A manual of operative surgery (1910) (14763290875)

Identifier: manualofoperativ0001trev (find matches)
Title: A manual of operative surgery
Year: 1910 (1910s)
Authors: Treves, Frederick, Sir, 1853-1923 Hutchinson, Jonathan, 1859-1933
Subjects: Surgical Procedures, Operative Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School



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terzi— S.M FIG. 49. -POSITION AND RELATIONS OF THE STOMACH AND DUODENUM, SHOWINGALSO THEIR ARTERIAL SUPPLY. (After Testut.) s, Stomach ; p, Pylorus ; D, Third part of duodenum; c, Hepatic flexure of colon (note thetransverse colon is cutaway) ; C. A., The coronary artery ; G. E. D., Right gastro-epiploicartery running in the great omentum ; s. M., Superior mesenteric artery, with its inferiorpancreatico-duodenal branch (p. d. i.). gastrojejunostomy we found the pylorus close to the rightanterior superior iliac spine ! The fundus of the stomach reaches on the left side to a pointas high as the level of the sixth chondro-sternal articulation,and is directly in contact with the diaphragm (Fig. 49). The uncovered area of the stomach is normally representedby a triangle, the right side of which is formed by the edge ofthe liver, the left side by the borders of the eighth and ninth
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chap, in) THE STOMACH 173 costal cartilages, and the base by a horizontal line drawnbetween the tips of the tenth costal cartilages (Fig. 50). The tip of the cartilage of the tenth rib is an important land-mark, and it is one not difficult to recognise. Tillaux pointsout that this cartilage has a distinct tip, that it is attached tothe ninth cartilage by a ligament some six or seven mm. inwidth, that it plays over the latter cartilage, and producesunder the finger a special crepitus (bruit). (See Fig. 50.) The position of the lower edge of the liver in the left sub-costal angle is liable to variation, but under normal conditionsit may be represented by a line drawn from the ninth rightcartilage to the tip of the eighth left cartilage. The -pyloric opening is small, and has an average diameterof 16 mm. This about corresponds to the diameter of a six-penny-piece. The arterial and lymphatic supply of the stomach is of specialinterest in regard to excision of tumours of that organ (see Fi