Abdomen

“ I must first tell you, however, that the diaphragm keeps up intimate relations with his neighbor below—the stomach. Every time he rises in the breast the stomach rises behind him; and not only the stomach, but also its companions, the intestines. All the officials employed in the business of digestion travel regularly with him; coming down as well as going up in company. Put your hand upon your abdomen and breathe strongly and you will feel the rebound of all the movements of the diaphragm. ”

“ In the Solid Viscera of the Thorax and Abdomen.—The liver is small, the gall-bladder distended with bile, and the heart and kidneys deprived of any surrounding fat. All the internal organs are shrivelled and bloodless.
3. In the Stomach and Intestines.—The stomach in some cases is quite healthy, but more or less stained with bile; in others it is found collapsed, contracted, empty, and the mucous membrane more or less ulcerated. The intestines are thin, contracted, empty, and so shrunken that the canal is almost obliterated. ”

“ But the damage is not done to the heart and lungs alone. The liver is crowded out of place until it sometimes reaches clear across the abdomen and is creased with ruts from the pressure of the ribs upon it. The stomach is also pressed out of place. It belongs close up under the diaphragm, but it is crowded by the pressure down until it lies in the abdominal cavity, as low down, sometimes, as the umbilicus, six or eight inches below where it belongs. ”

“ The abdomen contains the stomach, a large membranous bag capable of holding about three pints, which is situated on the left side of the body and crosses it towards the right; the liver, which weighs from fifty to sixty ounces, and lies on the right side of the body, with its upper surface touching the diaphragm, while its lower surface touches the intestines and right kidney ”

“ The abdomen may be divided into three regions; in the upper region will be seen the liver, extending across from the right to the left side, the stomach and spleen on the left, and the pancreas and duodenum behind; in the middle region is the transverse part of the colon, with the upper part of the ascending and descending colon, omentum, small intestines, mesentery, and behind, the kidneys and supra-renal capsules; in the inferior region is the lower part of the omentum and small intestines, ascending and descending colon, and ureters. ”

“ At a short distance below the junction of this gland with the stomach, the intestine contracts, and twists upon itself. There is no true pyloric valve, but this turn in the intestine to all intents and purposes acts as one. The intestine next proceeds towards the liver. This organ is large, its upper surface concave, its lower convex; it is divided by the suspensory ligament, which attaches it to the walls of the abdomen, into two lobes; in the adult male it is of a dark brownish colour, mottled; it overlaps the stomach and portions of the small intestine. ”

“ In the kind and degree of abdominal affection of which we are now treating, the abdomen is sometimes harder than natural, but it often remains nearly as soft as in health through the greater part of the disease. ”

“ It has been well observed that each of the three great divisions of the body is the appointed seat of a separate set of organs, all of them alike important in the animal economy. As the head contains the organs of mastication, and the thorax those of motion, so the abdomen is the appropriate site of the generative organs. These, however, are chiefly internal, and will be most conveniently considered when treating of the anatomy of the abdomen. ”

“ When we open the abdomen of subjects that have died in this state, without wounding the swelled intestines, these immediately burst out, swell more, and occupy twice as large a space as they were contained in in the abdomen ”

“ The abdomen, attached to the posterior part of the thorax by a slender ligament, has, for an outer covering; six folds or scales of unequal breadth, overlapping each other, and contains the honey-bag, or first stomach, the ventricle, or true stomach (Plate II. Figs. 1 and 2 f) , with other intestines, to be hereafter referred to.
The honey-bag (Figs. 1 and 2 d) is an enlargement of the gullet, and, although called the first stomach, no digestion takes place here. In shape it is like a taper oil-flask ”

“ The abdomen of a lady aged 52 years, having been afflicted for a long time with plethora abdominalis, began at last to swell and to grow hard, her complexion being tinged with a greyish-yellow colour, whilst her organs of digestion were impaired at the same time. ”

“ If, after removing all pressure, and giving those wonderful organs in the abdominal cavity full opportunity to perform their vital functions, the mischievous effects of the long continued pressure do not at once disappear, you may percuss and knead the abdomen a few minutes, morning and evening. Weak digestion, torpid liver and constipation are, by this simple means, frequently cured, and invariably relieved. ”

“ The mortality of such an operation is very small.
By a freak of nature or by disease the stomach sometimes is narrowed in the middle, forming what is called an “hour-glass stomach.” In such a case we open the abdomen, make an opening into the two parts of the stomach and unite the two so that we re-establish the single cavity of the stomach. The mortality of the operation is very slight, eight per cent. Again, sometimes the stomach becomes unduly dilated, thus interfering seriously with its function. ”

“ The curved shaping in the front gives a cup-like support over the lower part of the abdomen. Through the holding-knot in the groin and pull-loop at the heaviest part of the abdomen, specific control and support are secured. ”

“ The abdomen extends from the arch of the diaphragm to the lower extremity of the pelvis. It contains all the viscera of alimentation: the digestive system together with the glands belonging to it; the liver and pancreas, besides the renal system and, in women, the organs of generation (uterus and ovaries) . The diaphragmatic arch, having its convex side uppermost, enters the thoracic frame as far as the first dorsal vertebra. The intestinal [Pg 306] mass is more noticeable and prominent in persons having a narrow pelvis; in children, for example, the abdomen is very prominent. ”

“ In the stomach it causes a sensation of warmth which is diffused over the abdomen and quickly followed by a general glow of the body. In moderate quantity, it induces an increased blood-supply which enables the mucous follicles and gastric glands to produce a more abundant secretion of stomach juices. ”

“ Most of these organs in the natural state can undergo a considerable amount of movement: the lungs expand widely, the cavity of the chest enlarging at the same time in all directions by the bulging out of the ribs and pressing down of the diaphragm. This communicates a movement to the abdominal organs, as may easily be felt if the hand is placed on the abdomen while two or three deep breaths are taken. The stomach during digestion expands and churns the food about; and considerable movement takes place among the bowels, the coils of which pass freely over one another. ”

“ And afterwards I parted the stomach from its external tunic, as I had done the intestines. I found no obstruction in the mesenteric glands; but every evolution of the mesentery firmly cohered together. The liver also adhered closely to the diaphragm, and its adjacent parts: and in the vesicula fellis I found the bile pretty thick, neither too green nor too yellow, but a tint between both. I met with nothing remarkable in the other parts of the abdomen. In opening the thorax, I found the lungs closely adhering to the ribs laterally, and posteriorly and interiorly close to the pericardium. ”

“ B. By being absorbed into the system, where 5. they are found to have the power of dissolving a. the tenacious and thick bile contained in the biliary ducts, and are even capable of dissolving gall-stones which are in the course of formation; b. of removing congestion of the blood in general, but principally that in the mesenteric vein, thus accelerating the circulation of the blood in the venous system; c. of dispersing the accumulated lymph and fatty deposits in the lymphatic vessels and glandular organs of the abdomen (principally of the liver) ”

“ It contains the liver, with the gall-bladder, under its right lobe, the stomach, the pancreas, the spleen, the two kidneys, the bladder and the intestines. The more highly organized of the inferior animals have a similar structure. ”

“ When the stomach and intestines are thus filled with their proper food, not only the motions of the gastric glands, the pancreas, liver, and lacteal vessels, are excited into action; but at the same time the whole tribe of irritative motions are exerted with greater energy, a greater degree of warmth, colour, plumpness, and moisture, is given to the skin from the increased action of those glands called capillary vessels; pleasurable sensation is excited, the voluntary motions are less easily exerted, and at length suspended ”

“ Nature has beautifully apportioned the space in the abdominal cavity, each part of the viscera having ample room for the performance of its special function, but any abnormal increase in size of any part of the contents of the cavity must necessarily create disturbance. Now, when the food leaves the stomach, where it has been churned into a pulpaceous mass, it passes into the duodenum or second stomach, where it receives an augmentation of liquid material from the liver and pancreas ”

“ The stomach and intestines, with other important structures, such as the liver, kidneys and generative organs, are contained in a lower cavity, separated by a muscular midriff, the diaphragm, from the upper part or thorax, containing the blood-purifying and pumping organs, the lungs and the heart. ”

“ The process of digestion, as the food passes from one end of the tract to the other, is performed by the aid of the secretions of various glands, which open into the alimentary canal at different points in its course. The principal of these are the salivary glands, situated on the pharynx and oesophagus, and the liver, biliary or hepatic gland, connecting with the stomach. With these may be considered the anal and ink-glands, which, in certain genera, connect with the terminal portion of the rectum. ”

“ Now this food is changed into a soft mass in the stomach, and then passes through long winding intestines, that are folded up below the stomach. As it passes through these intestines, there are multitudes of little hollow tubes, small as hairs, that pump out the nourishment and carry it to a particular blood-vessel, when it is emptied into the heart, and mixes with the blood. This is the way the blood is constantly renewed. Now it is the blood that thus conveys strength and nourishment to every part of the body. ”

“ The food is masticated by a very complicated system of jaws and teeth, and after it has been mixed with a secretion, which is poured into the mouth by salivary glands, it passes through a long muscular œsophagus into the stomach, where it is acted upon by fluids furnished by a liver and other glands, before it passes into the long, convoluted intestine, where the nutritive portions are absorbed into the blood, while the waste products are discharged from the body through the anus. ”

“ The stomach forms the gastric juice.
9. The intestines are about twenty-five feet long. They form the intestinal juice.
10. The liver lies under the ribs of the right side. It is about half as large as the head. It makes bile.
11. When not needed for immediate use, the bile is stored up in a sac called the gall-bladder.
12. The pancreas is a gland which lies just back of the stomach. It makes pancreatic juice.
13. The spleen is found near the pancreas.
14. There are five important digestive organs—the mouth, the stomach, the intestines, the liver, and the pancreas. ”

“ We have, in succession, the mouth (M.) , separated from the nasal passage (Na.) above the palate; the pharynx (ph.) , where the right and left nasal passages open by the posterior nares into the mouth; the oesophagus (oes.) ; the bag-like stomach, its left (Section 6) end being called the cardiac (cd.st.) , and its right the pyloric end (py.) ; the U-shaped duodenum (ddnm.) and the very long and greatly coiled ileum (il.) . The duodenum and ileum together form the small intestine; and the ileum is dilated at its distal end into a thick-walled sacculus rotundus (s.r.) ”

“ Now the liver, stomach, and all the intestines below the diaphragm, have no support from above, and so the question is, what sustains these organs, weighing from six to twelve pounds, so that they do not sink down on to the delicate pelvic organs below? The answer is, they are held up chiefly by abdominal breathing, as above explained. For at every rise of the diaphragm a vacuum is made above the abdominal viscera, lifting them upward, and this is done at every breath, and we breathe about twenty times each minute. ”

“ The stomach has in front of it the liver (see fig. 1) , the diaphragm and the anterior abdominal wall, while behind it are the pancreas, left kidney, left adrenal, spleen, colon and mesocolon. These structures form what is known as the stomach chamber. When the stomach is empty it contracts into a tubular organ which is frequently sharply bent, and the transverse colon ascends to occupy the vacant part of the stomach chamber.
The last inch of the stomach before reaching the pylorus is usually tubular and is known as the pyloric canal. ”

“ I have never dissected the stomach of a drunkard, in which the organ did not manifest some remarkable deviation from its healthy condition. But the derangement of the stomach is not limited to the function of nutrition merely. This organ is closely united to every other organ, and to each individual tissue of the body, by its sympathetic relations. When the stomach, therefore, becomes diseased, other parts suffer with it. The functions of the brain, the heart, the lungs, and the liver, become disordered ”