9 The Spleen


9 The Spleen


General Facts

  • Size: 10–12cm long, 6–7cm wide, 3–4cm thick (about fist sized)

  • The spleen weighs 150-200g.

  • In its normal size, it is not palpable.


The spleen is located intraperitoneally in the hypochondrium on the left side, at the height of ribs 9–11.

Its longitudinal axis runs approximately by rib 10 from top to bottom, from back to front, and from outside to inside.

The splenic bed is bordered caudally by the phrenicocolic ligament on the left.

Topographic Relationships

  • diaphragm

  • stomach

  • left kidney and adrenal gland

  • transverse colon

  • phrenicocolic ligament on the left (= sustentaculum lienis)

  • pancreas

  • ribs 9–11 on the left


  • organ pressure

  • turgor

  • phrenicocolic ligament on the left

  • gastrosplenic ligament

  • splenorenal ligament (previously phrenicolienal ligament)

  • pancreaticosplenic ligament



Splenic artery (via the splenorenal ligament).


Splenic vein (via the splenorenal ligament).

Lymph Drainage

Pancreaticolienal lymph nodes with connection to celiac, hepatic, and gastric lymph ducts.

Fig. 9.1 Location of the spleen at the height of ribs 9-11.
Fig. 9.2 Attachments of the spleen.


  • sympathetic nervous system from T5 to T9 via the major splanchnic nerve and switching in the celiac plexus

  • vagus nerve

Organ Clock

Maximal time: 9–11 a.m.

Minimal time: 9–11 p.m.

Organ-Tooth Interrelationship

For basic information, see page 34.

  • First back tooth in the lower jaw on the left

  • First molar in the upper jaw on the left

Movement Physiology according to Barral


The spleen follows the movements of the diaphragm: during inhalation, we see a shift in a caudal-medial direction; during exhalation it is in the opposite direction.

The spleen’s position is also affected by shifts in body posture and changes in the tension and length of the phrenicocolic ligament on the left and the transverse colon. A full stomach similarly displaces the spleen anteroinferiorly.


  • removal of old or damaged blood cells (especially erythrocytes), thrombocytes, microorganisms, or immune complexes

  • antigen-induced differentiation and proliferation of B and T lymphocytes

  • storage of thrombocytes and erythrocytes


Symptoms that Require Medical Clarification

  • Splenomegaly


Definition. This term refers to an enlarged spleen. The increase in size can be so great that the spleen becomes palpable.

Causes. Splenomegaly is a possible symptom in different pathologies, such as:

  • blood and lymph diseases (lymphoma, leukemia, hemolytic anemia)

  • liver diseases (cirrhosis, hepatitis)

  • rheumatic disorders

  • portal hypertension

  • storage disorders (e.g., amyloidosis)

  • infectious diseases (e.g., malaria, typhoid)

  • sarcoma

  • abscess

  • echinococcal cyst

Clinical. The spleen is palpable or diagnosable by technical means because it is enlarged.

In cases where the enlargement of the spleen is gradual, symptoms arise as a result of the displacement. In cases with a more rapid enlargement, we can see coliclike pain in the left upper abdomen radiating into the left shoulder.

As splenomegaly is often a secondary symptom, we must pay attention to other signs of disease.


Definition. The occurrence of anemia, granulocytopenia, or thrombocytopenia as the result of splenic hyperfunction. This hyperfunction frequently occurs together with a splenomegaly.

Causes. See page 89 (splenomegaly).

Clinical. See page 89 (splenomegaly). Changes in the blood count.

Osteopathic Practice

Cardinal Symptom

  • Splenomegaly

Typical Dysfunctions

A typical dysfunction in the sense of an adhesion/fixation, ptosis, or spasm does not exist in the spleen.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jul 12, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on 9 The Spleen

Full access? Get Clinical Tree

Get Clinical Tree app for offline access