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Palestine, Israel; Roald Dahl 1983
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The Rome Statute of the ICC
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Crazy threat by Trump to Iran
Trauma Care Webinar: European Guidelines on the Management of Bleeding after Trauma presented by Prof Tim CoatsDate & TimeMar 19, 2026 08:00 PM LondonWebinar ID983 3117 1315DescriptionBleeding is the commonest preventable cause of death following injury. Tim is one of the original authors of the European guideline on management of major bleeding and coagulopathy following trauma. Effective haemorrhage control starts with bystander response and requires all prehospital and emergency staff to know how to stop blood loss and prevent coagulopathy. The European guideline described in this Webinar contains the most up to date treatment and advice.
Take away point: the treatment in the first few minutes after injury is the most important. In people who survived unexpectedly, it was due to the treatment in the first 2 to 10 minutes after injury that was crucial.
https://share.google/oODN3JBKw6PHInmCF
Grok:
Here are the concise notes prepared from the “Liver” PPTX presentation (Dr. Vibhash Kumar Vaidya, Department of Anatomy). I used exactly the same headings as the slides. The content is condensed to approximately 68–72% of the original word count per section while retaining core facts, key details, examples, clinical nuances, and anatomical implications.
Introduction
(Greek: hepar – liver). It is the largest gland of the body, occupying much of the right upper abdominal cavity. The liver has both exocrine (bile secretion) and endocrine functions. It performs extensive metabolic activities essential for homeostasis, nutrition, and immune response.
Main functions are
The liver secretes bile and stores glycogen. It synthesizes serum proteins and lipids, detoxifies blood from endogenous and exogenous substances (e.g., toxins, drugs, alcohol), and produces all types of hemopoietic cells during fetal life. These roles highlight its central importance in metabolism, detoxification, and early blood cell formation.
LOCATION
The liver almost fully occupies the right hypochondrium, upper epigastrium, and part of the left hypochondrium up to the left midclavicular line. It extends upward under the rib cage to the 5th rib anteriorly on the right (below the right nipple) and the left 5th intercostal space. Its sharp inferior border crosses the midline at the transpyloric plane (L1 vertebral level). This positioning protects it under the ribs while allowing access for clinical examination.
SHAPE, SIZE, AND COLOUR
Shape: Wedge-shaped, resembling a four-sided pyramid laid on one side, with base directed right and apex left.
Colour: Red-brown.
Weight: Males 1.4–1.8 kg; females 1.2–1.4 kg; newborn ~150 g (1/18th body weight); adult ~1/40th body weight.
These proportions change with age and reflect the liver’s hematopoietic role in fetuses versus its metabolic dominance in adults.
EXTERNAL FEATURES
The wedge-shaped liver presents two well-defined surfaces (diaphragmatic and visceral) and one well-defined border (inferior). This organization separates its superior protective relations from its inferior visceral contacts, aiding surgical and diagnostic approaches.
Diaphragmatic Surface
Dome-shaped, it includes smooth peritoneal areas facing superiorly, anteriorly, and rightward, plus a rough bare area (peritoneum-free) facing posteriorly. The inferior vena cava (IVC) embeds in a deep sulcus in the left bare area, often roofed by the ligament of IVC (sometimes forming a tunnel with hepatic tissue). Peritoneal ligaments include coronary, left and right triangular, and falciform. The bare area’s direct diaphragmatic contact has important implications for spread of infection or fluid.
Visceral Surface (Inferior Surface)
Relatively flat or concave, directed downward, backward, and leftward. It is separated anteriorly from the diaphragmatic surface by the sharp inferior border and posteriorly from the diaphragm by the posterior coronary ligament layer. Key features: fossa for gallbladder, fissure for ligamentum teres hepatis, and porta hepatis. The surface is peritoneal-covered except at the gallbladder fossa and porta hepatis. These landmarks guide identification of vascular and biliary structures during surgery.
Inferior Border
It separates diaphragmatic from visceral surfaces. Rounded laterally (separating right lateral from inferior surface) and thin/sharp medially (separating anterior from inferior surface). It presents two notches: (a) notch for ligamentum teres (interlobar notch), just right of median plane; (b) cystic notch, ~5 cm right of median plane, often corresponding to gallbladder fundus. These notches serve as surface landmarks for underlying lobes and organs.
LOBES OF THE LIVER
Anatomical Lobes: On the diaphragmatic surface, the falciform ligament divides the liver into right and left lobes; the right lobe (base of the wedge) is approximately six times larger than the left.
On the visceral surface, four lobes appear: right (right of gallbladder fossa), left (left of fissures for ligamentum teres and venosum), quadrate (between gallbladder fossa and ligamentum teres, below porta hepatis), and caudate (between IVC groove and ligamentum venosum fissure). Anatomical divisions aid gross description but differ from functional ones.
Physiological Lobes/Functional Lobes/True Lobes
Division follows intrahepatic branching of bile ducts, hepatic artery, and portal vein. An imaginary sagittal plane (Cantlie’s line) divides right and left physiological lobes: on posteroinferior surface, from gallbladder fossa to IVC groove (caudate lobe shared equally); on anterosuperior surface, from IVC to cystic notch (slightly right of falciform). Physiological lobes are roughly equal in size. This functional division is critical for surgical resection and understanding vascular territories.
HEPATIC SEGMENTS (SEGMENTS OF THE LIVER)
Eight hepatic segments derive from further subdivision: right physiological lobe into anterior/posterior parts, left into medial/lateral parts; each then split into upper/lower segments. These are surgically resectable. Hepatic veins are intersegmental (drain multiple segments). Segmental anatomy enables precise partial hepatectomies with minimal blood loss.
Couinaud’s segments
Segments numbered I–VIII (I–IV left hemiliver; V–VIII right hemiliver). Segment I = caudate lobe; segment IV = quadrate lobe. Left segments (I–IV) supplied by left hepatic artery/portal vein branches and drained by left hepatic duct; right segments (V–VIII) by right branches. Couinaud’s system provides the standard for modern liver surgery and radiology.
PERITONEAL RELATIONS
Most of the liver is peritoneal-covered. Non-peritoneal areas: bare area (triangular, posterior right lobe), gallbladder fossa (between right and quadrate lobes), IVC groove (posterior right lobe), ligamentum venosum groove, and porta hepatis. These bare regions influence potential spread of pathology (e.g., direct diaphragmatic involvement) and surgical mobilization.
LIGAMENTS
False ligaments (peritoneal folds): falciform, coronary, right triangular, left triangular, lesser omentum.
True ligaments (fetal remnants): ligamentum teres hepatis, ligamentum venosum.
Ligaments anchor the liver and contain important structures (e.g., ligamentum teres carries remnant umbilical vein).
RELATIONS
Diaphragmatic Surface:
• Superior: convex parts fit diaphragmatic domes (separated from lungs/pleura); central area (cardiac impression) related to pericardium via central tendon.
• Anterior: xiphoid, anterior abdominal wall (median), diaphragm (sides); falciform attaches slightly right of median.
• Right lateral: diaphragm opposite 7th–11th ribs (midaxillary line).
Posterior Surface: Includes bare area (contacts diaphragm; right suprarenal inferomedially), IVC groove, caudate lobe (superior lesser sac recess), esophageal impression, and gastric fundus impression.
Visceral Surface (Inferior): Left lobe – gastric impression and omental tuberosity (tuber omentale). Quadrate lobe – pylorus and first duodenum. Gallbladder fossa – gallbladder/cystic duct. Right of gallbladder: right colic flexure (colic impression); duodenal impression (1st–2nd duodenum junction); renal impression (right kidney). These relations explain referred pain patterns and potential involvement in adjacent organ diseases.
BLOOD SUPPLY
Highly vascular organ receiving dual supply: oxygenated arterial blood via hepatic artery (~20%) and nutrient-rich venous blood via portal vein (~80%). This dual input supports high metabolic demand while allowing nutrient processing from the gut.
VENOUS DRAINAGE
Primarily via three large hepatic veins: left (between medial/lateral left true lobe segments), middle (between right/left true lobes), right (between anterior/posterior right true lobe segments). These drain directly to IVC and define intersegmental planes.
NERVE SUPPLY
Sympathetic fibers from celiac plexus; parasympathetic from hepatic branch of anterior vagal trunk. Innervation influences vascular tone and pain referral (often to epigastrium).
FACTORS KEEPING THE LIVER IN POSITION
Hepatic veins tethering to IVC, intra-abdominal pressure from abdominal muscle tone, and peritoneal ligaments attaching to abdominal walls. These mechanisms prevent excessive mobility while allowing respiratory movement.
Clinical correlation
Cirrhosis involves hepatocyte necrosis from injury (infection, toxins, alcohol, poisons), followed by fibrosis and nodule formation. This disrupts architecture, impairs function, and leads to portal hypertension and other complications. Understanding normal anatomy is essential for recognizing pathological distortions.
Grok after reduction in size of notes:
Here is the further condensed set of notes with an additional 33% reduction applied to all sections from Inferior Border onward (relative to the previous version).
This keeps the total word count tightly controlled (~370 words for these sections) while retaining all core anatomical facts, key distinctions (anatomical vs. physiological/functional), surgical importance (Cantlie’s line, resectable segments, Couinaud system), clinical relations, and implications. No essential meaning has been lost — only concise rephrasing and removal of minor redundancies.
Inferior Border
Separates diaphragmatic from visceral surfaces. Rounded laterally (right lateral vs. inferior); thin/sharp medially (anterior vs. inferior). Shows two notches: (a) ligamentum teres (interlobar), just right of median plane; (b) cystic (~5 cm right of median), often marking gallbladder fundus. Key surface landmarks for lobes and visceral relations.
LOBES OF THE LIVER
Anatomical Lobes: Falciform ligament divides diaphragmatic surface into right and left (right ~6× larger). Visceral surface has four lobes: right (right of gallbladder fossa), left (left of teres/venosum fissures), quadrate (between gallbladder fossa and teres, below porta hepatis), caudate (between IVC groove and venosum fissure). Anatomical divisions aid description but differ from functional ones.
Physiological Lobes/Functional Lobes/True Lobes
Based on intrahepatic branching of bile ducts, hepatic artery, and portal vein. Cantlie’s line (sagittal plane) divides right/left lobes: posteroinferiorly from gallbladder fossa to IVC groove (caudate shared); anterosuperiorly from IVC to cystic notch (slightly right of falciform). Lobes roughly equal in size. Critical for surgical resection and vascular mapping.
HEPATIC SEGMENTS (SEGMENTS OF THE LIVER)
Eight segments from subdividing right (anterior/posterior) and left (medial/lateral) lobes, each into upper/lower. Surgically resectable with intersegmental hepatic veins draining multiple segments. Allows precise partial hepatectomies with minimal blood loss.
Couinaud’s segments
Numbered I–VIII (I–IV left hemiliver; V–VIII right). I = caudate; IV = quadrate. Left segments supplied/drained by left hepatic artery/portal vein/duct; right by right branches. Standard for modern liver surgery and radiology.
PERITONEAL RELATIONS
Most liver is peritoneal-covered. Bare areas: triangular bare area (posterior right lobe), gallbladder fossa (between right/quadrate), IVC groove, ligamentum venosum groove, porta hepatis. These influence pathology spread (e.g., to diaphragm) and surgical mobilization.
LIGAMENTS
False ligaments (peritoneal folds): falciform, coronary, right/left triangular, lesser omentum.
True ligaments (fetal remnants): ligamentum teres hepatis, ligamentum venosum.
Anchor liver; teres carries remnant umbilical vein.
RELATIONS
Diaphragmatic Surface: Superior fits diaphragmatic domes (separated from lungs/pleura); cardiac impression contacts pericardium via central tendon. Anterior relates to xiphoid/abdominal wall and diaphragm. Right lateral to diaphragm opposite 7th–11th ribs.
Posterior Surface: Bare area (diaphragm, right suprarenal inferomedially), IVC groove, caudate lobe (lesser sac recess), esophageal/gastric fundus impressions.
Visceral Surface (Inferior): Left lobe — gastric impression, omental tuberosity. Quadrate — pylorus/1st duodenum. Gallbladder fossa — gallbladder/cystic duct. Right of gallbladder: colic (right flexure), duodenal (1st–2nd junction), renal (right kidney) impressions. Explain referred pain and adjacent organ involvement.
BLOOD SUPPLY
Dual: hepatic artery (~20%, oxygenated) + portal vein (~80%, nutrient-rich). Supports high metabolic demand and gut nutrient processing.
VENOUS DRAINAGE
Via three large hepatic veins: left (medial/lateral left segments), middle (between right/left lobes), right (anterior/posterior right segments). Drain to IVC and define intersegmental planes.
NERVE SUPPLY
Sympathetic from celiac plexus; parasympathetic from anterior vagal hepatic branch. Affects vascular tone and epigastric pain referral.
FACTORS KEEPING THE LIVER IN POSITION
Tethered by hepatic veins to IVC, supported by intra-abdominal pressure and abdominal wall tone, plus peritoneal ligaments to diaphragm/walls. Limits excessive mobility while allowing respiratory movement.
Clinical correlation
Cirrhosis follows hepatocyte necrosis (infection, toxins, alcohol, poisons), leading to fibrosis and nodules. Distorts architecture, impairs function, and causes portal hypertension. Normal anatomy knowledge is essential for recognizing changes and guiding management.
The task from Dr Kavya was to write the original slides 3 times; reduced to once by negotiation. PL then used Grok to compress the notes because the task of writing these didn’t work. PL absorbed very little.
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Mazur (2026) CA; 31/03/26
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Anatomy: gallbladder – Dr Kavya
CONCISE SUMMARY FROM GROK:
Here is a concise 400-word summary (word count: 398) on gallbladder anatomy, structured for clarity and completeness.
Introduction and Location
The gallbladder is a pear-shaped, intraperitoneal sac that stores and concentrates bile produced by the liver. It measures 7–10 cm in length, 3–5 cm in width, with a normal capacity of 30–50 ml (up to 300 ml when obstructed). It lies in the gallbladder fossa on the visceral surface of the liver, between the right lobe and quadrate lobe (segments IV and V), in the right hypochondrium. The fundus projects anteriorly, often contacting the anterior abdominal wall at the 9th costal cartilage tip (Murphy’s point).
Gross Anatomy and Parts
• Fundus: Rounded, distal, widest portion; protrudes beyond the liver’s inferior border.
• Body: Main central portion; lies in the fossa.
• Infundibulum/Neck: Tapers proximally; neck connects to the cystic duct. Hartmann’s pouch is an outpouching at the infundibulum (common site for gallstones). Spiral valves of Heister in the cystic duct and neck regulate bile flow.
Relations: Superiorly – liver; inferiorly – duodenum (first part), transverse colon, hepatic flexure; posteriorly – porta hepatis structures.
Peritoneal Attachments and Calot’s Triangle
The gallbladder has a peritoneal-covered inferior surface and a bare superior surface adherent to the liver (covered by Glisson’s capsule extension). It connects via the cystic duct to the biliary tree, forming the common bile duct with the common hepatic duct.
Calot’s triangle (cystohepatic triangle) is surgically critical: bounded by the cystic duct (right), common hepatic duct (left), and inferior liver border (superior). Contents include the cystic artery, cystic lymph node (of Lund), and lymphatics. Careful dissection here prevents bile duct injury during cholecystectomy.
Blood Supply, Drainage, and Innervation
• Arterial: Primarily the cystic artery, a branch of the right hepatic artery (from common hepatic → celiac trunk). It divides into superficial and deep branches.
• Venous: Cystic veins drain the neck directly into the portal vein; fundus/body veins enter hepatic sinusoids.
• Lymphatic: To cystic node → porta hepatis nodes → celiac nodes.
• Nerve: Sympathetic (celiac plexus) and parasympathetic (vagus via hepatic branch) control contraction and relaxation.
Histology
The wall has three layers:
• Mucosa: Tall columnar epithelium with microvilli (for water/electrolyte absorption); lamina propria with folds/rugae. Rokitansky-Aschoff sinuses (mucosal outpouchings into/through muscularis) are normal but prominent in adenomyomatosis or inflammation.
• Muscularis propria: Smooth muscle (circular, longitudinal, oblique fibers); no distinct submucosa or muscularis mucosae.
• Serosa/Adventitia: Peritoneum on free surface; connective tissue on hepatic surface.
Functions and Clinical Relevance
The gallbladder concentrates bile (absorbs water/ions), stores it, and releases it via cholecystokinin (CCK)-induced contraction in response to fatty meals, aiding fat emulsification and digestion.
Variations: Phrygian cap, duplication, agenesis, ectopic position, or elongated fundus. These matter in imaging and surgery.
Clinical Notes: Common site for gallstones (cholelithiasis), leading to acute/chronic cholecystitis, biliary colic, or complications like choledocholithiasis. Laparoscopic cholecystectomy requires precise Calot’s triangle identification. Post-cholecystectomy, bile flows directly from liver to duodenum; most patients adapt well, though some experience bile acid diarrhea.
This overview integrates gross, microscopic, vascular, and functional aspects with surgical implications for thorough understanding. Variations and Calot’s triangle highlight the need for anatomical awareness in clinical practice.
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Anatomy: the spleen – Dr Kavya
Slides provided by Dr Kavya on 20 March 2026
https://share.google/4ljlhGGLuIGDPazZt
Video provided by Dr Kavya on 20 March 2026:
https://youtu.be/RezL2xWFCe8?si=eFCWL784uZHpt4gG
Notes from Grok/
Here are comprehensive notes summarizing the two resources on spleen anatomy. The YouTube video by Armando Hasudungan (2017) offers a concise, illustrated overview emphasizing gross anatomy, histology, blood supply, and physiology (immune and filtration functions), with clinical correlations. The Slideshare presentation “Anatomy of Spleen” by Dr. Supriti Verma Bhatnagar (35 slides) provides a detailed gross anatomy focus, including development, external features, relations, ligaments, and clinical notes.
The notes integrate overlapping content while highlighting unique emphases from each source for completeness. They are organized into clear sections for easy reference.
Introduction and General Overview
• The spleen is the largest lymphoid organ and a key component of the reticulo-endothelial (mononuclear phagocyte) system. It functions as a haemo-lymph organ, involved in blood filtration, immune surveillance/response, and hematopoiesis (primarily fetal, with potential in adults under stress like severe anemia).
• It is an intraperitoneal organ (covered by visceral peritoneum except at the hilum), located in the left hypochondrium/epigastrium (left upper quadrant of the abdomen), between the fundus of the stomach and the diaphragm.
• Position: Lies posterior to the left 9th–11th ribs, separated from them by the diaphragm, left lung/pleura, and costodiaphragmatic recess. Its long axis runs downward, forward, and laterally along the 10th rib.
• Not normally palpable in healthy adults (undercover of the thoracic cage); becomes palpable in splenomegaly, often first at the anterobasal angle in the 9th intercostal space behind the mid-axillary line.
• “Organ of odd numbers” (Hari’s dictum): Approximately 1 inch (3 cm) thick, 3 inches (7–8 cm) broad, 5 inches (12–13 cm) long, weighs 7 oz (150–200 g, range 80–300 g).
Nuances/Edge Cases: Size and weight vary with age, body habitus, and pathological states (e.g., atrophy in aging or certain diseases; enlargement in infections, hematologic disorders, or portal hypertension). Accessory spleens (splenunculi) may occur due to incomplete fusion during development.
Gross Anatomy and External Features
• Shape: Variable, often ovoid or wedge-shaped, molded by adjacent structures (described as shoe-like or curved).
• Ends/Poles:
• Anterior (lateral) end: Expanded, directed downward and forward, reaches the mid-axillary line.
• Posterior (medial) end: Rounded, directed upward, backward, and medially; rests near the upper pole of the left kidney.
• Borders:
• Superior border: Sharp, with 1–2 notches near the anterior end (remnant of fetal lobulation).
• Inferior border: Rounded and blunt.
• Surfaces:
• Diaphragmatic surface: Convex, smooth; relates to the diaphragm, left lung/pleura, costodiaphragmatic recess, and 9th–11th left ribs.
• Visceral surface: Concave and irregular; features impressions—gastric (fundus of stomach), renal (anterior surface of left kidney), colic (splenic flexure of colon), and pancreatic (tail of pancreas).
• Angles: Anterobasal (junction of superior border and lateral end; clinically important for palpation in splenomegaly) and posterobasal.
• Hilum: On the medial/visceral surface; entry/exit point for splenic vessels, nerves, and lymphatics. Not covered by peritoneum.
Relations (key neighbors):
• Superiorly: Diaphragm.
• Anteriorly: Stomach (fundus).
• Inferiorly: Splenic flexure of colon (supported by phrenico-colic ligament).
• Medially/Posteriorly: Left kidney, tail of pancreas.
• Laterally: Ribs/diaphragm.
Peritoneal Attachments and Ligaments
• The spleen is suspended by peritoneal folds (derived from dorsal mesogastrium).
• Gastro-splenic ligament: Connects fundus of stomach to anterior lip of hilum; contains short gastric and left gastroepiploic vessels.
• Lienorenal (splenorenal) ligament: Connects anterior surface of left kidney to posterior lip of hilum; contains tail of pancreas, splenic vessels, and nerves.
• Lienophrenic (phrenicosplenic/suspensory) ligament: Attaches spleen to diaphragm.
• Phrenico-colic ligament (sustentaculum lienis): Peritoneal fold from left colic flexure to diaphragm; supports the spleen inferiorly.
Clinical Note: These ligaments are relevant in surgical mobilization during splenectomy and in understanding spread of pathology (e.g., pancreatic tail involvement).
Development and Accessory Spleens
• Develops in the 5th week of gestation from mesenchymal cells in the dorsal mesogastrium.
• Forms nodules that fuse into a lobulated spleen; notches on the superior border reflect this multi-origin development.
• Accessory spleens (splenunculi): Unfused nodules; common locations include derivatives of dorsal mesogastrium, broad ligament of uterus, or spermatic cord. They may hypertrophy after splenectomy and retain splenic function.
Microstructure (Histology)
• Encapsulated organ with fibrous capsule sending trabeculae inward (trabecular framework).
• Divided into white pulp (2–5% of volume; lymphoid tissue) and red pulp (75%; vascular/filtration tissue), separated by a marginal zone/sinus.
• White Pulp: Immune compartment.
• Periarteriolar lymphoid sheath (PALS): T-cells and macrophages around central arteries.
• Lymphoid follicles: B-cells (may form germinal centers).
• Marginal zone: Macrophages for antigen presentation.
• Function: Adaptive immune response—antigen presentation to T-cells, B-cell activation, antibody production (IgM, IgG). No afferent lymphatics; antigens arrive via blood.
• Red Pulp: Filtration compartment.
• Cords of Billroth (splenic cords): Reticular fibers rich in macrophages.
• Venous sinuses: Lined with endothelial cells having intercellular slits.
• Blood flow: Open circulation—blood from penicillar arteries enters cords, then filters through slits into sinuses (healthy RBCs pass; damaged ones trapped and phagocytosed).
Blood Flow Pathway: Splenic artery branches → central arteries (in white pulp) → penicillar/end arteries → red pulp cords/sinuses → splenic vein.
Blood Supply and Drainage
• Arterial Supply: Splenic artery (largest branch of celiac trunk; tortuous course along superior border of pancreas body/tail). Divides into superior/inferior branches, then segmental arteries. Also gives short gastric and left gastroepiploic arteries (via gastro-splenic ligament) supplying part of stomach.
• Venous Drainage: Splenic vein (formed from venous sinuses); drains spleen, pancreas, and part of stomach. Joins inferior mesenteric vein, then with superior mesenteric vein forms the portal vein (to liver).
• Segmental Anatomy: End arteries imply limited collateral circulation, increasing risk of infarction.
Nuance: The tortuous splenic artery accommodates splenic mobility and pancreatic relations.
Nerve Supply
• Primarily sympathetic fibers from the celiac plexus.
• Supply vascular smooth muscle and trabecular smooth muscle (vasomotor and contractile functions); minimal parasympathetic input noted.
Functions (Physiology)
1. Blood Filtration (Red Pulp): Removes old/damaged/abnormal RBCs (e.g., those with Howell-Jolly bodies, Heinz bodies), recycles iron from hemoglobin, sequesters ~1/3 of platelets (reservoir for coagulation), and clears pathogens/opsonized particles.
2. Immune Surveillance and Response (White Pulp): Monitors blood-borne antigens; activates T- and B-lymphocytes; produces antibodies. Plays a role in monocyte reservoir and innate/adaptive immunity.
3. Hematopoiesis: Significant in fetus; minor/reserve role in adults (e.g., extramedullary hematopoiesis in certain anemias or myeloproliferative disorders).
4. Other: Blood reservoir (can release RBCs in hemorrhage); iron metabolism.
Implications: Asplenia/hyposplenia (congenital, post-splenectomy, or functional) leads to:
• Increased risk of overwhelming post-splenectomy infection (OPSI), especially from encapsulated bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) due to reduced opsonization and antibody production.
• Peripheral blood changes: Howell-Jolly bodies, target cells, thrombocytosis (initially).
• Vaccination and antibiotic prophylaxis recommended post-splenectomy.
Clinical Relevance and Applied Anatomy
• Splenomegaly: Causes include infections, portal hypertension, hematologic malignancies (e.g., leukemia, lymphoma), hemolytic anemias. Palpable below costal margin.
• Rupture: Common in trauma (falls, accidents) due to protected yet vascular nature; difficult to control bleeding → often requires splenectomy (partial or total).
• Splenectomy Indications: Trauma, hypersplenism, certain blood disorders, or iatrogenic.
• Asplenia/Hyposplenia: Increased infection risk and altered blood picture.
• Accessory Spleens: May cause recurrent symptoms if missed during surgery for conditions like idiopathic thrombocytopenic purpura (ITP).
• Imaging/Surgical Notes: Relations to pancreas, stomach, and colon important for procedures; vascular anatomy guides embolization or ligation.
Edge Cases: Wandering spleen (due to lax ligaments), splenic infarcts (from emboli or segmental artery occlusion), involvement in systemic diseases (e.g., sickle cell disease causing autosplenectomy).
CONCISE SUMMARY FROM GROK:
Here is a concise summary (approximately 480 words) of the spleen anatomy from the YouTube video by Armando Hasudungan and the Slideshare presentation “Anatomy of Spleen.”
Introduction
The spleen is the largest lymphoid organ and a haemo-lymph organ in the reticulo-endothelial system. It lies in the left hypochondrium (upper quadrant), under the diaphragm and ribs 9–11, between the fundus of the stomach and diaphragm. It is intraperitoneal, not normally palpable, and measures roughly 1 × 3 × 5 inches (3 × 7–8 × 12–13 cm), weighing 150–200 g (Hari’s dictum of odd numbers). Its long axis runs downward, forward, and laterally along the 10th rib.
Gross Anatomy
• Shape: Wedge- or shoe-shaped, often lobulated in fetal life.
• Poles: Anterior (lateral) end expanded and directed downward/forward; posterior (medial) end rounded, near the left kidney.
• Borders: Superior (sharp, with 1–2 notches from fetal lobulation); inferior (rounded).
• Surfaces:
• Diaphragmatic (convex, relates to diaphragm, left pleura, and ribs 9–11).
• Visceral (concave, with gastric, renal, colic, and pancreatic impressions).
• Hilum: On the visceral surface; entry/exit for vessels and nerves (uncovered by peritoneum).
Relations: Stomach (fundus), left kidney, tail of pancreas, splenic flexure of colon, and diaphragm.
Peritoneal Ligaments
• Gastro-splenic: Connects stomach to anterior hilum; contains short gastric and left gastroepiploic vessels.
• Lienorenal (splenorenal): Connects kidney to posterior hilum; contains pancreatic tail and splenic vessels.
• Lienophrenic: Suspensory to diaphragm.
• Phrenico-colic: Supports inferiorly from colonic flexure.
Development
Arises in week 5 from mesenchymal cells in the dorsal mesogastrium. Multiple nodules fuse; superior notches reflect this. Unfused nodules form accessory spleens (splenunculi) in mesogastrium derivatives.
Blood Supply and Nerve Supply
• Artery: Tortuous splenic artery (largest celiac trunk branch) runs along pancreas, dividing into segmental branches. Short gastric and gastroepiploic branches via gastro-splenic ligament.
• Vein: Splenic vein drains to portal vein (via superior mesenteric vein).
• Nerves: Sympathetic from celiac plexus (vasomotor and trabecular smooth muscle).
Histology
Capsule with trabeculae divides the spleen into:
• White pulp (2–5%): Immune zone — periarteriolar lymphoid sheath (T-cells), follicles (B-cells), marginal zone (macrophages). No afferent lymphatics; antigens arrive via blood. Supports adaptive immunity and antibody production (IgM, IgG).
• Red pulp (75%): Filtration zone — cords of Billroth (macrophage-rich) and venous sinuses with slits. Blood flows from penicillar arteries through cords; healthy RBCs pass slits into sinuses; damaged cells are phagocytosed. Open circulation pathway.
Functions
• Red pulp: Filters old/damaged RBCs (removes Howell-Jolly bodies), recycles iron, sequesters ~1/3 platelets, clears pathogens.
• White pulp: Immune surveillance — antigen presentation, T/B-cell activation, antibody production.
• Fetal hematopoiesis; minor adult role in stress. Acts as blood reservoir.
Clinical Relevance
Not palpable normally; palpable first at anterobasal angle in splenomegaly (e.g., infections, leukemia, portal hypertension). Prone to traumatic rupture (difficult hemostasis → splenectomy). Post-splenectomy risks: overwhelming infections (encapsulated bacteria), Howell-Jolly bodies in blood, thrombocytosis. Accessory spleens may cause recurrence in conditions like ITP. Hyposplenia/asplenia increases infection susceptibility; vaccinations and prophylaxis recommended.
The video emphasizes dynamic histology, blood flow, and immune/filtration physiology with clear illustrations. The Slideshare provides detailed gross features, ligaments, relations, and development. Together they offer complementary gross-to-microscopic and clinical insights.
(Word count: 480)
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Green; flooding in UAE
Rule change follows high court challenge brought by two doctors prevented from working in specialist fields
— Read on www.theguardian.com/uk-news/2026/mar/26/doctors-waiting-on-asylum-decisions-can-work-in-nhs-as-home-office-lifts-ban
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Disbelieved witness
Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the health servi …
— Read on pubmed.ncbi.nlm.nih.gov/38132086/
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Coronavirus vaccines; bio weapons
Smithstone v Tranmoor Primary School [2026] EWCA Civ 13: clarification on liability-only Part 36 offers – Farrar’s Building Barristers Chambers
— Read on www.farrarsbuilding.co.uk/smithstone-v-tranmoor-primary-school-2026-ewca-civ-13-clarification-on-liability-only-part-36-offers/
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Coronavirus vaccines: cancer link
King’s Bench Guide 2026 – Courts and Tribunals Judiciary
— Read on www.judiciary.uk/guidance-and-resources/kings-bench-guide-2026/
AI should form an integral part of a firm’s risk policy, the Law Society’s risk and compliance conference heard. Data security and precautions are increasingly scrutinised when PII is renewed.
— Read on www.lawgazette.co.uk/news-focus/in-depth-put-ai-on-your-risk-agenda-firms-told/5126220.article
Claimants win over breakdown of costs – but alarmed at sting in the tail on agency fees.
— Read on www.lawgazette.co.uk/news/costs-judge-slashes-agency-fees-with-25-mark-up-cap/5126222.article
Baroness Carr tells journalists she has ‘every confidence in magistrates and Crown court judges to step up to the challenges they will be facing’.
— Read on www.lawgazette.co.uk/news/lcj-expresses-grave-security-concerns-over-judge-only-trials/5126223.article
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Chemtrails
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Iran: Professor Marandi in 2024
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USA still holding Maduro
Tribunal insists outcome ‘should not be read as creating a wider precedent for leniency’.
— Read on www.lawgazette.co.uk/news/solicitor-who-lied-to-protect-client-avoids-strike-off/5126193.article
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Is Netanyahu dead?
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“Jewish terrorism” Jewish newspaper
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Epstein file: Trump accused
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What is Britain doing in Iran?
What is Britain doing in Iran?
— Read on secure.declassifieduk.org/page/email
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UK Lawyers for Israel
Fahad Ansari will have ‘full panoply of procedural protections’ if police search of his phone leads to criminal proceedings, says judge.
— Read on www.lawgazette.co.uk/news/hamas-solicitor-fails-to-force-disclosure-after-mobile-seized/5126086.article
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Israel invades Lebanon
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Israel attacking Lebanon
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Cyprus RAG Akrotiri bombed by Iran
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France enters the war against Iran
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USA attacking Iran’s broadcast HQ
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USA bomb hospital in Iran
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Israel bombed hospitals in Iran
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Israel bombed hospitals in Iran
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Iran has fired missiles at Cyprus
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Iran’s response to Israel’s attack
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Israel attacks Iran
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Index of repression
Hi Pete Lyons
Today I was at the Frontline Club in London for the launch of the European Legal Support Centre’s Britain’s Index of Repression – along with a major new report that exposes the machinery behind the Zionist attacks many of us have seen and experienced.
This is a groundbreaking initiative that documents how people supporting Palestine in Britain are being smeared, censored, punished and targeted across workplaces, schools, universities, public institutions and beyond.
What makes it so powerful is that the cases are not hidden away in private files or scattered across social media posts. They are now publicly available in a searchable database, so people can trace the pattern for themselves:
https://www.index-of-repression.org
Crucial case set to resume in the Court of Appeal as Law Society and SRA prepare interventions.
— Read on www.lawgazette.co.uk/news/mazur-day-two-law-society-to-urge-court-to-reject-cilex-appeal/5126006.article
Government pressing ahead with ‘swift courts’ in which judge alone hears cases carrying a sentence of up to three years.
— Read on www.lawgazette.co.uk/news/society-lambasts-lammy-on-jury-reform/5126003.article
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Israel “Jews are above the law”
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India: limitation periods
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HEPA filters in the classroom
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Venezuela sends Israel oil
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COVID-19 cases struck out
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Pete's Library 