Wikipedia

Spleen

For other uses, seeSpleen (disambiguation).
This article usesanatomical terminology.

Thespleenis anorganfound in almost allvertebrates.Similar in structure to a largelymph node,it acts primarily as abloodfilter. The word spleen comes fromAncient Greekσπλήν(splḗn).[1]

Spleen
Position of the human spleen
Details
SystemImmune system(lymphatic system)
ArterySplenic artery
VeinSplenic vein
NerveSplenic plexus
Identifiers
Latinsplen, lien
Greekσπλήν
MeSHD013154
TA98A13.2.01.001
TA25159
FMA7196
Anatomical terminology
3D medical animation still showing structure of as well as location of the spleen in human body
A 3D medical animation still of spleen structure and exact location

The spleen plays very important roles in regard tored blood cells(erythrocytes) and theimmune system.[2]It removes old red blood cells and holds a reserve of blood, which can be valuable in case ofhemorrhagic shock,and alsorecycles iron.As a part of themononuclear phagocyte system,it metabolizeshemoglobinremoved fromsenescentred blood cells. Theglobinportion of hemoglobin is degraded to its constitutiveamino acids,and thehemeportion is metabolized tobilirubin,which is removed in theliver.[3][4]

The spleen housesantibody-producing lymphocytes in itswhite pulpandmonocyteswhich remove antibody-coated bacteria and antibody-coated blood cells by way of blood andlymph nodecirculation. These monocytes, upon moving to injured tissue (such as the heart aftermyocardial infarction), turn intodendritic cellsandmacrophageswhile promoting tissue healing.[5][6][7]The spleen is a center of activity of themononuclear phagocyte systemand is analogous to a large lymph node, as its absence causes a predisposition to certaininfections.[8][4]

In humans, the spleen is purple in color and is in theleft upper quadrantof theabdomen.[3][9]The surgical process to remove the spleen is known as asplenectomy.

Structure

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The spleen is underneath the left part of thediaphragm,and has a smooth, convex surface that faces the diaphragm. It is underneath the ninth, tenth, and eleventh ribs. The other side of the spleen is divided by a ridge into two regions: an anterior gastric portion, and a posterior renal portion. The gastric surface is directed forward, upward, and toward the middle, is broad and concave, and is in contact with the posterior wall of thestomach.Below this it is in contact with the tail of thepancreas.The renal surface is directed medialward and downward. It is somewhat flattened, considerably narrower than the gastric surface, and is in relation with the upper part of the anterior surface of the left kidney and occasionally with the leftadrenal gland.

There are four ligaments attached to the spleen:gastrosplenic ligament,splenorenal ligament, colicosplenic ligament, and phrenocolic ligament.[10]

Measurements

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90%confidence intervalof spleen length byabdominal ultrasonographyby height of the person[11]
Height Spleen length
Women Men
155–159 cm 6.4–12 cm
160–164 cm 7.4–12.2 cm 8.9–11.3 cm
165–169 cm 7.5–11.9 cm 8.5–12.5 cm
170–174 cm 8.3–13.0 cm 8.6–13.1 cm
175–179 cm 8.1–12.3 cm 8.6–13.4 cm
180–184 cm 9.3–13.4 cm
185–189 cm 9.3–13.6 cm
190–194 cm 9.7–14.3 cm
195–199 cm 10.2–14.4 cm

The spleen, in healthy adult humans, is approximately7 to 14 centimetres (3 to5+1⁄2in) in length.

An easy way to remember the anatomy of the spleen is the 1×3×5×7×9×10×11 rule. The spleen is 1 by 3 by 5 inches (3 by 8 by 13 cm), weighs approximately 7 oz (200 g), and lies between the 9th and 11th ribs on the left-hand side and along the axis of the 10th rib. The weight varies between 1 oz (28 g) and 8 oz (230 g) (standardreference range),[12]correlating mainly to height, body weight and degree of acute congestion but not to sex or age.[13]

  • Spleen seen onabdominal ultrasonography
  • Maximum length of spleen onabdominal ultrasonography
  • Back of lumbar region, showing surface markings for kidneys, ureters, and spleen
  • Side of thorax, showing surface markings for bones, lungs (purple), pleura (blue), and spleen (green)

Blood supply

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Visceral surface of the spleen

Near the middle of the spleen is a long fissure, thehilum,which is the point of attachment for thegastrosplenic ligamentand the point of insertion for thesplenic arteryandsplenic vein.There are other openings present forlymphatic vesselsandnerves.In addition to the splenic artery, collateral blood supply is provided by the adjacent short gastric arteries.[14]

Like thethymus,the spleen possesses onlyefferent lymphatic vessels.The spleen is part of thelymphatic system.Both theshort gastric arteriesand the splenic artery supply it with blood.[15]

Thegerminal centersare supplied byarteriolescalledpenicilliary radicles.[16]

Nerve supply

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The spleen is innervated by thesplenic plexus,which connects a branch of theceliac gangliato thevagus nerve.

The underlyingcentral nervousprocesses coordinating the spleen's function seem to be embedded into thehypothalamic-pituitary-adrenal-axis,and thebrainstem,especially thesubfornical organ.[17]

Development

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The spleen is unique in respect to its development within thegut.While most of the gutorgansareendodermallyderived, the spleen is derived frommesenchymal tissue.[18]Specifically, the spleen forms within, and from, thedorsal mesentery.However, it still shares the same blood supply—theceliac trunk—as theforegutorgans.

Function

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Pulp

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Micrographof splenic tissue showing the red pulp (red), white pulp (blue) and athickened inflamed capsule(mostly pink – top of image).H&E stain.
The spleen contains two different tissues, white pulp (A) and red pulp (B). The white pulp functions in producing and growing immune and blood cells. The red pulp functions in filtering blood of antigens, microorganisms, and defective or worn-out red blood cells.
Area Function Composition
red pulp Mechanical filtration ofred blood cells.In mice: Reserve ofmonocytes[5]
white pulp Active immune response through humoral and cell-mediated pathways. Composed of nodules, calledMalpighian corpuscles.These are composed of:

Other

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Other functions of the spleen are less prominent, especially in the healthy adult:

  • Spleen produces all types of blood cells during fetal life
  • Production ofopsonins,properdin,andtuftsin.
  • Release ofneutrophilsfollowing myocardial infarction.[19]
  • Creation ofred blood cells.While thebone marrowis the primary site ofhematopoiesisin the adult, the spleen has important hematopoietic functions up until the 5th month of gestation. After birth,erythropoieticfunctions cease, except in some hematologic disorders. As a major lymphoid organ and a central player in thereticuloendothelial system,the spleen retains the ability to produce lymphocytes and, as such, remains a hematopoietic organ.
  • Storage ofred blood cells,lymphocytesand other formed elements. The spleen of horses stores roughly 30 percent of the red blood cells and can release them when needed.[20]In humans, up to a cup (240 ml) of red blood cells is held within the spleen and released in cases ofhypovolemia[21]andhypoxia.[22]It can storeplateletsin case of an emergency and also clears old platelets from the circulation. Up to a quarter oflymphocytesare stored in the spleen at any one time.

Clinical significance

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Thalassemia-enlarged spleen taken aftersplenectomy

Enlarged spleen

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Main article:Splenomegaly

Enlargement of the spleen is known assplenomegaly.It may be caused bysickle cell anemia,sarcoidosis,malaria,bacterial endocarditis,leukemia,polycythemia vera,pernicious anemia,Gaucher's disease,leishmaniasis,Hodgkin's disease,Banti's disease,hereditary spherocytosis,cysts,glandular fever (includingmononucleosisor 'Mono' caused by theEpstein–Barr virusand infection fromcytomegalovirus), andtumours.Primary tumors of the spleen includehemangiomasandhemangiosarcomas.Marked splenomegaly may result in the spleen occupying a large portion of the left side of the abdomen.

The spleen is the largest collection oflymphoid tissuein the body. It is normally palpable in preterm infants, in 30% of normal, full-termneonates,and in 5% to 10% of infants and toddlers. A spleen easily palpable below thecostal marginin any child over the age of 3–4 years should be considered abnormal until proven otherwise.

Splenomegaly can result from antigenic stimulation (e.g., infection), obstruction of blood flow (e.g., portal vein obstruction), underlying functional abnormality (e.g.,hemolytic anemia), or infiltration (e.g.,leukemiaor storage disease, such asGaucher's disease). The most common cause of acute splenomegaly in children is viral infection, which is transient and usually moderate. Basic work-up for acute splenomegaly includes acomplete blood countwith differential, platelet count, andreticulocyteand atypical lymphocyte counts to exclude hemolytic anemia and leukemia. Assessment ofIgMantibodies to viral capsid antigen (a risingtiter) is indicated to confirm Epstein–Barr virus orcytomegalovirus.Other infections should be excluded if these tests are negative.

Calculators have been developed for measurements of spleen size based onCT,US,andMRIfindings.[23]

Splenic injury

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Main article:Splenic injury

Trauma,such as aroad traffic collision,can causerupture of the spleen,which is a situation requiring immediate medical attention.

Asplenia

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Main article:Asplenia

Aspleniarefers to a non-functioning spleen, which may becongenital,or caused by traumatic injury, surgical resection (splenectomy) or a disease such assickle cell anaemia.Hyposplenia refers to a partially functioning spleen. These conditions may cause[6]a modest increase in circulatingwhite blood cellsandplatelets,a diminished response to somevaccines,and an increased susceptibility to infection. In particular, there is an increased risk ofsepsisfrompolysaccharide encapsulated bacteria.Encapsulated bacteria inhibit binding of complement or prevent complement assembled on the capsule from interacting with macrophage receptors. Phagocytosis needs natural antibodies, which are immunoglobulins that facilitate phagocytosis either directly or by complement deposition on the capsule. They are produced byIgMmemory B cells(a subtype ofB cells) in themarginal zoneof the spleen.[24][25]

Asplenectomy(removal of the spleen) results in a greatly diminished frequency of memory B cells.[26]A 28-year follow-up of 740World War IIveterans whose spleens were removed on the battlefield showed a significant increase in the usual death rate frompneumonia(6 rather than the expected 1.3) and an increase in the death rate fromischemic heart disease(41 rather than the expected 30), but not from other conditions.[27]

Accessory spleen

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Anaccessory spleenis a small splenic nodule extra to the spleen usually formed in earlyembryogenesis.Accessory spleens are found in approximately 10 percent of the population[28]and are typically around 1 centimeter in diameter.Splenosisis a condition where displaced pieces of splenic tissue (often followingtraumaor splenectomy)autotransplantin the abdominal cavity as accessory spleens.[29]

Polyspleniais a congenital disease manifested by multiple small accessory spleens,[30]rather than a single, full-sized, normal spleen. Polysplenia sometimes occurs alone, but it is often accompanied by other developmental abnormalities such asintestinal malrotationorbiliary atresia,or cardiac abnormalities, such asdextrocardia.These accessory spleens are non-functional.

Infarction

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Main article:Splenic infarction

Splenic infarctionis a condition in which blood flow supply to the spleen is compromised,[31]leading to partial or completeinfarction(tissue death due to oxygen shortage) in the organ.[32]

Splenic infarction occurs when thesplenic arteryor one of its branches are occluded, for example by ablood clot.Although it can occurasymptomatically,the typical symptom is severepainin theleft upper quadrant of the abdomen,sometimes radiating to the left shoulder. Fever and chills develop in some cases.[33]It has to be differentiated from other causes ofacute abdomen.

Hyaloserositis

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The spleen may be affected byhyaloserositis,in which it is coated withfibroushyaline.[34][35]

Society and culture

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There has been a long and varied history of misconceptions regarding the physiological role of the spleen, and it has often been seen as a reservoir for juices closely linked to digestion.[36]In various cultures, the organ has been linked tomelancholia,due to the influence ofancient Greek medicineand the associated doctrine ofhumourism,in which the spleen was believed to be a reservoir for an elusive fluid known as "black bile" (one of the four humours).[36]The spleen also plays an important role intraditional Chinese medicine,where it is considered to bea key organthat displays theYinaspect ofthe Earth element(its Yang counterpart is the stomach). In contrast, theTalmud(tractate Berachoth 61b) refers to the spleen as the organ oflaughterwhile possibly suggesting a link with the humoral view of the organ.

Etymologically,spleencomes from theAncient Greekσπλήν(splḗn), where it was the idiomatic equivalent ofthe heartin modern English.Persius,in his satires, associatedspleenwith immoderate laughter.[37]

In English,William Shakespearefrequently used the wordspleento signifymelancholy,but alsocapriceand merriment.[37]InJulius Caesar,he uses the spleen to describe Cassius's irritable nature:

Must I observe you? must I stand and crouch
Under your testy humour? By the gods
You shall digest the venom of your spleen,
Though it do split you; for, from this day forth,
I'll use you for my mirth, yea, for my laughter,
When you are waspish.[38]

The spleen, as a byword for melancholy, has also been considered an actual disease.[39]In the early 18th century, the physicianRichard Blackmoreconsidered it to be one of the two most prevalent diseases in England (along withconsumption).[39]In 1701,Anne Finch(later, Countess of Winchilsea) had published aPindaric ode,The Spleen,drawing on her first-hand experiences of an affliction which, at the time, also had a reputation of being a fashionablyupper-classdisease of the English.[40]Both Blackmore andGeorge Cheynetreated this malady as the male equivalent of "the vapours",while preferring the morelearnedterms "hypochondriasis"and"hysteria".[39][41][42]In the late 18th century, theGermanwordSpleencame to denoteeccentricand hypochondriac tendencies that were thought to be characteristic of English people.[37]

InFrench,"splénétique" refers to a state of pensive sadness or melancholy. This usage was popularised by the poems ofCharles Baudelaire(1821–1867) and his collectionLe Spleen de Paris,but it was also present in earlier19th-century Romantic literature.

Food

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The spleen is one of the many organs that may be included inoffal.It is not widely eaten as a principal ingredient, but cow spleen sandwiches are eaten inSiciliancuisine.[43]Chicken spleen is one of the main ingredients ofJerusalem mixed grill.[44]

Other animals

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Laparoscopicview of a horse's spleen (the purple and grey mottled organ)

Incartilaginousandray-finned fish,the spleen consists primarily of red pulp and is normally somewhat elongated, as it lies inside theserosallining of theintestine.In manyamphibians,especiallyfrogs,it has the more rounded form and there is often a greater quantity of white pulp.[45]

Inreptiles,birds, andmammals,white pulp is always relatively plentiful, and in birds and some mammals the spleen is typically rounded, but it adjusts its shape somewhat to the arrangement of the surrounding organs. In most vertebrates, the spleen continues to produce red blood cells throughout life; only in mammals this function is lost in middle-aged adults. Many mammals have tiny spleen-like structures known ashaemal nodesthroughout the body that are presumed to have the same function as the spleen.[45]The spleens of aquatic mammals differ in some ways from those of fully land-dwelling mammals; in general they are bluish in colour. Incetaceansandmanatees,they tend to be quite small, but in deep divingpinnipeds,they can be massive, due to their function of storing red blood cells.

Marsupials have y-shaped spleens, and it develops postnatally.[46][47][48][49]

The only vertebrates lacking a spleen are thelampreysandhagfishes(the early-branchingCyclostomata,orjawless fishes). Even in these animals, there is a diffuse layer of haematopoeitic tissue within the gut wall, which has a similar structure to red pulp and is presumedhomologouswith the spleen of higher vertebrates.[45]

In mice, the spleen stores half the body'smonocytesso that, upon injury, they can migrate to the injured tissue and transform intodendritic cellsandmacrophagesto assistwound healing.[5]

Additional images

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  • Transverse section of the spleen, showing the trabecular tissue and the splenic vein and its tributaries
  • Spleen
  • Laparoscopic view of human spleen

See also

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References

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  1. ^Liddell, Henry George; Scott, Robert (1940)."σπλήν".In Jones, Henry Stuart; McKenzie, Roderick (eds.).A Greek-English Lexicon.Vol. 2:λ–φώδης(New (9th) ed.). Oxford: Clarendon Press. p. 1628.OCLC13606128– via Perseus Digital Library.
  2. ^Kapila, Vaishali; Wehrle, Chase J.; Tuma, Faiz (2022),"Physiology, Spleen",StatPearls,Treasure Island, FL: StatPearls Publishing,PMID30725992,retrieved2022-12-04
  3. ^abMebius, RE; Kraal, G (2005). "Structure and function of the spleen".Nature Reviews. Immunology.5(8): 606–16.doi:10.1038/nri1669.PMID16056254.S2CID3258595.
  4. ^abSahin, NE; Oner, Z; Oner, S; Turan, MK (10 January 2022)."A study on the correlation between spleen volume estimated via cavalieri principle on computed tomography images with basic hemogram and biochemical blood parameters".Anatomy & Cell Biology.55(1): 40–47.doi:10.5115/acb.21.177.PMC8968228.PMID35000931.
  5. ^abcSwirski, FK; Nahrendorf, M; Etzrodt, M; Wildgruber, M; Cortez-Retamozo, V; Panizzi, P; Figueiredo, JL; Kohler, RH; Chudnovskiy, A; Waterman, P; Aikawa, E; Mempel, TR; Libby, P; Weissleder, R; Pittet, MJ (2009)."Identification of splenic reservoir monocytes and their deployment to inflammatory sites".Science.325(5940): 612–16.Bibcode:2009Sci...325..612S.doi:10.1126/science.1175202.PMC2803111.PMID19644120.
  6. ^abJia, T; Pamer, EG (2009)."Immunology: Dispensable but not irrelevant".Science.325(5940): 549–50.Bibcode:2009Sci...325..549J.doi:10.1126/science.1178329.PMC2917045.PMID19644100.
  7. ^"Finally, the Spleen Gets Some Respect"By Natalie Angier,The New York Times,August 3, 2009
  8. ^Brender, Erin (2005-11-23). Richard M. Glass (ed.)."Spleen Patient Page".Journal of the American Medical Association.294(20). Illustrated by Allison Burke: 2660.doi:10.1001/jama.294.20.2660.PMID16304080.
  9. ^Loscalzo, Joseph; Fauci, Anthony S.; Braunwald, Eugene; Dennis L. Kasper; Hauser, Stephen L; Longo, Dan L. (2008).Harrison's principles of internal medicine.McGraw-Hill Medical.ISBN978-0-07-146633-2.
  10. ^Ostermann, P. A. W.; Schreiber, H. W.; Lierse, W. (September 1987)."Der Bandapparat der Milz und seine Bedeutung bei chirurgischen Eingriffen".Langenbeck's Archiv für Chirurgie(in German).371(3): 207–216.doi:10.1007/BF01259432.ISSN0023-8236.PMID3683035.S2CID35213355.
  11. ^Chow, Kai Uwe; Luxembourg, Beate; Seifried, Erhard; Bonig, Halvard (2016). "Spleen Size Is Significantly Influenced by Body Height and Sex: Establishment of Normal Values for Spleen Size at US with a Cohort of 1200 Healthy Individuals".Radiology.279(1): 306–13.doi:10.1148/radiol.2015150887.ISSN0033-8419.PMID26509293.
  12. ^Molina, D. Kimberley; DiMaio, Vincent J.M. (2012). "Normal Organ Weights in Men".The American Journal of Forensic Medicine and Pathology.33(4): 368–372.doi:10.1097/PAF.0b013e31823d29ad.ISSN0195-7910.PMID22182984.S2CID32174574.
  13. ^Sprogøe-Jakobsen, Susan; Sprogøe-Jakobsen, Ulrik (1997). "The weight of the normal spleen".Forensic Science International.88(3): 215–223.doi:10.1016/S0379-0738(97)00103-5.ISSN0379-0738.PMID9291593.
  14. ^Keramidas, D. C.; Kelekis, D.; Dolatzas, T.; Aivazoglou, T.; Voyatzis, N. (1984)."The collateral arterial network of the spleen following ligation of the splenic artery in traumatic rupture of the spleen; an arteriographic study".Zeitschrift für Kinderchirurgie.39(1): 50–51.doi:10.1055/s-2008-1044169.PMID6730702.S2CID29302459.
  15. ^Blackbourne, Lorne H (2008).Surgical recall.Lippincott Williams & Wilkins. p.259.ISBN978-0-7817-7076-7.
  16. ^"Penicilliary radicles".Medical-dictionary.thefreedictionary.com.Retrieved2011-04-03.
  17. ^Lori, Andrea; Perrotta, Marialuisa; Lembo, Giuseppe; Carnevale, Daniela (2017-06-07)."The Spleen: A Hub Connecting Nervous and Immune Systems in Cardiovascular and Metabolic Diseases".International Journal of Molecular Sciences.18(6): 1216.doi:10.3390/ijms18061216.ISSN1422-0067.PMC5486039.PMID28590409.
  18. ^Vellguth, Swantje; Brita von Gaudecker; Hans-Konrad Müller-Hermelink (1985). "The development of the human spleen".Cell and Tissue Research.242(3): 579–92.doi:10.1007/BF00225424.PMID4075378.S2CID19864892.
  19. ^"Rapid neutrophil mobilization by VCAM-1+ endothelial cell-derived extracellular vesicles | Cardiovascular Research | Oxford Academic".Academic.oup.com.Retrieved2022-02-15.
  20. ^Carey, Bjorn (May 5, 2006)."Horse science: What makes a Derby winner – Spleen acts as a 'natural blood doper,' scientist says".NBC News. Archived fromthe originalon April 15, 2015.Retrieved2006-05-09.
  21. ^"Spleen: Information, Surgery and Functions".Chp.edu.Childrens Hospital of Pittsburgh. 2010-11-17. Archived fromthe originalon 2011-09-26.Retrieved2011-04-03.
  22. ^Lodin-Sundström, Angelica; Schagatay, Erika (June 2010). "Spleen contraction during 20 min normobaric hypoxia and 2 min apnea in humans".Aviation, Space, and Environmental Medicine.8(6): 545–49.doi:10.3357/ASEM.2682.2010.PMID20540444.
  23. ^"Splenic Index & Volume Calculator (CT/MRI/US)+ Expected Normal".Rad At Hand.Retrieved2024-07-15.
  24. ^Di Sabatino, A; Carsetti, R; Corazza, GR (Jul 2, 2011). "Post-splenectomy and hyposplenic states".Lancet.378(9785): 86–97.doi:10.1016/S0140-6736(10)61493-6.PMID21474172.S2CID30554953.
  25. ^Carsetti, R; Rosado, MM; Wardmann, H (February 2004). "Peripheral development of B cells in mouse and man".Immunological Reviews.197:179–91.doi:10.1111/j.0105-2896.2004.0109.x.PMID14962195.S2CID20654498.
  26. ^Kruetzmann, S; Rosado, MM; Weber, H; Germing, U; Tournilhac, O; Peter, HH; Berner, R; Peters, A; Boehm, T; Plebani, A; Quinti, I; Carsetti, R (Apr 7, 2003)."Human immunoglobulin M memory B cells controlling Streptococcus pneumoniae infections are generated in the spleen".The Journal of Experimental Medicine.197(7): 939–45.doi:10.1084/jem.20022020.PMC2193885.PMID12682112.
  27. ^Dennis Robinette, C.; Fraumeni, Josephf. (1977). "Splenectomy and Subsequent Mortality in Veterans of the 1939–45 War".The Lancet.310(8029): 127–29.doi:10.1016/S0140-6736(77)90132-5.PMID69206.S2CID38605411.
  28. ^Moore, Keith L.(1992).Clinically Oriented Anatomy(3rd ed.). Baltimore: Williams & Wilkins. p. 187.ISBN978-0-683-06133-8.
  29. ^Abu Hilal M; Harb A; Zeidan B; Steadman B; Primrose JN; Pearce NW (January 5, 2009)."Hepatic splenosis mimicking HCC in a patient with hepatitis C liver cirrhosis and mildly raised alpha feto protein; the important role of explorative laparoscopy".World Journal of Surgical Oncology.7(1): 1.doi:10.1186/1477-7819-7-1.PMC2630926.PMID19123935.
  30. ^"polysplenia"atDorland's Medical Dictionary
  31. ^Chapman, J; Bhimji, SS (2018), "article-29380",Splenic Infarcts,Treasure Island (FL): StatPearls Publishing,PMID28613652,retrieved2019-02-27
  32. ^Jaroch MT, Broughan TA, Hermann RE (October 1986). "The natural history of splenic infarction".Surgery.100(4): 743–50.PMID3764696.
  33. ^Nores, M1; Phillips, EH; Morgenstern, L; Hiatt, JR (February 1998). "The Clinical Spectrum of Splenic Infarction".The American Surgeon.64(2): 182–88.PMID9486895.{{cite journal}}:CS1 maint: numeric names: authors list (link)
  34. ^"Hyaloserositis".Online Medical Dictionary.Accessed on: June 21, 2008.
  35. ^"Sugar-coated spleen".Drugs.com.
  36. ^abRiva MA, Ferraina F, Paleari A, Lenti MV, Di Sabatino A (2019). "From sadness to stiffness: the spleen's progress".Internal and Emergency Medicine.14(5): 739–743.doi:10.1007/s11739-019-02115-2.PMID31152307.S2CID172137672.
  37. ^abcStanley Eric(2002). "Polysemy and synomyny and how these concepts were understood from the eighteenth century onwards in treatises, and applied dictionaries of English". In Coleman J, McDermott A (ed.).Historical dictionaries and historical Dictionary Research: Papers from the international conference on historical lexicography and lexicology, at the University of Leicester, 2002.Germany: Walter de Gruyter. pp. 170–171.ISBN978-3-11-091260-9.
  38. ^Julius Caesarby William Shakespeare Act 4:1
  39. ^abcBynum B (2002)."The spleen".Lancet.359(9317): 1624.doi:10.1016/S0140-6736(02)08479-9.PMID12048004.S2CID33529100.
  40. ^Rogers KM (1989). "Finch's" Candid Account "vs. Eighteenth–Century Theories of the Spleen".Mosaic: A Journal for the Interdisciplinary Study of Literature.22(1): 17–27.ISSN0027-1276.JSTOR24780450.
  41. ^Cheyne, George:The English Malady; or, A Treatise of Nervous Diseases of All Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal and Hysterical Distempers with the Author's Own Case at Large,Dublin, 1733. Facsimile ed., ed. Eric T. Carlson, M.D., 1976, Scholars' Facsimiles & Reprints,ISBN978-0-8201-1281-7
  42. ^Blackmore, Richard:Treatise of the spleen and vapors.London, 1725
  43. ^Rao, Tejal (2010-05-03)."Spleen Sandwiches: An Italian Tradition".The Atlantic.Retrieved2022-01-03.
  44. ^Rogov, Daniel (2007-03-22)."Dining Out / Mixed Jerusalem grill in Tel Aviv".Haaretz.Retrieved2022-01-03.
  45. ^abcRomer, Alfred Sherwood; Parsons, Thomas S. (1977).The Vertebrate Body.Philadelphia: Holt-Saunders International. pp. 410–11.ISBN978-0-03-910284-5.
  46. ^Old JM, Selwood L, Deane EM (2002)."Development of the lymphoid tissues of the stripe-faced dunnart (Sminthopsis macroura) ".Cells Tissues Organs.175(4): 192–201.doi:10.1111/j.0021-8782.2004.00310.x.PMC1571326.
  47. ^Old JM, Selwood L, Deane EM (2004). "A developmental investigation of the liver, bone marrow and spleen of the stripe-faced dunnart (Sminthopsis macroura) ".Developmental and Comparative Immunology.28(4): 347–355.doi:10.1016/j.dci.2003.08.004.
  48. ^Old JM, Selwood L, Deane EM (2004)."The appearance and distribution of mature T and B cells in the developing immune tissues of the stripe-faced dunnart (Sminthopsis macroura) ".Journal of Anatomy.205(1): 25–33.doi:10.1111/j.0021-8782.2004.00310.x.PMC1571326.
  49. ^Old JM, Deane EM (2003)."The detection of mature T and B-cells during development of the lymphoid tissues of the tammar wallaby (Macropus eugenii) ".Cells Tissues Organs.203(1): 123–131.doi:10.1046/j.1469-7580.2003.00207.x.PMC1571143.
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