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Clinical & Surgical Anatomy of the Spleen & Portal System - Coggle…
Clinical & Surgical Anatomy of the Spleen & Portal System
Clinical Examination & Radiological Imaging
Palpation
Pathological (Splenomegaly)
Volume enlargement allows it to project below the costal margin, making it clinically palpable (notched anterior border is a key landmark)
Normal Spleen
Non-palpable under the left costal margin
Radiology
Visualized via Ultrasound (US), CT Scan (Scanner), or Scintigraphy
Portal Hypertension (HTP) & Porto-Caval Anastomoses
In portal system obstruction, increased vascular resistance causes Portal Hypertension (PHT / HTP). Blood is shunted through physiological porto-caval anastomoses, resulting in pathognomonic varicose dilations :
Gastro-Esophageal Varices & Splenomegaly
Venous backpressure leads to high-risk esophageal varices and congestive enlargement of the spleen
Abdominal Wall Collateral Circulation
Dilation of paraumbilical veins creates the characteristic Caput Medusae
Rectal Hemorrhoids
Engorgement of the submucosal hemorrhoidal plexus at the anorectal junction
Trauma, Surgery & Oncological Implications
Lower Left Thoracic Trauma (Fragility & Laceration)
Due to its position opposite the 9th–11th ribs and its friable, fragile parenchyma, the spleen is highly vulnerable to laceration and severe intraperitoneal hemorrhage in blunt left base thoracic trauma
Conservative Splenic Surgery (Partial Splenectomy)
Modern surgery favors conservative techniques (partial splenectomy) rather than total removal, enabled by its metameric segmental vascular architecture
Although crucial for immunity, the spleen is not a vital organ
Hepatic Metastases in GI Cancers (Portal Metastatic Route)
Because venous blood from the GI tract drains via the portal system directly into the liver, primary gastrointestinal carcinomas (e.g., colorectal cancer) frequently metastasize to the liver first