 This is going to be a demonstration of the spleen and the sphenic vessels. We have retained the spleen in situ and my instrument is pointing towards the spleen and we can see the location of the spleen there. The spleen is located in the left hypochondrium and it is in relation to ribs 9th, 10th and 11th. These three ribs run parallel to the coastal surface of the spleen like my finger is showing. Here itself we have a very important clinical correlation. If there is fracture of the left 9th, 10th or 11th ribs we have to take sphenic injury for granted and we have to assume sphenic injury is present unless proved otherwise by ultrasound. The spleen has got two surfaces with the surface that we can see here. This is the visceral surface and I shall mention the organs which are related to the visceral surface just now. The other surface which we cannot see is the one where my instrument is pointing and that is the costodiframatic surface and that is the one which is in relation to the 9th, 10th and 11th ribs and the left dome of the diaphragm. Now let's take a look at the ligaments of the spleen. As to the hylum of the spleen where the blood vessels enter we have two ligaments. One ligament is called the gastro sprenic ligament and I am going to show you the remnant of the gastro sprenic ligament. So this is the remnant of the gastro sprenic ligament extending from the fundus and the upper part of the greater curvature of the stomach of the hylum of the spleen. Running in the gastro sprenic ligament, we have the left gastroepiploid artery and the vasabrivia. The next ligament also most of it which we have removed is the spleen orenal ligament extending from the spleen to the left kidney. And running in the spleen orenal ligament, we have the tail of the pancreas and we have the spleenic artery and the spleenic vein. So these are the two ligaments which attach the hylum of the spleen to the various visceral structures. And finally there is a ligament again which has been removed called the phrenocolic ligament which extends from the spleenic fracture of the colon which has been removed to the abdominal wall. And that phrenocronic ligament supports the spleen. There are three ligaments which are related to the spleen. Gastro sprenic ligament also referred to in the earlier textbooks as the lino gastric ligament. Then we have the spleen orenal ligament also referred to as the lino renal ligament and the sprenocolic ligament. Now let's take a look at the blood vessels, the spleenic artery and the spleenic vein. In order to see the spleenic artery and the spleenic vein clearly, we have reflected up not only the stomach but also the pancreas. And we are looking at the vessels from the under surface. This artery that we have picked up here, this is the largest branch of the celiac trunk and this is the spleenic artery. This runs along the superior part of the pancreas and we have dissected it out completely from there. First thing that we notice about the spleenic artery is that it is highly tortuous because the spleenic artery forms part of the bed of the stomach. And because the stomach is constantly in motion, therefore the spleenic artery tortuosity compensates for the movement of the stomach. Just below the spleenic artery, we have this structure here. This is the spleenic vein. The spleenic vein runs on the posterior surface of the pancreas in this groove here and we have dissected it out also. As they near the spleen, both the spleenic artery and the spleenic vein, they run in the spleen orenal ligament. And the spleenic artery gives posterior gastric branches. It gives greater and dorsal pancreatic branches. It gives the left gastropyloid which we can see here which runs in the greater curvature of the stomach from left to right and it also gives vasoprivia. Vasoprivia are multiple small branches which supply the fundus and the upper part of the greater curvature of the stomach. Both the left gastropyloid artery and the vasoprivia, they run in the gastro spleenic ligament. So these are the blood vessels which supply the spleen. And once these blood vessels enter the hyalum of the spleen, they ramify and they supply the spleenic sinusoids which I shall open up subsequently. Now let's take a look at the boundaries and the borders and the surfaces of the spleen. So for that, I'm going to put my hand right behind the diaphragmatic surface of the spleen as you are seeing now. And I'm doing a maneuver. This maneuver is what we do during surgery or emergency spleenic to me. We pull the spleen out from the location and that is what we have done here. Now I have delivered the spleen out. This is almost like eviscerity in the spleen and we can see the hyalum of the spleen much more clearly. As I was mentioning, this is the maneuver that we do during emergency spleenic to me when there's a spleenic rupture and the patient is bleeding profusely through the spleenic sinusoids. We deliver the spleen out and we clamp the spleenic pedicle, namely the gastro spleen ligament and the spleenal ligament together and we clamp it and we remove the spleen. So let's mention the boundaries and the surfaces. We can see the visceral surface here and we can see the diaphragmatic surface here. This is the superior border of the spleen and we can see the superior border of the spleen is notched. This is an important clinical point. When the spleen is enlarged, the condition being known as spleenomegaly and when we are palpating the abdomen to feel for the spleen, we put one hand behind the left costal margin and the right hand palpates obliquely up and when we feel the spleen, we recognize the spleen by means of its spleenic notch in the superior border of the spleen. And this is how we differentiate an enlarged spleen from an enlarged kidney. So this is the superior border and just under the superior border, this depression that we see here, this is referred to as the gastric area because it is related to the stomach. Then we have the inferior border. And just above the inferior border, this depression where my finger is tracing, this is referred to as the renal area because it is related to the left kidney where my hand is showing. And finally, this is the anterior border and this is the border which is resting on the freinocolic ligament which I mentioned a little while earlier and therefore just behind the anterior border, this place is referred to as the colic area because this is related to the spleenic flexure of the colon and the beginning of the descending colon. In this connection also we can mention one important clinical correlation. When we are doing a coronoscopy, in this region, when the coronoscope reaches this area, we can see the impression of the spleen to the colon and that is referred to as the spleenic impression. This is a coronoscopy to show the spleenic impression seen through the spleenic flexure of the colon. Whenever we are doing any surgery on the spleen, the tail of the pancreas is intimately related to the high number of the spleen. So, therefore the tail of the pancreas is likely to be injured. I want to mention one more thing. There is something called accessory spleenic tissue or spleenanculi. The spleenanculi are located along the left side of the abdomen. They may be located. They may be located in the gastro spleenic ligament, spleenoreal ligament, left part of the lesser momentum. They can be present all the way down from here. They can be present even in the inguinal region, in the ovary in the femate and they can be present in the testis in the main, all on the left side. The significance of the spleenaculi is when we are doing an elective spleenectomy for hypersprainism, we have to look for the spleenaculi and remove them because if we do not remove them, once we have removed the main spleenaculi with hypertrophy and they will also take over the function and they will go into hypersprainism. That is the significance of knowing the location and searching for them and removing them as and when required. In the next part of this section, we are going to open up the spleen and we are going to show the interior contents of the spleen. Cutting open the spleen. Okay, go. Go. Okay, okay, okay, my finger is there. Okay, okay, okay, no more. So she has cut open the visceral plutonium, she has cut the spleenic capsule and she has entered the spleenic pulp. Now what we are going to do is, I am going to manually separate the two halves and now we are looking at the spleenic sinusoids. Most of it is occupied by the red pulp. Where is the white pulp? White corpuscles sometimes may not be visible, sometimes they may be visible. Red pulp is the one which is the maximum and this is the one which contains the spleenic sinusoids. That's why it's called red pulp. It is filled with blood without any endothelium and this is the surface which bleeds. Extending from the capsule, this thin layer that you see here, extending from that, there will be partial trabiculate, which also are very small, you may not be able to see it except under low power microscope. Similarly, inside the trabiculate will be the spleenic veins and inside the red pulp will be the spleenic arteries, branches. And around the arteries, there will be collection of lymphoid tissue and there will be also collections of lymphoid tissue elsewhere, which are known as white corpuscles. So this is what we see when we cut open the spleen and we can see some branches of the spleenic veins here, which have been all thrombosed here. So this is one of the branches here. So this is what we see when we cut open the spleen. I am removing this visceral peritonium here. This is the visceral peritonium. So that is all for now. Thank you very much for watching. If you have any questions or comments, please put them in the comment section below to send us an email. Have a nice day.