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angularis on the lesser curvature, and to the notch on the greater ady described. It forms a rounded chamber, capable of great distenn the stomach is empty it contracts to a narrow tube-like structure. ich is seldom completely empty, the body usually tapers from the proximal end of the pyloric portion (Fig. 925). prica.—The pyloric portion of the stomach extends from the incisura the lesser curvature, and a variable and inconstant notch on the ture, as far as to the pyloric orifice (Fig. 925). from the body of the stomach in being more tubular in shape, and cker walls. in divided anatomically into two portions, the pyloric canal and the cum respectively. ic canal is a short more or less tubular portion rather more than ngth, extending from the sulcus intermedius on the greater curvaloric constriction. The proximal portion, called the pyloric antrum,

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Ductus hepaticus and arteria cystica

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vertebra NSVERSE SECTION OF THE TRUNK AT THE LEVEL OF THE FIRST LUMBAR VERTEBRÆ. ng relations of stomach, pancreas, kidneys, etc. From a subject ten years old.

ded. It is not clearly demarcated from the body of the stor nt line of division on the greater curvature. On the lesser curvature in the incisura angularis to the pyloric canal, and it is occasionally ards on the side of the greater curvature so as to form a chamber or emera princeps" of His.

ATIONS AND CONNEXIONS OF THE STOMACH.

mach has been removed, after the body has been hardened, a chamber or recess n as the stomach chamber. It is (Figs. 920 and 921) a space in the upper and he abdominal cavity which is completely occupied by the stomach when that ed, but into which the transverse colon also passes, doubling up in front of the he latter is empty: r presents an arched roof, an irregularly sloping floor, and an anterior wall. ed partly by the visceral surface of the left lobe of the liver, and in the rest of

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its extent by the left cupola of the diaphragm, which arches gradually downwards behind and on the left to meet the floor.

The floor or “ stomach bed” (Fig. 921) is a sloping shelf on which the posterior surface of the stomach rests, and by which it is supported. The bed is formed posteriorly by the superior pole of the left kidney (with the supra-renal gland) and the gastric surface of the spleen; anterior to this, by the wide anterior surface of the pancreas; and more anteriorly still, by the transverse mesocolon running forwards above the small intestine, from the anterior edge of the pancreas to the transverse colon (Fig. 921), which completes the floor anteriorly.

Finally, the anterior wall of the stomach chamber is formed by the abdominal wall, between the ribs on the left and the liver on the right side.

This chamber is completely filled by the stomach, when that organ is distended. When, og the other hand, the stomach is empty and contracted, it still rests on the floor, or stomach bed, but occupies only the inferior portion of the chamber, whilst the rest of the space is filled by the transverse colon, which turns gradually upwards as the stomach retracts, and finally comes to lie both above and in front of that organ and immediately beneath the diaphragm-a fact to be remembered in clinical examinations of this region.

Peritoneal Relations. — The stomach is almost completely covered by

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Cut surface of liver

Lobus caudatus A. gaatrica sinistra

1. coeliaca Lig, hepato-duodenale A. hepatica propria

Vena porte Ductus choledochus

Esophagus
Spleen
Glandula suparanta
Left kidney

A. lienalis
Flexura coli sinista

Cauda pancreatis
A. lienalis

Peritoneum dividi
Colon transvers

lie

Mescolon

transversam
A. gastro-duodenalis
Pars descendens duodeni

A. gastrica dextra
Pars superior duodení

A. hepatica
Colon transversum

Pancreas

Facies anterior pancreatis
Fig. 921.-STOMACH CHAMBER VIEWED FROM THE FRONT AND FROM BELOW.

From the specimen figured in Fig. 912, after removal of the stomach.

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peritoneum—the anterior surface being clothed by that of the general peritoneal sac, and the posterior surface by the anterior layer of the bursa omentalis (see p. 1162) From the lesser curvature the hepato-gastric ligament extends to the liver, whilst to the greater curvature the gastro-lienal and gastro-colic ligaments are attached Finally, a small peritoneal fold, known as the gastro-phrenic ligament, is found running from the stomach up to the diaphragm along the left side of the cesophagus.

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A small irregularly triangular area (Fig. 919), about 2 inches wide and 14 inches from above downwards, during moderate distension of the stomach, on the posterior surface below and to the left of the cardia, is not covered with peritoneum, and over it the organ is in direct contact with the diaphragm, occasionally also with the superior extremity of the left kidney and the suprarenal gland. From the left angle of this “ uncovered area " the attachment of the gastro-lienal ligament starts ; and at the right angle is the commencement of a fold through which the left gastric artery passes to the stomach. This fold is called the left gastro-pancreatic fold.

The right gastro-pancreatic fold is a fold of peritoneum passing from the right extremity of

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of the pancreas to the first part of the duodenum. It encloses the hepatic

Capacity of the Stomach.—Probably no organ in the body varies more ne limits of health than the stomach. Moreover, as its tissues change so eath, measurements made on softened and relaxed organs are not only aite misleading. Consequently it is difficult, perhaps impossible, to arrive mate of its size and capacity. of the stomach in the fully distended condition is about 10 to 11 inches ), and its greatest diameter not more than 4 to 41 inches (10 to 11.2 cm.); ety in the average state rarely exceeds 40 ounces, or 1 quart.

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-THE COURSE OF THE LARGE INTESTINE. The jejunum and ileum have been removed.

has been estimated by different authorities at from 10 to 13} inches (26 to 34 eter, from 3 to 6 inches (8 to 15 cm.); and its capacity from 1} to 5 pints. The of the capacity given by Dr. Sidney Martin are probably the most accurate : he capacity varies between 9 and 59 oz., with an average of from 35 to 40, or a little ce in a direct line from the cardiac to the pyloric orifice varies from 3 to 5 inches m.), and that from the cardia to the summit of the fundus from 2 to 4 inches .). - the weight, the average of twelve wet specimens freed from their omenta was 41 oz. (135 grms.), with a maximum of 7 oz. (198·45 grms) and a minimum of rins.). Glendinning gives the weight as 4} oz.

child at birth the stomach is scarcely as large as a small hen's egg, and its bout 1 oz. (28.3 grms.). In shape it corresponds pretty closely to that of d the fundus is well developed. It is vertical in position. ed Stomach (Fig. 918). — As a result of disease, or of constriction of the of the abdomen, the stomach is occasionally displaced in position and distorted

that instead of running obliquely forwards, downwards, and to the right, nearly vertically along the left side of the vertebral column, in which direction considerable length. Its inferior part bends rather suddenly, and runs upwards and to the right to join the pylorus, which is often placed quite superficially below the liver. As a result of the displacement, the left extremity of the pancreas is pushed downwards from the horizontal until it almost assumes a vertical position. The narrowing and inversion of the inferior margin of the thoracic framework at the same time constricts the stomach about its middle, and may lead to a bilocular condition..

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Hour-glass or Bilocular Stomach.—This is a condition of the organ, by no means rare, in which the stomach is more or less completely separated into two divisions—a cardiac and a pyloric—the normal arrangement in certain rodents and other animals. As a rule the former division is the larger, but occasionally the two are nearly equal, or the pyloric portion may exceed the cardiac in size. Sometimes the condition is temporary, and the result of a vigorous contraction of the circular muscular fibres at the seat of constriction. In other cases it is

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permanent, and may be due to cicatricial contraction after gastric ulcer, or to some other pathological condition. The condition is more frequent in the female than the male, and is rarely found in the fætus or child.

Position of the Stomach.— When empty, or nearly so, the stomach lies in the left hypochondrium and left part of the epigastrium, with its fundus directed posteriorly towards the diaphragm, its long axis lying almost in a horizontal plane and its pyloric part running to the right to join the duodenum. this state the whole organ is narrow and attenuated, particularly the pyloric part, which is contracted, and resembles a piece of thick-walled small intestine.

When distended, both the cardiac and pyloric parts become full and rounded (Fig. 923). It still lies within the hypochondriac and epigastric regions; but in exceptional cases, or in extreme distension, it may pass down below the subcostal plane and reach into the umbilical and left lumbar regions. As a result of the

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