APPLIED ANATOMY. 



THE SPLEEN. 



The spleen lies high up in the left posterior corner of the abdomen in contact 

 with the diaphragm. It follows the direction of the tenth rib, being covered by the 

 ninth, tenth, and eleventh ribs and extending from a point 4. 5 to 5 cm. (ij^ to 2 in.) 

 external to the median line posteriorly to the midaxillary line anteriorly. Its upper 

 end is opposite the tenth dorsal vertebra, or ninth spine (see Fig. 433). 



Relations. It has four surfaces: a posterior one, which lies in contact with 

 the diaphragm; an anterior one toward the stomach; an inferior small one, resting 

 on the splenic flexure of the colon; and an internal one, in contact with the left 

 kidney at its upper anterior portion. The hilum is on its anterior or gastric surface 

 and posterior to it is a depression in which is lodged the tail of the pancreas. 



Ligaments. The spleen is covered with peritoneum except at the hilum, 

 which is on its anterior surface ; here two ligaments are given off a posterior one, the 

 lienorenal, going from the 'spleen to the kidney and containing the blood-vessels, 

 and an anterior one, the gastrosplenic (also called omentum) going to the stomach. 

 The lienophrenic ligament (suspensory ligament) runs from the left crus of the 

 diaphragm to the upper inner edge of the spleen and blends with the two former 

 ligaments. These three ligaments form a pedicle from which the spleen swings, and 

 it is by their stretching that the spleen at times descends and is detected below 

 the edge of the ribs. A fourth ligament, the phrenocolic (costocolic) runs from the 

 diaphragm opposite the tenth and eleventh ribs to the splenic flexure of the colon. 

 The upper surface of the colon is concave, forming a fossa (splenic fossa) in which 

 the spleen rests and which, of course, aids in supporting it. 



Splenic Enlargement. The spleen is enlarged in many diseases, such as 

 malaria, leukaemia, typhoid fever, and others. This enlargement is to be detected by 

 palpation and percussion. The normal spleen lies under the ribs, therefore it can be 

 palpated only when it enlarges and projects beyond the costal margin or when its 

 pedicle (ligaments) becomes stretched and allows it to wander down. Normal 

 percussion dulness extends anteriorly to the midaxillary line; posteriorly it merges 

 into the kidney dulness and cannot be limited. From above down the dulness would 

 be from the ninth to the eleventh rib in the posterior axillary line. 



Wounds of the Spleen. The upper portion of the spleen rises as high as 

 the tenth dorsal vertebra or ninth spine ; as the lung posteriorly descends at least one 

 vertebra lower and the pleura still another lower, it follows that a penetrating wound 

 entering the ninth costal interspace in the line of the angle of the scapula would 

 wound first the pleura, then the lung, then the diaphragm, then the spleen, and 

 finally the stomach. If it entered one interspace below the tenth it would open 

 the pleural cavity but would probably escape the edge of the lung. 



THE KIDNEYS. 



The kidneys when normal are about 12 cm. (4^ in.) long, 6 cm. (2^ in.) 

 broad and 3 cm. ( I ^ in. ) thick. The right is the thicker and the left a little the 

 longer. 



They lie in the lumbar regions under the lower portion of the thoracic wall. 

 Their upper ends are nearer the midline than the lower and the inner edges point 

 forward and inward, thus one surface is antero-external and the other postero- 

 internal. 



Relations to the Surface. Viewed posteriorly the right kidney has its upper 

 edge opposite the eleventh dorsal spine and the lower edge of the eleventh rib. 

 Its lower edge is opposite the upper edges of the third lumbar spine and vertebral 

 body and about 4 cm. (i^ in.) above the highest point of the crest of the ileum, 

 which is opposite the fourth spine (Fig. 433). The left kidney is usually 1.25 cm. 

 (^ in.) higher, but being a little longer than the right, its lower limit may not be 

 quite that much higher. The kidney is slightly lower in women and children than 

 in men. The inner border reaches 10 cm. (4 in.) and the hilum 4 to 5 cm. (i^ to 

 2 in.) from the median line, the latter being in front of the interval between the first 



