Spleen structure histology. Histological structure and blood supply to the spleen

31.03.2020

The spleen is an unpaired organ located in abdominal cavity on the greater curvature of the stomach, in ruminants - on the scar. Its shape varies from flat elongated to round; in animals different types shape and size may vary. The color of the spleen - from intense red-brown to blue-violet - is due to the large amount of blood it contains.

Figure: 212. Palatine tonsils:

AND - dogs, B - sheep (according to Ellenberger and Trautman); and - pits of the tonsils; b - epithelium; in - reticular tissue; d - lymphatic follicles; d - loose connective tissue; e - glands; f - bundles of muscle fibers.

The spleen is a multifunctional organ. In most animals, this is an important organ of lymphocyte formation and immunity, in which, under the influence of antigens present in the blood, cells are formed either that produce humoral antibodies or participate in cellular immunity reactions. In some animals (rodents), the spleen is a universal organ of hematopoiesis, where cells of lymphoid, erythroid and granulocytic germs are formed. The spleen is a powerful macrophage organ. With the participation of numerous macrophages, it destroys blood cells and especially erythrocytes ("graveyard of erythrocytes"), the decay products of the latter (iron, proteins) are again used in the body.

Figure: 213. Cat spleen (according to Ellenberger and Trautnan):

a - capsule; b - trabeculae; in - trabecular artery; r - trabecular vein; d - light center of the lymphatic follicle; e - central artery; f - red pulp; s - the vascular vagina.

The spleen is the organ of blood deposition. The depositing function of the spleen is especially pronounced in horses and ruminants.

The spleen develops from clusters of rapidly multiplying mesenchymal cells in the dorsal mesentery. In the initial period of development, the formation of a fibrous frame, vascular bed and reticular stroma from the mesenchyme occurs in the anlage. The latter is colonized by stem cells and macrophages. Initially, it is the organ of myeloid hematopoiesis. Then there is an intensive invasion of lymphocytes from the central lymphoid organs, which are initially located evenly around the central arteries (T-zone). B-zones are formed later, which is associated with the concentration of macrophages and lymphocytes on the side of the T-zones. Simultaneously with the development of lymph nodules, the formation of the red pulp of the spleen is also observed. In the early postembryonic period, an increase in the number and volume of nodules, the development and expansion of centers of reproduction in them is noted.

Microscopic structure of the spleen. The main structural and functional elements of the spleen are the musculoskeletal system, represented by the capsule and the trabecular system, and the rest of the intertrabecular part is the pulp, built mainly of reticular tissue. Distinguish between white and red pulp (Fig. 213).

Spleen covered serous membranetightly fused with the connective tissue capsule. From the capsule to the inside of the organ, there are crossbeams - trabeculae, which form a kind of reticular frame. The most massive trabeculae are at the gate of the spleen, they contain large blood vessels - trabecular arteries and veins. The latter belong to the veins of the muscleless type and on the preparations quite clearly differ in structure from the wall of the arteries.

The capsule and trabeculae are composed of dense fibrous connective and smooth muscle tissue. A significant amount of muscle tissue develops and is contained in the deposit type spleen (horse, ruminants, pigs, carnivores). The contraction of smooth muscle tissue helps to push the deposited blood into the bloodstream. IN connective tissue capsules and trabeculae are dominated by elastic fibers, allowing

the spleen to change its size and withstand a significant increase in its volume.

White pulp (pulpa lienis alba) macroscopically and on unstained preparations is a collection of light gray rounded or oval formations (nodules), irregularly dispersed throughout the spleen. The number of nodules in different animal species is different. In the spleen of cattle there are many of them and they are clearly delimited from the red pulp. Less nodules in horse and pig spleen.

With light microscopy, each lymph nodule is a formation consisting of a complex of cells of lymphoid tissue located in the adventitia of the artery and numerous hemocapillaries extending from it. The artery of the nodule is called central. however, it is more often located eccentrically. In a developed lymph node, several structural and functional zones are distinguished: periarterial, light center with a mantle zone and a marginal zone. The periarterial zone is a kind of clutch consisting of small lymphocytes closely adjacent to each other and interdigitating cells. Lymphocytes in this zone belong to the recirculating T-cell pool. They penetrate here from the hemocapillaries, and after antigenic stimulation they can migrate into the sinuses of the red pulp. Interdigitating cells are special process macrophages that absorb antigen and stimulate blast-transformation, proliferation and transformation of T-lymphocytes into effector cells.

The light center of the nodule in structure and functional purpose corresponds to the follicles lymph node and is a thymus-independent site. There are lymphoblasts, many of which are at the stage of mitosis, dendritic cells that fix the antigen and preserve it for a long time, as well as free macrophages containing absorbed decay products of lymphocytes in the form of stained bodies. The structure of the light center reflects functional state lymph node and can change significantly with infections and intoxications. The center is surrounded by a dense lymphocytic rim - the mantle zone.

A marginal zone is located around the entire nodule. which contains T- and B-lymphocytes and macrophages. It is believed that functionally this zone is one of the areas of cooperative interaction of different types of cells in the immune response. The B-lymphocytes located in this zone as a result of this interaction and stimulated by the corresponding antigen proliferate and differentiate into antibody-forming plasma cells that accumulate in the cords of the red pulp. The shape of the splenic nodule is maintained by a network of reticular fibers - in the thymus-independent area, they are located radially, and in the T-zone - along the long axis of the central artery.

Red pulp (pulpa lienis rubra). An extensive part (up to 70% of the mass) of the spleen, located between the lymph nodes and trabeculae. Due to the content in it of a significant amount of erythrocytes, it has a red color on unstained preparations of the spleen. It consists of reticular tissue with free cellular elements in it: blood cells, plasma cells and macrophages. In the red pulp, there are numerous arterioles, capillaries and peculiar venous sinuses (sinus venosus); a wide variety of cellular elements are deposited in their cavities. The red pulp is rich in sinuses at the border with the marginal zone of lymph nodes. The number of venous sinuses in the spleen of animals of different species is not the same. There are many of them in rabbits, guinea pigs, dogs, less in cats, cattle and small ruminants. Areas of red pulp located between the sinuses are called splenic. or pulp cords, which contain many lymphocytes and the development of mature plasma cells occurs. Macrophages of the pulp cords carry out phagocytosis of damaged erythrocytes and participate in the exchange of iron in the body.

Circulation. The complexity of the structure and multifunctionality of the spleen can be understood only in connection with the peculiarities of its blood circulation.

Arterial blood is directed to the spleen through the splenic artery. which through the gate enters the organ. Branches extend from the artery that go inside the large trabeculae and are called trabecular arteries. In their wall there are all the membranes characteristic of muscular-type arteries: intima, media and adventitia. The latter grows together with the connective tissue of the trabecula. From the trabecular artery, arteries of small caliber depart, which enter the red pulp and are called pulp arteries. Elongated lymphatic sheaths are formed around the pulp arteries; as they move away from the trabecula, they enlarge and take a spherical shape (lymph node). Inside these lymphatic formations, many capillaries leave the artery, and the artery itself is called the central one. However, the central (axial) location is present only in the lymphatic sheath, and in the nodule it is eccentric. Upon leaving the nodule, this artery splits into a series of branches - brush arterioles. Oval clusters of elongated reticular cells (ellipsoids, or sleeves) are located around the terminal sections of the brush arterioles. In the cytoplasm of the endothelium of ellipsoid arterioles, microfilaments are found, which are associated with the ability of ellipsoids to contract - a function of peculiar sphincters. The arterioles then branch out into capillaries. some of them flow into the venous sinuses of the red pulp (closed circulation theory). According to the theory open circulation arterial blood

from the capillaries out into the reticular tissue of the pulp, and from it seeps through the wall into the sinus cavity. Venous sinuses occupy a significant part of the red pulp and can have different diameters and shapes depending on their blood supply. The thin walls of the venous sinuses are lined with an intermittent endothelium located on the basal lamina. Reticular fibers run along the surface of the sinus wall in the form of rings. At the end of the sinus, at the site of its transition to the vein, there is another sphincter.

Depending on the reduced or relaxed state of the arterial and venous sphincters, the sinuses can be in different functional states. When the venous sphincters contract, the blood fills the sinuses, stretches their wall, while the blood plasma goes through it into the reticular tissue of the pulpal cords, and blood cells accumulate in the sinus cavity. In the venous sinuses of the spleen, up to 1/3 of the total number of erythrocytes can be retained. When both sphincters are open, the contents of the sinuses enter the bloodstream. Often this happens with a sharp increase in oxygen demand, when the sympathetic nervous system is excited and the sphincters relax. This is also facilitated by the reduction smooth muscles capsules and trabeculae of the spleen.

The outflow of venous blood from the pulp occurs through the vein system. The wall of the trabecular veins consists only of the endothelium, which is closely adjacent to the connective tissue of the trabeculae, that is, these veins do not have their own muscular membrane. This structure of the trabecular veins facilitates the expulsion of blood from their cavity into the splenic vein, which exits through the gate of the spleen and flows into the portal vein.

The color of the spleen - from intense red-brown to blue-violet - is due to the large amount of blood it contains.

Figure: 212. Palatine tonsils:

A - dogs, B - sheep (according to Ellenberger and Trautman); a - pits of the tonsils; b - epithelium; c - reticular tissue; d - lymphatic follicles; d - loose connective tissue; e - glands; g - bundles of muscle fibers.

Figure: 213. Cat spleen (according to Ellenberger and Trautnan):

a - capsule; b - trabeculae; c - trabecular artery; d - trabecular vein; e - light center of the lymphatic follicle; e - central artery; g - red pulp; h - vascular vagina.

The spleen is the organ of blood deposition. The depositing function of the spleen is especially pronounced in horses and ruminants.

The spleen is covered with a serous membrane that grows tightly with the connective tissue capsule. From the capsule to the inside of the organ, there are crossbeams - trabeculae, which form a kind of reticular frame. The most massive trabeculae are at the gate of the spleen, they contain large blood vessels - trabecular arteries and veins. The latter belong to the veins of the muscleless type and on the preparations quite clearly differ in structure from the artery wall.

The capsule and trabeculae are composed of dense fibrous connective and smooth muscle tissue. A significant amount of muscle tissue develops and is contained in the deposit type spleen (horse, ruminants, pigs, carnivores). The contraction of smooth muscle tissue helps to push the deposited blood into the bloodstream. In the connective tissue of the capsule and trabeculae, elastic fibers predominate, allowing

the spleen to change its size and withstand a significant increase in its volume.

With light microscopy, each lymph nodule is a formation consisting of a complex of cells of lymphoid tissue located in the adventitia of the artery and numerous hemocapillaries extending from it. The artery of the nodule is called central, but more often it is located eccentrically. In a developed lymph node, several structural and functional zones are distinguished: periarterial, light center with a mantle zone and a marginal zone. The periarterial zone is a kind of clutch consisting of small lymphocytes closely adjacent to each other and interdigitating cells. Lymphocytes in this zone belong to the recirculating T-cell pool. They penetrate here from the hemocapillaries, and after antigenic stimulation they can migrate into the sinuses of the red pulp. Interdigitating cells are special process macrophages that absorb antigen and stimulate blast-transformation, proliferation and transformation of T-lymphocytes into effector cells.

The light center of the nodule in structure and functional purpose corresponds to the follicles of the lymph node and is a thymus-independent site. There are lymphoblasts, many of which are at the stage of mitosis, dendritic cells that fix the antigen and preserve it for a long time, as well as free macrophages containing absorbed decay products of lymphocytes in the form of stained bodies. The structure of the light center reflects the functional state of the lymph node and can change significantly with infections and intoxications. The center is surrounded by a dense lymphocytic rim - the mantle zone.

Around the entire nodule, there is a marginal zone, which contains T- and B-lymphocytes and macrophages. It is believed that functionally this zone is one of the areas of cooperative interaction of different types of cells in the immune response. The B-lymphocytes located in this zone as a result of this interaction and stimulated by the corresponding antigen proliferate and differentiate into antibody-forming plasma cells that accumulate in the cords of the red pulp. The shape of the splenic nodule is maintained using a network of reticular fibers - in the thymus-independent area they are located radially, and in the T-zone - along the long axis of the central artery.

Red pulp (pulpa lienis rubra). An extensive part (up to 70% of the mass) of the spleen, located between the lymph nodes and trabeculae. Due to the content in it of a significant amount of erythrocytes, it has a red color on unstained preparations of the spleen. It consists of reticular tissue with free cellular elements in it: blood cells, plasma cells and macrophages. In the red pulp, there are numerous arterioles, capillaries and peculiar venous sinuses (sinus venosus); a wide variety of cellular elements are deposited in their cavities. The red pulp is rich in sinuses at the border with the marginal zone of lymph nodes. The number of venous sinuses in the spleen of animals of different species is not the same. There are many of them in rabbits, guinea pigs, dogs, less in cats, cattle and small ruminants. The areas of the red pulp located between the sinuses are called splenic, or pulp cords, which contain many lymphocytes and the development of mature plasma cells occurs. Macrophages of the pulp cords carry out phagocytosis of damaged erythrocytes and participate in the exchange of iron in the body.

Circulation. The complexity of the structure and multifunctionality of the spleen can be understood only in connection with the peculiarities of its blood circulation.

Arterial blood is directed to the spleen through the splenic artery, which enters the organ through the gate. Branches extend from the artery that go inside the large trabeculae and are called trabecular arteries. In their wall there are all the membranes characteristic of muscular-type arteries: intima, media and adventitia. The latter grows together with the connective tissue of the trabecula. From the trabecular artery, arteries of small caliber depart, which enter the red pulp and are called pulp arteries. Elongated lymphatic sheaths are formed around the pulp arteries; as they move away from the trabecula, they enlarge and take on a spherical shape (lymph node). Inside these lymphatic formations, many capillaries leave the artery, and the artery itself is called the central one. However, the central (axial) location is present only in the lymphatic sheath, and in the nodule it is eccentric. Upon leaving the nodule, this artery splits into a series of branches - brush arterioles. Oval clusters of elongated reticular cells (ellipsoids, or sleeves) are located around the terminal sections of the brush arterioles. In the cytoplasm of the endothelium of ellipsoid arterioles, microfilaments are found, which are associated with the ability of ellipsoids to contract - a function of peculiar sphincters. The arterioles further branch into capillaries, some of them flow into the venous sinuses of the red pulp (closed circulation theory). According to the theory of open circulation, arterial blood

Depending on the reduced or relaxed state of the arterial and venous sphincters, the sinuses can be in different functional states. When the venous sphincters contract, the blood fills the sinuses, stretches their wall, while the blood plasma goes through it into the reticular tissue of the pulpal cords, and blood cells accumulate in the sinus cavity. In the venous sinuses of the spleen, up to 1/3 of the total number of erythrocytes can be retained. When both sphincters are open, the contents of the sinuses enter the bloodstream. Often this happens with a sharp increase in oxygen demand, when the sympathetic nervous system is excited and the sphincters relax. This is also facilitated by the contraction of the smooth muscles of the capsule and trabeculae of the spleen.

Spleen histology drug

SPELEEN [ 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 of iron, proteins, etc. S. does not belong to the number of vital important organs, but due to 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 clusters 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. Fibrous membrane and trabeculae of S. rabbit, guinea pig, rats and humans are less developed than the spleen of dogs and cats, which is characterized by the powerful development of connective tissue. Trabeculae in S. of animals are much richer in smooth muscle cells than in the human spleen, and peritrabecular nerve plexuses present in S. of a pig and dog are absent in S. of a person. 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 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 growing 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 transverse dimension - 9 times.

The most characteristic in the subsequent stages of embryonic development of S. is the intensified formation of its musculoskeletal elements - the reticular stroma, the system of vascular 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 formed lymph, 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). By the 26-28th week, cystocular arterioles have already formed in the red pulp. By 28-32 weeks

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, vasocontaining trabeculae and newly formed avascular trabeculae C. form unified systemassociated 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 - the inflow of the portal vein (see) - starts 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

At 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 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

Distinguish the outer convex diaphragmatic surface S. (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-inferior 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-graphical-anatomical position of S. depends on the type of constitution: in people with high and narrow chest it is located lower and vertically, in people with a wide chest it is higher and horizontal. The size, position, filling of the stomach and transverse colon significantly affect the position of C.

The peritoneum (see) covering S. from all sides, with the exception of the gate and the site, to which the tail of the pancreas is adjacent, forms ligaments (duplications): gastro-splenic (lig.gastrolienale), short arteries and veins pass through the cut stomach, limf, vessels from the stomach to splenic limf, nodes; phrenic-splenic (lig. phrenicolienale) and spleen-renal (lig. lienorenale), between the leaves a cut lie on a nek-rum extent splenic artery and vein. S.'s fixation is carried out by hl. arr. due to intra-abdominal pressure (see), the phrenic-splenic ligament, as well as the phrenic-colonic ligament passing from the lower surface of the diaphragm to the left bend of the colon and forming a horizontal plate covering the lower end of S. in the form of a blind bag.

The blood supply is carried out by the splenic artery (a. Lienalis) - an artery of the muscular type with a powerful internal elastic membrane. It is the largest branch of the celiac trunk. Its length is from 80 to 300 mm, diameter is from 5 to 12 mm. The splenic artery runs from right to left behind the parietal sheet of the peritoneum along the upper edge of the pancreas to S.'s gate (printing. Fig. 1). In 3% of cases, it passes in front of the pancreas, and sometimes partially in its parenchyma. In 80% of cases, the splenic artery is divided into two, in 20% - into three or more branches of the first order. Doubling of the artery or its origin directly from the aorta is rare. In adulthood and old age, the splenic artery becomes tortuous. In accordance with the number of intraorgan branches of the splenic artery S. is divided into segments (zones).

The splenic vein (v. Lienalis) is 11/2 times larger in caliber than the splenic artery, is formed at S.'s gate as a result of the fusion of S.'s intraorgan veins, pancreatic veins, left gastroepiploic veins and short gastric veins. It lacks valves, but in the middle shell of its wall there is a well-developed elastic membrane - a layer of transversely oriented muscle cells.

S.'s vascular system is of particular interest, since its peculiar structure plays an essential role in the function of this organ. For many years, the issue of "closed" or "open" blood flow through C. was discussed. First of all, this concerned the venous sinuses of C., which are part of the venous bed of the organ, lined with endothelium with an intermittent basement membrane, which contributes to their significant stretching and a change in the diameter of the lumen from 10 to 45 microns. Intravital observations carried out by Nicely (MN Knisely, 1936) did not show the presence of venous vessels open to the circulating blood or pulp, which gave grounds to consider S.'s blood circulation "closed". However, this has not been confirmed by other researchers. In the crust, it was established that from the intrasplenic branches of the splenic artery the arteries of the trabeculae depart, then going through the limf, follicles and giving rise to capillaries (printing. Fig. 2). Leaving the limf, follicles, these capillaries are divided into thin branches, partially disappearing in the pulp, partially directly flowing into the venous sinuses. There are gaps between the cells of the endothelium of the sinuses, through to-rye the pulp and sinuses communicate with each other. With the synchronous compression of the arteriolar sleeves and sphincters located at the border of the venules with the sinuses, the latter are closed on long time... These dilated sinuses contain either erythrocytes (blood plasma is filtered) or lymphocytes, splenic macrophages, leukocytes, and altered red blood cells. When the sphincters relax, the sinuses are included in the blood flow. From the sinuses, blood enters the veins of the red pulp, to-rye, uniting, form the splenic vein. Normally, erythrocytes pass both through arteriovenous shunts (see Arterio-venous anastomoses), and in a roundabout way - through the red pulp.

Lymphatic drainage. Lymph, nodes and limf, S.'s vessels are concentrated in the zone of its gate and surround the arteries penetrating into S.. A few limf, vessels are in the fibrous membrane, or capsule, C. Lymph flows into celiac limf. nodes.

Innervation. S.'s nerves are branches of the celiac plexus and vagus nerves that form a powerful subserous and thinner plexus in the zone of S.'s gate (see Vegetative nervous system). Penetrating into S., nerves form intratrabecular plexuses of various densities, innervating connective and smooth muscle tissue.

X-RAY ANATOMY

In the picture in direct projection, S. is visible under the costal part of the left half of the diaphragm. Medially, the gas bubble of the stomach and the shadow of the left kidney are traced (Fig. 1), at the lower pole - the left bend of the colon (splenic bend). During inhalation, S.'s shadow is determined at the level of IX - XII ribs, its lower pole can be located at the level of I - II of the lumbar vertebrae. S.'s upper pole is usually located medial to the lower one. However, horizontal, oblique and vertical position C. In a typical case, C.'s shadow is bean-shaped, with smooth contours, and uniform. In length it does not exceed 150 mm (more often 80-120 mm), in diameter - 80 mm (more often 50-60 mm). On the roentgenogram in the lateral projection, S. is visible closer to the posterior slope of the diaphragm against the background of the spine. S.'s lobulation is revealed, its fixation by diaphragmatic-splenic and diaphragmatic-colonic ligaments. S. is better visible in conditions of a pneumoperitoneum (see). On tomograms in conditions of pneumoretroperitoneum (see) or pneumorena (see) S.'s relationship with the left kidney is clearly visible (Fig. 2). When computed tomography (see. Computer tomography) in the pictures, made at the level of 140-220. Ml up from the navel, S.'s cross section is seen in the form of a crescent shadow of irregular shape.

HISTOLOGY

Under the serous membrane of S. (tunica serosa), consisting of one layer of mesothelial cells, there is a fibrous membrane (tunica fibrosa) with a thickness of up to 180-200 microns in the gate area and up to 90-100 microns on the convex side of the organ. The outer layers of the fibrous membrane consist mainly of collagen and reticular fibers, the inner layers contain many elastic fibers oriented in different directions. Trabeculae (trabeculae lienis s. Splenicae) radiate from S.'s gate radially, to-rye then connect to the fibrous membrane. Arteries, veins, efferent lymph, vessels and nerve fibers... In addition, avascular trabeculae with a thickness of 30 to 255 microns depart from the fibrous membrane into the pulp, connected by thick reticular fibers to each other and thin fibers with a stromal base of the sinuses.

The connective tissue framework and a few smooth muscle cells make up the musculoskeletal system of S., capable of withstanding its significant increase in volume.

In S., white and red pulp are distinguished. White pulp consists mainly of lymphocytes (see); it accounts for 6 to 20% of the weight of the spleen. Two main components are distinguished in it - periarterial lymph, clutches (primary follicles), consisting mainly of T-lymphocytes, and secondary lymph, follicles (malpighian bodies) - nodular accumulations of mainly B-lymphocytes. Primary follicles are cylindrical formations, to-rye are surrounded by large arterial vessels (the so-called central arteries) passing into S.'s red pulp from trabeculae. Secondary lymph, follicles are located within primary follicles, more often at the level of arterial trunks bifurcation.

The main trunk of the central artery, leaving the lymph, the follicle, splits into 2-3 brush arterioles, in the walls of which, according to Irino (S. Irino, 1978), there are pores that open between the reticular cells of the red pulp. In places of narrowing brush arterioles are surrounded by arterial sleeves, specific for S., consisting of a reticular syncytium and thin reticular fibers (see. Reticular tissue). Upon leaving the sleeve, the arterioles branch into capillaries, to-rye form blind thickenings or pass into the venous capillaries and flow into the venous sinuses. In the periarterial zones limf, follicles are located mainly T-lymphocytes entering S. with blood. On the periphery of lymph, follicles on the border with the red pulp are located B-lymphocytes participating in the formation of antibodies (see. Immunocompetent cells).

Newly formed # primary lymph, follicles are small, dia. 0.2-0.3 mm, accumulation of lymphocytes. The follicle volume increases by 2-3 times as it matures, 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, the 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) there are reticular fibers, 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 with similar 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 nucleated parts of which, oriented along the length of the sinus, are interconnected by thin bridges, which together creates 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 cm2 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, the connective tissue of S. 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. polychrome coloration, violation of the clear orientation of fibers, their fragmentation. In limf, follicles, the walls of blood vessels thicken, the 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. At the age after 50 years, 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 years they are often fragmented.

NORMAL AND PATHOLOGICAL PHYSIOLOGY

For a long period of time, S. was considered a "mysterious" body, since its normal functions were not known. Actually, and still cannot be considered that they have been fully studied. Nevertheless, in the crust, time already 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 during burns, trauma, and other tissue damage. S. actively participates in the immune response - its cells recognize foreign this organism antigens 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 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. Splen-ectomy 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) at healthy person also destroyed ch. 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 out 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). Reducing, S. is able to throw out the blood deposited in it into the vascular bed. At the same time 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. S.'s influence on erythropoiesis is tried to be confirmed 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, platelet production, the process of de-nucleation 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 glycogen levels in it. The enhancement of the glycogen-fixing function of the liver, which occurs after splenectomy, is also persistently 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 the removal of S. in parabiotic animals allow us to conclude that S. humoral factors, 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 lingers in S. with congestive 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 discovered even phagocytosis of leukocytes in S. at inf. hepatitis. According to Hermann (G. Gehrmann, 1970), destruction of thrombocytes 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 leukolytic conditions). S. at the same time is only a place of destruction of blood corpuscles and can play an essential role in the production of antibodies. Splenectomy often results in positive effect... 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 in erythrocytes of Jolly's bodies and target 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 condition 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. S.'s color and consistency depend on blood filling; they change at pulp hyperplasia, deposition of amyloid, various pigments, fibrosis, S.'s defeat acute and hron. infections, anemias, leukemias, malignant lymphomas, histiocytosis. For microscopic examination, take pieces from different parts of the spleen, fix them in formalin and (or) zenker-formol, 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 in autoimmune diseases... 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. So, for diabetes mellitus, atherosclerosis, 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). At hemosiderosis S. has a rusty-brown color, sometimes slightly increased. In the red pulp with gistol. 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 can disappear during recovery. 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 in 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), atrophy of limf, follicles of varying degrees. With prolonged stagnation of blood, fibrosis of the pulp cords (cyanotic induration of the spleen) is noted. 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 fibrous-hyaline areas ("glazed" spleen), S.'s adhesions with surrounding tissues are possible. S.'s surface on a 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 with calcium salts, are revealed - Gandhi-Gamna's nodules, or sclero-pigmented nodules (printing. Fig. 5). Iron impregnation in the area of \u200b\u200bscars 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. the state of the body.

Productive inflammation in S. with the formation of granulomas of various structures and development of splenomegaly can be observed in tuberculosis (see below), sarcoidosis (see), brucellosis (see), tularemia (see), visceral mycoses (see), leprosy ( cm.). The sizes of granulomas vary: fibrosis occurs in their outcome. 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 are found, acute inflammation, sometimes paired gummies are nice; 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, abundance in S.'s tissue of plasmablasts and plasma cells (see), proliferation of histiocytes (see) and macrophages (see) are characteristic of a humoral immune response; quite 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 an 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 common histologically. Hypoplasia of the white pulp up to its complete aplasia is observed with 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 amyloidosis of S., 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. apply percussion and palpation S. to practice (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 the S. runs almost horizontally, the lower - 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 size according to MG Kurlov is carried out in the patient's lying position with 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 before 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 fingers of the investigator. 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 \u200b\u200bthe 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 direct and lateral projection. By special methods rentgenol. studies are cT scan (see Computer tomography), celiacography (see) and lienography (see), diagnostic pneumoperitoneum (<5м.) и пневморен (см.), дополняемые томографией (см.). В дифференциальной и топической диагностике изолированного поражения С. важная роль принадлежит артериографии (см.), компьютерной томографии, диагностическому пневмоперитонеуму.

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 51Cr, 99mTc or 197Hg 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 cm2; at S.'s diseases the accumulation of the radionuclide is uneven, the area of \u200b\u200bthe 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), pronounced thrombocytepenia (see). Before puncture with the help of percussion and palpation determine S.'s size and position, carry out an x-ray and radioisotope study. S.'s puncture is performed without anesthesia in the position of the patient on his back or on his side. Thin needles are used for puncture, usually used for intramuscular injections. The needle should be free from barbs at the end, and the syringe should be absolutely dry. The needle is injected into S. to a depth of 20 mm, a punctate is obtained, which is subjected to a 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 malformations 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 usually combined with malformations of the heart and vascular system. Wedge, the diagnosis of asple-nia is difficult. In these cases, radiography 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. can be functionally defective - unable to accumulate a radiopharmaceutical. It is also observed in those 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 because of 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 pain in the abdomen 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 shown (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 using methods of radioisotope research. Clinically, this condition does not manifest itself. However, with 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 SV Lobachev and OI 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, and 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 region of 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 magnitude 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 \u200b\u200bthe IX-XI ribs, to-rye bend and press on S. outside. If the ribs are fractured, their fragments can damage S. and penetrate into its parenchyma. In case of a fall 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 legs, a rupture of the capsule in its weakest places.

In the diagnosis of closed injuries of S., data of anamnesis, 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 and cough. 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-stand up" 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. Symptom Shchet-kin-Vlumberg (see. Shchetkina-Blumberg symptom), as a rule, is mild. Weinert's symptom is positive - if the examiner covers the victim's lumbar region with both hands on both sides, then tissue resistance is determined on the left. A symptom of Kulenkampf-fa is often found - a sharp pain on palpation of the abdomen without tension of the muscles of the anterior abdominal wall. At percussion it is possible to erroneously determine an increase in S.'s boundaries due to the presence of blood clots in its area. Sometimes there is a sign of Pitts and Bellens - the boundaries of dullness, detected during percussion of the anterior abdominal wall, move in the right half of the abdomen when the position of the patient's body changes and do not change on the left, which is associated with the accumulation of blood clots around the damaged S.

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. In this case, 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. a study reveals a change in the size and shape of S., signs of the presence 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 blackout of the left sub-diaphragm of the flax space, in which S.'s outlines, the 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 injuries, 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 measures (see Resuscitation).

Treatment of open and closed S.'s injuries is, as a rule, operational. At open S.'s injuries 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, carefully drain 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 Event) 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 closing a wound C. Wedge-shaped excision of a crushed section of S. is performed with single deep injuries with crushed edges. 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 with the aim of removing 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 damages of S. are 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 the entire organ) and without violating the integrity of the capsule. With a safe S. capsule, the formation of subcapsular superficial and deep (central) hematomas is possible, 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.

First aid (see) and first aid (see) consist in the imposition of an aseptic dressing on the wound, the introduction of anesthetics and the rapid removal (removal) of victims from the battlefield.

Victims should not be detained at the stage of first aid, they should be quickly evacuated to the stage of providing qualified medical care (see). At the regimental medical station (see), only the non-transportable (agonizing) are left.

When providing qualified medical care in the process of carrying out honey. sorting (see. Medical sorting) of victims with combat defeats S. are divided into the following groups: 1) with severe symptoms of intra-abdominal bleeding, 2) with signs of peritonitis, 3) with suspected closed injury of S.

Persons with severe symptoms of intra-abdominal bleeding are immediately referred to the operating room. For the victims of this group, the operation begins, without waiting for the complete recovery of hemodynamic parameters, and at the same time they carry out anti-shock measures. The operation is performed under inhalation anesthesia (see) with the use of muscle relaxants (see). In military field conditions, median or obliquely transverse cuts are used to access the damaged S. At S.'s injuries, as a rule, splenectomy is performed. Only in exceptional cases is it permissible to suture a small superficial wound of S. with hemming of a large omentum. After surgical treatment of the inlet and outlet of the wound, S.'s bed is drained with a perforated synthetic tube, which is taken out in the left hypochondrium.

The wounded with symptoms of peritonitis in the absence of signs of nrofuse intra-abdominal bleeding are sent to the anti-shock ward for preoperative preparation.

If there is a suspicion of a closed injury and S.'s wound, the condition of the victim is monitored, in order to clarify the diagnosis according to the indications, laparocentesis is used (see). If blood is found in the abdominal cavity, the victims are sent to the operating room.

After surgery and the expiration of the period of non-transportability, the wounded are evacuated to the stage of providing specialized medical care (see). The most frequent postoperative complications are the divergence of the edges of the wound of the anterior abdominal wall, peritonitis, subphrenic abscess (see), as well as adhesive intestinal obstruction (see Intestinal obstruction).

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 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 disease, Hand-Schüller - Christian 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 trunk of the portal vein 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 at sickle-cell anemia (see), sometimes at Mark-kiafava-Mikel's disease of l and (see. Hemolytic anemia) and nodular periarteritis (see. Periarteritis nodular). S.'s heart attacks with prolonged septic endocarditis (see) develop as a result of detachment 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. there are characteristic multiple white or yellowish color foci of necrosis. Similar changes can be found in generalized infections. There is no obstruction of arterial vessels.

Wedge, the picture depends on the size of the heart attack. Diagnosis of small S.'s heart attacks is difficult due to 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 p "ubets, occasionally a cyst is formed. At suppuration of a heart attack S. 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 most important in a wedge, in relation to the group, are represented by large isolated abscesses of S., to-rye can be observed at bacteremia against the background of endocarditis or salmonellosis; at infection of 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 pain in the upper left half of the abdomen and chest are usually observed (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 heard rarely. X-ray can 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. Detection of non-vascularized tissue of an organ at arteriography against the background of the corresponding wedge, picture also testifies in favor of S.'s abscess. 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 prognosis is determined, as a rule, by complications, such as, for example, 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 hematogenous and lymphogenous. Macroscopically, on the surface of the enlarged S.'s section, multiple gray or pale yellow millet tubercles sharply delimited from the surrounding tissue are visible. Tuberculomas in S. are rare. The tubercles can be located in both the red and white pulp. They consist of epithelioid cells, Pirogov-Langhans cells, as well as plasma and lymphoid cells. In punctate, single epithelioid cells are usually found; Pirogov-Langhans cells in punctate are rare (see. Tuberculosis).

Isolated S. tuberculosis often proceeds with a meager wedge, symptomatology. Splenomegaly of varying severity, ascites, and subfebrile temperature are most often noted. In the blood, leukopenia (sometimes leukocytosis), lymphopenia, in some cases - neutropenia, thrombocytopenia (as well as thrombocytosis), anemia are found. Sometimes the 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. researches of punctate S., however, the only reliable criterion is the detection of mycobacteria of tuberculosis in a smear or sowing them from 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 hydatidous form (unicameral echinococcus) is more common, recognition of a cut presents 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 overstretching of its capsule at 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. At 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, in connection with which the pulpous pi follicular form is distinguished.

Among primary malignant neoplasms of S., lymphosarcomas are in the first place (see). Tumor growths can be nodular or diffuse; they consist of atypical lymphoid cells and cause a gradual increase in C.'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. Leukemia) on the basis of a wedge, picture, changes in 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.

Sarcoma (see) strikes S. diffusely or in the form of separate nodes. In this case, the shape of the organ does not change, but its size increases. When the tumor grows outside the capsule and fuses with the surrounding tissues, organ deformation is possible. Metastases of S.'s sarcoma develop quickly, affecting at first limf, nodes of S.'s gate and liver, then mesenteric, lumbar. Hematogenous spread of the tumor leads to the development of metastatic nodes in distant organs, and primarily in the liver and lungs. Often S. is involved in the process for the second time with malignant lymphomas (lymphogranulomatosis, various forms of lymphosarcoma), reticulosarcoma. However, cases of malignant lymphomas (especially lymphogranulomatosis) are described, the only wedge, manifestation to-rykh is splenomegaly (see).

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 do 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. tumors (surgery and chemotherapy).

When indications for surgical intervention for this or that pathology 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 to revise the abdominal organs in this area (see . Laparo-tomia). In case of combined damage with suspected injury to the organs of the chest cavity, a thoracoabdominal approach is indicated. To remove S., which has normal dimensions, paracostal access is shown without dissection of the rectus abdominis muscle.

Anatomy, physiology - P and r and V. V. Selected works, t. 1, p. 46, M., 1974; Physiology of the blood system, Physiology of erythropoiesis, ed. V.N. Chernigovsky, p. 256, J1. 1979; Folkov B. and Neil E. Blood circulation, trans. from English., M., 1976; H x about l and-r and I 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 3 a-Kurdaev V.E. Diagnosis of abdominal injuries, Voen.-med. zhurn., no. 12, p. 26, 1972; Borodin IF and Orlyan-with and I am V.F. Some questions of diagnosis and treatment of closed injuries of the spleen, Wedge, hir., No. 4, p. 29, 1980; B at g at l about in GK Subcutaneous injuries of the spleen, in the same place, p. 54; G e l-l er LI Physiology and pathology of the spleen, M., 1964, bibliogr .; H l and N c RM and R about and N with to and y 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; D y m sh and c 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. 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 VN Subcutaneous ruptures of the spleen based on materials from the surgical clinics of the Institute named after 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 injury 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 and Mr. K., etc. Scanning of the spleen, Honey. radiol., t. 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. \u200b\u200bD. 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. \u200b\u200ba. W. A. \u200b\u200bPathologie 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. Gol'ber, G. I. Kositsky (normal and pathological physiology), G. A. Pokrovsky (met. Research, malformations, injuries, operations), L.K.Semenova (an., hist., embr.), G.P. Filimonov (rent.), M.P. Khokhlova (pat.an.), I. Ya. Yakovleva (onc .).

Spleenis an organ of lymphoid hematopoiesis and a biological filter. Red blood cells are destroyed in it. Having the property to change its volume, the spleen, by contracting, increases the total blood content in the blood. sist. and raises shelter. pressure, while relaxing and increasing its volume, turns into a depot for storing excess blood. The main structural and functional elements are the musculoskeletal system, represented by the capsule and the trabecular system, and the intertrabecular part, the pulp.

The spleen is covered with a serous membrane that fuses tightly with the capsule. The trabeculae crossbeams extend inward from the capsule, they branch and connect to one another, forming the spongy skeleton of the spleen. Together with them, blood vessels also penetrate into the organ. Capsule and trabeculae the spleen is built from dense fibrous comp. and smooth muscle. White pulp - a complex of lymph nodes in the spleen (malpighian bodies). They are real. protective function of the spleen and produce the bulk of blood lymphocytes. Lymph. spleen nodules differ from the same limf nodules. nodes by the presence of central arteries. In the developed lymph nodes are distinguished periarterial zone-consists of small lymphocytes closely adjacent to each other and integrating cells; light center- they have lymphoblasts, dendritic cells and free macrophages (the center is surrounded by a mantle zone, a protal lymphocytic rim).

Around the whole knot marginal zone-contains T and B-lymphacytes and macrophages.

Red pulp-interfolicular tissue filled with erythrocytes. It consists of reticular tissue with blood cells, plasma cells and macrophages in it. There are venous sinuses (numerous arterioles, capillaries)

Circulation.Arterial blood is directed along the splenic artery, which through the gate enters the organ, where the splenic vein exits. The artery and vein ramifications are initially the same and follow the trabeculae within the vascular sheaths like trabecular arteries and veins. Then the paths of the vessels diverge: the artery is introduced into the pulp as a pulp artery, and the vein continues its path along the trabecula. One vessel enters the nodule - the central artery. On leaving the limf. the central artery nodule disintegrates into a number of branches - arteries are tassel arterioles. These arteries are characterized by the presence of env. their sleeves are made of reticular tissue - the arterial sleeve. The arteries of the brush pass into the arterial capillaries. The spleen sinusoid system is formed from the cells of the reticular tissue. Their walls are endothelial cells elongated along the length of the vessels.

Material taken from the site www.hystology.ru

The spleen is an unpaired organ located in the abdominal cavity on the greater curvature of the stomach, in ruminants - on the scar. Its shape varies from flat elongated to round; in animals of different species, the shape and size may be different. The color of the spleen - from intense red-brown to blue-violet - is due to the large amount of blood it contains.

Figure: 212. Palatine tonsils:

Figure: 213. Cat spleen (according to Ellenberger and Trautnan):

a - capsule; b - trabeculae; in - trabecular artery; r - trabecular vein; d - light center of the lymphatic follicle; e - central artery; f - red pulp; s - the vascular vagina.

The spleen is the organ of blood deposition. The depositing function of the spleen is especially pronounced in horses and ruminants.

Microscopic structure of the spleen.The main structural and functional elements of the spleen are the musculoskeletal system, represented by the capsule and the trabecular system, and the rest of the intertrabecular part is the pulp, built mainly of reticular tissue. Distinguish between white and red pulp (Fig. 213).

The capsule and trabeculae are composed of dense fibrous connective and smooth muscle tissue. A significant amount of muscle tissue develops and is contained in the deposit type spleen (horse, ruminants, pigs, carnivores). The contraction of smooth muscle tissue helps to push the deposited blood into the bloodstream. In the connective tissue of the capsule and trabeculae, elastic fibers predominate, allowing the spleen to change its size and withstand a significant increase in its volume.

With light microscopy, each lymph nodule is a formation consisting of a complex of cells of lymphoid tissue located in the adventitia of the artery and numerous hemocapillaries extending from it. The artery of the nodule is called central, but more often it is located eccentrically. In a developed lymph node, several structural and functional zones are distinguished: periarterial, light center with a mantle zone and a marginal zone. The periarterial zone is a kind of clutch consisting of small lymphocytes closely adjacent to each other and interdigitating cells. Lymphocytes in this zone belong to the recirculating T-cell pool. They penetrate here from the hemocapillaries, and after antigenic stimulation they can migrate into the sinuses of the red pulp. Interdigitating cells are special process macrophages that absorb antigen and stimulate blast-transformation, proliferation and transformation of T-lymphocytes into effector cells.

Red pulp (pulpa lienis rubra). An extensive part (up to 70% of the mass) of the spleen, located between the lymph nodes and trabeculae. Due to the content in it of a significant amount of erythrocytes, it has a red color on unstained preparations of the spleen. It consists of reticular tissue with free cellular elements in it: blood cells, plasma cells and macrophages. In the red pulp, there are numerous arterioles, capillaries and peculiar venous sinuses (sinus venosus); a wide variety of cellular elements are deposited in their cavities. The red pulp is rich in sinuses at the border with the marginal zone of lymph nodes. The number of venous sinuses in the spleen of animals of different species is not the same. There are many of them in rabbits, guinea pigs, dogs, less in cats, cattle and small ruminants. The areas of the red pulp located between the sinuses are called splenic, or pulp cords, which contain many lymphocytes and the development of mature plasma cells occurs. Macrophages of the pulp cords carry out phagocytosis of damaged erythrocytes and participate in the exchange of iron in the body.

Circulation.The complexity of the structure and multifunctionality of the spleen can be understood only in connection with the peculiarities of its blood circulation.

Arterial blood is directed to the spleen through the splenic artery, which enters the organ through the gate. Branches extend from the artery that go inside the large trabeculae and are called trabecular arteries. In their wall there are all the membranes characteristic of muscular arteries: intima, media and adventitia. The latter grows together with the connective tissue of the trabecula. From the trabecular artery, arteries of small caliber depart, which enter the red pulp and are called pulp arteries. Elongated lymphatic sheaths are formed around the pulp arteries; as they move away from the trabecula, they increase and take a spherical shape (lymph node). Inside these lymphatic formations, many capillaries leave the artery, and the artery itself is called the central one. However, the central (axial) location is present only in the lymphatic sheath, and in the nodule it is eccentric. Upon leaving the nodule, this artery splits into a series of branches - brush arterioles. Oval clusters of elongated reticular cells (ellipsoids, or sleeves) are located around the terminal sections of the brush arterioles. In the cytoplasm of the endothelium of ellipsoid arterioles, microfilaments were found, which are associated with the ability of ellipsoids to contract - the function of peculiar sphincters. The arterioles further branch into capillaries, some of them flow into the venous sinuses of the red pulp (theory of closed circulation). In accordance with the theory of open circulation, arterial blood from the capillaries enters the reticular tissue of the pulp, and from it seeps through the wall into the sinus cavity. Venous sinuses occupy a significant part of the red pulp and can have different diameters and shapes depending on their blood supply. The thin walls of the venous sinuses are lined with an intermittent endothelium located on the basal lamina. Reticular fibers run along the surface of the sinus wall in the form of rings. At the end of the sinus, at the site of its transition to the vein, there is another sphincter.

Depending on the reduced or relaxed state of the arterial and venous sphincters, the sinuses can be in different functional states. When the venous sphincters contract, the blood fills the sinuses, stretches their wall, while the blood plasma goes through it into the reticular tissue of the pulpal cords, and blood cells accumulate in the sinus cavity. In the venous sinuses of the spleen, up to 1/3 of the total number of erythrocytes can be retained. When both sphincters are open, the contents of the sinuses enter the bloodstream. Often this happens with a sharp increase in oxygen demand, when the sympathetic nervous system is excited and the sphincters relax. This is also facilitated by the contraction of the smooth muscles of the capsule and trabeculae of the spleen.

1. The state of blood filling of the red pulp (diffuse or focal plethora, moderate blood filling, weak blood filling, exsanguination), focal hemorrhages, areas of hemorrhagic impregnation.

2. Condition of lymphatic follicles (of medium size, decreased, in a state of atrophy, enlarged and merged with each other, in a state of hyperplasia, with marginal or total delimphatization, with expanded reactive centers, with the presence of small rounded hyaline inclusions in them, the walls of the central arteries of the follicles are not changed or with the presence sclerosis and hyalinosis).

3. The presence of pathological changes (tuberculous granulomas, foci of white spleen infarction, tumor metastases, calcifications, etc.).

4. State of the red pulp (the presence of reactive focal or diffuse leukocytosis).

5. State of the spleen capsule (not thickened, with the phenomenon of sclerosis, leukocyte infiltration, with the overlays of purulent-fibrinous exudate).

Example # 1.

SELEZENKA (1 object) - pronounced diffuse plethora of red pulp. Lymphatic follicles are increased to varying degrees in size due to hyperplasia, some of them merge with each other. In most follicles, there is a pronounced enlightenment of the reactive centers. The walls of the central arteries of the follicles are thickened due to mild hyalinosis. The spleen capsule is not thickened.

Example # 2.

SELEZENKA (1 object) - preserved red pulp in a state of uneven plethora. Lymphatic follicles in a state of mild and moderate atrophy, with signs of moderately pronounced delimpatization of the marginal zones. The walls of the central arteries of the follicles are thickened due to mild sclerosis, moderate hyalinosis. A large section of the sections is occupied by a fragment of metastasis of squamous cell non-keratinizing lung cancer. The spleen capsule is slightly thickened due to sclerosis.

No. 09-8 / XXX 2007

Table № 1

State healthcare institution

"SAMARA REGIONAL BUREAU OF FORENSIC MEDICAL EXPERTISE"

To the "Act of Forensic Histological Research" No. 09-8 / XXX 2007

Table № 2

Forensic expert Filippenkova E.I.

97 STATE CENTER

CENTRAL MILITARY DISTRICT

Table № 8

Specialist E. Filippenkova

MINISTRY OF DEFENSE OF THE RUSSIAN FEDERATION

97 STATE CENTER

FORENSIC AND CRIMINALISTIC EXAMINATIONS

CENTRAL MILITARY DISTRICT

443099, Samara, st. Venzeka, 48 tel. 339-97-80, 332-47-60

To the "Conclusion of a specialist" No. XXX 2011

Table № 9


Figure: 1. In the pulp of the spleen, a fragment of a large-focal destructive hemorrhage of a dark red color, with a predominant hemolysis of erythrocytes, pronounced leukocytosis, with a concentration of granulocytes at the edges of the hematoma. Coloring: hematoxylin-eosin. Magnification x100.	Figure: 2. Along the edges of the hematoma in a number of fields of view, small foci of leukocyte infiltration (arrows), the beginning of the formation of the demarcation shaft. A small amount of disintegrating granulocytes. Coloring: hematoxylin-eosin. Magnification x250.

Figure: 3. In the thickness of the hemorrhages, there are few small inclusions of loose fibrin in the form of ribbon-like lumpy masses, with a large number of leukocytes along the course of its filaments (arrows). Coloring: hematoxylin-eosin. Magnification x100.	Figure: 4. In the tissues surrounding the spleen, against the background of moderate edema, there is a large-focal destructive hemorrhage of dark red color, with a predominant hemolysis of erythrocytes, pronounced leukocytosis (arrow). Exsanguination of the spleen pulp. Coloring: hematoxylin-eosin. Magnification x100.

Specialist E. Filippenkova

A.A. Karandashev, T.I. Rusakova

Possibilities of forensic medical examination to identify the conditions for the occurrence of damage to the spleen and the prescription of their formation.

- M .: ID PRAKTIKA-M, 2004 .-- 36p.

ISBN 5-901654-82-X

The color of histopreparations is also of great importance. To solve the questions about the duration of the damage to the spleen, along with the coloring of the preparations with hematoxylin eosin, it is mandatory to use additional stains according to Perls and van Gieson, which determine the presence of iron-containing pigments and connective tissue.

Two-stage or "delayed" rupture of the spleen according to the literature, they develop in 3-30 days and make up from 10 to 30% of all her injuries.

According to S. Dahriya (1976) 50% of such ruptures occur in the first week, but not earlier than 2 days after the injury, 25% in the 2nd week, 10% may occur after 1 month.

J. Hertzann et al. (1984) revealed rupture of the spleen after 28 days. According to M.A. Sa-pozhnikova (1988), two-stage ruptures of the spleen were observed in 18% and did not occur earlier than 3 days after the injury.

Yu.I. Sosedko (2001) observed ruptures of the spleen capsule in the place of the formed subcapsular hematoma in the period from several hours to 26 days from the moment of injury.

As you can see, with two-stage ruptures after trauma of the spleen parenchyma, a significant time interval, up to 1 month, passes before the rupture of the capsule that accumulates in the subcapsular hematoma.

According to Yu.I. Neighbor (2001), an objective indicator of the prescription of the formation of the subcapsular hematoma of the spleen is the leukocyte reaction, which in the damaged area begins to be reliably determined after 2-3 hours. A demarcation shaft is gradually formed from granulocytes, which is visible under a microscope after 12 hours, completing its formation by the end of the day. The disintegration of granulocytes in the area of \u200b\u200bdamage to the spleen begins on days 2-3; on days 4-5, a massive disintegration of granulocytes occurs, when nuclear detritus clearly predominates. In fresh hemorrhage, the structure of erythrocytes is not changed. Their hemolysis begins 1-2 hours after injury. The border of fresh hemorrhages with the surrounding tissues is indistinct. Then fibrin is deposited along the periphery, which after 6-12 hours clearly delineates the hematoma from the surrounding parenchyma. Within 12-24 hours, fibrin is compacted in the hematoma with spread to the periphery, then it undergoes organization. Signs of the organization of blood clots in the vessels of the spleen are evidence that at least 3 days have passed since the injury. The constituent elements of the hematoma are erythrocytes, white blood cells, fibrin. By the 3rd day, the initial manifestations of resorption of the decay products of erythrocytes with the formation of siderophages are determined. From the same period, hemosiderin is seen intracellularly on histopreparations. The release of small grains of hemosiderin from disintegrating macrophages is observed from 10-12 days (early period) to 2 weeks. To detect them, it is necessary to examine histological preparations stained according to Perls. On preparations stained with hematoxylin-eosin, the “younger” the hemosiderin, the lighter (yellow) it is. The dark brown color of hemosiderin lumps indicates that at least 10-12 days have passed since the injury. The histiocytic-fibroblastic reaction, detected on the 3rd day after the injury, indicates the initial process of organizing the subcapsular hematoma of the spleen. On the 5th day, collagen fibers are formed. Cords from histiocytic-fibroblastic elements, separate newly formed vessels grow into the damaged area. The process of resorption and organization of the hematoma continues until the formation of a capsule, which takes at least 2 weeks to form.

Research results A.A. Karandashev, T.I. Rusakova:

When the spleen is injured, ruptures of the capsule and damage to the parenchyma of the organ with hemorrhages in the damaged areas are histologically observed. Often, hemorrhages are in the form of hematomas with clear margins that fill the lesions. Depending on the severity of the injury, large ruptures of the capsule and parenchyma, parenchymal ruptures with the formation of a subcapsular hematoma and multiple ruptures of the capsule and parenchyma with areas of tissue destruction, fragmentation and the formation of small intraparenchymal lesions with hemorrhages are observed. The parenchyma in intact areas is sharply anemic.

In case of injury with damage to the spleen and fatal at the scenehematomas in the area of \u200b\u200borgan damage consists mainly of unchanged erythrocytes and white blood cells without a perifocal cellular reaction. There is a plethora of red pulp. There are no signs of resorption and organization.

With a favorable outcome and prompt removal of the damaged spleen, in 2 hours after injury, along with the described picture, there is a moderate number of unchanged granulocytes in the composition of hematomas. Perifocal cellular reaction is not detected, only in places in the sinuses, geographically close to the damaged area, there are few small accumulations of granulocytes.

After 4-6 hours there is an indistinct concentration of mostly unchanged granulocytes at the edges of the hematoma, loss of fibrin in the form of granular-filamentous masses. As part of the hematoma, hemolyzed erythrocytes are determined, located mainly in the center of the hematoma.

About in 7-8 hours hematoma is represented mainly by hemolyzed erythrocytes. Unchanged erythrocytes are determined only in places along the edge of the hematoma. Among granulocytes, there are few decaying cells. Granulocytes along the edges of the hematoma form small, few accumulations, in places forming structures, such as a demarcation shaft.

By 11-12 o'clock the number of disintegrating granulocytes increases significantly. Granulocytes, unchanged and decaying in different quantitative proportions, form a fairly clear demarcation shaft on the border with intact parenchyma. Separate granulocytes, both in the hematoma and in the area of \u200b\u200bperifocal granulocytic infiltration, with signs of decay. Fibrin is most compacted along the edges of the hematoma in the form of ribbon-like lumpy masses.

By 24 hours there are many disintegrating granulocytes in the hematoma and demarcation shaft.

Subsequently, the number of granulocytes in the sinuses of the nearest perifocal zone gradually decreases. Swelling of the reticuloendothelial cells lining the sinuses is noted. The number of disintegrating granulocytes increases, fibrin becomes denser.

By 2.5-3 days in the spleen, the so-called "silent" period can be observed. This is the most uninformative period of time in which the absence of a perifocal reaction (leukocyte and proliferative) is noted, which may be due to a certain stage of the traumatic process, in which proliferative changes have not yet begun, and the leukocyte reaction has already ended.

By the end of 3 days along the edge of the hematoma and on the border with the intact parenchyma, a few siderophages can be found. From the side of the intact parenchyma, histio-fibroblastic elements begin to grow into the compacted masses of fibrin in the form of indistinct cords.

The processes of organization of damage in the spleen occur in accordance with the general laws of tissue healing. A characteristic sign of productive, or proliferative, inflammation is the predominance in the morphological picture of the proliferative moment, that is, the multiplication of tissue elements, tissue proliferation. Most often, the process of growth during productive inflammation occurs in the supporting, interstitial tissue. Microscopic examination in such a growing connective tissue reveals a predominance of young forms of connective tissue elements - fibroblasts and, along with them, histiocytes, lymphoid elements and plasma cells are found in various quantitative proportions.

TO 6-7 days the formation of the hematoma capsule begins. Cords of histio-fibroblastic elements in the form of chaotically and orderly arranged structures grow into the hematoma, in places with the formation of delicate, thin collagen fibers, which is very clearly visible when stained according to Van Gieson. The number of siderophages in the forming capsule increases significantly. At the initial stage of hematoma organization, vascular neoplasms are not observed in the hematoma encapsulation zone. This is probably due to the structural features of the organ pulp, the vessels of which have the form of sinusoids.

TO 7-8 days hematoma is represented by hemolyzed erythrocytes, a huge amount of nuclear detritus of disintegrated granulocytes, fibrin. The latter, in the form of a dense eosinophilic mass, clearly delimits the hematoma from intact tissue. From the side of the parenchyma, multiple cords of histio-fibroblastic elements grow into the hematoma over a considerable length, among which siderophages are determined when stained according to Perls. In places around the hematoma, a forming capsule is visible, consisting of orderedly oriented fibroblasts, fibrocytes, collagen fibers. Siderophages are also determined in the composition of the capsule.

TO 9-10 days along with siderophages, the extracellular arrangement of hemosiderin in the form of grains and lumps is noted.

With a term about 1 month hematoma is completely represented by hemolyzed erythrocytes, erythrocyte shadows, fibrin clumps, in places with an admixture of nuclear detritus. The hematoma is surrounded by a capsule of varying degrees of maturity. On its outer edge, the connective tissue of moderate maturity is represented by fibers rich in cellular elements of the fibrocytic type, rather orderly located. For the rest of the capsule, the connective tissue is immature, consists of histiocytic-fibroblastic elements, macrophages, lymphoid cells, with few collagen fibers. Lumps of hemosiderin are determined in places. Cords of histiocytic-fibroblastic elements grow from the capsule into the hematoma over a considerable length.

Chernova Marina Vladimirovna

PATHOMORPHOLOGY AND SM-ASSESSMENT OF CHANGES IN THE Spleen

WHEN DETERMINING THE DURATION OF ITS DAMAGE.

Novosibirsk, 2005

the reaction to damage is divided into reaction in the area of \u200b\u200bdamage, perifocal area, area of \u200b\u200bred pulp, white pulp;
estimated the state of the lymphoid follicles of the spleen at different periods of the post-traumatic period(hyperplasia, normal size, some decrease in size, clarification of reactive centers) ;
used immunohistochemical research method (IHCI) to assess reactive changes in lymphocytes;
according to M.V. Chernova: the organ-specificity of the structure during the post-traumatic period makes it possible to distinguish 5 time intervals: up to 12 hours, 12-24 hours, 2-3 days, 4-7 days, more than 7 days.

To carry out the differentiation of lymphocytes, leukocyte antigens (AG) were used to identify the types of lymphocytes, + the distribution of lymphocytes in the red pulp was taken into account:

IN within 1 day after injury spleen follicles were of average size, their reactive centers were moderately expressed, the follicles of injured animals ( laboratory mice, which under ether anesthesia inflicted shock damage on the spleen, brought out to the edge of the surgical incision of the abdominal wall) did not differ from the follicles of animals before the injury.

On 2-3 days - an increase in the size of follicles, a greater severity of their reactive centers, the formation of new smaller ones.

On 4-7 days- there was a gradual depletion of the white pulp, the follicles decreased, became the same size, and some even slightly smaller than usual, their reactive centers were poorly expressed.

FIRST 12 HOURS

- hemorrhage zone -erythrocytes are well contoured and brightly colored with eosin, among them polynuclear leukocytes are found in small numbers;

- perifocal zone -practically absent;

- zone of red pulp -plethora of sinusoids of the pulp, perifocal edema is not pronounced, short-term stasis with subsequent paresis of the blood vessels;

- zone of white pulp -the spleen follicles are of medium size, their reactive centers are moderately expressed, the follicles of the white pulp do not differ from the follicles before the injury;

- IGHI -the ratio of the number of T-cells (CD3) in the red and white pulp of the spleen was approximately 1: 2, the ratio of B-lymphocytes (CD20) in the red and white pulp was 1: 2.5 during the first day (3).

OVER 12 HOURS UP TO 24 HOURS INCLUDED

- hemorrhage zone -erythrocytes are also well contoured and brightly stained with eosin, there are practically no changes; among the masses of erythrocytes, there are unchanged polynuclear leukocytes in small numbers, single macrophages and lymphocytes;

- perifocal zone -the beginning of the formation of the limiting shaft between the area of \u200b\u200bhemorrhage and the surrounding normal tissue of the spleen, the forming border shaft consists mainly of unchanged polynuclear neutrophils, as well as lymphocytes and macrophages in small numbers;

- zone of red pulp -in the circumference of the formed hemorrhage, perifocal edema develops, there is a plethora of sinusoids of the pulp, in some places the parenchyma is soaked with pinkish fibrin (due to the paralytic reaction of blood microvessels and exudation of the liquid part of the blood into the extravascular environment);

- zone of white pulp -without dynamics (the spleen follicles are of medium size, their reactive centers are moderately expressed, the follicles of the white pulp do not differ from the follicles before the injury);

- IGHI -the ratio of the number of T-cells (CD3) in the red and white pulp of the spleen remains 1: 2, however, the total number of cells of this type increases slightly: a significant increase in the number of T-helpers (CD4), the ratio of B-lymphocytes (CD20) in the red and white pulp are also 1: 2.5 (3), without a tendency to increase their number in both zones.

OVER 1 AND UP TO 3 DAYS

- hemorrhage zone -erythrocytes in the form of rounded "shadows" due to their loss of hemoglobin, the number of altered and unchanged renal erythrocytes is equal, against their background fibrin threads are sometimes noted. The number of polynuclear leukocytes increases significantly, they are diffusely scattered, and some are in the stage of decay, among them lymphoid cells are visible everywhere, while the number of macrophages also increases;

- perifocal zone -perifocal reactive phenomena are maximally expressed: in comparison with the second half of the first day, the total number of neutrophils increases almost 2 times, and 1/3 of them were degeneratively altered leukocytes. At the same time, the number of macrophages increases by 2 times and the number of lymphocytes increases by almost 1.5 times;

- zone of red pulp -against the background of stromal edema, there is a sharp expansion of the sinusoids of the red pulp and anemia of the parenchyma, an extreme degree of plasma impregnation, fibrinoid necrosis, a slight increase in the total number of cellular elements, mainly due to polynuclear leukocytes, the beginning of the formation of intravascular thrombi;

- zone of white pulp -follicular hyperplasia, high severity of their reactive centers;

- IGHI -a decrease in the number of T-helpers in the red pulp by almost 2 times, a slight increase in the number of T-cells in the white pulp, the number of T-helpers (CD4) without dynamics, an increase in the number of B-lymphocytes (CD20) mainly in the white pulp by almost 1.5 times.

OVER 3 AND UP TO 7 DAYS

- hemorrhage zone -the number of altered erythrocytes is more than 2 times higher than the number of altered, the maximum increase in the number of macrophages, the number of polynuclear leukocytes, 2/3 of them are degeneratively altered or are in varying degrees of destruction. Redistribution of polynuclear leukocytes in the form of clusters in combination with lymphocytes and macrophages, along compacted bundles and fibrin bands, the appearance of fibroblasts;

- perifocal zone -a slight decrease in the total number of cellular elements, mainly due to polynuclear leukocytes, especially unchanged ones, an increase in the number of lymphocytes by 2 times and a slight increase in the number of macrophages. The appearance of a significant number of fibroblasts, which, in combination with other cellular elements, form a well-defined demarcation line;

- zone of red pulp -there is a tendency for the expansion of the sinusoids of the red pulp, which, due to the existing anemia of the parenchyma, takes the form of a tissue with defective areas, the number of polynuclear leukocytes decreases, slightly exceeding the initial one, the maximum increase in lymphoid cells is noted on the 4th-7th day, the final formation of intravascular thrombi;

- zone of white pulp -follicular hyperplasia, their structure is almost uniform, in places the follicles merge with each other;

- IGHI -a decrease in the number of T-cells (CD3) in both red and white pulp, a decrease in the number of T-helpers (CD4) by 2-2.5 times, an increase in the number of B-lymphocytes (CD20) by 2 times.

OVER 7 DAYS

- hemorrhage zone -fibrin in the form of grains is detected in the substrate, there is a pronounced increase in the number of fibroblasts, the appearance of loose collagen fibers, a decrease in the number of leukocytes, most of which are in a state of decay. The number of lymphocytes reaches a maximum level, and the number of macrophages also increases, most of which contain hemosiderin in the cytoplasm, at the maximum on the 10-12th day, although pigment grains begin to appear intracellularly from 5-7 days.

- perifocal zone -the total number of cellular elements is reduced, largely due to unchanged polynuclear leukocytes and to a lesser extent due to altered ones. The number of lymphoid elements and macrophages at the same quantitative level. On the 10-12th day, a large number of fibroblasts are located not only along the demarcation line, but also go beyond it in the direction of hemorrhage, forming tympanic structures;

- zone of red pulp -without significant dynamics;

- zone of white pulp -depletion of the white pulp, the follicles reach the same size, and some are even slightly smaller, their reactive centers are not expressed;

- IGHI -the number of T-cells (CD3) in the white pulp decreases by almost half (in relation to the initial), the number of T-helpers (CD4) reaches a minimum level (the ratio in the red and white pulp is 1: 3.5 (4)), a tendency to a decrease in the number of B-lymphocytes (CD20).

Spleen structure histology. Histological structure and blood supply to the spleen

Spleen histology drug

COMPARATIVE ANATOMY

EMBRYOLOGY

ANATOMY

X-RAY ANATOMY

HISTOLOGY

NORMAL AND PATHOLOGICAL PHYSIOLOGY

PATHOLOGICAL ANATOMY

SURVEY METHODS

PATHOLOGY

Developmental defects

Damage

Diseases

Tumors

Report a typo

Text to be sent to our editors:

Your comment (optional):