Clarissa GurbaniYear 3 Medical StudentUniversity of Manchester

Length – approx 12cm (5 inches) in adults Weight – approx 160 g Colour – deep red Position

◦ Between 9th to 11th ribs on left side

◦ Splenic artery From coeliac trunk (T12), a branch of the abdominal

aorta Branches into trabecular arteries Further branches surrounded by white pulp Capillaries discharge blood into red pulp

◦ Splenic vein Joins SMV to form hepatic portal vein

Gastrosplenic ligament◦ Broad band of mesentery◦ Attaches spleen to lateral border of stomach

Surfaces◦ Diaphragmatic – smooth and convex◦ Visceral – i.e. conforming to shape of:

Stomach (gastric area) Left kidney (renal area)

Hilum◦ Pt of communication of splenic vessels with spleen◦ Groove that marks border between gastric and

renal areas.

Surrounding capsule – collagen + elastic fibres

Cellular components divided into ‘pulp’:Red pulp •Function – mechanical filtration of RBCs•Contains – RBCs, blood components, free and fixed macrophages•Sequence of filtration – network of reticular fibres blood-filled sinusoids lined with macrophages small veins trabecular veins hilum•NB: marginal zone i.e. where red pulp meets white

White pulp

•Function – active immune response via humoral and cell-mediated pathways.•Composed of nodules (Malpighian corpuscles):

•Lymphoid follicles – rich in B cells•Periarteriolar lymphoid sheathes (PALS) – rich in T cells

1. Removal of abnormal RBCs and other blood components (via phagocytosis)

2. Fe storage (recycled from RBCs)3. Initiation of immune responses by

B and T cells in response to circulating antigens

Cannot get above it (ribs overlie the top) Dull to percussion (kidneys are resonant

due to underlying bowel) Moves more with inspiration towards RIF Medial notch

Causes can be divided into:◦ Infective◦ Haematological◦ Neoplastic

Also can be grouped with associated features◦ Fever◦ Lymphadenopathy◦ Purpura◦ Arthritis◦ Ascites◦ Murmurs◦ Anaemia◦ Weight loss and CNS signs◦ Massive

Infection ◦ Malaria◦ SBE/IE◦ Hepatitis◦ EBV◦ TB◦ CMV◦ HIV

Sarcoid Malignancy

Glandular fever (mono)◦ Aka infectious mononucleosis◦ Secondary to EBV infection

Leukaemias, lymphoma Sjogren’s syndrome

◦ Xerostomia (dry mouth), xerophthalmia (dry eyes)◦ Another cause of xerophthalmia? – Vit A

deficiency

Septicaemia Typhus DIC (Disseminated Intravascular

Coagulation) Amyloid Meningococcaemia

Sjogren’s syndrome RA and SLE Infection e.g. Lyme Vasculitis, Behcet’s

Carcinoma Portal HTN

SBE/IE Rheumatic fever Hypereosinophilia Amyloid

Sickle-cell Thalassaemia Leishmaniasis Leukaemia Pernicious anaemia

◦ Lack of secretion of intrinsic factor (IF) from gastric oxyntic cells, which is needed for B12 absorption

POEM (polyneuropathy, organomegaly, endocrinopathy, M-protein banding)

Cancer, lymphoma TB Arsenic poisoning Paraproteinaemia

Malaria Leishmaniasis Myelofibrosis Chronic myeloid leukaemia Gaucher’s syndrome

The Oxford Handbook of Clinical Medicine, 8th edition

Martini’s Fundamentals of Anatomy and Physiology, 8th edition

Macleod’s Clinical Examination, 12th edition

Thank you!