9 The Spleen
Anatomy
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.
Location
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
Attachments/Suspensions
organ pressure
turgor
phrenicocolic ligament on the left
gastrosplenic ligament
splenorenal ligament (previously phrenicolienal ligament)
pancreaticosplenic ligament
Circulation
Arterial
Splenic artery (via the splenorenal ligament).
Venous
Splenic vein (via the splenorenal ligament).
Lymph Drainage
Pancreaticolienal lymph nodes with connection to celiac, hepatic, and gastric lymph ducts.
Innervation
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
Mobility
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.
Physiology
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
Pathologies
Symptoms that Require Medical Clarification
Splenomegaly
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.
Hypersplenism
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.
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