1374 



CLINICAL AND TOPOGRAPHICAL ANATOMY 



with, the patient standing upright, the cardiac portion (the fundus and body- 

 together) is vertical, and the smaller pyloric portion is directed backward and to 

 the right and slightly upward (fig. 1125). The most fixed point is the cardiac 

 orifice. 



The cardiac orifice lies under the seventh left costal cartilage 2 cm. (f in.) from the sterno- 

 xiphoid junction at a depth of about 10 cm. (4 in.) from the surface. Behind, this point corre- 

 sponds to the tenth thoracic vertebra. 



The pyloric orifice Hes in the transpyloric plane when the patient is recumbent, but'when the 

 patient is standing it falls to the level of the second or third lumbar vertebra, or lower still 



Fig. 1108. — Photograph of an Empty Stomach. (J. S. B. Stopford.) 



when any transient faintncs.s or nausea causes loss of muscular tone (Barclay). The pylorus is 

 slightly to the right f)f tlie middle line in the empty stomach. As the stomach fills it descends 

 further and moves a litt 1(; further to the right. The Ic.sucr curvature presents a definite notch at 

 the junction of the cardiu(! und pyloric; portions of the stomach — the incisura aiigidaris. The 

 yrealer curvature reaches the umbilical i)laiie in the erect posture, even when the stomach is 

 empty. When the viscus is full this curval uro lies distinctly below this plane, being lower in 

 women than in men (Hertz). The pi/ldric portion of the full stomach is directed backward 

 and u little upward, as the disteridcwl pyloric vest ibulc moves furt her to the riglit than the pyloric 

 orifice und lies on an anterior plane. In IIk; rc^cumbent posture the greater curvul ure lies above 

 the lunbilical [jlane, even when moderately distcsiided, and the stomach is more oblicpiely placed. 

 'VliafariiluH invarial)ly contains gas, even when the stomach contains no food, in which case the 

 org.iii forni.s u contracted J-sluiped tulx' ((ig. J lO.S). In cxtrenie distention the left dome of the 

 diaphragm is so j)ushed up by t lie fundus that it lies at a level as high as or even higher than the 



