilage, i inch from the sternum, while the pylorus is 

 situated on the transpyloric plane (p. 234), about half an inch 

 to the right of the median plane. A line joining the right 

 side of the cardiac orifice to the upper border of the pylorus, 

 drawn with a slight downward convexity, represents the lesser 

 curvature (Fig. 92). The greater curvature begins at the left 

 side of the cardiac orifice and passes upwards and to the 

 left, reaching its highest point on the fifth rib. It then passes 

 downwards and to the left as far as the anterior axillary line. 

 The rest of the greater curvature passes to the right with a 

 gentle downward convexity, and finally ascends rather sharply 

 to join the lower border of the pylorus (Fig. 92). 



A tympanitic stomach note is obtained on percussion over 



