diaphragm.pptx

Anatomy of Diaphragm

1. Diaphragm

2. Diaphragm Separates Thoracic & abdominal cavity Principle muscle of respiration Peripheral muscular part Central fibrous part Central tendon Diaphragm Thorax Abdomen

3. Surfaces & parts Superior Features Dome or Cupola Projection on either side Central tendon Depression in centre Relations Rt. & Lt. Pleura & fibrous pericardium Inferior Lined by peritoneum Rt. Side Liver, kidney, suprarenal gland Lt. side Liver, fundus, spleen, kidney, suprarenal gland

4. 1)Sternal part “post . Xiphiod process” 2) Costal part lower 6 rips 3)Vertebral part 2 crura and ligaments Has 3 origin:

5. Sternal part Arises by 2 fleshy slips From back of the xiphoid process

6. Costal part 6 muscular slips on each Side From Inner surfaces of Lower 6 cartilages & a djacent parts of ribs

7. Vertebral part Arises by 2 crura 5 arcuate ligaments

8. Crura Right & Left crus Right crus Right side of anterior aspect of upper 3 lumbar Left crus Left side of anterior aspect of upper 2 lumbar vertebrae 1 2 3 Right crus 1 st 3 lumbar Left crus 1 st 3 lumbar

9. Arcuate ligaments Median arcuate ligament Tendinous ligament Between upper ends of two crura At T-12 level

10. Arcuate ligaments Medial arcuate ligament Thickened upper psoas fascia Extends From Side of body of L2 vertebra To Tip of transverse process of L1 2 1 Medial arcuate ligament L2 to TP of L1

11. Arcuate ligaments Lateral arcuate ligament Thickened upper margin of fascia Covers Quadratus lumborum muscle (anterior layer of thoracolumbar fascia) Extends From Tip of transverse process of L1 To 12 th rib 2 1 Lateral arcuate ligament L1 to TP 12 th rib

12. Insertion Central tendon Muscle fibres converge from circumferential origin Features of central tendon Trifoliate in shape An anterior Two tongue shaped posterior Fused with fibrous pericardium Nearer to sternum than vertebral column central tendon

13. Openings in diaphragm 2 types Major Minor

14. Major openings Aortic Oesophageal Venacaval

15. Location of the 3 main Openings

16. Aortic opening Osseo aponeurotic Lies behind diaphragm (median arcuate ligament) Features Level - T 12 Shape – round Boundaries Front – median arcuate ligament Behind – body of 12 th thoracic vertebra On sides – crus Structures passing Aorta Thoracic duct Azygos vein

17. Oesophageal opening Lies in muscular part Fibres from right crus encircle it Level - T10 Shape – Elliptical Structures passing Oesophagus Gastric or Vagus nerves Oesophageal branches of left gastric artery Phreno - oesophageal ligament Lymphatics from liver

18. Venacaval opening Situation - central tendon of diaphragm Level – T 8 Shape - Quadrilateral Structures passing Inferior vena cava Right phrenic nerve Few lymph vessels from liver

19. Minor openings 8 openings Behind Medial arcuate ligament Lateral arcuate ligament Piercing crura Right & left crus Between origins of Sternal & costal Costal & transverse abdominis Costal orgins

20. Space of Larry Gap between Muscular slips from Xiphoid process & 7 th costal cartilage Structure passing Superior epigastric vessels

21. Other structures Musculophrenic Between 7 th & 8 th ribs Lower 5 intercostal nerves and vessels Between adjacent costal slips (7 th to 11 th ) Subcostal Deep to lateral arcuate Sympathetic Deep to medial arcuate Greter , lesser and least splanchnic Piercing crus

22. Nerve supply Motor Phrenic nerve (C3-5) Sensory Central part Phrenic nerve Peripheral part Lower 6 intercostal nerves

23. Arterial supply Superior phrenic Throcic aorta Inferior phrenic Abdominal aorta Pericardiophrenic Internal thoracic Musculo phrenic Internal thoracic Superior epigastric Internal thoracic Lower five intercostal Throcic aorta Subcostal Throcic aorta

24. Development Develops from 4 sources Septum transversum Pleuroperitoneal membrane Medial dorsal portion of primary oesophageal mesentry Marginal ingrowths of the body wall

25. Applied anatomy Hiccups Due to involuntary spasmodic contraction Accompanied by closure of glottis Hernia Hiatal hernia Sliding hernia Cardiooesophageal junction & cardiac end of stomach pass into posterior mediastinum

26. Suprarenal glands Ductless gland Yellowish retroperitoneal organ Located at upper poles of each kidney At the level of T12 Component of hypothalamic-pituitary-suprarenal axis Responsible for coordinating stress response and metabolism

27. Right suprarenal gland - Features Pyramid( )shaped Caps the upper pole of right kidney Apex Base 3 borders Anterior Has hilum for suprarenal vein Medial Lateral 3 surfaces Anteromedial Anterolateral Posterior

28. Relations Anterior Right lobe of liver and inferior vena cava Posterior Diaphragm

29. Left suprarenal gland - Features Crescentic in shape Extends along the medial border of left kidney From upper pole to hilus 2 poles Upper & lower 2 borders Medial & lateral 2 surfaces Anterior Hilum for suprarenal vein Posterior

30. Relations Anterior Pancreas, lesser sac and stomach Posterior Diaphragm Left suprarenal gland

31. Arterial supply Each gland is supplied by 3 arteries from 3 distinct sources Superior suprarenal artery A branch of inferior phrenic artery Middle suprarenal artery A branch of the abdominal aorta Inferior suprarenal artery A branch of the renal artery

32. Venous drainage Each gland is emptied only by just one vein Which comes from the hilus of the gland Right suprarenal vein empties into Inferior vena cava Left suprarenal vein empties into Left renal vein

33. Sheath Encircled by 2 sheaths Immediate covering of loose areolar tissue consisting of a large amount of perirenal fat Outer to this renal fascia encloses the suprarenal gland along with the kidney but the gland is divided from the kidney by a septum

34. Development Cortex From coelomic epithelium (mesothelium) derived from mesoderm Medulla From Neural crest cells

35. Mechanism of respiration Increase in vertical diameter by diaphragmatic contraction Anteroposterior diameter by pump handle movement of sternum Transverse diameter by bucket handle movements of lower ribs