Abnormalities In The Size Of The Stomach

In the normal state, the size or capacity of the stomach varies within wide limits, and this is more marked in pathological conditions. The following figures of capacity were obtained by Ziemssen 1 as the result of a large number of post-mortem examinations of the stomachs of persons of about the same size who during life had never manifested signs of digestive troubles. The largest stomach of these held 1,680 c.c. (or fifty-six ounces), the smallest 250 c.c. (eight ounces); the other figures ranged between these limits. While some years ago any stomach of very large size was considered as diseased, Ewald first pointed out that the organ, no matter how great its capacity, may still be able to work perfectly and satisfactorily. He therefore suggested that an acquired or congenital large stomach with normal functions should be designated as "me-yastria." A very large stomach causing manifest digestive disturbances is generally spoken of as a dilated stomach (dilatation of the stomach, gastrec-tasia). The most extensive degrees of gastric dilatation are found in cases of obstruction of the pylorus.

1 Ziemssen, cited from C. A. Ewald: "Diseases of the Stomach," p. 110.

Anyustatio ventriculi denotes an extremely small stomach. In very marked degrees of this condition the stomach may have a capacity of hardly an egg in size, and may appear even narrower than the duodenum (Haller). Angustatio ventriculi is generally found in most cases of oesophageal or cardiac strictures (principally cancerous); occasionally, however, it occurs alone in cirrhosis ventriculi.

Abnormalities In The Shape Of The Stomach

The shape of the stomach is occasionally found altered, caused by cicatricial changes after extensive ulcers. The hour-glass form is one which gives rise to grave disturbances and can frequently be recognized during life. Inflation with carbonic-acid gas shows the hour-glass shape of the organ; lavage six to seven hours after a meal will occasionallv fail to remove all the contents. After the wash-water has come out clear for a time there may occur a sudden admixture of chvme.

Abnormalities In The Position Of The Stomach

The abnormal positions of the stomach may be either congenital or acquired. Among the congenital abnormalities we would mention the transposition of the stomach in the thoracic cavity which occurs if there is a partial or a complete defect at the diaphragm. The stomach is found to be situated on the right side of the abdomen (pyloric portion to the left) in cases of general transposition of the viscera. Both these anomalies are extremely rare. Among acquired anomalies a vertical position of the stomach is occasionally found. The pylorus is then situated much lower and farther to the left than normally. This condition is mostly found in women and can be easily recognized either by the gastrodiaphaneor by inflation of the stomach, which reveals a lengthy but narrow configuration, its horizontal diameter not extending to the right of the linea alba.

1Haller "Elem Physiol. "Lib. xix Sect. 1. §3.

Descensus ventriculi or gastroptosis (low position of the stomach) is the most frequent anomaly; it usually occurs in connection with a ptosis of several other intestinal organs, and will therefore be best described under enteroptosis, or Glenard's disease.