those are related to your practical exams clear so in the practical fiber whenever you are appearing you will have this organ second you have the clinical questions which are based on the injury of spleen clear so at the end of this lecture i will tell you how to attempt that clinical question and also will discuss about the important aspects of your practical exam okay so first what is this plane what is the introduction so is plane is called as a organ of mystery by gallon now this is the first multiple choice question which of the following is organ of mystery answer is spleen the second thing is that when you will see the spleen it is a soft purplish organ and it is the part of your lymphatic system okay what ex next is that it is surrounded by the capsule it is surrounded by the capsule and this capsule is having the smooth muscle cells but not in human beings but not in human beings and whenever there is a construction of the capsule whenever there is a contraction in these smooth muscle fibers rbc they will come out but sometimes when you are doing the histological examination smooth muscle cells that means it is showing the evolution of your spleen okay now what is the position and dimensions of this organ now when you will see the abdominal areas we are dividing this areas in the nine quadrants from abdominal quadrants so this is your upper and left so in this quadrant you will have the organ known as spleen this plane lies under the diaphragm on the left side of diaphragm our left this is your diaphragm is this is the question which you will have very commonly that left upper quadrant may cause answer is spleen then this is very very important now this is known as rule of odd numbers this is known as rule of odd numbers now when you will see the numbers you will have 1 3 5 7 9 11 what these are indicating or you can say the question is that rule of odd number is applicable one inch thick three inch breadth and five inch is the length okay so one three five are related to the dimension then you will have seven seven is indicating the weight so when you will see the weight of the spleen it is 7 ounce 7 ounces roughly around 150 grams then you will have 9 and 11 that means spleen lies against nine to eleventh rib tk is my tandy i have me which is not written here to make this rule of odd number so one three five seven nine eleven what does it means 135 is indicating the dimension of this plane 7 is its weight 7 ounce and 9 to 11 is indicating the positioning of your spleen in relation to ninth to eleventh trip okay so this is what you have to keep in mind and the important thing which you have to remember which is here in the last line with the advancement of the age is 11th so this is 11 this will become 10 and this is become 9 in the same way so this is the 12 this is 11 this is 10 and this is 9. so hey is lies against the 9th 10th and 11th rib so when you will see this area this area is become important because you have to first look for the 9th 10th 11th ribs and when you will do the dissection in this part you will realize that the spleen is present here so so you have to keep this thing in mind that is plain present on the left side against ninth tenth and eleventh rib clear so what is the axis of this plane now x is elongated organ so when you will see the long axis of the spleen this long axis lies along the tenth rib tantra however ninth and eleventh downward forward and so this is written here that it is directed downward forward and laterally so because the spleen present in the left side is so this is what is about the axis of spleen now next is its external feature spleen when you will take out the spleen and if you will see what are the external features of the spleen so yes long axis there are two surfaces two angles and one high lump external features or some book says lower pole it is known as upper end or upper pole then you will have three borders so this is the one border this is the upper border or you can say anterior border this is the lower water or you can say the posterior water and this is your intermediate border or your middle border teen water organization then you will have the two surfaces foreign the lower pole does not normally project any further this plane is not placed anteriorly to the mid axillary line it is present behind here so if this is my 9th 10th 11th rib i will find the spleen here it is not present anteriorly because we are saying that it is not extending anterior to the mid axillary line so yea not behind the mid auxiliary line the highland lies in the angle between stomach and left kidney [Music] so this is written here that hilum lies between the stomach and left kidney now what next is that the interior border is not now up called when you will see the inferior water and upper water you will realize the inferior border upper body is so this is the meaning of this line which is the most important question for your exam the next is peritoneal relations now this peritoneal relation is again the important short note for your exam from this topic now what you have to important thing you have to remember that spleen lies foreign [Applause] the next question is what are the peritoneal ligaments or folds of peritoneum zinc organ suspended retroperitoneal organisms in this diagram you will appreciate this very well this is your spleen is [Applause] renal so this is the important concept which you have to remember in this diagram now here what you are able to see is that it is the ct scan or transfer section of this [Applause] is key city skin yet yes from the inferior side this is the inferior view which you are able to appreciate here the next thing is that the two leaves of the greater momentum two leaves of greater momentum passes from the hilum forward to the greater curvature of the stomach and that will form the gastroespec is and it also goes backward to the front of your left [Applause] short gastric is answer is short gastric arteries which are the branch you will have these questions very frequently in your as pedicles of your spleen so a question yoga key define or write down the name of particles of spleen so explain capacity then there is a very high chances that patient will develop the diabetes mellitus because tale of pancreas so tale of pancreas should be avoided to injured during the spleen ectomy in they are known as visceral relations they are known as visceral relations so the concave visceral surface is oriented towards other abdominal organs or vocals say gastric renal colic and there is a small impression for the splenic hilum where you will have the tail of pancreas spleen keeper is so this is the important thing which you have to remember [Applause] we have to keep these notches in the upper part because we as know we are having this knowledge that these notch which are present here are the characteristic feature of anterior water or upper border split inferior okay so this is the important thing which you have to keep in mind whenever you are reading or you are dealing with the spleen what are the important facts about the enlargement of this plane they get a b so it may extend across the upper approaches [Applause] 150 300 to 400 gram it is almost double of the size so this is the important thing its normal size before its anterior border passes beyond the left costal margin so spleen palpate minimum requirement double of the size a palpable spleen is identified by the notch at its anterior border now this is again become important left side or left side differentiates whatever the degree of enlargement the spleen glides in the contact with diaphragm and anterior abdominal wall in front of now you've got important in front of the splenic flexor of colon alone which remains anchored by the phrenic resonance on the contrary agar suppose so retroperitoneal tumors like kidney do not displace the overlying colon and they are caused by the band of colonic resonance metabolism foreign foreign [Applause] okay the structures that are related to the surface of the spleen can be identified by holding the convexity [Applause] foreign so when we will hold it in this manner then it automatically the long axis will go downward forward and laterally okay and long axis consider is yes so these are the important thing which you have to keep in mind in this slide now what is the development now [Applause] begins to develop in the fifth week of intrauterine life as a several condensation of the mesodermal cell so it's it's called region consumer mesoderms in dorsal mesogastrium in dorsal mesogastrium ventral divided into the spleno renal and gastroesplanic ligament posterior is original condensation becomes aggregated into a single organ and the splenic notch may represent a reason where these are incompletely fused fusion of what is splenium kuli is planing kills are nothing but this is the name given to the accessory spleen this is a short note for example splenon kelly kyoto splenium kili is a single or multiple accessory spleens accessory springs are completely separated from the body of main spleen any maintenance along the splenic vessel or in the peritoneal attachment they occur in around 20 percent of the population tk and are rarely larger than 2 centimeters size now we'll talk about the blood supply of the spleen now when you will see the explaining blood supply splenic artery is a branch of celiac trauma abdominal out now if you will see this diagram you can see that this is the serpentine wavy appearance of the artery and this artery is arising from this common trunk which is known as celiac trunk and he articulated now this artery gives off multiple artery divides into the two or three main branches from which the five or more tk super that is your closed circulation of spleen and open circulation of spleen they get close circulation or open circulation close circulation fast flow of blood from arteries to sinus endothelium endothelium capillary endothelium or sinuses close circulation like another it travels through the cavernous spaces of the spleen and finally re-enters the vasculature through the inter-endothelial foreign so we are seeing here that endothelium from arteries to sinus there is a continuity of endothelium so in nutshell when you are seeing this diagram you have to examine both the place where you can appreciate this is the site of your closed circulation this is the site of your open splenic circulation so close or open splenic circulation basics are concept one more concept and that is splenic you will have the history of road traffic accident tk or road traffic accident and if you will have hit on the left side there are very high chances he is clinic rupture and it is associated with the fracture of lower the patient is presenting to the emergency with hypotension tachycardia restlessness or in the condition of shock the phrenic now causes your referred pain in the left shoulder okay left shoulder sensory supply case supraclavicular now or supraclavicular root value c3c4c5 now foreign [Applause] it is as the collected blood gets clotted so that the law the less without shifting is known as balances commonly asked road traffic accident tk and he is presented to you in emergency with paler tachycardia restlessness of deka the answer is irritation of diaphragm due to phrenic now you have the referred pain tk so this is what is about the spleen at the end of this lecture you should able to understand what is the anatomy of the spleen how to hold the spleen in exam what are the different visceral relations of this plane what are the ligaments of this plane and your cover sign in relation to the cover sign so this is all about today's lecture thank you