The source of the development of the spleen. Histological structure and blood supply to the spleen

SPLEEN [lien(PNA, JNA, BNA)] - an unpaired parenchymal organ located in the abdominal cavity, performing immunological, filtration and hematopoietic functions, taking part in the metabolism, in particular iron, proteins, etc. S. does not belong to the number of vital organs, but in connection with the listed functional features, it plays an essential role in the body.

COMPARATIVE ANATOMY

The shape, size, and ratio of structural elements of S. in animals belonging to different taxonomic groups are extremely diverse. S. in reptiles is reduced, in nek-ry fish and amphibians it is presented in the form of separate accumulations of lymphoid tissue located under the serous membrane of the stomach or intestines. S. in birds is a separate small organ, distinguished by a variety of forms. In mammals, the shape, size, and weight of S. are highly variable. The fibrous membrane and trabeculae of C. rabbit, guinea pig, rat, and man are less developed than the spleen of dogs and cats, which is characterized by a powerful development of connective tissue. Trabeculae in S. of animals are much richer in smooth muscle cells than in the human spleen, and the peritrabecular nerve plexuses present in S. of a pig and a dog are absent in S. of humans. A sheep and a goat have a relatively short S. of a triangular shape; in cattle and a pig, S. has a wide, short, "tongue-like" shape.

EMBRYOLOGY

S. is laid in the form of an accumulation of mesenchymal cells in the thickness of the dorsal mesentery at the 5th week of intrauterine development. At the 6th week, S.'s primordium begins to separate, the first blood islands are formed in it. In a 7-week-old embryo, S. is clearly delimited from the stomach, surrounded by a single-layer (coelomic) epithelium. At 9-10th week S. is included in hematopoiesis, carried out by hl. arr. extravascularly. The main product of increasing hematopoiesis is erythrocytes, granulocytes, megakaryocytes; less intense lymphocytopoiesis. The intraorgan vascular bed is organized, primary arteries, veins, sinuses and a delicate network of reticular fibers in the gate area are formed. From the 7th to the 11th week of intrauterine development, S.'s length increases 7-9 times, and the transverse size - 9 times.

The most characteristic in the subsequent stages of embryonic development of S. is the enhanced formation of its musculoskeletal elements - the reticular stroma, the system of vasocontaining trabeculae, and collagen structures.

By the 13-14th week of intrauterine development, the venous sinus system differentiates. From the 15-16th week the number of formalized limf, follicles increases, and gradually the foci of erythro- and myelopoiesis are reduced, "lymphocytopoiesis intensifies. By the 25-26th week, the predominant component of S. is lymphoid tissue (see). K 26 -28th week in the red pulp already formed kistochian arterioles. By 28-32th week

S. ceases to function as an organ of myelopoiesis and is structurally formed as a lymphoid organ, although in the postnatal period the formation of follicles is still continuing. By the time the fetus is born, the capsule, vascular trabeculae and newly formed avascular trabeculae S. form a single system associated with the system of venous sinuses and containing reticular, collagen, elastic, and muscle components.

Formation of complex angioarchitectonics of S. begins with the intensive development of veins. The primary splenic vein - an inflow of the portal vein (see) - begins from the plexus located on the upper surface of C .; it is further joined by the primary intraorgan veins. S.'s arteries differentiate later.

ANATOMY

In newborn S., in 85% of cases, it has a lobed structure, a rounded shape and pointed edges; its weight (weight) is from 8 to 12 g, dimensions are from 21 X 18 X 13 to 55 X 38 X 20 mm. In childhood, S. has the shape of a regular tetrahedron; later it becomes more elongated, sometimes bean-shaped. S.'s weight increases intensively; by 5 years it reaches 35-40 g, by 10 years 65-70 g, by 15 years 82-90 g, by 20 years 150-200 g. On average, the length of S. in adults is 80-150 mm, width is 60-90 mm, thickness 40-60 mm; weight 140-200 g.

Distinguish the outer convex diaphragmatic surface C. (facies diaphragmatica), adjacent to the costal part of the diaphragm (see), and the visceral surface (facies visceralis), facing other organs of the abdominal cavity. The anterior part of the visceral surface adjacent to the stomach (see) is called the gastric surface (facies gastrica), the posterior lower area adjacent to the left kidney (see) and the adrenal gland (see) is called the renal surface (facies renalis). On the border of the anterior and posterior sections of the lower surface of S., the gate of the spleen (hilus lienis) is distinguished - the place of entry into the organ of the arteries and. nerves and exit from it veins and limf, vessels (S.'s vascular pedicle). Colon surface S. (facies colica) - a triangular section of the visceral surface, to which the left bend of the colon (see Intestine) and the tail of the pancreas adjoin from below (see). The lower, or anterior, pole of S. (anterior end, T.) is somewhat pointed; the posterior, or upper, pole (posterior end, T.) is more rounded. The blunt lower edge, formed by the diaphragmatic and renal surfaces, faces the left kidney. The pointed edge formed by the gastric and diaphragmatic surfaces is often scalloped.

S. is directed by the longitudinal axis from behind and from top to front and down parallel to the course IX - XI of the left ribs, so that its projection field on the side wall of the chest is between the iX and XI ribs, in front reaching the anterior axillary line, 30-40 mm behind to the spine. Topographic-grapho-anatomical position of S. depends on the type of physique: in people with a high and narrow chest it is located lower and vertically, in people with a wide chest it is higher and horizontally higher. The size, position, filling of the stomach and transverse colon significantly affect the position of C.

Newly formed # primary lymph, follicles are small, dia. 0.2-0.3 mm, accumulation of lymphocytes. The volume of the follicle as it matures increases 2-3 times, the central artery moves to the periphery. The light central zone of lymph, the follicle (center of reproduction, embryonic center) contains reticular cells, lymphocytes, lymphoblasts, macrophages; high mitotic activity is noted in it. The structure of this zone reflects the functional state of the body and can change significantly during intoxication and infections. On the periphery of the follicle in the so-called. the mantle zone contains a dense layer of medium and small lymphocytes (Fig. 3). The reverse development of limf, follicle begins, according to Jager (E. Jager, 1929), with atrophy or hyalinosis of its internal capillary network. Gradually, the follicle atrophies, is replaced by connective tissue.

Between the free cells of the white pulp (lymphocytes, monocytes, macrophages and a small number of granulocytes) reticular fibers are located, to-rye perform a supporting function. It is believed that they consist of a substance synthesized by reticular cells.

The marginal zone - a poorly discernible part of S.'s tissue - surrounds the white pulp and lies on the border with the red pulp. Many small arterial branches flow into this zone from the white pulp. It primarily accumulates damaged and defective cells, foreign particles. With hemolytic anemias, damaged erythrocytes are concentrated and phagocytosed in this zone.

The red pulp, which accounts for 70 to 80% of S.'s weight, consists of the reticular skeleton, sinuses, arterioles, capillaries, venules, free cells and various deposits. Macrophages of the red pulp, in addition to the supporting function, can carry out phagocytosis (see). These properties are not possessed by the cells lining the walls of the sinuses, similar in morphology. They are located on the basement membrane, which has many small holes, through which the cellular elements of the red pulp can freely pass. Free cells are located between the reticular fibers of the red pulp: lymphocytes (see), erythrocytes (see), platelets (see), macrophages (see), plasma cells (see).

The walls of the venous sinuses consist of a reticular syncytium, the nucleus-containing parts of which, oriented along the length of the sinus, are interconnected by thin bridges, which together create a kind of lattice with numerous lumens.

In the peri-arterial plexuses of the red pulp, the nerves are more numerous than in the paravenous. Terminal nerve trunks penetrate the walls of the sinuses and arterial sleeves.

In the circumference of limf, follicles, networks of limf, capillaries begin. The diverting limf, vessels from the trabeculae and fibrous membrane follow to the regional (celiac) limf. nodes.

The ratio of the structural components of S. changes with age. By the end of the first year of life, the amount of white pulp doubles, reaching an average of 21% of the total weight of C. (in a newborn, about 10-11%). Red pulp is also noticeably reduced (from 86 to 75%). At the age of 5, the white pulp is 22%, but then, by the age of 15, its weight decreases to 14-16%, remaining approximately at the same level until the age of 50, and by the age of 60-70 it again decreases to 7%. The maximum number of limf, follicles per 1 cm 2 of S.'s area (in a newborn) sharply decreases already in the first year of life, when the number of mature follicles increases and atrophic follicles appear. The diameter of limf, S.'s follicles of the newborn is from 35 to 90 microns, and in the 2nd year of life - from 160 to 480 microns. Already in the first years of life, S.'s connective tissue reaches significant development - by the age of 12, the thickness of the fibrous membrane increases 10 times, the number of collagen, reticular and elastic fibers increases.

At the age of 20 to 40, S.'s micro-architectonics relatively stabilizes. In the future, signs of aging appear - varicose veins. polychrome coloration, violation of clear orientation of fibers, their fragmentation. In limf, follicles, the walls of blood vessels thicken, capillaries close, the central artery narrows. With age, there is a partial atrophy of lymph, follicles and connective tissue develops in their place. Deposits of fibrin, fibrinoid, or hyaline in the central arteries appear by age 10. After the age of 50, these substances are found in all links of the vascular bed of C. After 60 years, individual thickened elastic membranes and trabecular arteries split, and after 70 they are often fragmented.

NORMAL AND PATHOLOGICAL PHYSIOLOGY

For a long period of time S. was considered a "mysterious" organ, since its normal functions were not known. Actually, until now, one cannot assume that they have been fully studied. Nevertheless, at the present time, much about S. can be considered established. So, a number of basic fiziol is described. functions Participation in cellular and humoral immunity (see), control over circulating blood corpuscles, hematopoiesis (see Hematopoiesis), etc.

The most important function of S. is immune. It consists in the capture and processing of harmful substances by macrophages (see. System of mononuclear phagocytes), purification of the blood from various foreign agents (bacteria, viruses). S. captures and destroys endotoxins, insoluble components of cell detritus in burns, trauma, and other tissue damage. S. actively participates in the immune response - her cells recognize antigens foreign to this organism and synthesize specific antibodies (see).

The sequestration function is carried out, in particular, in the form of control over circulating blood cells. First of all, this applies to erythrocytes, both aging and defective. Fiziol. the death of erythrocytes occurs after they reach about 120 days of age, pathologically altered - at any age. It is not clear exactly how phagocytes distinguish between senescent and viable cells. Apparently, the nature of the biochemical and biophysical changes occurring in these cells matters. For example, there is an assumption, according to S.'s cut, cleans the circulating blood from cells with a changed membrane. So, with hereditary microspherocytosis, erythrocytes cannot pass through S., they stay in the pulp for too long and die. It was shown that S. has a better ability than the liver to recognize less defective cells and functions as a filter. In the spleen, granular inclusions (Jolly's bodies, Heinz's bodies, iron granules) are removed from erythrocytes (see) without destroying the cells themselves. Splenectomy and S.'s atrophy lead to an increase in the content of these cells in the blood. The increase in the number of siderocytes (cells containing iron granules) after splenectomy is especially clearly detected, and these changes are persistent, which indicates the specificity of this function of C.

Splenic macrophages reutilize iron from destroyed erythrocytes, converting it into trans-ferrin, i.e., the spleen takes part in iron metabolism.

S.'s role in the destruction of leukocytes has not been studied enough. There is an opinion that these cells in fiziol. conditions die in the lungs, liver and C .; platelets (see) in a healthy person are also destroyed by hl. arr. in the liver and S. Probably S. also takes another part in thrombocytopoiesis, since after splenectomy about S.'s damage, thrombocytosis occurs and the ability of platelets to agglutination increases.

S. not only destroys, but also accumulates blood corpuscles - erythrocytes, leukocytes, platelets. In particular, it contains from 30 to 50% or more circulating platelets, to-rye, if necessary, can be thrown into the peripheral bed. With patol. states their deposition is sometimes so great that it can lead to thrombocytopenia (see).

If S.'s blood outflow is disturbed, it increases, for example, with portal hypertension (see), and, according to some researchers, can accommodate a large amount of blood, being its depot (see Blood depot). Shrinking, S. is capable of throwing the blood deposited in it into the vascular bed. In this case, S.'s volume decreases, and the number of erythrocytes in the blood increases. However, normal S. contains no more than 20-40 ml of blood.

S. participates in the exchange of proteins and synthesizes albumin, globin (the protein component of hemoglobin), factor VIII of the blood coagulation system (see). S.'s participation in the formation of immunoglobulins is important, a cut is provided by the numerous cells producing immunoglobulins (see), probably of all classes.

S. takes an active part in hematopoiesis, especially in the fetus (see). In an adult, it produces lymphocytes and monocytes. S. is the main organ of extra-medullary hematopoiesis in violation of normal processes of hematopoiesis in the bone marrow, eg, with osteomyelofibrosis, hron. blood loss, osteoblastic cancer, sepsis, miliary tuberculosis, etc. There are indirect data confirming the possibility of S.'s participation in the regulation of bone marrow hematopoiesis. They try to confirm S.'s influence on erythropoiesis on the basis of the fact of the appearance of reticulocytosis after removal of normal S., for example, when it is damaged. However, this may be due to the fact that S. delays the early release of reticulocytes. The mechanism of an increase in the number of granulocytes after splenectomy remains unclear - either more of them are formed and they quickly leave the bone marrow, or they are less actively destroyed. The pathogenesis of thrombocytosis developing in this case is also unclear; most likely, it arises due to the removal of these cells from the S. depot. These changes are of a transient nature and are usually observed only during the first month after splenectomy.

S. probably regulates the maturation and release of erythro- and granulocytopoiesis cells from the bone marrow, the production of platelets, the process of denuclearization of maturing erythrocytes, and the production of lymphocytes. It is quite probable that lymphokines synthesized by C's lymphocytes can have an inhibitory effect on hematopoiesis (see Mediators of cellular immunity).

Data on changes in certain types of metabolism after splenectomy are contradictory. The most characteristic change in the liver after splenectomy is an increase in the level of glycogen in it. The enhancement of the glycogen-fixing function of the liver, which occurs after splenectomy, is also firmly maintained when the liver is influenced, leading to a weakening of this function (poisoning with phosphorus and carbon tetrachloride, the introduction of dinitrophenol, thyroxine in the experiment). Similar changes are noted in patients with nek-ry hron. liver diseases. At the same time, the development of fatty liver infiltration is inhibited, the level of ketone bodies and cholesterol in the liver decreases. Experiments with S.'s removal from parabiotic animals allow us to conclude that humoral factors are produced in S., the absence of which causes an increased fixation of glycogen and, thereby, influences the processes of fat accumulation in this organ for the second time.

S. plays a large role in the processes of hemolysis (see). In patol. conditions, it can delay and destroy a large number of altered erythrocytes, especially with some congenital (in particular, microspherocytic) and acquired hemolytic (including autoimmune nature) anemias (see. Hemolytic anemia). A large number of erythrocytes is delayed in S. at stagnant plethora, polycytemia (see). It has also been established that the mechanical and osmotic resistance of leukocytes decreases when they pass through the S. So, G. Lepehne found even phagocytosis of leukocytes in S. at inf. hepatitis. According to Hermann (G. Gehrmann, 1970), destruction of platelets in S. is also possible, in particular at idiopathic thrombocytopenia (see).

S.'s dysfunction is observed at nek-ry patol. conditions (severe anemia, nek-ry inf. diseases, etc.), as well as with hypersplenism.

Hypersplenism should not include cytolytic diseases that solve an independent nosology (for example, hereditary and acquired hemolytic anemias, idiopathic thrombocytopenic purpura, immune leucolytic conditions). At the same time, the page is only a place of destruction of blood corpuscles and can play an essential role in the production of antibodies. Splenectomy is often beneficial. Excessive destruction of erythrocytes is accompanied by the development of generalized hemosiderosis (see), including the spleen. With hereditary and acquired disorders of lipid metabolism (see. Thesaurismosis), accumulation of a large amount of lipids is noted in the spleen, which leads to splenomegaly (see).

Decreased S.'s function (hyposplenism) is observed with S.'s atrophy in old age, with starvation, hypovitaminosis. It is accompanied by the appearance of Jolly's bodies and target erythrocytes in erythrocytes, siderocytosis.

PATHOLOGICAL ANATOMY

With the functional and morphological features of the spleen, in particular with belonging to the organs of immunogenesis, the variety of its structural changes is associated with many patol. processes.

In a macroscopic examination of S. (measurement of dimensions, weighing, an incision along the long axis through the gate and transverse cuts into plates 10-20 mm thick) pay attention to the state of the walls and lumen of the vessels of S. gate, capsules, color and texture of tissue, the presence of focal changes (hemorrhages, necrosis, scars, granulomas, etc.). The increase in S.'s sizes and its weight (more than 250-300 g) is usually associated with patol. changes, to-rye, however, can be observed in the non-enlarged organ. Color and consistency of S. depend on blood filling; they change with pulp hyperplasia, deposition of amyloid, various pigments, fibrosis, S.'s defeat at acute and hron. infections, anemias, leukemias, malignant lymphomas, histiocytosis. For microscopic examination, take pieces from various parts of the spleen, fix them in formalin and (or) zenkerformol, Carnoy's liquid; embedding in paraffin is recommended.

The most frequent manifestation of S.'s dystrophy is hyalinosis of small arteries and arterioles (see. Arteriolosclerosis), which is usually observed normally at the age after 30 years; less often, hyaline is deposited in the form of lumps in limf, follicles and red pulp. Mucoid and fibrinoid swelling of S.'s connective tissue (see.Mucous dystrophy, Fibrinoid transformation), primarily of the walls of the venous sinuses and small vessels (up to their fibrinoid necrosis), the prolapse of protein precipitates in the centers of lymph, follicles are noted as a regularity of the disease with auchto. As a result, coarsening of the walls of the sinuses of S. occurs, the peri-arterial, so-called. bulbous, sclerosis, most pronounced in systemic lupus erythematosus (see).

S.'s amyloidosis is usually observed with general amyloidosis (see) and takes second place in frequency after kidney amyloidosis. Sometimes in diseases causing secondary amyloidosis (tuberculosis, hron. Purulent processes), only C amyloidosis can be observed. Lymph, follicles when amyloid is deposited in them on a cut through the organ have the appearance of vitreous bodies, similar to sago grains. In these cases, they speak of the "sago" spleen. S.'s weight in such cases is increased slightly. Diffuse prolapse of amyloid in the walls of the sinuses, blood vessels and along the reticular fibers is accompanied by an increase in S.'s weight (up to 500 g); its tissue is dense, greasy, yellowish-red in color ("greasy", "ham" spleen). A combined deposition of amyloid in lymph, follicles and red pulp is also possible.

At a number of diseases in S., xanthoma cells scattered diffusely or lying in the form of clusters are found (see. Xanthomatosis). They are formed when lipid metabolism is disturbed due to the accumulation of lipids in macrophages. Thus, with diabetes mellitus, atherosclerosis, and familial xanthomatosis, cholesterol is excessively deposited in S.'s macrophages (and other organs); cells similar to xanthoma, sometimes. occur with idiopathic thrombocytopenic purpura; massive accumulation of certain types of lipids is observed in S. with thesaurismosis, which leads to the formation of cells characteristic of this or that form of the disease - Gaucher and Pick cells, to the development of significant secondary changes in S. and an increase in its size (see Gaucher disease, Niemann - Pick's disease).

S.'s hemosiderosis - excessive deposition of hemosiderin in it - is a manifestation of general hemosiderosis (see), and is observed with hemochromatosis (see), diseases and patol. states accompanied by increased hemolysis, violation of iron utilization, especially with hemolytic, hypoplastic and iron-refractory anemias (see), leukemia (see), malaria (see), relapsing fever (see), sepsis (see), hron. eating disorders (dyspepsia, diseases of the stomach and intestines). With hemosiderosis S. has a rusty-brown color, sometimes slightly increased. In the red pulp with histol. research reveals numerous siderophages, in the endothelium of the sinuses, the walls of blood vessels, trabeculae, S.'s capsule - hemosiderin deposits (printing. Fig. 3). Local hemosiderosis of S. is often found in areas of hemorrhage. In their centers and in extensive foci of necrosis, crystals of hematoidin can be detected (see. Bile pigments). At malaria in S. there is a delay of hemomelanin, to-rye during recovery can disappear. Deposition in S. of coal pigment, which penetrates hematogenously from the lungs, is also possible. With morfol. research it is necessary to take into account the possibility of loss at fixing S.'s tissue in solution of formalin so-called. formalin pigment settling diffusely in the tissue in the form of brown grains.

Often in S. there are foci of necrosis (see). Small foci usually arise due to toxic effects during infections, large foci are due to circulatory disorders.

Circulatory disorders in S. come to light quite often. Active hyperemia is found in acute infections and is characterized by congestion of the pulp arteries. With general venous plethora due to S.'s heart failure, it is increased, dark red, its weight is 300-400 g. Histologically, blood overflow of S.'s stretched sinuses is determined (printing. Fig. 4), limf, follicles atrophy of varying degrees. With prolonged stagnation of blood, fibrosis of the pulp cords is noted (cyanotic induration of the spleen). Portal hypertension (see), developing with cirrhosis of the liver, sclerotic narrowing or thrombosis in the portal vein system, obliterating phlebitis of the hepatic veins, leads to the development of significant changes of the same type in S. and its pronounced increase (cirrhotic splenomegaly, thrombophlebitic splenomegaly). S.'s weight can be increased to 1000 g or more, its tissue is fleshy, the capsule is thickened, often contains extensive fibro-hyaline areas ("glazed" spleen), S.'s adhesions with surrounding tissues are possible. S.'s surface on the cut is motley due to focal hemorrhages, the presence of multiple dense nodules of orange-brown color. With gistol. the study reveals stagnation of blood, however, less pronounced than with general venous plethora, uneven expansion of the venous sinuses with distinct endothelial hyperplasia, multiple hemorrhages of various ages, reduction of lymph. follicles with proliferation of connective tissue in their area (spleen fibrosis), fibrosis of the pulp cords. In S.'s tissue, areas of sclerosis, impregnated with iron and often calcium salts, are revealed - Gandhi-Gamna's nodules, or sclero-pigmented nodules (printing. Fig. 5). Iron impregnation in the area of ​​scars also occurs at hron. leukemias, hemolytic anemias, thesaurismosis, etc. A decrease in S.'s blood supply is observed with massive acute or prolonged repeated blood loss (see), hypoplastic anemia (see).

Inflammatory changes in S. (splenitis) are constantly found at inf. diseases. Their nature and intensity depend on the characteristics of the pathogen and immunol. state of the body.

Productive inflammation in S. with the formation of granulomas of various structures and development of splenomegaly can be observed with tuberculosis (see below), sarcoidosis (see), brucellosis (see), tularemia (see), visceral mycoses (see), leprosy ( cm.). The sizes of granulomas vary: in their outcome fibrosis occurs. S., as a rule, is amazed at miliary tuberculosis; similar changes can be detected in children with post-vaccination complications with generalization of the process. At early congenital syphilis in S. pale treponemas, acute inflammation, sometimes nice paired gums are found; with visceral syphilis, gum in the spleen are rare.

Hyperplasia of S.'s lymphoid tissue reflects its participation in the body's immune reactions during antigenic irritation of various origins (see. Immunomorphology). The presence of large limf, follicles with light tsentralsh, an abundance of plasmablasts and plasma cells in S.'s tissue (see), proliferation of histiocytes (see) and macrophages (see) are characteristic of a humoral immune response; often this is accompanied by hyperplasia of the endothelium of the sinuses, tissue dysproteinosis (printing. Fig. 6 and 7). With a cellular immune response, an increase in the number of lymphocytes in T-dependent zones of S. without their plasmatization, the appearance of large basophilic cells-immunoblasts, a macrophage reaction is found. The reaction of the immune response mainly according to the humoral type is observed in S. at the majority of acute infections, according to the cellular type - at inf. mononucleosis, transplant rejection, nek-ry hron. infections. A mixed type of immune response is often found histologically. Hypoplasia of the white pulp up to its complete aplasia is observed in immunodeficiency syndromes, starvation, corticosteroid treatment, and after radiation therapy. Significant atrophic changes in the white and red pulp are observed during intensive treatment of malignant tumors and leukemias with antineoplastic agents, massive S. amyloidosis, and widespread sclerotic changes. With osteomyelofibrosis, marble disease, cancer metastases to the bone marrow in S., regenerative growths of hematopoietic tissue are often revealed - foci of extramedullary hematopoiesis (printing. Fig. 8).

Cadaveric changes in S. arise early due to the proximity to the intestine - autolysis of cells of the red pulp, stroma, and somewhat later of the white pulp occurs.

SURVEY METHODS

Into the wedge. practice use percussion and S.'s palpation (see Palpation, Percussion), laparoscopy (see Peritoneoscopy), X-ray and radioisotope research, splenomanometry, S.'s puncture biopsy, adrenaline test (see).

S.'s percussion is carried out in a vertical or horizontal (on the right side) position of the patient. Dullness over the upper edge of S. along the anterior axillary line is differentiated with a pulmonary sound, approximately along the edge of the costal arch or 10-20 mm higher than it, with a tympanic sound over the stomach. The upper border of dullness over S. runs almost horizontally, the lower one - from behind and from above, down and forward. With a high standing, the upper outer surface of S. can be at the level of the VIII rib, with a low - at the level of the XII rib. More often S. is located between the IX and XI ribs.

Determination of S.'s sizes according to MG Kurlov is carried out in the patient's position lying with an incomplete turn on the right side, if possible without displacing the pelvis. Percussion along the tenth intercostal space starting from the spine and along the borders of dullness determine the long size C. If * C. protrudes from the hypochondrium, then take into account the length of its protruding part. S.'s width is determined by percussion from above from the anterior axillary line towards the posterior axillary line. The results of the study are recorded in the form of a fraction, in a cut, the length is indicated in the numerator, and the width of C is indicated in the denominator. With an increase in C, the length of its protruding part is indicated in front of the fraction, for example. 6 22/11 cm.

S.'s palpation is performed in a horizontal position of the patient on the back and in the right lateral position. With a deep breath, the increased S. descends and "rolls" over the examiner's fingers. With a significant increase in S., its lower edge descends into the abdominal cavity and it is possible to probe the characteristic notch on it, its front surface, to determine its consistency and soreness. Normally S. is not palpable.

Laparoscopy in the absence of adhesive process makes it possible to examine S., edges are normally bluish-red; on its surface you can see scars, retractions and other patol. changes.

Roentgenol. S.'s research is carried out in a vertical and horizontal position of the patient. At fluoroscopy, the area of ​​the left half of the diaphragm is examined, noting its mobility, the abdominal organs bordering on S., the left lung. The conditions of S.'s research can be improved by introducing gas into the large intestine and stomach. Overview images are performed in frontal and lateral projection. By special methods rentgenol. researches are computed tomography (see. Computer tomography), celiacography (see) and lienography (see), diagnostic pneumoperitoneum (see) and pneumoren (see), supplemented by tomography (see). In differential and topical diagnosis of isolated S.'s defeat an important role belongs to arteriography (see), computed tomography, diagnostic pneumoperitoneum.

Obtaining a radionuclide image of S. is based on the property of cells of the macrophage system to absorb damaged erythrocytes or colloids from the blood. For research, erythrocytes labeled with 51 Cr, 99m Tc or 197 Hg are used (see Radiopharmaceuticals). On a scan (see. Scanning) or a scintigram (see. Scintigraphy) S.'s area with a uniform accumulation of radionuclide in the norm is 35-80 cm 2; with S.'s diseases, the accumulation of the radionuclide is uneven, the area of ​​the spleen increases.

S.'s puncture is shown in those cases when the reason for its increase is not established. Contraindications to puncture are hemorrhagic diathesis (see), severe thrombocyte (see). Before puncture with the help of percussion and palpation determine S.'s size and position, carry out X-ray and radioisotope research. S.'s puncture is performed without anesthesia in the patient's position on the back or on the side. For puncture, thin needles are used, usually used for intramuscular injections. The needle should be free of barbs at the end, and the syringe should be absolutely dry. The needle is introduced into S. to a depth of 20 mm, a punctate is obtained, which is subjected to cytological examination (see). Complications of S.'s puncture can be ruptures of the capsule and parenchyma, accompanied by intra-abdominal bleeding.

PATHOLOGY

S.'s pathology includes malformations, injuries (open and closed), S.'s diseases and tumors.

Developmental defects

S.'s developmental defects include its complete absence, dystopia, wandering S., a change in shape and the presence of additional S. Complete absence of S. (asplenia) is extremely rare and is usually combined with malformations of the heart and vascular system. Wedge, the diagnosis of asplenia is difficult. In these cases, X-ray and computed tomography are not always informative, since the effect of S.'s absence may be due to her dystopia or displacement. Directed radioisotope research plays an important role in establishing the correct diagnosis. However, in patients with congenital heart defects S. may be functionally defective - unable to accumulate a radiopharmaceutical. It is also observed in cases when S. has an irregular shape with the presence of deep cutouts or is unusually elongated (the so-called tailed spleen), sometimes reaching with one pole of the pelvic cavity. In some cases, lobular S. (consisting of many shares) occurs. These malformations usually do not require treatment.

As a result of ectopia or dystopia, S. can change its position in the abdominal cavity and be, for example, in the retroperitoneal space, in the umbilical or diaphragmatic hernia (splenic hernia), between the bottom (fornix) of the stomach and the dome of the diaphragm, in the right half of the abdominal cavity, what is observed at transposition of organs (see).

In addition to this, usually fixed, displacement of the organ, there is a so-called. wandering S., moving in the abdominal cavity due to the weakness of its ligamentous apparatus, for example, with splanchnoptosis (see), congenital absence of the mesentery of the stomach. Such a S. hangs on the vascular-ligamentous pedicle, extending from the horseshoe-shaped part of the duodenum, and can be twisted around its axis (S.'s volvulus); at the same time, patients complain of a feeling of pressure and abdominal pain of a transient nature. The repeated twisting of S.'s leg can cause a wedge, a picture of an acute abdomen (see). The S. is most often increased in size, dense, dark red on the cut with extensive foci of necrosis. The slowly developing volvulus leads to a kind of colliquation necrosis of S., sometimes to its fusion with the surrounding intestinal loops, and then intestinal obstruction (see). Surgical treatment - laparotomy is indicated (see) followed by splenectomy (see).

Additional S. (from one to several hundred) is the most frequent anomaly in the development of this organ. Additional S. can be located at the gate of the main S. and along the splenic vessels, in the omentum, Douglas space. The identification of additional S. is possible with the help of methods of radioisotope research. Clinically, this condition does not manifest itself. However, with a splenectomy carried out with to lay down. the purpose, for example, with autoimmune hemolytic anemia, lymphogranulomatosis, additional S. must be removed to prevent recurrence of the disease.

Damage

Submitted by S.V. Lobachev and O.I. Vinogradova, S.'s injuries occur on average in 22.2% of cases of all injuries of the abdominal organs. They are divided into open and closed. Open injuries are the result of wounds (gunshot, stab-cut, etc.), sometimes they can occur during surgery on the abdominal organs, for example, during operations on the stomach, pancreas, colon.

Diagnosis of open injuries is usually not difficult - the localization of the inlet and outlet of the wound, the direction of the wound channel, and the nature of the wounding instrument matter.

Closed injuries of S. (blunt injury of S.) are possible upon impact in the left hypochondrium, compression of the abdomen and lower parts of the chest, fracture of the ribs on the left as a result of a fall from a height, a blow by an air or water wave, a moving vehicle, etc. depends on the degree of S.'s mobility, the height of the diaphragm (when inhaling or exhaling), intra-abdominal pressure, the amount and degree of blood filling of the organ. With a sharp impact or compression, the page bends like a horseshoe, its poles approach each other, as a result of which the capsule breaks along the diaphragmatic surface. On the visceral surface S.'s capsule bursts when striking in the area of ​​the IX-XI ribs, to-rye bend and press on S. outside. When ribs are fractured, their fragments can damage S. and penetrate into its parenchyma. When falling from a height, a sharp concussion, tears and tears of S.'s parenchyma are possible in the places of attachment of ligaments, adhesions and vascular pedicles, a rupture of the capsule in its weakest places.

In the diagnosis of closed injuries of S., the data of anamnesis, an assessment of the circumstances of the incident, the position of the injured and traumatic object, the nature and signs of damage on the victim's body (abrasions, bruises) are important.

The most characteristic symptoms of intra-abdominal bleeding (see) are dizziness, fainting, cold sweat. The pains are usually aching in nature, constant and accompanied by a feeling of bursting in the left hypochondrium, irradiate to the left shoulder and scapula, intensify, as a rule, with a deep breath pi coughing. Nausea and vomiting are possible.

On examination, pallor of the skin and mucous membranes, dry and coated tongue are revealed; respiratory movements of the anterior abdominal wall, especially its left half, are weakened. The symptom of "vanka-vstanka" is characteristic - the patient seeks to take a sitting position.

Palpation can determine the tension of the muscles of the anterior abdominal wall (see Muscle protection symptom) in the left abdomen and left hypochondrium. Shchetkin's symptom -<люмберга (см. Щеткина - Блюмберга симптом), как правило, слабо выражен. Положителен симптом Вейнерта - если исследующий охватывает обеими руками поясничную область пострадавшего с обеих сторон, то слева определяется резистентность тканей. Часто встречается симптом Куленкампффа - резкая болезненность при пальпации живота без напряжения мышц передней брюшной стенки. При перкуссии можно ошибочно определить увеличение границ С. в связи с наличием сгустков крови в ее области. Иногда наблюдается признак Питтса и Белленса - границы тупости, выявляемой при перкуссии передней брюшной стенки, перемещаются в правой половине живота при изменении положения тела больного и не изменяются слева, что связано со скоплением сгустков крови вокруг поврежденной С.

When a rectal examination (see) is determined by the soreness and overhang of the anterior wall of the rectum due to the accumulation of blood in the lower abdominal cavity. At the same time, the patient may feel heaviness in the rectum and the urge to defecate. At a gynecological examination (see), the soreness of the posterior fornix of the vagina is noted, with puncture to-rogo often find blood. With rentgenol. research reveals a change in the size and shape of S., signs of blood in the abdominal cavity (see. Hemoperitoneum), changes in neighboring organs. Subcapsular closed S.'s injuries are accompanied by an increase in all S. and its transverse size, an increase in the intensity of its shadow. The increase in these signs, found during repeated studies, precedes the rupture of the organ capsule. At rupture of S.'s capsule and internal bleeding it is possible with the help of computed tomography to find directly the rupture line and indistinct darkening of the left subphrenic space, in which S.'s outlines, left kidney are lost. Darkening often extends to the left lateral canal of the abdominal cavity.

The so-called. S.'s secondary ruptures can be observed several hours or days after the injury as a result of damage to its parenchyma and subsequent rupture of the capsule; thus there is a wedge, a picture of intra-abdominal bleeding.

With an unclear wedge, a picture that allows, however, to suspect S.'s damage, the most informative diagnostic method is laparoscopy, and if it is impossible or worsening of the patient's condition, diagnostic laparotomy (see).

In cases of difficult diagnosis of S.'s damage, observation of the patient is permissible within no more than two hours. Victims with concomitant injury and S.'s damage can enter the hospital in a state of shock (see) and acute blood loss (see), which requires resuscitation (see Resuscitation).

Treatment of open and closed S.'s injuries is, as a rule, operational. At open injuries of S. it includes primary surgical treatment of a wound (see). Splenectomy is made more often (see), however, some surgeons in some cases carry out savings operations. For example, at single ruptures, small tears and cracks of S. with preserved blood circulation in the organ, suturing of S.'s wound is performed (splenorrhaphy); sutured with interrupted catgut sutures with hemming of a large omentum on the leg, which provides biol. tamponade (see) and conditions for the development of collateral circulation. After suturing S.'s wound and covering it with a large omentum, it is necessary to make sure of the reliability of hemostasis, thoroughly dry the abdominal cavity and suture the operating wound. It is not necessary to tamp S.'s wound with gauze tampons, since after their removal secondary bleeding may occur. Gauze tampons can also promote suppuration with the subsequent development of peritonitis (see), and, in addition, after their removal, conditions are created for the eventration of the abdominal organs (see Eventration) and the formation of a postoperative hernia (see).

When the upper or lower pole of S. is torn off, it can be cut off, and the resulting defect can be sutured with mattress catgut sutures and covered with a large omentum on the leg in the same way as when suturing C. At the same time, the edges of the wound are economically excised and the defect is sutured with interrupted catgut sutures with suturing of a large omentum on the leg.

S.'s resection (splenotomy) can be performed in order to remove an unviable part of an organ, cut off with a cross section within healthy tissues. Mattress catgut sutures are applied to S.'s fabric, with a large omentum on the leg stitching to them.

The prognosis depends on the severity of the injury and the timeliness of surgical treatment.

Features of combat damage, staged treatment. Combat damage S. is divided into open and closed, to-rye can be single or multiple, isolated or combined.

Of the open injuries, gunshot wounds are more often observed - bullet and shrapnel (through, blind and tangential). Of all the wounds to the abdomen during the Great Patriotic War of 1941-1945. S.'s wounds were, according to I. M. Vorontsov, 5%, according to I. S. Belozor, - 7%. At the same time, shrapnel wounds prevailed over bullet wounds (70.8% and 29.2%, respectively), and blind wounds prevailed over through and tangential wounds. S.'s gunshot wounds are often accompanied by life-threatening bleeding. Closed injuries of S. are divided into two groups: with violation of the integrity of the capsule (superficial and deep cracks, marginal and central ruptures, crushing of the parenchyma and separation of part or all of the organ) and without violating the integrity of the capsule. If S.'s capsule is intact, subcapsular superficial and deep (central) hematomas may form, to-rye can cause secondary ruptures of S.'s capsule (two-stage rupture) with subsequent massive hemorrhage into the abdominal cavity.

S.'s injuries, combined with injuries of the left lower ribs, the left lung, the diaphragm, the left kidney, the liver and other internal organs, are among the extremely severe injuries.

The wounded, to-eye regarding S.'s damage, promptly performed surgical intervention, in the overwhelming majority of cases recover and after carrying out rehabilitation measures can return to duty.

Diseases

In patol. S.'s process is involved at many inf. diseases - typhoid fever and typhus (see. Typhoid fever, Epidemic typhus), sepsis (see), anthrax (see), inf. mononucleosis (see. Mononucleosis infectious), acute viral hepatitis (see. Hepatitis viral), inf. lymphocytosis (see. Acute infectious lymphocytosis), cytomegaly (see), malaria (see), visceral leishmaniasis (see), tularemia (see), listeriosis (see), brucellosis (see), syphilis (see. ). The page is usually also amazed at systemic acute and hron. histiocytosis (see. Histiocytosis, Lettertera-Siwe's disease, Henda-Schüller's - Christian's disease).

Violation of the outflow of blood through the splenic vein leads to a progressive increase in C. With prolonged blockade of the outflow, bleeding from varicose-dilated collateral veins of the stomach, rectum, esophagus is possible. Acute obliteration of the portal vein trunk is accompanied by symptoms resembling intestinal obstruction. The diagnosis is established on the basis of a wedge, picture and splenoportography data (see). Operational treatment - the imposition of a splenorenal anastomosis (see), and with severe splenomegaly and cytopenia - splenectomy (see).

Thrombophlebitic splenomegaly, see Splenomegaly.

A splenic infarction can develop as a result of thromboembolism of the branches of the splenic artery or its local thrombosis in leukemia, collagen diseases, a number of infections, atherosclerosis, and also often in subendothelial infiltration of S.'s vessels with tumor cells in the terminal stage of hron. myeloid leukemia, lymphosarcoma, with tumor metastases. S.'s heart attacks are often observed with sickle-cell anemia (see), sometimes with Markiafava-Mikeli's disease (see. Hemolytic anemia) and periarteritis nodosa (see. Periarteritis nodosa). S.'s heart attacks with prolonged septic endocarditis (see) develop as a result of separation of overlays on the aortic valve and embolism of S.'s vessels. Ischemic and hemorrhagic heart attacks S. have a wedge-shaped or irregular shape (see. Heart attack). Multiple merging infarctions give S.'s tissue a spotty appearance - a "spotted" spleen. Often, at the same time, perisplenitis is noted (see) with the development of further fibrosis of the capsule and the picture of the so-called. glaze C. In this case, if the embolus is infected, an abscess develops in the infarction zone. In the terminal phase of uremia (see) in S. characteristic multiple white or yellowish color foci of necrosis appear. Similar changes can be found in generalized infections. There is no blockage of arterial vessels.

Wedge, the picture depends on the size of the heart attack. Diagnostics of small heart attacks of S. is difficult because of scarcity a wedge. symptoms. With more extensive lesions as a result of the tension of the capsule, the development of perisplenitis, pains appear in the left hypochondrium, often radiating to the back and intensifying on inspiration. On the left, a pronounced phrenicus symptom is determined (see). In the perisplenitis zone, you can hear the rubbing noise of the peritoneum.

Treatment is aimed at eliminating the causes of the heart attack. Organization of S.'s infarction usually ends with the formation of a scar, occasionally a cyst forms. With suppuration of S.'s infarction, splenectomy is shown.

Spleen abscess. Small, asymptomatic flowing abscesses of S. are often found at generalized not amenable to treatment inf. diseases. The group, which is the most important in a wedge, in relation to the group, is represented by large isolated abscesses of S., to-rye can be observed at bacteremia against the background of endocarditis or salmonellosis; when infected with S.'s heart attacks, which are often observed in hemoglobinopathies, sickle-cell anemia; at infection of subcapsular hematomas, and also after to lay down. vascular embolization C. The reason for the development of an abscess C. Can serve as a breakthrough into it of a subphrenic abscess (see).

In a wedge, a picture, fever and pains are usually observed in the upper left half of the abdomen and chest (due to reactive pleurisy). The pain may radiate to the left shoulder. Quite often, muscle tension of the anterior abdominal wall and splenomegaly are detected. The friction noise of S.'s capsule is rarely heard. Radiography may reveal a darkening zone in the left upper quadrant of the abdomen, displacement of other organs, for example, the colon, kidney, stomach, displacement of the left dome of the diaphragm, as well as left-sided pleurisy.

When scanning S. and a liver abscesses to dia. 20-30 mm. S.'s abscess is also detected by ultrasound examination. In favor of S.'s abscess is also evidenced by the detection of non-vascularized tissue of an organ at arteriography against the background of the corresponding wedge, picture. S.'s abscess can be complicated by hemorrhage into the abscess cavity, a breakthrough into the abdominal cavity, kidney, pleural cavity.

Treatment of S.'s abscess is usually carried out with broad-spectrum antibiotics. If antibiotic therapy is ineffective, splenectomy is performed.

The forecast is determined, as a rule, by complications, such, for example, as the development of peritonitis (see) when S.'s abscess breaks out into the abdominal cavity or pleurisy (see) - when it breaks into the pleural cavity.

Spleen tuberculosis. More often S. is involved in the process with general miliary tuberculosis. 'Infection occurs both by hematogenous and lymphogenous pathways. Macroscopically, on the surface of the enlarged S.'s section, multiple gray or pale yellow millet tubercles, sharply demarcated from the surrounding tissue, are visible. Tuberculomas in S. are rare. The tubercles can be located both in the red and in the white pulp. They consist of epithelioid cells, Pirogov-Langhans cells, as well as plasma and lymphoid cells. In punctate, single epithelioid cells are usually detected; Pirogov-Langhans cells in punctate are rare (see. Tuberculosis).

Isolated S. tuberculosis often proceeds with a meager wedge, symptomatology. Splenomegaly of varying severity, ascites, low-grade fever are most often noted. In the blood, leukopenia (sometimes leukocytosis), lymphopenia are found, in some cases - neutropenia, thrombocytopenia (as well as thrombocytosis), anemia. Sometimes aplastic syndrome develops, with cut it is necessary to exclude tuberculous damage to the bone marrow. With rentgenol. examination of the abdominal cavity can reveal petrified foci in the area C.

Diagnosis of S.'s tuberculosis is difficult if there are no signs of fresh or previously existing tuberculosis of other organs. The diagnosis is based on the results of cytol. studies of S.'s punctate, however, the only reliable criterion is the detection of mycobacterium tuberculosis in a smear or sowing them from the punctate. It should be borne in mind that with concomitant S.'s amyloidosis, her repeated punctures may turn out to be uninformative. If S.'s tuberculosis is suspected, but in the absence of reliable evidence, specific tuberculostatic therapy ex juvantibus is performed.

Spleen syphilis. At acquired primary syphilis S. has the usual sizes; with congenital and acquired secondary syphilis, it is increased due to hyperplastic changes in the red pulp; at S.'s tertiary syphilis hl is increased (sometimes significantly). arr. due to syphilitic cirrhosis of the liver, growths of specific granulation tissue can be detected in S. Treatment is directed at the underlying disease (see Hepatolienal Syndrome, Syphilis).

Echinococcus of the spleen. Its form is more often hydatid (unicameral echinococcus), recognition of a cut presents well-known difficulties. In diagnostics, an important role is played by ultrasound (see. Ultrasound diagnostics) and computed tomography (see. Computed tomography). In some cases, rupture of the echinococcus bladder and seeding with daughter scolexes of the abdominal cavity is possible (see. Echinococcosis).

Spontaneous rupture of the spleen occurs at inf. mononucleosis, lymphosarcoma, myeloid leukemia. The cause of its development is the disintegration of a tumor, S.'s rapid increase and hyperextension of its capsule with splenomegaly. Wedge. the picture is characterized by sudden severe pain in the left hypochondrium, signs of irritation of the peritoneum, rapidly growing anemia.

Treatment is prompt. As a rule, splenectomy is performed, but recently, especially in children, partial resection and suturing of S.'s rupture (splenorrhaphy) have been used more often.

The prognosis depends on the underlying disease.

Tumors

S.'s primary tumors, both benign and malignant, are rare. From benign tumors in S. hemangioma (see), lymphangioma (see), fibroma (see), hamartoma (see) are found. Hemangioma can be single or multiple, of various sizes (from a small nodule to a large tumor with a diameter of 50-100 mm and more); it is located deep in the tissue and on the surface, has a cavernous or capillary structure. With a thin-walled superficial hemangioma, rupture of S.'s capsule with bleeding into the abdominal cavity is possible. Sometimes hemorrhages, thrombosis occur in the tumor, its organization is noted with deposits of calcium salts.

Lymphangioma occurs in the form of separate nodes, as well as conglomerates of cysts with transparent or cloudy contents, to-rye penetrate S. and lead to an increase in its size. S.'s fibroma looks like a single small node and does not appear clinically. Hamartoma (splenoma), like fibroma, in most cases is found only at autopsy. It is small in size, usually located deep in the tissue of S., often encapsulated, built like the tissue of S. itself, but differs from it in the ratio of white and red pulp, and therefore distinguish between pulpous and follicular forms.

Among primary malignant neoplasms of S. in the first place are lymphosarcomas (see). Tumor growths can be nodular or diffuse; they consist of atypical lymphoid cells and cause a gradual increase in S.'s sizes. S.'s primary lymphosarcoma is differentiated with its secondary involvement in the process at other primary localizations of lymphosarcoma, hron. lymphocytic leukemia (see. Leukemias) on the basis of a wedge, picture, changes in the blood and bone marrow. At S.'s primary lymphosarcoma, in contrast to hron. lympho-leukemia, low leukocytosis and lymphocytosis are observed.

Reticulosarcoma is less common (see), isolated cases of angiosarcoma (see) and fibrosarcoma (see) of the spleen are described.

At the beginning of development of a tumor of S. usually do not give a wedge, manifestations. Only in the process of growth of tumor nodes and an increase in the organ as a whole, patients feel heaviness, dull pain in the left hypochondrium.

Metastases in S. of cancer, melanoma, chorionepithelioma and other malignant tumors are rare.

Combined treatment of S.'s tumors (surgery and chemotherapy).

When indications for surgical intervention for this or that pathology of S. use various approaches, for example, in case of S.'s injuries, use the upper median, paramedial incisions or traisrectal incision, which can be extended downward, allowing for an audit of the abdominal organs in this area (see . Laparotomy). In case of combined damage with suspected injury to the organs of the thoracic cavity, a thoracoabdominal approach is indicated. For removal of S., which has normal dimensions, paracostal access is shown without dissection of the rectus abdominis muscle.

Bibliography:

Anatomy, physiology- Parin V.V.Selected works, vol. 1, p. 46, M., 1974; Physiology of the blood system, Physiology of erythropoiesis, ed. V.N. Chernigovsky, p. 256, L., 1979; Folkov B. and Neil E. Blood circulation, trans. from English., M., 1976; Chkholaria ND Blood vessels of the spleen, Tbilisi, 1965; Embryogenesis of human organs, ed. V. B. Suchkova, p. 123, Volgograd, 1974; Herrath E. Bau und Funktion der normalen Milz, B., 1958; Irino S., Murakami T. a. F and jiet a T. Open circulation in the human spleen, Arch, histol. jap., v. 40, p. 297, 1977; Miller J. F. a. o. Interaction between lymphocytes in immune responses, Cell. Immunol., V. 2, p. 469, 1971.

Pathology - Abrikosov A.I. Private pathological anatomy, century. 1, p. 74, M. - L., 1947; Akimov V. I. and Kantor 3. M. Closed trauma of the abdomen, Kiev, 1963; Almazov V.A. and others. Leukopenia, p. 157, L., 1981; Askerkhanov R.P. About surgical approaches to the liver and spleen, Vestn. hir., t. 114, no. 4, p. 36, 1975; Bart I. Spleenka, trans. from Hungarian., Budapest, 1976; Berkutov A.N. and Zakurdaev V.E.Diagnosis of abdominal injuries, Voen.-med. zhurn., no. 12, p. 26, 1972; Borodin IF and Orlyanskaya VF Some questions of diagnosis and treatment of closed injuries of the spleen, Wedge, hir., No. 4, p. 29, 1980; Bugulov GK Subcutaneous injuries of the spleen, in the same place, p. 54; Geller LI Physiology and pathology of the spleen, M., 1964, bibliogr .; Glants RM and Rozhinsky MM Saving surgery of injuries of the spleen, M., 1973, bibliogr .; Gorshkov S. 3., Volkov V. S. and Kartashova T. I. Closed injuries of the spleen, Owls. med., no. 3, p. 28, 1978; Dymshits RA, etc. Spleen and erythropoiesis, Usp. fiziol. Sciences, vol. 4, no. 3, p. FROM, 1973; Zverkova AS About the role of the spleen in tumors and leukemias, Doctor, case, No. 7, p. 80, 1975; And in and sh-to about L. M. Closed trauma of the spleen, in the book: Traumatism. and will restore, hir. children age, ed. G. Ya. Epstein, p. 199, L., 1964; Karr Y. et al. Lymphoreticular diseases, trans. from English., M., 1980; Kassirsky I.A. and Alekseev G.A. Clinical hematology, p. 736, M., 1970; To and sh to about in-with to and y A.N., Tyut and L.A. N. and Che-emis and V.M. N. X-ray diagnostics of closed injuries and wounds of the abdominal organs, Military medical zhurn., no. 2, p. 22, 1982; To about m and s-sarenko V.P. Splenin, Kiev, 1961; Koretskaya T.I., Moskaleva G.P. and Gudim V.I. The role of the spleen in the regulation of erythropoiesis, Pat. fiziol. and experiment. ter., no. 4, p. 67, 1975; Lindenbraten LD and Naumov LB Methods of X-ray examination of organs and systems of a person, Tashkent, 1976; Meshkova V.N. Sklifosovsky (for the period from 1945 to 1958), Proceedings of the Institute of. Sklifosovsky, vol. 6, p. 70, M., 1961; The experience of Soviet medicine in the Great Patriotic War 1941 -1945, v. 12, p. 233, 507, M., 1949; Pathological anatomical diagnostics of human tumors, ed. N.A.Kraevsky, etc., M., 1982; Guide to Hematology, ed. A. I. Vorobyov and Yu. I. Lorie, p. 47, etc., M., 1979; Sikharulidze TS and Keleshe in and LF Damage to the spleen with combined trauma of the organs of the chest and abdominal cavities, Vestn. hir., t. 117, no. 10, p. 89, 1976; At t to and V. V. N. and Pakalns A. K. Diagnostics and treatment of closed injuries of the spleen, in the same place, t. 119, No. 10, p. 115, 1977; X e n-n and K., etc. Scanning of the spleen, Med. radiol., vol. I, no. 11, p. 18, 1966; Surgical treatment of diseases of the blood system, ed. O.K. Gavrilova and D.M. Grozdova, M., 1981; Shcherb and t e N to about MK and Beresnev EA. Emergency X-ray diagnostics of acute diseases and injuries of the abdominal organs, M., 1977; F g e s e n O. u., Kretschmer H. Beziehungen zwischen Milz und Hamopoese, Z. ges. exp. Med., Bd 154, S. 36, 1971; G e d d e s A. K. a. Moore S. Acute (infantile) Gaucher's disease, J. Pediat., Y. 43, p. 61, 1953, bibliogr .; Die Milz, hrsg. v. K. Lennert u. D. Harms, B.- N. Y. 1970; Pathology, ed. by W. A. ​​D. Anderson a. J. M. Kissane, v. 2, p. 1489, St Louis, 1977; Physiologie und Pathologie der Milz, hrsg. v. A. Hittmair, Basel-N. Y. 1955; R i nge 1 J. Infantilni forma Gaucherovy nemoci, Voj. zdra-votn. Listy, s. 541, 1954, bibliogr .; S o-d e m a n W. A. ​​a. W. A. ​​Pathologie Physiology, mechanisms, Philadelphia, 1974; The spleen, ed. by A. Blaus-tein, p. 45, N. Y. - L. 1963; S t and t-t e H. J. Hypersplenismus und Milzstruk-tur, Stuttgart, 1974; Williams W. J. a. o. Hematology, p. 611 a. o., N. Y. a. o., 1977.

V. G. Savchenko; I.I.Deryabin, A.I. Chalganov (military), L.M. Golber, G.I. Kositsky (normal and pathological physiology), G.A. operations), L.K.Semenova (an., hist., embry.), G.P. Filimonov (rent.), M.P. Khokhlova (pat.an.), I. Ya. Yakovleva (onc.) ...

(fig. 11)
The spleen is fixed with a mixture of Zeiker and formalin, and the sections are stained with hematoxylin and eosin.
Outside, the spleen is clothed with a connective tissue capsule, tightly fused with the peritoneum. The capsule contains a large number of elastic fibers and smooth muscle cells. The nuclei of the latter on the preparation are difficult to distinguish from the nuclei of connective tissue cells. Both of these constituent parts of the capsule serve as the structural basis for the change in the volume of the spleen, which can stretch and accumulate blood in itself and contract, throwing it into the bloodstream. From the side of the body cavity, the capsule is covered with a serous membrane, the squamous epithelium of which is clearly visible on the preparation. Connective tissue strands - trabeculae, intertwined in a network-like manner and forming a dense frame - extend from the capsule into the organ. They have a small amount of muscle. The capsule and trabeculae in the spleen are thicker than in the lymph node. The tissue in the spleen is called the pulp. The basis of the entire pulp is the reticular syncytium with reticulin fibers, in the loops of which blood cells lie freely. The syncytium and fibers are not visible on the specimen, since the cells densely fill all the syncytium loops. Depending on the type of cells, red and white pulp are distinguished. Already at low magnification, one can see that the main mass is red pulp (on the preparation it is pink), round or oval islets of white pulp are interspersed into it (on the preparation it is blue-violet in color). These islands are called splenic or Malpighian bodies; they resemble secondary lymph node nodules. Thus, the white pulp is a collection of morphologically unrelated Malpighian bodies.
At high magnification, you can see the structure of the red and white pulp.
Almost all types of blood cells are found in the red pulp in the loops of the reticular syncytium. Most of all there are erythrocytes, as a result of which the red pulp in a living state has a red color. In addition, there are many lymphocytes, granulocytes, monocytes and macrophages, which absorb erythrocytes that are destroyed in the spleen.
To study the white pulp, it is enough to consider the structure of one Malpighian body. Its "peripheral part is dark, as it is formed by an accumulation of small lymphocytes with dense intensely colored nuclei and a thin rim

Rice. 11. Cat's spleen ”(enlarged 1-she" approx. 5, rev. 10):
/ - capsule, 2 - trabecula, 3 - malpighian body (white pulp), 4 - central artery, B - trabecular artery, 6 - penicillary arteries, 7 - venous sinus, 8 - red pulp, 9 - nuclei of flat epithelium of the serous membrane

cytoplasm. The center of the body is lighter. “Here. There are large cells with light round nuclei and a wide layer of cytoplasm - lymphoblasts and large lymphocytes. This is the multiplication center, from where new lymphocytes constantly enter the red pulp.

there is a central artery, the wall of which, intensely colored in pink, is clearly visible against the background of a purple little body. Since the artery forms bends, two transverse sections of one artery often fall into one body.
Particular attention should be paid to the blood vessels of the spleen. They enter and exit the spleen in the area of ​​the gate - in the place where the capsule is wrapped inside the organ. Trabecular arteries pass along the trabeculae. Blood from the trabecular artery enters the pulp, and then into the central artery passing through the Malpighian body. The central artery splits within the red pulp into tassel (peicillary) arteries (these are usually seen next to the malpighian body). The brush arteries at the ends have thickenings - arterial sleeves, which are growths of the reticular tissue of the pulp (it is very difficult to distinguish them on the preparation).
The cystic arteries become capillaries, from which blood is poured directly into the pulp. Venous blood accumulates in the venous sinuses, which are also located in the red pulp. The sinuses are best viewed at high magnifications of the microscope. At low magnification, they are visible around the Malpighian bodies, in the form of pink or orange spots filled with blood, with blurred borders. The sinus wall is formed by a syncytium pierced by longitudinal slits. The syncytium nuclei protrude strongly into the lumen of the sinus. The venous sinuses flow into the pulp and then into the trabecular veins. There are no lymphatic vessels inside the spleen.
The study of the structure of the spleen shows that lymphocytes are formed in the Malpighian bodies, which then enter the red pulp and are carried away by the blood flow into the bloodstream. Depending on the physiological state, a large amount of blood can accumulate in the red pulp. Macrophages, formed from the reticular syncytium, absorb foreign particles, in particular bacteria and dead erythrocytes, from the blood flowing into the red pulp.

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The superficial part of the organ is diaphragmatic (upper) and visceral (lower). The upper one fits snugly to the diaphragm, and the lower one is located in the area of ​​the bottom of the stomach of the left kidney and adrenal gland and is adjacent to the large intestine. The lower surface has holes or gates of the organ, it is necessary for the passage of veins, lymph nodes, arteries and nerves through it. The spleen is located inside the peritoneum, while forming connections with the diaphragm, stomach and colon. The place of localization of the spleen depends on the individual characteristics of these organs.

How the spleen is born

Organ laying begins in the fifth to sixth week of pregnancy. First, there is an accumulation of cells of the embryonic rudiment in the inner part of the dorsal mesentery. The next stage is the nucleation of lymphoid cells and gaps, from which sinuses will subsequently appear.

In the 2nd trimester of pregnancy, the venous sinuses and other vessels become noticeable. Ingrowing trabeculae appear from the connective membrane.

At the end of the 2nd trimester of pregnancy, the outlines of the future spleen and lymphocytes are visible.

Spleen dimensions:

• length x width x thickness = 10–12 cm x 8–9 cm x 4–5 cm;
• weight - 150-200 g;
• location - between the 9th and 11th rib of the sternum;
• the axis of placement of the spleen is directed obliquely and directed to the place of dislocation of the 10 rib.

The spleen is considered the only organ in the direction of the bloodstream that is capable of containing a large amount of lymphoid tissue.

The main functional features of the spleen

• Immune protection of cells from the entry of pathogenic microbes into the body.
• Due to its placement, the spleen is able to filter and phagocytose foreign particles supplied with the blood, thereby protecting the organ. The presence of B-T-lymphocytes, APC and phagocytic particles make it possible to cope with this function in full.
• The destructive effect of red blood cells on the organ.
• The duration of the existence of erythrocytes is about 3 months, after which they are destroyed in the spleen. The reason for their destruction is to change their shell and flexibility.
• Absorption and digestion of decaying red blood cells by macrophages.

The hemoglobin present in them breaks down into several elements, the main of which are protein and iron. As a result of a chemical process, protein breaks down into amino acids, which are later needed for protein synthesis. Iron is transported to the brain to participate in the formation and maturation of red cells. The heme released from iron is converted into bilirubin, which is secreted in the form of bile into the liver.

What is the spleen made of?

From above, the organ is covered with connective tissue, which forms a capsule. In the inner part there are trabeculae (plates) that build the base. Taken together, the capsule and plates make up the spleen's supporting-contractile framework. The presence of fibrous-connective tissue, in which the main share is occupied by elastic fibers, makes it possible for the organ to easily change its size. The myocytes contained in the capsule and trabeculae act as a pusher of the flowing blood into the main artery. The stroma of the spleen is located in the lumens of the trabeculae. The internal contents of the parenchyma have 2 sections: a white and a red panel.

What is white remote control (parenchyma)

This is a component of the spleen, elliptical in shape and a whitish-gray hue, which is a confirmation of the multiple accumulation of lymphocytes in it. Includes lymphoid tissue with lymph nodules and periarterial pedicles and lymphoid sleeves. The white keypad is subdivided into the following zones:

• periarterial - characterized by a massive accumulation of T-lymphocytes;
• central - consists of B-lymphoblasts, B-lymphocytes, typical phagocytic and dendritic cells. The light shade of the core is a litmus test of the state of the spleen. When the organ is damaged by ARVI and intoxication of the body, the unpaired parenchymal organ changes its shade. The appearance of light centers in the follicles indicates the organ's reaction to the ingress of foreign particles into the body;
• the peripheral surrounds the periarterial and central zones. Its color is slightly darker than other zones. The composition of the mantle is characterized by the accumulation of small lymphocytes in it, which are sandwiched between circular connective fibers;
• the marginal zone is presented as a bridge for the transition of the white to red parenchyma. It consists of specific macrophages that differ from the usual ones in a number of features. The width of the zone is 100 µm and is surrounded by lymph nodes and PALV. False particles that have entered the body from the blood artery are inhibited in the marginal zone and sent by macrophages to the surface of the white parenchyma;
• PALV have a long shape and are located in the T-zone of the spleen in the direction of the pulp artery in the form of accumulated lymphoid tissue.

Red parenchyma (remote)

Located between the white parenchyma and the plates. It builds up erythrocytes between the plates. Red pulp is subdivided into the following zones:

• the venous sinuses are located at the very beginning of the venous system. The upper part of the walls is tightened with connecting fibers. There are also sphincters that regulate the outflow and flow of blood through the venous sinuses. If a sphincter contraction occurs in the venous zone, then this is a signal of the accumulation of a huge amount of blood in the spleen sinus;
• the zone of the (pulp) cord is located between the venous sinuses, in which the gradually migrating white bodies turn into active B- and T-lymphocytes, which are engaged in phagocytosing old destroyed erythrocytes, which play an important role in iron exchange processes in the body.

Evidence of the transformation of hemoglobin is the presence of bilirubin and transferrin. Bilirubin enters the liver, from where it is sent to bile. Transferrin has the function of supplying iron to newly created red cells.

The main functions of the red parenchyma:

• Ensuring the safety of platelets, white and red cells.
• Monitoring the process of destruction of old red blood cells with platelets.
• Phagocytosis of foreign particles.
• Guaranteed maturation process of lymphoid cells and migration of monocytes to macrophages.

Blood supply to the spleen

It is carried out at the expense of the splenic artery, the first section of which is located on the reverse side of the upper part of the pancreas and at the end of the tail of the pancreas diverges into 2-3 branches tending to the exit of the spleen. In terms of its size, it is 2 times larger in diameter than the main artery, and it can often be seen in the lower position. On the reverse side of the pancreas, the splenic vein, in combination with the superior mesenteric vein, forms a single portal vein trunk.

Ensuring the connection of organs with the nervous system

The presence of supersensitive nerve fibers ensures the full performance of the splenic organ. They are located in the plates and in almost all plexuses near the trabecular vessels and arteries of the white parenchyma. Nerve endings were found in fibrous tissue, on smooth muscle cells of trabeculae and blood vessels, and in the reticular stroma of the spleen.

Effect of age on the condition of the spleen

In the old age group, atrophic changes in both parenchyma are noted in the spleen, which makes the visibility of the trabecular apparatus clear. The process of minimizing the lymph nodes in the spleen becomes noticeable, which is marked by a modification of the shape and size. The connective fibers become coarse and wavy. In babies and old people, huge megakaryocytes appear in the organ. With aging, the amount of respiratory pigments increases, which indicates the process of erythrocyte dying. Its location remains intracellular.

Regeneration

The histological features of the spleen are the presence of a physiological process of regeneration of lymphoid and stem cells, which occurs within the limits of individually existing differons. Scientific research data has shown that regeneration of a partially removed spleen is a reality. This is made possible by its regenerative properties. However, it was not possible to achieve its complete restoration.

Gallbladder - histology

The daily amount of secreted bile is 500 ml. Bile is produced by hepatocytes. Further, bile is distributed throughout the system, forming bile capillaries, ducts and ducts.

A network is gradually formed, which can be divided into left and right ducts. When combined into one whole, they form one common hepatic duct. From the gallbladder, the vesicle leaves.

The vesicular, bile and hepatic ducts are covered with mucous epithelium in one layer. Plasticity - thinned and covered with a weakly expressed layer of smooth muscles, the thickening of which reaches a maximum around the duodenum 12. A sphincter is located near the intramural part, which is the main regulator of the outflow of bile.

According to its anatomical features, the gallbladder is a hollow organ filled with bile, which is, as it were, glued to the lower lobe of the liver. Its inner part is also lined with a single-layer mucous epithelium. There are multiple folds on it, which can be visually noticeable if the gallbladder is empty. The presence of mitochondria in the tissue promotes the secretion of a small amount of mucus, which can be seen in the secreted bile.

The main functional features of the gallbladder: the accumulation of bile through the absorption of water and, if necessary, its release into the digestive system.
Although the gallbladder has underdeveloped smooth muscles, when they contract, a hormone (cholecystokinin) is released, which is stimulated by the presence of fat in food in the small intestine. The entry of bile into the intestine occurs in portions, since the peristaltic waves of the intestine affect the work of the sphincter.

As can be seen from the histology, the gallbladder works at 100% every day. Therefore, if the patient is shown removing the spleen, he will have to do double work, which will negatively affect the body in the form of a number of infectious diseases and weakening of the immune system.

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The spleen is an unpaired lymphoid organ involved in the processes of immunity and hematopoiesis. The spleen is the largest part in the lymphatic system. All the functions performed by the organ are still not fully understood. It is known that during pregnancy, the spleen is the main organ of hematopoiesis for the fetus. The formation of the organ takes place in the fifth week of the child's development. By the 11th week of embryogenesis, the spleen becomes a functioning organ. The full formation of the spleen occurs after adolescence.

Main functions and role of the spleen

1. Filtration of foreign substances.
2. Control over the content of red blood cells in the blood. The production of new blood cells, the destruction of old or damaged red blood cells. The spleen is a reservoir for new red blood cells that are released in an emergency (trauma).
3. Participates in the functioning of the immune system.
4. Iron accumulation.

As you can see, the role of the spleen in the human body cannot be underestimated. It is needed for the normal functioning of the circulatory system, as well as maintaining the immune system. If it is necessary to remove an organ, the work of the above systems is disrupted, which leads to a decrease in the body's immune functions.

What is the location of the spleen

Topographically, the spleen is localized in the left hypochondrium behind the stomach, under the lung. The pancreas, large intestine and left kidney are located nearby. The diaphragm is located below the spleen. In relation to the spine, the spleen is located between the thoracic and lower edges of L1. Since it is closely connected with other organs, splenomegaly may form if they are damaged.

In relation to the physique of a person, a high and low location of the spleen is distinguished. In the first case, the upper edge of the spleen is at the level of the eighth rib. In the second case, the upper end is localized below the ninth rib.

There are abnormal locations of the spleen. These include:

• The presence of an additional lobule.
• Asplenia is a congenital or acquired (surgery) absence of the spleen.

The structure of the spleen

The normal shape of the spleen can be oval or oblong (like a crescent moon).

In a histological examination of the spleen, the structural and functional units of the organ are distinguished - the capsule and trabecula. The surface of the spleen is covered by a capsule, from which the trabeculae extend into the organ. Between the trabeculae, the stroma is localized, in the loops of which the parenchyma is located. It includes two sections - white and red pulp.

Thus, several components of the spleen are distinguished:

• Capsule.
• Trabecula.
• White pulp (represented by an accumulation of leukocytes).
• Red pulp (formed by erythrocytes, contains blood vessels and cords of Billroth).

The color of the surface of the spleen is dark red. Allocate the outer and inner surfaces of the organ. The outer surface of the spleen is adjacent to the diaphragm, and the inner to the internal organs, which is why it is called visceral.

The blood supply to the spleen occurs through a branch of the celiac trunk - the splenic artery.

Organ dimensions

Normally, the weight of the spleen should be up to 250 grams. On average, about 150-180 grams. Palpation of the spleen is possible when it is enlarged above 400 grams. With less splenomegaly, an ultrasound examination of the organ helps to identify pathology.

The quiet organ percussion according to Kurlov helps to determine the size of the spleen. Percussion technique: the patient is asked to lie on his right side, put his right hand under his head, and stretch his right leg forward. The left hand can be left on the chest, the leg can be bent at the knee.

Percussion is carried out starting from the fifth rib, moving downward. A mark is put in the place where the sound is dulled. Having determined the upper border, the doctor moves up, establishing the lower border of the spleen in the place of dullness of the sound. The front and back boundaries are set in a similar way. In this way, the size of the spleen is established. Normally, they are equal to the following values:

When conducting ultrasound diagnostics, the normal sizes of the spleen are:

• Length: 8-14cm
• Width: 5-7 cm
• Thickness: 3-5cm

1. men - 200 gr
2. women about - 150 gr

Spleen size in children

Depends on the age of the child. In newborns, the length of the organ is about 40 mm, and the width is about 36 mm. In children over one year old, the length and width are, respectively, 70 * 50 mm. In adolescence, the spleen increases to 100 * 58 mm.

Ultrasound of the spleen allows you to establish not only the size, shape, but also the structure of the organ. It is important to exclude the presence of changes in the outline of the organ, as well as pathological formations. With an enlarged spleen (splenomegaly), an inflammatory process can be assumed. Pathological inclusions in the organ are found in cancer, spleen calcifications or in the formation of a cyst.

In the presence of the above changes, it is necessary to differentiate them and begin the correct treatment.

Spleen diseases

There are no specific symptoms indicating the presence of spleen pathology. Sometimes it is possible to identify an organ disease only with a random examination or already at a late stage of the process.

The presence of pathology is evidenced by:

• Splenomegaly (enlargement of an organ in size). It is detected by percussion and palpation of the organ, as well as by the appointment of ultrasound diagnostics.
• Changes in blood counts... A decrease in the number of erythrocytes is characteristic.
• Immunodeficiency Disruption of the spleen leads to a decrease in the protective functions of the body.

The patient's complaints are of a general nature. Among them, one can distinguish aching periodic pain in the abdomen, weakness, rapid fatigability, possibly an increase in body temperature, nausea.

Diseases of the spleen are divided into primary (arising as an independent disease) and secondary (concomitant with the underlying disease).

Spleen cyst

Allocate congenital (primary) and secondary spleen cysts. In the first case, the cause of the development of pathology is a violation of the development of the fetus. In the second case, the cyst is formed against the background of another disease (inflammation, infection, trauma).

Symptoms depend on the size of the cyst. If the formation is insignificant, the clinical picture may appear years later. With the growth or formation of a large focus, complaints of heaviness in the abdomen, nausea, and unstable stools may appear.

The danger of a spleen cyst lies in the possibility of its rupture. In order to minimize the risk of complications, surgical treatment of pathology is indicated.

Cancer education

Allocate malignant and benign formations of the spleen. Most often, oncology is a secondary disease. The final reason for the formation of the pathology is not known.

Due to the absence of specific complaints, it is not always possible to identify the disease at an early stage. Clinically, oncological disease is manifested by the presence of shortness of breath, weakness, a possible increase in body temperature up to 38 ° C, weight loss, and fatigue. In the late stage, splenomegaly appears, a sharp pain syndrome in the abdomen, and dyspeptic symptoms are possible.

To make an accurate diagnosis, palpation and various research methods are used (blood test, CT, MRI, biopsy, X-ray, ultrasound of the abdominal organs).

Treatment of oncological pathology is complex, including surgery, chemotherapy and radiation therapy.

Spleen abscess

Severe condition, which is characterized by the formation of purulent cavities. It is a secondary pathology. It is often formed against the background of an infectious disease, organ injury or after a splenic infarction.

Symptomatically manifests itself as severe pain localized in the left hypochondrium, an increase in body temperature above 38 ° C, chills, sweating, nausea and vomiting, splenomegaly.

Requires immediate hospitalization and immediate treatment. The appointment of antibacterial therapy is shown, as well as a surgical operation in order to sanitize the foci of suppuration.

The spleen lies along the blood vessels and is an organ that varies greatly in size. From the surface, the spleen is covered with a connective tissue capsule, which reaches its greatest thickness in the area of ​​the gate. The capsule contains smooth muscle cells, the number of which sharply increases in some representatives of the living world, including horses, predators, etc. The surface of the capsule is covered with mesothelium. All this creates a completely movable capsule structure. Numerous layers of loose unformed connective tissue - trabeculae depart from the capsule. These trabeculae contain numerous blood vessels, smooth myocytes. Trabeculae can anastomose with each other. The splenic stroma is formed by the reticular tissue. Distinguish between white and red pulp, the basis of which is the reticular tissue.

White pulp represented by numerous lymphoid follicles scattered throughout the spleen. The white pulp makes up about one-fifth of the mass of the spleen. The lymphoid follicles of the spleen are built from lymphoid tissue and are called malpighian bodies. The lymphoid follicles of the spleen differ in structure from the follicles of the lymph node. Each lymphoid follicle of the spleen contains a central artery, which, due to the corkscrew motion, can enter the cut several times. In the Malpighian body, 4 zones are distinguished, including the periarterial zone, the light center, the mantle zone, the marginal zone. The light center (reactive center, reproduction center) and the mantle zone represent the B-zone, in which the antigen-dependent stage of B-lymphocyte maturation occurs. This zone is characterized by a specific microenvironment, including type 1 dendritic cells, macrophages, and a small number of T-lymphocytes. In the light center, blast transformation and multiplication of B-lymphocytes occurs, and in the mantle zone, cooperation of T- and B-lymphocytes and the accumulation of memory B-cells take place. The periarterial zone is the T-zone. Here, an antigen-dependent stage of maturation of T-lymphocytes occurs under the influence of a specific microenvironment (type 2 dendritic cells, macrophages, a small number of B-lymphocytes). This zone increases significantly with a cell-type immune response. The marginal zone is common for T and B lymphocytes. Adjacent to it are the marginal (marginal) sinuses. In the marginal zone, cooperative interactions of T and B lymphocytes occur. In addition, T- and B-lymphocytes, as well as antigens, which are captured by macrophages, enter the white pulp through this zone. Plasma cells migrate through this zone into the red pulp. The cellular composition of this zone is represented by lymphocytes (mainly B-lymphocytes and plasma cell precursors), macrophages and reticular cells.

Red pulp represented by numerous blood vessels, including venous sinuses. Venous sinuses have a diameter of up to 40 microns and in structure resemble sinusoidal capillaries (lined with endothelium, which lies on the interrupted basement membrane). The red pulp also includes splenic cords containing erythrocytes, granular and non-granular leukocytes, plasmocytes at different stages of development, that is, destruction of old erythrocytes, maturation of plasma cells occurs here. It was found that the blood cells from the capillaries enter the splenic cords, and then migrate through the gaps between the endothelial cells of the venous sinus wall into its lumen. This is facilitated by increased blood pressure due to its constant inflow and periodic contractions of smooth muscle cell bundles in the wall of the trabecular arteries and the spleen capsule.

The spleen is characterized by an abundant blood supply. About 800 ml of blood flows through the spleen every minute. The splenic artery enters the gate of the spleen, which splits into numerous trabecular arteries, the latter pass into the pulp arteries, in the adventitia of which there are accumulations of lymphoid tissue (lymphoid sheaths) belonging to the white pulp. The pulp artery enters the lymphoid follicle, acquires a corkscrew course and is called the central artery. In the malpighian follicle, the central artery provides numerous capillaries for nourishing its tissues. Coming out of the follicle, the central artery splits into many branches, which are called tassel arteries. The cystic arteries are surrounded by periarterial muffs composed of reticular cells, macrophages, and lymphocytes. At the ends of the brush arteries, sphincters are formed, consisting of clusters and reticular cells. The cystic arteries pass into capillaries, from which blood enters the venous sinuses. Sphincters are located at the ends of the venous sinuses. From the venous sinuses, blood enters the pulp veins, trabecular veins, and splenic veins. Trabecular veins and venous sinuses do not have a muscular membrane, therefore, if damaged, the vessels do not collapse, which leads to the development of parenchymal bleeding.

Distinguish open and closed blood supply spleen. When awake, blood flows in the spleen, without leaving the red pulp (closed blood supply). In a state of rest and rest, part of the blood is deposited, including in the venous sinuses, which creates conditions for the release of part of the blood into the red pulp, where the death of old erythrocytes occurs.

The spleen regenerates well both under physiological conditions and after injury. Under the experimental conditions, the possibility of complete restoration of the spleen was shown even after removal of 80-90% of its volume. However, complete restoration of the shape and size of the spleen does not occur.

Spleen functions.

1. Hematopoietic function: the formation of T- and B-lymphocytes.

2. Immune function: due to lymphocytes, it participates in the regulation of the cellular and humoral immune response.

3.Depot of blood: due to the double system of sphincters.

4. Here the death of most red blood cells occurs.

6.Depot of blood stem cells.

B-lymphocytopoiesis.

In the bone marrow, B-lymphoblasts, B-prolymphocytes and B-lymphocytes are formed from the B-lymphocyte progenitor cell sequentially as a result of proliferation and differentiation. The formed B-lymphocytes from the bone marrow with the blood flow enter the peripheral organs of hematopoiesis, where they populate the B-zones. Under the influence of antigens, the antigen-dependent stage of B-lymphocyte formation is carried out here. In this case, blast forms are formed, and then plasma cells that produce antibodies.

T-lymphocytopoiesis.

Progenitor cells of T-lymphocytes and T-lymphoblasts from the red bone marrow enter the subcapsular zone of the thymus. In the thymus, proliferation and differentiation of T-lymphocytes occurs. In this case, the formation of T-prolymphocytes and T-lymphocytes occurs sequentially. The formed T-lymphocytes with the blood flow then enter the peripheral organs of hematopoiesis, where they populate the T-zones. An antigen-dependent stage of T-lymphocytopoiesis occurs in the T-zones.

Morphological features of the spleen in children

The spleen begins to function as a hematopoietic organ even in the embryonic period. However, the spleen of a newborn child has a number of significant morphological features.

First of all, a newborn child of the first years of life, as a rule, has several accessory spleens ranging in size from the head of a needle to the size of an average apple. In a newborn baby, the weight of the spleen is 8 - 12 grams. After the birth of a child, an increase in the mass of the spleen is noted, as a result of which by the age of 5 years this figure reaches 35 - 40 g, and by the period of puberty it is already 80 - 90 g. cells. Single weakly expressed, thin layers of connective tissue - trabeculae depart from the capsule. After birth, the spleen capsule gradually thickens, the number of elastic and muscle elements in it increases, and the trabeculae become wider. Finally, the capsule is formed by the age of 7 - 10 years, and the trabeculae by the age of 18 - 20.

The spleen of a newborn child contains few, immature lymphoid follicles, most of which are small with indistinct contours. Light centers in lymphoid follicles are formed only by the end of the first year of a child's life. In 85% of newborns, the spleen has a lobular structure. After birth, the lobular nature of the structure of the spleen is gradually erased, an increase in the number of lymphoid follicles with pronounced light centers is noted. This process lasts up to 18 - 20 years.