Objectives

Discuss the gross features of spleen.

Give its blood and nerve supply.

Describe the inguinal lymph nodes.

SiteSite: : Left hypochondrium.Left hypochondrium.

It lies under the diaphragm between it and It lies under the diaphragm between it and the fundus of the stomach.the fundus of the stomach.

MeasurementsMeasurements::

--11 inch (thickness) x 3 inches (Breadth) x 5 inch (thickness) x 3 inches (Breadth) x 5 Inches (length)Inches (length)..

- - -Weight: 875 gram (7 ounces)Weight: 875 gram (7 ounces)..

- -Surface anatomy: Behind left 9, 10, 11 ribsSurface anatomy: Behind left 9, 10, 11 ribs..

SurfaceSurface anatomyanatomy ::It lies parallel to the ribs It lies parallel to the ribs number 9, 10 , and 11 number 9, 10 , and 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 10th rib.the 10th rib.Its medial end lies 1 1/2 Its medial end lies 1 1/2 inches from the spine of inches from the spine of T. 10, while the lateral T. 10, while the lateral end lies just behind the end lies just behind the mid-axillary line.mid-axillary line.

ShapeShape: : 3 borders, 2 ends, 2 3 borders, 2 ends, 2 surfaces.surfaces.

A. EndsA. Ends1) lateral end (Broad)1) lateral end (Broad)2) medial end (tapering)2) medial end (tapering)

B. BordersB. BordersUpper border (Sharp & Upper border (Sharp & notched)notched)Lower border (Broad)Lower border (Broad)Intermediate border (thick, Intermediate border (thick, incomplete. Extends from incomplete. Extends from the medial end till the the medial end till the hilum).hilum).

SurfacesSurfaces 1- Diaphragmatic surface: 1- Diaphragmatic surface:

Convex, Related to the diaphragm which Convex, Related to the diaphragm which separates it from 3 structures :-------separates it from 3 structures :-------

- Lower part of left pleura,- Lower part of left pleura, - Base of left lung,- Base of left lung, - Left 9, 10, 11 ribs.- Left 9, 10, 11 ribs.

22 - -Visceral surfaceVisceral surface::- Concave, irregular, directed to the abdominal cavity.Concave, irregular, directed to the abdominal cavity.- Contains the hilum and impressions for 4 abdominal Contains the hilum and impressions for 4 abdominal

organs:organs:- 1- 1- Gastric impressionGastric impression (related to posterior wall of fundus (related to posterior wall of fundus

of stomach).of stomach).- 2- 2- Renal impressionRenal impression..- 3- 3- Colic impressionColic impression (left colic flexure). (left colic flexure).- 4- 4- Pancreatic impressionPancreatic impression (tail of pancreas). (tail of pancreas).

Peritoneal relationsPeritoneal 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 hilumexcept at the hilum..

It is attached and related to the following ligaments:It is attached and related to the following ligaments:

1- Gastro-splenic ligament1- Gastro-splenic ligament

2- Lieno-renal ligament.2- Lieno-renal ligament.

-The gastrosplenic ligamentThe 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-renal ligamentThe lieno-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

Arterial Supply:Arterial Supply:Splenic artery (branch of the Splenic artery (branch of the coeliac trunk).coeliac trunk).It has a tortuous course at the It has a tortuous course at the upper border of the pancreas.upper border of the pancreas.It passes with the tail of the It passes with the tail of the pancreas in the lieno-renal pancreas in the lieno-renal ligament.ligament.At the hilum it divides into 5 or 6 At the hilum it divides into 5 or 6 splenic branches.splenic branches.

Venous drainage:Venous 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 notesClinical notes::SplenomegalySplenomegaly It is an enlargement of the It is an enlargement of the spleenspleen beyond beyond its normal size. Many disorders, including infections, its normal size. Many disorders, including infections, anemias, can cause an enlarged spleen. Enlarged anemias, can cause an enlarged spleen. Enlarged spleen extends spleen extends downward and mediallydownward and medially (due to the (due to the presence of the phrenico-colic ligament that prevents its presence of the phrenico-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.Injury of the spleen is common due to fracture of the 9, Injury of the spleen is common due to fracture of the 9, 10, 11 ribs, automobile accidents, during playing contact 10, 11 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 (10-15% of people). Accessory spleens are common (10-15% of people). They are found at the hilum of spleen, the lieno-renal, or They are found at the hilum of spleen, the lieno-renal, or the gastro-splenic ligaments.the gastro-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).

SpleenectomySpleenectomySpleen 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. ...Its that helps the body fight infections. ...Its attachments to other organs are gently cut. attachments to other organs are gently cut.

Inguinal lymph nodesInguinal lymph nodesI- Superficial inguinal LNs:I- Superficial inguinal LNs: Site: In the proximal region of the Site: In the proximal region of the

femoral triangle.femoral triangle. No: 12- 20 No: 12- 20 Two groups:Two groups: A- Horizontal group:A- Horizontal group: i- Mediali- Medial: It drains: Anterior : It 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- Lateralii- Lateral: It drains; buttock and : It drains; buttock and back below iliac crest.back below iliac crest.

B- Vertical group:B- Vertical group: It drains the It drains the lower limb. It is present at the end lower limb. It 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.

Inguinal lymph nodes Inguinal lymph nodes contcont..

II- Deep inguinal LNs:II- 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: 1-3. One of them may - No: 1-3. 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 LNsLNs