Transcript Spleen - 05blocks

Objectives
 Discuss the gross features of spleen.
 Give its blood and nerve supply.
 Describe the inguinal lymph nodes.
Site :
Left hypochondrium.
It lies under the diaphragm between it and
the fundus of the stomach.
Measurements:
-1 inch (thickness) x 3 inches (Breadth) x 5
Inches (length).
- Weight: 875 gram (7 ounces). - Surface anatomy: Behind left 9, 10, 11 ribs.
Surface anatomy :
It lies parallel to the ribs
number 9, 10 , and 11
on the left side.
The long axis of the
spleen lies parallel to
the 10th rib.
Its medial end lies 1 1/2
inches from the spine of
T. 10, while the lateral
end lies just behind the
mid-axillary line.
Shape :
3 borders, 2 ends, 2
surfaces.
A. Ends
1) lateral end (Broad)
2) medial end (tapering)
B. Borders
Upper border (Sharp &
notched)
Lower border (Broad)
Intermediate border (thick,
incomplete. Extends from
the medial end till the
hilum).
Surfaces
1- Diaphragmatic surface:
Convex, Related to the diaphragm which
separates it from 3 structures :------- Lower part of left pleura,
- Base of left lung,
- Left 9, 10, 11 ribs.
2- Visceral surface:
-
Concave, irregular, directed to the abdominal cavity.
Contains the hilum and impressions for 4 abdominal
organs:
1- Gastric impression (related to posterior wall of fundus
of stomach).
2- Renal impression.
3- Colic impression (left colic flexure).
4- Pancreatic impression (tail of pancreas).
Peritoneal relations
The spleen is completely covered by peritoneum of
the greater sac except at the hilum.
It is attached and related to the following ligaments:
1- Gastro-splenic ligament
2- Lieno-renal ligament.
The gastrosplenic ligament (between hilum of spleen and fundus and greater curvature of stomach) contains:
- Short gastric vessels
- Left gastroepiploic vessels
- Lymph nodes
The lieno-renal ligament (between hilum of spleen and left
kidney) contains:
- Splenic vessels
- Tail of pancreas
- Lymph nodes
Arterial Supply:
Splenic artery (branch of the
coeliac trunk).
It has a tortuous course at the
upper border of the pancreas.
It passes with the tail of the
pancreas in the lieno-renal
ligament.
At the hilum it divides into 5 or 6
splenic branches.
Venous drainage:
The spleen is drained by the splenic vein
that passes on the posterior surface of the
pancreas to unit with superior mesenteric
vein to form the portal vein posterior to the
neck of the pancreas.
Clinical notes:
Splenomegaly It is an enlargement of the spleen beyond
its normal size. Many disorders, including infections,
anemias, can cause an enlarged spleen. Enlarged
spleen extends downward and medially (due to the
presence of the phrenico-colic ligament that prevents its
direct downward descent). The splenic notch(s) may be
felt by palpation through the anterior abdominal wall.
Injury of the spleen is common due to fracture of the 9,
10, 11 ribs, automobile accidents, during playing contact
sports, or due to penetrating wounds of the lower left
thorax.
Accessory spleens are common (10-15% of people).
They are found at the hilum of spleen, the lieno-renal, or
the gastro-splenic ligaments.
The tail of pancreas is in close relation to the hilum of
spleen so it could be injured during splenectomy
(surgical removal of the spleen).
Spleenectomy
Spleen removal is surgery to remove a
diseased or damaged spleen the organ
that helps the body fight infections. ...Its
attachments to other organs are gently cut.
Inguinal lymph nodes
I- Superficial inguinal LNs:
Site: In the proximal region of the
femoral triangle.
No: 12- 20
Two groups:
A- Horizontal group:
i- Medial: It drains: Anterior
abdominal wall below
umbilicus, lower part of anal
canal, external genitalia (male
and female).
ii- Lateral: It drains; buttock and
back below iliac crest.
B- Vertical group: It drains the
lower limb. It is present at the end
of the great saphenous vein.
All the above groups of LNs send
efferents to deep inguinal and
external iliac LNs.
Inguinal lymph nodes cont.
II- Deep inguinal LNs:
- Site: Deep (under) to deep
fascia on the medial side of
the femoral vein.
- No: 1-3. One of them may
lie in the femoral canal
(lymph node of Cloquet).
- Afferent: from deep
lymphatics of the lower limb
and from superficial inguinal
LNs.
- Efferent: to external iliac
LNs