the anatomy of spleen avery good read.pptx

Details of spleen

1. SPLEEN

2. Competency AN47.5 Describe & demonstrate major viscera of abdomen under following headings (anatomical position, external and internal features, important peritoneal and other relations, blood supply, nerve supply, lymphatic drainage, and applied aspects)

3. OBJECTIVES Location Anatomical position External features Relations Peritoneal reflection and Ligaments

4. INTRODUCTION Encapsulated mass of vascular and lymphoid tissues . LOCATION occupies partly epigastric region and mainly Lt hypochondrium

5. It is a haemo -lymph organ In fetal life- produces RBC In adult life- replaces worn out RBC & produces lymphocytes. Major repository of phagocytic macrophages

6. SHAPE Slightly curved wedge to a domed tetrahedron AXIS OF SPLEEN Lies obliquely along the long axis of the 10 th rib.

7. Lt 9 th rib Lt 10 th rib

8. Shape: Oblong- colic imp. is absent Tetrahedral- colic impression is prominent

9. 1” thickness 3” breadth 5” length 7 oz weight 9 to 11 ribs of lt side- position of spleen Left 10 th rib- coincides with axis of spleen Harris’s dictum of odd numbers 1,3,5,7,9,11

10. Characteristics Highly vascular Friable, elastic & pink in color Moves with respiration

11. Presenting parts 2 ends- medial Lateral 2 surfaces- diaphragmatic Visceral 2 borders- superior inferior (intermediate border) 2 angles- anterior basal Posterior basal

12. Medial end Posterior extremity Blunt & rounded Situated – towards vertebral column Lies opposite to 10 th thoracic spine, 3.5 to 4 cm to the left of mid-dorsal line

13. Lateral End Anterior Extremity Broad – as a border Extend from superior to inferior border Related with lt colic flexure & phrenico - colic lig .

14. Diaphragmatic surface Smooth & convex Relations Diaphragm- separated by recess of greater sac Lower border of Lt. lung & pleural sac- in upper 1/3 Lt. Costo-diaphragmatic recess- in lower 2/3 Lt. 9 th to 11 th ribs with IC spaces

15. Diaphragm 9 to 11 ribs (left) Intercostal space

16. Visceral Surfaces 4 impressions- gastric, renal, colic & pancreatic Gastric impression: Shallow, concave fossa Directed upward, forward & medially Hilum of spleen – lies in its lower part

17. GASTRIC IMPRESSION RENAL IMPRESSION COLIC IMPRESSION PANCREATICIMPRESSION

18. Gastric Impression Relations Fundus of stomach- separated by recess of greater sac Hilum- gives attachment to gastrosplenic lig . & Lieno -renal lig .

19. Renal Impression Anterior surface of left kidney Sometimes- left supra renal gland Above structures are separated from spleen by recess of greater sac.

20. Colic Impression Situated in front of lateral end Left colic flexure PANCREATIC IMPRESSION Lies b/w colic impression & lateral end of hilum Tail of pancreas b/w layers of lieno -renal ligament

21. Superior Border Separates gastric impression from diaphragmatic surface Close to lateral end – has 2 or 3 notches –indicates lobulated development of spleen INFERIOR BORDER Separates renal impression from diaphragmatic surface

22. Anterior Basal angle Inferior Border Superior Border Intermediate Border

23. Anterior Basal angle Junction b/w superior border & lateral end Lies in 9 th intercostal space or slightly behind left mid-axillary line When spleen is enlarged – anterior basal angle can be palpated under left costal margin- hence it is clinical angle of spleen.

24. Posterior Basal angle Junction of inferior border and lateral end of spleen Posterior Basal angle

25. Ligaments of spleen Gastrosplenic ligament Lieno -renal ligament Lieno -phrenic ligament Phrenico -splenic ligament

26. Gastrosplenic Ligament Bi-layered peritoneal fold Extent – fundus of stomach to anterior lip of hilum of the spleen Anterior layer- Posterior layer-. Contains- short gastric vessels and left gastro-epiploic vessels

27. Gastro splenic ligament Phrenic colic ligament Lieno renal ligament

28. Gastrosplenic Lig Lienorenal Lig Spleen

29. Lieno -renal ligament Bi-layered peritoneal fold Extent- posterior lip of hilum of the spleen to anterior surface of left kidney Anterior layer- Posterior layer- Contains- splenic vessels, nerves & lymphatics & sometimes tail of pancreas

30. Lieno -phrenic Ligament Upward continuation of lieno -renal ligament Connects hilum of spleen to diaphragm Suspends the spleen from above- suspensory ligament of spleen

31. Phrenico -colic Ligament Triangular peritoneal fold Extends- left colic flexure to diaphragm opposite left 10 th or 11 th rib It suspends the spleen from below- sustentaculum lienis

32. Lymphatic drainage- pancreatico -splenic nodes Nerve supply- celiac plexus ( symphathetic )

33. Vascular segments

34. Clinical anatomy

35. SPLENOMEGALY : Hodgkin's disease. M alaria . leukemia. heart failure. cirrhosis. tumors in the spleen or from other organs that have spread to the spleen. viral, bacterial, or parasitic infections.

36. SPLENIC RUPTURE : Susceptible to trauma d/t Friable Fracture of ribs Subjected to Shearing forces Kehr’s Sign

37. 1) Phagocytosis 2) Immune system : Under antigenic stimulation, there occurs increased lymphopoiesis 3) Haemopoiesis and lymphopoiesis : Lymphocytes manufractured take part in immune response of the body. 4) Storage of RBCs FUNCTIONS OF SPLEEN

38. Clinical Correlates While doing splenectomy care should be taken to avoid injury to the tail of the pancreas – that lies close to hilum of the spleen Phrenico colic ligament prevents the direct downward displacement incase of enlargement of spleen Kehr’s sign- obstruction of smaller branches (end arteries) of splenic artery – splenic infarction- causes referred pain to left shoulder.