Spleen & portal vein

Anatomy of spleen

1. Spleen & Portal vein

2. Transpyloricplane (L1 vertebra)
passes through

3. Spleen
•Haemolymphorgan
•Womb & Tomb of RBC
–Formation of RBC
•During intra-uterine life
(till the 5
th
month)
–Destruction of old RBC
•Made up of
–Lymphoid tissue
•Reservoir of blood and
iron

4. Spleen -Location
•Lies between
–Fundusof stomach
and diaphragm
•Lies in
–Left hypochondrium
•Extends in between
–9
th
to 11
th
ribs

5. Measurements
•1-inch Thickness
•3 -inch Breadth
•5 –inch Length
•7 oz–Weight (150 gm)
•9-11 ribs related –(left
side)
Harris dictum of odd numberson Spleen :1,3,5,7,9 -11

6. External features
•Two ends
•Three borders
•Two surfaces
•Hilum

7. Ends
•Anterior or lateral end
–Expanded or more like a
border
–Directed downwards,
forwards and reaches mid
axillary line
•Posterior or medial end
–Rounded
–Directed upwards
backwards, medially
–Rest on upper pole of left
kidney

8. Borders
•Superior border
–Presents one or two notches
near anterior end
–Notches indicate spleen is
lobulated in development
•(fusion of different masses of
lymphoid tissue)
•Inferior border
–Rounded
•Intermediate border
–Thick, incomplete
–Extends from medial end till
hilum

9. Surfaces
•Diaphragmatic surface
–Convex and smooth
–Related to
•Diaphragm
•Lt lung & ltspleura
•Costodiaphragmaticrecess
•9
th
, 10
th
& 11
th
ribs of left
side

10. VISCERALSURFACE
•Concave, irregular, directed
to abdominal cavity
•Contains
–Hilumand impressions for 4
abdominal organs
•Gastric impression
–Related to posterior wall of
fundusof stomach
•Renal impression
•Colic impression (left colic
flexure)
•Pancreatic impression (tail
of pancreas)

11. Peritoneum
•Covers entire spleen
–Except the hilum
•Ligaments related
–Gastro-spleniclig.
–Lieno-renal lig.
–Phrenico-colic

12. Peritoneal connections
& contents
•Gastrosplenicligament
–Connections
•From fundusand greater curvature of
stomach
•To hilumof spleen
–Contents
•Shortgastric vessels
•Left gastroepiploicvessels
•Lymph nodes
•Lienorenalligament
–Connections
•From lower border of hilumof
spleen
•To anterior surface of kidney
–Contents
•Splenicvessels
•Tail of pancreas
•Lymph nodes

13. Applied importance of Gastro-splenic and lieno-renal ligament
•Accessory spleens
–Common in 10-15% of
people
–Found at the hilum of spleen
–Lieno-renal or the gastro-
splenic ligaments
•Tail of pancreas is in close
relation to hilum of spleen
–During surgical removal of
the spleen care must be
taken

14. Peritoneal
connections &
contents
•Phrenico-colic
–Sustentaculumlienis
–Connections
•From left colic flexure to
diaphragm
•Lienophrenic
–Suspensory ligament of
spleen
–Connections
•Apex of Spleen to
diaphragm

15. Arterial Supply
•Splenic artery
–Branch of Coeliac artery
•Very tortuous
•End artery
–Course
•Along the upper border of
pancreas
•Crosses lt. supra renal &
upper part of kidney
•Enters lienorenal ligament
•Reaches hilum by
dividing into 4-5
segmental arteries

16. Splenomegaly
•Enlargement of spleen
–Causes
•Cirrhosis
•Malaria
•Myeloid leukaemia
–Normally not palpable
–Enlarged spleen is
palpable
•Under left costal margin
–During inspiration

17. Clinical angle of spleen
•Anterior basal angle
–Junction of superior border
with lateral end
–Lies in 9
th
intercostalspace
behind left mid-axillaryline
–First palpable in
splenomegaly

18. Portal vein
•Collects blood
–Entire abdominal part of GI
tract
•Except lower rectum & anal
canal
–And also collects venous
blood from
•Gall bladder, pancreas &
spleen

19. Portal vein
•Characters
–Formed like vein
–Ends like artery
–Has two systems
•Capillaries in beginning
•Sinusoids at the end
–No valves
–No mixing of
•Splenic& sup mesenteric vein
–By diferentvelocity & gravity
–Right branch
•Contains the blood receives sup
mesenteric
–Left branch
•Contains the blood receives
spleenicvein

20. Portal vein -formation
•Union of
–Mesenteric & splenicv
–Behind neck of Pancreas
–Infrontof IVC
–At L 2 level

21. Portal vein -course
•Divided into3 parts
–Infra duodenal
–Retroduodenal
–Supraduodenal

22. Portal vein -Infra duodenal part
•Lies below
–First part of duodenum
•Relations
–Anterior
•Neck of pancreas
–Posterior
•IVC

23. Portal vein -Retro duodenal part
•Lies behind
–First part of duodenum
•Relations
–Anterior
•First part of duodenum
•Bile duct
•Gastroduodenalartery
–Posterior
•IVC

24. Portal vein -Supra duodenal part
•Lies above
–The first part of duodenum
–Lies in free margin of
lesser omentum
•Relations
–Anterior
•Hepatic artery
•Bile duct
–Posterior
•IVC

25. Portal vein -termination
•At portahepatis
–Divides into
•Right & left branches
•Right branch
–Shorter & wider
–End in rtlobe
–Receives cystic v
•Left branch
–Narrower &longer
–Gives branches to
•Caudate & quadrate lobe
–Receives
•Paraumbilicalv
–Embryological remnants along
with it
•Ligamentumteres
–Obliterated left umbilical vein
•Ligamentumvenosum
–Obliterated ductus venosus

26. Portal vein -Tributaries
•Formative
–Splenic
–Superior mesenteric

27. Portal vein -Tributaries
•In Trunk
–Right gastric
–Left gastric
–Superior
pancreaticoduodenal

28. Portal vein -Tributaries
•In branches
–In Right branch
•Cystic
–In left branch
•Paraumbilical

29. Portal hypertension
•Obstruction in portal vein
–Increase portal venous pressure
•Causes:
–Pre hepatic : Thrombosis of
portalvein
–Hepatic:Cirrhosis
–Post hepatic: Budd-Chiari
Syndrome
•Effects:
–Splenomegaly,
–Ascites,
–Collateralcirculationthroughsites
ofPortasystemicanastomosis
Budd-Chiari
Syndrome
-hepatic veins are
blocked by a clot,
usually left lobe is
affected.

30. Sites of porto-cavalanastomosis
•Five important sites of
portal -systemic
circulation
–Lower third of the
Esophagus
–ParaumbilicalArea
–Rectum & Anal canal
–Bare area of liver
–Retroperitonial

31. Caput medusae
•Veins around umbilicus is
dilated & distended
–Due to portal obstruction
•Veins involved
–From portal system
•Paraumbilicalveins
–Systemic veins
•From above umbilicus
–Lateral thoracic & superior
epigastric
•From below umbilicus
–Superficial epigastric, &
inferior epigastric

32. Oesophageal varices
•Dilatation of veins at
lower end of oesophagus
–Due to portal obstruction
–May rupture & cause
vomiting of blood
•Veins involved
–From portal system
•Oesophagealvein to left
gastric vein
–Systemic vein
•Oesophagealvein to
hemiazygosvein

33. Pilesor haemorrhoids
•Enlargement of veins of
anal canal
–Due to portal obstruction
•Veins involved
–From portal system
•Superior rectal
–Systemic vein
•Middle & inferior rectal

34. Bare area of liver
•Veins involved
–From portal system
•Hepatic venules
–Right division of the portal vein
–Systemic vein
•Phrenic & intercostal veins
•

35. Retroperitoneal
organs
•Systemic vein
–Lt renalV
•Portal vein
–SplenicV