Chap, xvii.] ABDOMINAL VISCERA. 327 



I have described a strangulated hernia in this 

 position which was exposed by operation. 



THE STOMACH. 



Above. 

 Liver, small omentum, diaphragm. 



Behind. 



In front. 



(From left to right) 



diaphragm, abdominal 



wall, liver. 



Stomach. 



Transverse meso-colon, 

 pancreas, crura, solar 

 plexus, great vessels, 

 spleen, left kidney, and 

 capsule. 



Below. 

 Great omentum, transverse colon, gastro-splenic omentum. 



When empty, the stomach lies at the back of the 

 abdomen, beneath the liver and some way from the 

 surface. When distended, the greater curvature is ele- 

 vated and carried forwards, the anterior surface is 

 turned upwards, and the posterior downwards (Fig. 

 34). The direction of the rotation depends upon 

 the fixity of the smaller curvature. When dis- 

 tended, the stomach is brought well against the 

 anterior belly wall, and may occupy the whole of the 

 middle line as far as the navel. Thus the stomach 

 is much more exposed to injury when full than 

 when empty. The cardiac orifice is situate behind 

 the seventh left costal cartilage, about one inch from 

 the sternum (Fig. 30). The pylorus, when the viscus 

 is empty, lies just to the right of the middle line, from 

 two to three inches below the sterno-xiphoid articula- 

 tion on the level of a line drawn between the bony ends 

 of the seventh ribs. When the stomach is distended 

 the pylorus may be moved nearly three inches to 

 the right (Braune). The cardiac orifice is on a level 

 behind with the ninth dorsal spinous process, the 

 pylorus with the twelfth dorsal spine (Fig. 31). A 

 horizontal line drawn between the extreme tips of the 

 tenth costal cartilages will about correspond to the 

 lower border of the non-distended stomach. The 



