4g. The Spleen

(Lien)

The spleen is situated principally in the left hypochondriac region, but its superior extremity extends into the epigastric region; it lies between the fundus of the stomach and the diaphragm. It is the largest of the ductless glands, and is of an oblong, flattened form, soft, of very friable consistence, highly vascular, and of a dark purplish color. 1 Development.—The spleen appears about the fifth week as a localized thickening of the mesoderm in the dorsal mesogastrium above the tail of the pancreas. With the change in position of the stomach the spleen is carried to the left, and comes to lie behind the stomach and in contact with the left kidney. The part of the dorsal mesogastrium which intervened between the spleen and the greater curvature of the stomach forms the gastrosplenic ligament. 2 Relations.—The diaphragmatic surface (facies diaphragmatica; external or phrenic surface) is convex, smooth, and is directed upward, backward, and to the left, except at its upper end, where it is directed slightly medialward. It is in relation with the under surface of the diaphragm, which separates it from the ninth, tenth, and eleventh ribs of the left side, and the intervening lower border of the left lung and pleura. 3

FIG. 1188– The visceral surface of the spleen. (See enlarged image) The visceral surface (Fig. 1188) is divided by a ridge into an anterior or gastric and a posterior or renal portion. 4 The gastric surface (facies gastrica), which is directed forward, upward, and medialward, is broad and concave, and is in contact with the posterior wall of the stomach; and below this with the tail of the pancreas. It presents near its medial border a long fissure, termed the hilum. This is pierced by several irregular apertures, for the entrance and exit of vessels and nerves. 5 The renal surface (facies renalis) is directed medialward and downward. It is somewhat flattened, is considerably narrower than the gastric surface, and is in relation with the upper part of the anterior surface of the left kidney and occasionally with the left suprarenal gland. 6 The superior extremity (extremitas superior) is directed toward the vertebral column, where it lies on a level with the eleventh thoracic vertebra. The lower extremity or colic surface (extremitas inferior) is flat, triangular in shape, and rests upon the left flexure of the colon and the phrenicocolic ligament, and is generally in contact with the tail of the pancreas. The anterior border (margo anterior) is free, sharp, and thin, and is often notched, especially below; it separates the diaphragmatic from the gastric surface. The posterior border (margo posterior), more rounded and blunter than the anterior, separates the renal from the diaphragmatic surface; it corresponds to the lower border of the eleventh rib and lies between the diaphragm and left kidney. The intermediate margin is the ridge which separates the renal and gastric surfaces. The inferior border (internal border) separates the diaphragmatic from the colic surface. 7 The spleen is almost entirely surrounded by peritoneum, which is firmly adherent to its capsule. It is held in position by two folds of this membrane. One, the phrenicolienal ligament, is derived from the peritoneum, where the wall of the general peritoneal cavity comes into contact with the omental bursa between the left kidney and the spleen; the lienal vessels pass between its two layers (Fig. 1039). The other fold, the gastrolienal ligament, is also formed of two layers, derived from the general cavity and the omental respectively, where they meet between the spleen and stomach (Fig. 1039); the short gastric and left gastroepiploic branches of the lienal artery run between its two layers. The lower end of the spleen is supported by the phrenicocolic ligament (see page 1155). 8 The size and weight of the spleen are liable to very extreme variations at different periods of life, in different individuals, and in the same individual under different conditions. In the adult it is usually about 12 cm. in length, 7 cm. in breadth, and 3 or 4 cm. in thickness, and weighs about 200 grams. At birth its weight, in proportion to the entire body, is almost equal to what is observed in the adult, being as 1 to 350; while in the adult it varies from 1 to 320 and 400. In old age the organ not only diminishes in weight, but decreases considerably in proportion to the entire body, being as 1 to 700. The size of the spleen is increased during and after digestion, and varies according to the state of nutrition of the body, being large in highly fed, and small in starved animals. In malarial fever it becomes much enlarged, weighing occasionally as much as 9 kilos. 9 Frequently in the neighborhood of the spleen, and especially in the gastrolienal ligament and greater omentum, small nodules of splenic tissue may be found, either isolated or connected to the spleen by thin bands of splenic tissue. They are known as accessory spleens (lien accessorius; supernumerary spleen). They vary in size from that of a pea to that of a plum. 10

Structure.—The spleen is invested by two coats: an external serous and an internal fibroelastic coat. 11 The external or serous coat (tunica serosa) is derived from the peritoneum; it is thin, smooth, and in the human subject intimately adherent to the fibroelastic coat. It invests the entire organ, except at the hilum and along the lines of reflection of the phrenicolienal and gastrolienal ligaments. 12 The fibroelastic coat (tunica albuginea) invests the organ, and at the hilum is reflected inward upon the vessels in the form of sheaths. From these sheaths, as well as from the inner surface of the fibroelastic coat, numerous small fibrous bands, trabeculæ (Fig. 1189), are given off in all directions; these uniting, constitute the frame-work of the spleen. The spleen therefore consists of a number of small spaces or areolæ, formed by the trabeculæ; in these areolæ is contained the splenic pulp. 13 The fibroelastic coat, the sheaths of the vessels, and the trabeculæ, are composed of white and yellow elastic fibrous tissues, the latter predominating. It is owing to the presence of the elastic tissue that the spleen possesses a considerable amount of elasticity, which allows of the very great variations in size that it presents under certain circumstances. In addition to these constituents of this tunic, there is found in man a small amount of non-striped muscular fiber; and in some mammalia, e. g., dog, pig, and cat, a large amount, so that the trabeculæ appear to consist chiefly of muscular tissue. 14

FIG. 1189– Transverse section of the spleen, showing the trabecular tissue and the splenic vein and its tributaries. (See enlarged image)

FIG. 1190– Transverse section of the human spleen, showing the distribution of the splenic artery and its branches. (See enlarged image) The splenic pulp (pulpa lienis) is a soft mass of a dark reddish-brown color, resembling grumous blood; it consists of a fine reticulum of fibers, continuous with those of the trabeculæ, to which are applied flat, branching cells. The meshes of the reticulum are filled with blood, in which, however, the white corpuscles are found to be in larger proportion than they are in ordinary blood. Large rounded cells, termed splenic cells, are also seen; these are capable of ameboid movement, and often contain pigment and red-blood corpuscles in their interior. The cells of the reticulum each possess a round or oval nucleus, and like the splenic cells, they may contain pigment granules in their cytoplasm; they do not stain deeply with carmine, and in this respect differ from the cells of the Malpighian bodies. In the young spleen, giant cells may also be found, each containing numerous nuclei or one compound nucleus. Nucleated red-blood corpuscles have also been found in the spleen of young animals. 15 Bloodvessels of the Spleen.—The lienal artery is remarkable for its large size in proportion to the size of the organ, and also for its tortuous course. It divides into six or more branches, which enter the hilum of the spleen and ramify throughout its substance (Fig. 1190), receiving sheaths from an involution of the external fibrous tissue. Similar sheaths also invest the nerves and veins. 16 Each branch runs in the transverse axis of the organ, from within outward, diminishing in size during its transit, and giving off in its passage smaller branches, some of which pass to the anterior, others to the posterior part. These ultimately leave the trabecular sheaths, and terminate in the proper substance of the spleen in small tufts or pencils of minute arterioles, which open into the interstices of the reticulum formed by the branched sustentacular cells. Each of the larger branches of the artery supplies chiefly that region of the organ in which the branch ramifies, having no anastomosis with the majority of the other branches. 17 The arterioles, supported by the minute trabeculæ, traverse the pulp in all directions in bundles (pencilli) of straight vessels. Their trabecular sheaths gradually undergo a transformation, become much thickened, and converted into adenoid tissue; the bundles of connective tissue becoming looser and their fibrils more delicate, and containing in their interstices an abundance of lymph corpuscles (W. Müller). 18

FIG. 1191– Transverse section of a portion of the spleen. (See enlarged image) The altered coat of the arterioles, consisting of adenoid tissue, presents here and there thickenings of a spheroidal shape, the lymphatic nodules (Malpighian bodies of the spleen). These bodies vary in size from about 0.25 mm. to 1 mm. in diameter. They are merely local expansions or hyperplasiæ of the adenoid tissue, of which the external coat of the smaller arteries of the spleen is formed. They are most frequently found surrounding the arteriole, which thus seems to tunnel them, but occasionally they grow from one side of the vessel only, and present the appearance of a sessile bud growing from the arterial wall. In transverse sections, the artery, in the majority of cases, is found in an eccentric position. These bodies are visible to the naked eye on the surface of a fresh section of the organ, appearing as minute dots of a semiopaque whitish color in the dark substance of the pulp. In minute structure they resemble the adenoid tissue of lymph glands, consisting of a delicate reticulum, in the meshes of which lie ordinary lymphoid cells (Fig. 1191). The reticulum is made up of extremely fine fibrils, and is comparatively open in the center of the corpuscle, becoming closer at its periphery. The cells which it encloses are possessed of ameboid movement. When treated with carmine they become deeply stained, and can be easily distinguished from those of the pulp. 19 The arterioles end by opening freely into the splenic pulp; their walls become much attenuated, they lose their tubular character, and the endothelial cells become altered, presenting a branched appearance, and acquiring processes which are directly connected with the processes of the reticular cells of the pulp (Fig. 1192). In this manner the vessels end, and the blood flowing through them finds its way into the interstices of the reticulated tissue of the splenic pulp. Thus the blood passing through the spleen is brought into intimate relation with the elements of the pulp, and no doubt undergoes important changes. 20 After these changes have taken place the blood is collected from the interstices of the tissue by the rootlets of the veins, which begin much in the same way as the arteries end. The connective-tissue corpuscles of the pulp arrange themselves in rows, in such a way as to form an elongated space or sinus. They become elongated and spindle-shaped, and overlap each other at their extremities, and thus form a sort of endothelial lining of the path or sinus, which is the radicle of a vein. On the outer surfaces of these cells are seen delicate transverse lines or markings, which are due to minute elastic fibrillæ arranged in a circular manner around the sinus. Thus the channel obtains an external investment, and gradually becomes converted into a small vein, which after a short course acquires a coat of ordinary connective tissue, lined by a layer of flattened epithelial cells which are continuous with the supporting cells of the pulp. The smaller veins unite to form larger ones; these do not accompany the arteries, but soon enter the trabecular sheaths of the capsule, and by their junction form six or more branches, which emerge from the hilum, and, uniting, constitute the lienal vein, the largest radicle of the portal vein. 21

FIG. 1192– Section of the spleen, showing the termination of the small bloodvessels. (See enlarged image) The veins are remarkable for their numerous anastomoses, while the arteries hardly anastomose at all. 22 The lymphatics are described on page 711. 23 The nerves are derived from the celiac plexus and are chiefly non-medullated. They are distributed to the bloodvessels and to the smooth muscle of the capsule and trabeculæ. 24

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