Die Milz als Organ des Pfortadersystems und ihr Versagen

Ewerbeck, Hans

doi:10.1007/978-3-642-94558-8_8

Cited by 8 publications

(5 citation statements)

References 70 publications

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“…In order to explain these postprandial volume dynamics, studies were conducted on the relation of the spleen to the haemodynamics of the splanchnic circulation. The splanchnic circulation comprises the arterial and venous blood flow in the digestive system and displays interdependencies among peristalsis, the portal venous system, the liver, and the spleen [41, 42]. If blood flow and pressure in the elastic mesenteric and portal vessels increase, the splenic artery reacts with vasoconstriction, leading to a reduced arterial blood supply [43, 44].…”

Section: Resultsmentioning

confidence: 99%

“…This postprandial hyperaemia leads to a sequential increase in blood flow in the mesenteric vessels and in the portal system, with a peak around 30 min after food intake [46, 47]. Following the venovasomotor reflex, the spleen initially responds with a reduction in its arterial supply and an amplified and slower rhythm [41, 42].…”

Section: Resultsmentioning

confidence: 99%

“…If the increasing postprandial hyperaemia and dilatation of the portal vessels reach a critical point where the spleen cannot withstand the increased portal pressure, it swells from the venous side and suspends its rhythmicity [41, 45]. In this second response, the spleen functions like an upstream “pressure reservoir” [41] which protects the liver and portal system from excessive overflow. This temporary venous congestion of the spleen continues until the hyperaemia has subsided.…”

Section: Resultsmentioning

confidence: 99%

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Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review

et al. 2020

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Background: Before the discovery of immunological and haematological functions of the spleen, it had for centuries been considered to be a digestive organ of variable size with a role in the portal vein system and nutritional metabolism. In the 19th and 20th centuries, volume changes in the spleen related to nutrition were studied using plethysmographic measurements. Rhythmical and regulatory functions of the spleen were demonstrated in the haemodynamics of the splanchnic region and were described as a “hepatolienal pendulum,” a “Windkessel function,” or a “pressure compensation.” These studies were mainly published in German-speaking countries and have not, as far as is known, been discussed in the English-speaking world so far. Summary: This review explores the historical development of the rhythmical regulatory function of the spleen in the splanchnic region. Older studies and results are followed up in the modern literature, wherever possible, up to the present. The clinical relevance is illustrated with portal hypertension (with congestive or hyperdynamic splenomegaly), coeliac disease, and chronic inflammatory bowel diseases (with functional hyposplenism). Key Message: The spleen’s rhythmical regulatory function in nutrition is based on an autonomous rhythm comprising cycles of contractions and dilations of the spleen of around 1 min. These cycles can be influenced by sympathetically mediated single contractions with a release of pooled blood or by portal vein congestion. After food ingestion, the spleen responds either with contraction according to a vasomotor reaction or postprandial congestion with significant increases in volume. The spleen’s rhythmical function is lost in the clinical picture of portal hypertension or in coeliac disease and chronic inflammatory bowel diseases. In the aforementioned gastrointestinal diseases, we recommend taking more account of the haemodynamics between the spleen, liver, and intestine. New innovative techniques for recording splenograms are required which, besides elastographic measurements of spleen stiffness, could offer an important tool for early detection, diagnosis, and therapeutic evaluation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review

et al. 2020

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“…This might result in a decrease in splenic volume, as observed by Betal et al () and Roshdy et al (). However, if the postprandial portal flow increases further, the spleen cannot cope with the increased pressure, the rhythm ceases and a compensatory pressure equalization takes place with swelling of the organ (Ewerbeck, ; Streicher, ). This function of a “hepatolineal blood pendulum” (Henschen & Reissinger, ) has also been described as the “regulatory principle of the portal system” (Streicher, ), the spleen being a “pressure reservoir” (Ewerbeck, ), an “auxiliary motor” (Gorjajew, ), a “pump” (Guillery, ), or a “windkessel function” in analogy to the systemic circulation (Henschen & Reissinger, ).…”

Section: Discussionmentioning

confidence: 99%

Postprandial dynamics of splenic volume in healthy volunteers

et al. 2020

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Throughout the history of medicine, many functions have been attributed to the spleen and numerous researchers have focused on a postulated digestive function. Beginning in 1825, systematic animal studies showed evidence for a postprandial increase in splenic volume (SV) with a peak 30 min to five hours after food intake. Since the introduction of imaging techniques, two studies have been conducted on humans, revealing a decrease in SV 30 to 45 min postprandially. The aim of this study was to examine possible postprandial changes in SV over a period of seven hours. The ethics‐approved, randomized crossover study included 10 healthy volunteers, who received a standardized meal (3,600 kJ) on one study day and fasted on the other. Sonographic measurements were obtained at six measurement points on each day. Thirty minutes after the meal, SV increased significantly by 38.2 ± 51.2 cm3 (17.3%; p = .04) compared to the baseline measurement and decreased gradually afterward. In males, SV 30 min after the meal was 70.2 ± 21.6 cm3 higher (p = .002) compared to the fasting condition and 60 min later it was still significantly increased. The apparent SV increase after food intake is discussed in relation to hemodynamic changes in the splanchnic region. It seems plausible that the spleen has a rhythmic and regulative function within the portal system, something which warrants further research and should be taken more into account in nutritional physiology.

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“…For all four spleen types, there exists a close association with the alimentary tract and a consequent inextricable relationship between the blood vascular system of the spleen and that of the alimentary tract (Laguesse, 1890; Maurer, 1890;Klaatsch, 1892;Tonkoff, 1900;Choronshitzky, 1900; Danchakoff, 1916;LBon, 1932;Weilacher, 1933;Hartmann, 1933;Ewerbeck, 1949;Yamada, 1951;Miki, 1968). However, the spleen's site of development differs so much according to species (stomach, stomach-intestine, and intestine) that the blood vascular relationships between the spleen and the alimentary tract described above become so complicated that it is difficult to determine the underlying fundamental rules of development.…”

mentioning

confidence: 99%

The development of the spleen in the Australian lungfish, Neoceratodus forsteri Krefft, with special reference to its relationship to the “gastro”‐enteric vasculature

Saito

1984

Am. J. Anat.

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The spleen of Neoceratodus forsteri Krefft grows in the shape of a " boomerang " on the left lateral-dorsal-right lateral part of the borderline between the foregut and the yolkgut . Development of the spleen follows the following stages: 1) appearance of the splenic primordium as a mesenchymal condensation in a limited portion of the region supplied by the third and fourth vitelline arteries on both sides, 2) development of the splenic sinuses within the primordium, 3) formation of the "gastric" and enteric splenic portal systems and 4) growth of the spleen along the anterior extremity of the spiral valve. The blood vascular dynamics of the foregut and the yolkgut are intimately involved with the formation of the spleen in this species. These processes were, therefore, compared with similar processes in other animals, and the characteristics of this organ common to vertebrates were investigated.

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Die Milz als Organ des Pfortadersystems und ihr Versagen

Cited by 8 publications

References 70 publications

Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review

Splenic Rhythms and Postprandial Dynamics in Physiology, Portal Hypertension, and Functional Hyposplenism: A Review

Postprandial dynamics of splenic volume in healthy volunteers

The development of the spleen in the Australian lungfish, Neoceratodus forsteri Krefft, with special reference to its relationship to the “gastro”‐enteric vasculature

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