Gastro Medicine - The Spleen

Question 1

Where is the spleen located?

Answer 1

• The spleen is located in the left upper quadrant of the abdomen and its size can vary depending upon the amount of blood it contains.
• The typical adult spleen is 12.5cm long and 7.5cm wide. The usual weight of the adult spleen is 150g.

Question 2

Anatomy of the Spleen?

Answer 2

Question 3

Relations?

Answer 3

Superiorly: Diaphragm

Anteriorly: Gastric impression

Posteriorly: Kidney

Inferiorly: Colon

Hilum: Tail of pancreas and splenic vessels (splenic artery divides here, branches pass to the white pulp transporting plasma

Question 4

What are the contents of the Spleen?

Answer 4

White pulp:

Immune function. Contains central trabecular artery. The germinal centres are supplied by arterioles called penicilliary radicles.

Red pulp:

Filters abnormal red blood cells.

Question 5

Function of the Spleen?

Answer 5

• Filtration of abnormal blood cells and foreign bodies such as bacteria.
• Immunity: IgM. Production of properdin, and tuftsin which help target fungi and bacteria for phagocytosis.
• Haematopoiesis: up to 5th month gestation or in haematological disorders.
• Pooling: storage of 40% platelets.
• Iron reutilisation
• Storage monocytes

Question 6

Disorders of the spleen?

Answer 6

Massive splenomegaly

• Myelofibrosis
• Chronic myeloid leukaemia
• Visceral leishmaniasis (kala-azar)
• Malaria
• Gaucher’s syndrome

(Deficiency of acid beta-glucocerebrosidase causes widespread accumulation of glucosylceramide-laden macrophages. Glucosylceramide accumulation is widespread, including the bone marrow, liver, spleen and lungs.)

Question 7

Other causes of Spleen disorder?

Answer 7

• Portal hypertension e.g. secondary to cirrhosis
• Lymphoproliferative disease e.g. CLL, Hodgkin’s
• Haemolytic anaemia
• Infection: hepatitis, glandular fever
• Infective endocarditis
• Sickle-cell*, thalassaemia
• Rheumatoid arthritis (Felty’s syndrome)