Spleen-Relations-Splenic Enlargement-Trauma to the Spleen

Spleen

The spleen is the largest single mass of lymphoid tissue in the body. It is oval shaped and is reddish and has a notched anterior border.
 It lies just beneath the left half of the diaphragm close to the 9th, 10th, and 11th ribs. The long axis lies along the shaft of the 10th rib, and its lower pole extends forward only as far as the midaxillary line and cannot be palpated on clinical examination .
 The spleen is surrounded by peritoneum, which passes from it at the hilum as the gastrosplenic omentum (ligament) to the greater curvature of the stomach(carrying the short gastric and left gastroepiploic vessels). The peritoneum also passes to the left kidney as the splenicorenal ligament (carrying the splenic vessels and the tail of the pancreas).

 

Relations

■■ Anteriorly: The stomach, tail of the pancreas, and left colic flexure. The left kidney lies along its medial border.

■■ Posteriorly: The diaphragm; left pleura (left costodiaphragmatic recess); left lung; and 9th, 10th, and 11th ribs.

 

Splenic Enlargement

An enlarged spleen extends downward and medially. direct downward enlargement of the organ is prevented by The left colic flexure and the phrenicocolic ligament . As the enlarged spleen projects below the left costal margin, its notched anterior border can be recognized by palpation through the anterior abdominal wall.

The spleen is situated at the beginning of the splenic vein, and in cases of portal hypertension it often enlarges from venous congestion.

Trauma to the Spleen

Although anatomically the spleen gives the appearance of being well protected, automobile accidents of the crushing or run-over type commonly produce laceration of the spleen. Penetrating wounds of the lower left thorax can also damage the spleen.

Surface Landmarks of the Abdominal Viscera-Gallbladder-Spleen-Liver-Pancreas-Kidneys-Stomach-Aorta

Surface Landmarks of the Abdominal Viscera

Gallbladder

The gallbladder is a pear-shaped sac,The fundus of the gallbladder lies opposite the tip of the right ninth costal cartilage—that is, where the lateral edge of the right rectus abdominis muscle crosses the costal margin

 

Spleen

It lies in the left upper quadrant and lies under cover of the 9th, 10th, and 11th ribs. Its long axis corresponds to that of the 10th rib, and in the adult it does not normally project forward in front of the midaxillary line. In infants, the lower pole of the spleen may just be felt

Liver

The liver is a large organ that occupies the upper part of the abdominal cavity is covered under  the lower ribs, and most of its bulk lies on the right side.
In infants, until about the end of the third year, the lower margin of the liver extends one or two fingerbreadths below the costal margin. In the adult who is obese or has a welldeveloped right rectus abdominis muscle, the liver is not palpable. In a thin adult, the lower edge of the liver may be felt a fingerbreadth below the costal margin. It is most easily felt when the patient inspires deeply and the diaphragm contracts and pushes down the liver.

 

Pancreas

The pancreas lies across the transpyloric plane. The head lies below and to the right, the neck lies on the plane, and the body and tail lie above and to the left.

 

Kidneys

the left kidney lies at a slightly  higher level than The right kidney (because of the bulk of the right lobe of the liver), and the lower pole can be palpated in the right lumbar region at the end of deep inspiration in a person with poorly developed abdominal muscles. Each kidney moves about 1 in. (2.5 cm) in a vertical direction during full respiratory movement of the diaphragm. The normal left kidney, which is higher than the right kidney, is not palpable. On the anterior abdominal wall, the hilum of each kidney lies on the transpyloric plane, about three fingerbreadths from the midline. On the back, the kidneys extend from the 12th thoracic spine to the 3rd lumbar spine, and the hili are opposite the 1st lumbar vertebra

Stomach

The stomach is a dilated part of the alimentary canal between the esophagus and the small intestine ,The cardioesophageal junction lies about three fingerbreadths below and to the left of the xiphisternal junction (the esophagus pierces the diaphragm at the level of the10th thoracic vertebra).

The pylorus lies on the transpyloric plane just to the right of the midline. The lesser curvature lies on a curved line joining the cardioesophageal junction and the pylorus. The greater curvature has an extremely variable position in the umbilical region or below.

Aorta

The aorta lies in the midline of the abdomen and bifurcates below into the right and left common iliac arteries opposite the 4th lumbar vertebra—that is, on the intercristal plane. The pulsations of the aorta can be easily palpated through the upper part of the anterior abdominal wall just to the left of the midline.