SPLEEN ANATOMY 2

*  White  pulp  consists of aggregation  of  lymphocytes,  plasma

   cells  and macrophages, it is essentially  lymphoid  follicles

   surrounding a central artery and is embedded in red pulp.

*  Red  pulp  is composed of thin walled splenic  sinuses  filled

   with blood surrounding the follicles of the white pulp.

*  In between the sinuses are plates or cords of cellular tissue.

*  Within the cordal network are erythrocytes and platelets.

Tagged  erythrocyte  studies have shown that  normal  cells  pass

quickly  through  the  organ  and are  returned  to  the  general

circulation.

*  Abnormal cells, however, are retained for considerable  period

   of time.

The large mass of retuculoendothelial tissue in the adult  spleen

serves  as  an effecxtive filter to separate out  abnormal  cells

from the circulation.

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SPLEEN LYMPHATICS & LYMPHOMA

SPLEEN LYMPHATICS AND LYMPHOMA

1. ANATOMY

1.1

The  adult  spleen weighs approximately 100 to 150  gm.  and  the

weigh decreases with age.

It  is siutated behind the fundus of the stomach and lies on  the

diaphragm  in  the region of the 9th, 10th and  11th  ribs.   The

arterial  supply is by the splenic artery and the  short  gastric

arteries.  The splenic vein is formed by the joining together  of

the hilar veins. Fig. 23.1

*  The  spleen is a highly vascular organ with a  splenic  artery

   and vein.

*  The  capsule of the human spleen is normally 1 to 2  mm  thick

   and branching connective tissue trabeculae projecting  inwards

   from the capsule divide the spleen into smaller compartments.

*  Vascular   structures  enter  the  splenic  substance,   blood

   vessels, lymphatics and nerves follows the trabeculae.

*  Splenic pulp is essentially eithe red or white
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INSULINOMA

HYPERINSULINISM (INSULNOMA)

Seventy five percent of patients with symptoms of hyperinsulinism

have a benign adenomas

CLINICAL MANIFESTATIONS

The lesion occurs most often from the fourth to seventh decade of

life.  Symptoms may take one of two general forms.

*  Sweating,  hunger, weakness, tachycardia and inward  trembling

   results from an acute fall of blood sugar.

*  Slower  decrease in blood sugar produces  "cerebral"  symptoms

   such  as  headache,  mental  confusion,  visual   disturbances

   convulsions and coma.

DIAGNOSIS

Whipple's triad consists of attacks

*  precipitated by fasting or exertion

*  fasting blood sugar below 50 mg/100 ml and

*  symptom  relieved  by oral or  intravenous  administration  of

   glucose

TREATMENT

Removal of the benign lesion.

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CANCER PANCREAS 3 treatment

7.5 TREATMENT

Operation  is  advised  to relieve the jaundice  and  bypass  the

Obstruction.  In   only   20% a   curative  operation  (Whipple's

operation) can be attempted when the disease is localised

A vertical or transverse incision is used. The second and third part duodenum are mobilized by Kochers maneuver upto the superior one mesenteric vessels, desiccation along these vessels behind the neck of pancreas is completed the pancreatic transected so is the stomach the continuity of the GIT is restored by anastomosis.

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