Download MBBS Anatomy PPT 70 Spleen Notes

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Splen (g)

Definition

? A large, highly vascular

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lymphoid organ .

? It is the largest of the ductless

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glands,

? Its soft, and dark purplish

color.

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Anatomy

Shape ? Wedge (Tetrahedral)

Location- Lt. Hypochondrium partly epigastrium

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Wedged between the gastric Fundus and the

diaphragm,

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lies beneath the 9th to 12th ribs,

The hilum sits in the angle between stomach and the

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kidney and is in contact with the tail of the pancreas

? Size & weight ? markedly variable

? Normal y ? not palpable

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? Harri's Dictum

? Its related to the odd numbers 1,3,5,7,9,11,

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? Thick , Broad, length, weight & relation.
? Position- Axis of spleen

lies obliquely along the long axis of the 10th rib.

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Directed- downwards, forwards & lateral y. (45*)

External features-
Two ends, Three borders & Two surfaces.

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? Peritoneal Relations-

? Surrounded by peritoneum & suspended by fol owing ligamnets-

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? Gastrosplenic ligament- short gastric vessels, lymphatics & symp.

N.

? Lienorenal ligamnet- tail of pancreas, splenic vessels,

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? pancreaticospleni lymoh nodes
? phrenicocolic ligamen ? supports only.

? Visceral relations-
visceral & diaphragmatic surface- costodiaphragmatic recess of

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pleura, lung, & 9,10,11th ribs of left side.


Blood Supply

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? Arteries :
The splenic artery which is the largest branch of

the celiac artery

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? Veins :
The splenic vein which joins the superior

mesenteric vein to form the portal vein

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? Lymph drainage :
The lymph vessels emerge from the hilum and

drain into the celiac nodes .

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? Lymph drainage :
The lymph vessels emerge from the hilum and drain into the celiac nodes .

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Nerve Supply- sympathetic fibres are derived from the coeliac plexus,

vasomotor in nature.

Functions of the spleen

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? the spleen processes foreign antigen

Immune

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? Make bacteria and fungi more susceptible to

function

phagocytosis.

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? Macrophages capture cel ular and noncel ular

material from the blood and plasma includes

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bacteria, especial y pneumococci

Filter function

?

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culling

Removal of effete, platelets and red cel s

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? removing the inclusions from red cel s and returning

the repaired red cel to the circulation

Pitting

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? up to 30--40 per cent of blood platelets are

Pooling

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sequestered within the spleen.

? removal of iron from ingested degraded haemoglobin

during red cel cul ing and return the iron to the

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plasma.

Iron reutilisation
? PALPATION OF THE SPLEEN

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? SPLENOMEGALY

? SPLENECTOMY

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? SPLENIC PUNCTURE

? SPLENIC INFARCTION- Kehr's sign.

SPLENOMEGALY

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What is splenomegaly ?

? Splenomegaly is an enlargement of the spleen beyond its normal size

Symptoms and signs

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Symptoms:

? Abdominal pain
? chest pain
? back pain

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Signs:

? palpable left upper quadrant
? Abdominal mass

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Causes of splenomegaly

Infection

Infarctio

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Cel ular

n and

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prolifera

injury

Causes of

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tion

splenom

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egaly

Cel ular

Congesti

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infiltrati

on

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on
1- Infection

Bacterial

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Viral

Protozoal

2- Cellular Proliferation

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Malignancies

Anemia

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? leukemia

? Spherocytosis

? lymphoma

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? Hemolytic

? Sarcoidosis

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? Myelofibrosis

? pernicious
3- Congestion

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Portal hypertension

Hepatic vein obstruction

Congestive heart failure

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4- collagen disease :

Felty's

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Still's

syndrome syndrome
Felty's syndrome

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? Felty syndrome is characterized by the

combination of:

1. rheumatoid arthritis

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2. splenomegaly
3. Neutropenia

5-Infarction and Injury

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? Embolism from ; bacterial endocarditis

1

, AF, MI

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? Splenic artery or vein thrombosis

2

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? Hematoma

3
Hypersplenism

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? Definition:
Hypersplenism is a type of disorder which causes the

spleen to rapidly and prematurely destroy blood

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Types & causes

1ry

? The problem within the spleen

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itself.

hypersplenism

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? chr. malaria

? TB

2ry

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? Polycythemia vera

? Tumors.

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hypersplenism ? Portal hypertension


Symptoms & signs

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? Symptoms of anemia

RBC

? Symptoms of leukopenia & recurrent

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WBC

infections

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? Symptoms of thrombocytopenia

platelets

+ splenomegaly

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Diagnosis & ttt

History taking

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Clinical examination

Imaging studies

Laboratory investigation

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Treat underlying dis.

splenectomy

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SPLENECTOMY

Splenectomy

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? Definition:
A splenectomy is the total or partial surgical removal of

the spleen
Indication of Splenectomy

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? Trauma:

A- accidental

B- during surgical procedure of

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surrounding structures

? As a part of other procedures:

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eg. Radical gastrectomy in gastric carcinoma. Total or

distal pancreatectomy.

? Hematological conditions:

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? A- RBC:

?

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- Hereditary spherocytosis

?

- Thalassaemia

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?

- SCA

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?

- Autoimmune hemolytic anemia (AIHA)

? B- WBC:

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?

- CML)

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?

- Lymphomamanagement

? C- Platelets:

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? - Idiopathic thrombocytopaenic purpura

(ITP)
? Vascular conditions:

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? a- Splenic Artery Aneurysm

? b- Portal hypertension (only if there are

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symptomatic esophageal varices) which we

called it segmental portal hypertension.

? Tumors or Abscess:

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? primary tumors of the spleen

? Splenic Abscess(Both are rare conditions)

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? Others: like cysts in spleen which could be

congenital, degenerative or parasitic like in hydatid

dis.

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? Remember that :

There are two diseases for which a splenectomy is the

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only treatment--primary cancers of the spleen and

hereditary spherocytosis (HS)

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Pre Operative Preparation

1.VACCINATIONS

2.PLT Transfusion

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3. Steroids

Special Pre-Op Preparations

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In SCD:



1 Prevention of hypoxia [ O2 ]

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2 hydration

3 Antibiotics

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4 Blood!!!!


Types

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partial

laparoscopic

complete

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open

splenectomy
Laparoscopic splenectomy

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? Removal through several small incisions.
? hospital stay.
? postoperative pain.
? risk of get infection

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? Leave smaller scars.
? Remove only middle size enlarged spleen.

Complete splenectomy

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Removal of enlarged

Removal of ruptured

spleen

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spleen

? Performed under

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? Common cause of

general anesthesia.

rupture is accidental

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? One of the open surgery.

trauma.

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? Most common

? To avoid bleeding, we

technique used if we

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ties the splenic artery

have .....

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before removing the

ruptured organ.
Partial splenectomy

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? Removes only part.
? Useful to reduces pain caused by splenomegaly.
? The pt. is less vulnerable to infection.

Complications

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co Earmplicyations Late complications


Postoperative complications

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? Lung:
Atelactasis
Pleural effusion
Subphrenic

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abscess

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Postoperative complications

? Stomach

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Dilatation
Perforation
Fistula
Haematemesis

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? Pancreas
Abscess
Pancreatitis
Fistula

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Postoperative complications

? Haematological

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increase in Plts

&WBC.

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? Postsplenectomy

Septicaemia

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D/T *H.inf

*St.pneum

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*N.mening