By By

Dr. Shawky M. Tayel Dr. Shawky M. Tayel

- - Professor of Anatomy, EmbryoIogy & Human Genetics Professor of Anatomy, EmbryoIogy & Human Genetics
, AIexandria FacuIty of Medicine, , AIexandria FacuIty of Medicine, ead of Anatomy Department ead of Anatomy Department - -
- - Genetics ConsuItant, CIinicaI Genomic Centre, AIex. FacuIty of medicine, Genetics ConsuItant, CIinicaI Genomic Centre, AIex. FacuIty of medicine,
- - Genetics ConsuItant, Suzanne Mubarak RegionaI Centre for Women's HeaIth Genetics ConsuItant, Suzanne Mubarak RegionaI Centre for Women's HeaIth
, AIex., Egypt , AIex., Egypt www.smcaIex.org www.smcaIex.org & DeveIopment & DeveIopment
- - FeIIow, MedicaI CoIIege of Ohio, USA, FeIIow, MedicaI CoIIege of Ohio, USA,
- - Member, American Society of Human Genetics. Member, American Society of Human Genetics.
Site : Site :
Left hypochondrium. Left hypochondrium.
t lies under the diaphragm between it and t lies under the diaphragm between it and
the fundus of the stomach. the fundus of the stomach.
easurements: easurements:
- -1 1 inch (thickness) x inch (thickness) x 3 3 inches (Breadth) x inches (Breadth) x 5 5
nches (length). nches (length).
- - - - Weight: Weight: 875 875 gram ( gram (7 7 ounces). ounces).
- - Surface anatomy: Behind left Surface anatomy: Behind left 9 9, , 10 10, , 11 11 ribs. ribs.
Surface Surface anatomy anatomy ::
t lies parallel to the ribs t lies parallel to the ribs
number number 9 9, , 10 10 , and , and 11 11
on the left side. on the left side.
The long axis of the The long axis of the
spleen lies parallel to spleen lies parallel to
the the 10 10th rib. th rib.
ts medial end lies ts medial end lies 1 1 1 1//2 2
inches from the spine of inches from the spine of
T. T. 10 10, while the lateral , while the lateral
end lies just behind the end lies just behind the
mid mid- -axillary line. axillary line.
Shape : Shape :
3 3 borders, borders, 2 2 ends, ends, 2 2
surfaces. surfaces.
A. Ends A. Ends
1 1) lateral end (Broad) ) lateral end (Broad)
2 2) medial end (tapering) ) medial end (tapering)
B. Borders B. Borders
Upper border (Sharp & Upper border (Sharp &
notched) notched)
Lower border (Broad) Lower border (Broad)
ntermediate border (thick, ntermediate border (thick,
incomplete. Extends from incomplete. Extends from
the medial end till the the medial end till the
hilum). hilum).
Surfaces Surfaces
1 1- - Diaphragmatic surface: Diaphragmatic surface:
Convex, Related to the diaphragm which Convex, Related to the diaphragm which
separates it from separates it from 3 3 structures : structures :------- -------
- - Lower part of left pleura, Lower part of left pleura,
- - Base of left lung, Base of left lung,
- - Left Left 9 9, , 10 10, , 11 11 ribs. ribs.
2 2- - Visceral surface: Visceral surface:
- - Concave, irregular, directed to the abdominal cavity. Concave, irregular, directed to the abdominal cavity.
- - Contains the hilum and impressions for Contains the hilum and impressions for 4 4 abdominal abdominal
organs: organs:
- - 1 1- - Gastric impression Gastric impression (related to posterior wall of fundus (related to posterior wall of fundus
of stomach). of stomach).
- - 2 2- - Renal impression Renal impression..
- - 3 3- - Colic impression Colic impression (left colic flexure). (left colic flexure).
- - 4 4- - Pancreatic impression Pancreatic impression (tail of pancreas). (tail of pancreas).
Peritoneal relations Peritoneal relations
The spleen is completely covered by peritoneum of The spleen is completely covered by peritoneum of
the greater sac the greater sac except at the hilum except at the hilum..
t is attached and related to the following ligaments: t is attached and related to the following ligaments:
1 1- - Gastro Gastro- -splenic ligament splenic ligament
2 2- - Lieno Lieno- -renal ligament. renal ligament.
- - The gastrosplenic ligament The gastrosplenic ligament (between hilum of spleen and (between hilum of spleen and
fundus and greater curvature of stomach) contains: fundus and greater curvature of stomach) contains:
- - Short gastric vessels Short gastric vessels
- - Left gastroepiploic vessels Left gastroepiploic vessels
- - Lymph nodes Lymph nodes
The lieno The lieno- -renal ligament renal ligament (between hilum of spleen and left (between hilum of spleen and left
kidney) contains: kidney) contains:
- - Splenic vessels Splenic vessels
- - Tail of pancreas Tail of pancreas
- - Lymph nodes Lymph nodes
ArteriaI SuppIy: ArteriaI SuppIy:
Splenic artery (branch of the Splenic artery (branch of the
coeliac trunk). coeliac trunk).
t has a tortuous course at the t has a tortuous course at the
upper border of the pancreas. upper border of the pancreas.
t passes with the tail of the t passes with the tail of the
pancreas in the lieno pancreas in the lieno- -renal renal
ligament. ligament.
At the hilum it divides into At the hilum it divides into 5 5 or or 6 6
splenic branches. splenic branches.
'enous drainage: 'enous drainage:
The spleen is drained by the splenic vein The spleen is drained by the splenic vein
that passes on the posterior surface of the that passes on the posterior surface of the
pancreas to unit with superior mesenteric pancreas to unit with superior mesenteric
vein to form the portal vein posterior to the vein to form the portal vein posterior to the
neck of the pancreas. neck of the pancreas.
Clinical notes: Clinical notes:
Splenomegaly Splenomegaly t is an enlargement of the t is an enlargement of the spIeen spIeen beyond beyond
its normal size. any disorders, including infections, its normal size. any disorders, including infections,
anemias, can cause an enlarged spleen. Enlarged anemias, can cause an enlarged spleen. Enlarged
spleen extends spleen extends downward and medially downward and medially (due to the (due to the
presence of the phrenico presence of the phrenico- -colic ligament that prevents its colic ligament that prevents its
direct downward descent). The splenic notch(s) may be direct downward descent). The splenic notch(s) may be
felt by palpation through the anterior abdominal wall. felt by palpation through the anterior abdominal wall.
njury of the spleen is common due to fracture of the njury of the spleen is common due to fracture of the 9 9, ,
10 10, , 11 11 ribs, automobile accidents, during playing contact ribs, automobile accidents, during playing contact
sports, or due to penetrating wounds of the lower left sports, or due to penetrating wounds of the lower left
thorax. thorax.
Accessory spleens are common ( Accessory spleens are common (10 10- -15 15% of people). % of people).
They are found at the hilum of spleen, the lieno They are found at the hilum of spleen, the lieno- -renal, or renal, or
the gastro the gastro- -splenic ligaments. splenic ligaments.
The tail of pancreas is in close relation to the hilum of The tail of pancreas is in close relation to the hilum of
spleen so it could be injured during spleen so it could be injured during splenectomy splenectomy
(surgical removal of the spleen). (surgical removal of the spleen).
Spleenectomy Spleenectomy
Spleen removal is surgery to remove a Spleen removal is surgery to remove a
diseased or damaged spleen the organ diseased or damaged spleen the organ
that helps the body fight infections. ...ts that helps the body fight infections. ...ts
attachments to other organs are gently cut. attachments to other organs are gently cut.
nguinal lymph nodes nguinal lymph nodes
- - Superficial inguinal LNs: Superficial inguinal LNs:
Site: n the proximal region of the Site: n the proximal region of the
femoral triangle. femoral triangle.
No: No: 12 12- - 20 20
Two groups: Two groups:
AA- - Horizontal group: Horizontal group:
i i- - edial edial: t drains: Anterior : t drains: Anterior
abdominal wall below abdominal wall below
umbilicus, lower part of anal umbilicus, lower part of anal
canal, external genitalia (male canal, external genitalia (male
and female). and female).
ii ii- - Lateral Lateral: t drains; buttock and : t drains; buttock and
back below iliac crest. back below iliac crest.
BB- - Vertical group: Vertical group: t drains the t drains the
lower limb. t is present at the end lower limb. t is present at the end
of the great saphenous vein. of the great saphenous vein.
All the above groups of LNs send All the above groups of LNs send
efferents to deep inguinal and efferents to deep inguinal and
external iliac LNs. external iliac LNs.
nguinal lymph nodes nguinal lymph nodes cont. cont.
- - Deep inguinal LNs: Deep inguinal LNs:
- - Site: Deep (under) to deep Site: Deep (under) to deep
fascia on the medial side of fascia on the medial side of
the femoral vein. the femoral vein.
- - No: No: 1 1- -3 3. One of them may . One of them may
lie in the femoral canal lie in the femoral canal
(lymph node of Cloquet). (lymph node of Cloquet).
- - Afferent: from deep Afferent: from deep
lymphatics of the lower limb lymphatics of the lower limb
and from superficial inguinal and from superficial inguinal
LNs. LNs.
- - Efferent: to external iliac Efferent: to external iliac
LNs LNs