Anatomy of spleen

1. Spleen & Portal vein

2. Transpyloric plane (L1 vertebra)
passes through

3. Spleen
• Haemolymph organ
• Womb & Tomb of RBC
– Formation of RBC
• During intra-uterine life
(till the 5th month)
– Destruction of old RBC
• Made up of
– Lymphoid tissue
• Reservoir of blood and
iron

4. Spleen - Location
• Lies between
– Fundus of stomach
and diaphragm
• Lies in
– Left hypochondrium
• Extends in between
– 9th to 11th ribs

5. Measurements
• 1- inch Thickness
• 3 - inch Breadth
• 5 – inch Length
• 7 oz – Weight (150 gm)
• 9-11 ribs related – (left
side)
Harris dictum of odd numbers on Spleen :1,3,5,7,9 -11

6. External features
• Two ends
• Three borders
• Two surfaces
• Hilum

7. Ends
• Anterior or lateral end
– Expanded or more like a
border
– Directed downwards,
forwards and reaches mid
axillary line
• Posterior or medial end
– Rounded
– Directed upwards
backwards, medially
– Rest on upper pole of left
kidney

8. Borders
• Superior border
– Presents one or two notches
near anterior end
– Notches indicate spleen is
lobulated in development
• (fusion of different masses of
lymphoid tissue)
• Inferior border
– Rounded
• Intermediate border
– Thick, incomplete
– Extends from medial end till
hilum

9. Surfaces
• Diaphragmatic surface
– Convex and smooth
– Related to
• Diaphragm
• Lt lung & lts pleura
• Costodiaphragmatic recess
• 9th, 10th & 11th ribs of left
side

10. VISCERAL SURFACE
• Concave, irregular, directed
to abdominal cavity
• Contains
– Hilum and impressions for 4
abdominal organs
• Gastric impression
– Related to posterior wall of
fundus of stomach
• Renal impression
• Colic impression (left colic
flexure)
• Pancreatic impression (tail
of pancreas)

11. Peritoneum
• Covers entire spleen
– Except the hilum
• Ligaments related
– Gastro-splenic lig.
– Lieno-renal lig.
– Phrenico-colic

12. Peritoneal connections
& contents
• Gastrosplenic ligament
– Connections
• From fundus and greater curvature of
stomach
• To hilum of spleen
– Contents
• Short gastric vessels
• Left gastroepiploic vessels
• Lymph nodes
• Lienorenal ligament
– Connections
• From lower border of hilum of
spleen
• To anterior surface of kidney
– Contents
• Splenic vessels
• Tail of pancreas
• Lymph nodes

13. Applied importance of Gastro-splenic and lieno-renal ligament
• Accessory spleens
– Common in 10-15% of
people
– Found at the hilum of spleen
– Lieno-renal or the gastro-
splenic ligaments
• Tail of pancreas is in close
relation to hilum of spleen
– During surgical removal of
the spleen care must be
taken

14. Peritoneal
connections &
contents
• Phrenico-colic
– Sustentaculum lienis
– Connections
• From left colic flexure to
diaphragm
• Lieno phrenic
– Suspensory ligament of
spleen
– Connections
• Apex of Spleen to
diaphragm

15. Arterial Supply
• Splenic artery
– Branch of Coeliac artery
• Very tortuous
• End artery
– Course
• Along the upper border of
pancreas
• Crosses lt. supra renal &
upper part of kidney
• Enters lienorenal ligament
• Reaches hilum by
dividing into 4-5
segmental arteries

16. Splenomegaly
• Enlargement of spleen
– Causes
• Cirrhosis
• Malaria
• Myeloid leukaemia
– Normally not palpable
– Enlarged spleen is
palpable
• Under left costal margin
– During inspiration

17. Clinical angle of spleen
• Anterior basal angle
– Junction of superior border
with lateral end
– Lies in 9th intercostal space
behind left mid-axillary line
– First palpable in
splenomegaly

18. Portal vein
• Collects blood
– Entire abdominal part of GI
tract
• Except lower rectum & anal
canal
– And also collects venous
blood from
• Gall bladder, pancreas &
spleen

19. Portal vein
• Characters
– Formed like vein
– Ends like artery
– Has two systems
• Capillaries in beginning
• Sinusoids at the end
– No valves
– No mixing of
• Splenic & sup mesenteric vein
– By diferent velocity & gravity
– Right branch
• Contains the blood receives sup
mesenteric
– Left branch
• Contains the blood receives
spleenic vein

20. Portal vein - formation
• Union of
– Mesenteric & splenic v
– Behind neck of Pancreas
– Infront of IVC
– At L 2 level

21. Portal vein - course
• Divided into 3 parts
– Infra duodenal
– Retroduodenal
– Supraduodenal

22. Portal vein - Infra duodenal part
• Lies below
– First part of duodenum
• Relations
– Anterior
• Neck of pancreas
– Posterior
• IVC

23. Portal vein - Retro duodenal part
• Lies behind
– First part of duodenum
• Relations
– Anterior
• First part of duodenum
• Bile duct
• Gastroduodenal artery
– Posterior
• IVC

24. Portal vein - Supra duodenal part
• Lies above
– The first part of duodenum
– Lies in free margin of
lesser omentum
• Relations
– Anterior
• Hepatic artery
• Bile duct
– Posterior
• IVC

25. Portal vein - termination
• At porta hepatis
– Divides into
• Right & left branches
• Right branch
– Shorter & wider
– End in rt lobe
– Receives cystic v
• Left branch
– Narrower &longer
– Gives branches to
• Caudate & quadrate lobe
– Receives
• Paraumbilical v
– Embryological remnants along
with it
• Ligamentum teres
– Obliterated left umbilical vein
• Ligamentum venosum
– Obliterated ductus venosus

26. Portal vein - Tributaries
• Formative
– Splenic
– Superior mesenteric

27. Portal vein - Tributaries
• In Trunk
– Right gastric
– Left gastric
– Superior
pancreaticoduodenal

28. Portal vein - Tributaries
• In branches
– In Right branch
• Cystic
– In left branch
• Paraumbilical

29. Portal hypertension
• Obstruction in portal vein
– Increase portal venous pressure
• Causes :
– Pre hepatic : Thrombosis of
portal vein
– Hepatic: Cirrhosis
– Post hepatic: Budd-Chiari
Syndrome
• Effects:
– Splenomegaly,
– Ascites,
– Collateral circulation through sites
of Portasystemic anastomosis
Budd-Chiari
Syndrome
- hepatic veins are
blocked by a clot,
usually left lobe is
affected.

30. Sites of porto-caval anastomosis
• Five important sites of
portal -systemic
circulation
– Lower third of the
Esophagus
– Paraumbilical Area
– Rectum & Anal canal
– Bare area of liver
– Retroperitonial

31. Caput medusae
• Veins around umbilicus is
dilated & distended
– Due to portal obstruction
• Veins involved
– From portal system
• Paraumbilical veins
– Systemic veins
• From above umbilicus
– Lateral thoracic & superior
epigastric
• From below umbilicus
– Superficial epigastric, &
inferior epigastric

32. Oesophageal varices
• Dilatation of veins at
lower end of oesophagus
– Due to portal obstruction
– May rupture & cause
vomiting of blood
• Veins involved
– From portal system
• Oesophageal vein to left
gastric vein
– Systemic vein
• Oesophageal vein to
hemiazygos vein

33. Piles or haemorrhoids
• Enlargement of veins of
anal canal
– Due to portal obstruction
• Veins involved
– From portal system
• Superior rectal
– Systemic vein
• Middle & inferior rectal

34. Bare area of liver
• Veins involved
– From portal system
• Hepatic venules
– Right division of the portal vein
– Systemic vein
• Phrenic & intercostal veins
•

35. Retroperitoneal
organs
• Systemic vein
– Lt renal V
• Portal vein
– Splenic V