342 The Spleen 



ribs, and making the patient take a deep breath, it may be often felt 

 in the child, especially if he be thin ; in the adult the healthy spleen 

 does not descend below the ribs, even on the deepest inspiration. The 

 spleen is temporarily enlarged during digestion, and permanently so 

 in cirrhosis of the liver (p. 337), in intermittent fevers, and in albu- 

 minoid disease ; in ague it may form an enormous mass, * ague-cake,' 

 which may weigh as much as 20 Ibs. The enlargement may be dia- 

 gnosed from an. ovarian tumour by its shape, and by the presence of 

 the notch, which may generally be made out. 



Beneath the peritoneum is the fibrous coat, which sends trabecuke 

 into the interior to support the spleen-pulp. 



The splenic artery is a large and tortuous trunk which reaches 

 the hilum by passing along the upper border of the pancreas, giving 

 branches to the pancreas and stomach in its course. 



The vein runs close behind the pancreas to enter the vena porta?, 

 receiving in its course gastric and pancreatic branches, and the in- 

 ferior mesenteric vein. The lymphatics pass to glands in the hilum, 

 and eventually to the thoracic duct. 



The nerves are derived from the solar plexus, and from the right 

 pneumogastric. The spleen is rich as regards its blood-vessels, but 

 poor as regards nerves. 



Occasionally the spleen breaks from its moorings, and, dragging 

 its vessels and nerves, drifts towards the pelvis, causing so much dis- 

 comfort as to demand extirpation. This may be effected through the 

 left semilunar line. From buffer-accidents, and other injuries to the 

 abdomen, the spleen may be ruptured and fatal haemorrhage or peri- 

 tonitis supervene, with, perhaps, no bruising of the surface of the body. 

 When the lower ribs of the left side are heavily struck their broken 

 ends may be driven through the diaphragm and into the spleen. 



THE PANCREAS 



The pancreas (3 or 4 oz.) (nav uptus, all Jlesh) extends from the 

 epigastric into the left hypochondriac region, crossing the aorta and 

 the crura of the diaphragm at the level of the first and second lumbar 

 vertebrae. The superior mesenteric vessels, splenic vein, and the be- 

 ginning of the vena portas are also posterior to it. 



Lying behind the peritoneum, the pancreas may be reached by 

 raising the great omentum and transverse colon and tearing through 

 the lower layer of the transverse meso-colon, which descends to form 

 the mesentery. Its head fits into the horse-shoe curve of the duo- 

 denum, the pancreatico-duodenal artery intervening between them in 

 front, and the common bile-duct behind. 



The body of the pancreas lies behind the stomach ; its tail reaches 

 the hilum of the spleen, and lies in front of the left kidney and capsule. 

 Above are the coeliac axis and the splenic artery. 





