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Terms in this set (12)
What exactly is the diaphragm?
• Double domed musculotendinous partition between thoracic and abdominal cavities.
• The muscular part of the diaphragm is situated to the periphery with fibre radiating to the central tendon (Aponeurotic part)
What is the function of the diaphragm?
• Main muscles of respiration
• It descends in inspiration and ascends in expiration
• Only the domes move
• Important venous circulation depression increase intra-abdominal pressure forcing IVC to the heart.
What is the central tendon?
• This is a tendon without any bony attatchments and is divided into three leaves
• It is closer to the anterior thorax.
What is the structure of the diaphragm?
Pericardium sits of the central part of the diaphragm and depresses it slightly
• Normally higher than left due to the liver below it.
• It reaches as high as the 5th rib in inspiration
• Reaches as high as the 5th rib in inspiration
Divided into 3 parts:
• Sternal - attaches to the xiphoid process
• Costal - attaches to the internal surface of the inferior 6 costal cartilages and adjoining ribs
• Lumbar - arising from medial and lateral arcuate ligaments and superior 3 lumbar vertebrae, the latter form the right and left crura.
What are the 3 principle attachments of the diaphragm?
• Lumbar vertebrae and arcuate ligaments
• Costal cartilages of ribs 7-12
• Xiphoid process of the sternum
What is the right and left crus?
The parts of the diaphragm that arise from the vertebrae are tendinous in structure and are known as the right and left crura:
• Right crus
o arises from L1-L3 and their interbral discs
o Some fibres from the right crus surround the oesophageal opening acting as a physiological sphincter to present reflux of the gastic contents into the oesophagus.
• Left crus
o Arises from L1-L2 and their invertebral discs
They arch over the aortic opening to form the Median arcuate ligament
The left and right crus fibres cross over to surround the oesophageal hiatus
Name the 3 main openings of the diaphragm, and at what level are these openings?
• Caval opening (T8)
o For the inferior vena cava, terminal branches of right phrenic nerve and lymphatic vessels.
• Oesophageal hiatus (T10)
o For the oesophagus, anterior and posterior vagal nerves, phrenic branches of the gastric vessels and lymphatic vessels
• Aortic hiatus (T12)
o For the aorta, thoracic duct and azygos and hemi-azygos veins
Name some other, less important openings
• Sternocostal triangle
• Crus openings on both sides
• Posterior opening in the diaphragm
• Sympathetic chain on trunk.
• The left phrenic nerves terminal branches through a small opening in the diaphragm muscle.
What is the innervation of the diaphragm?
• Motor innervation from a phrenic nerve
• The left half (Hemidiaphragm) is innervated by the left phrenic nerve and vice versa.
• The phrenic nerve comes from the cervical plexus.
• The majority of the arterial supply is from the inferior phrenic arteries, which arise directly from the abdominal aorta.
What is the purpose of the costodiaphragmatic and costomediastinal recesses both functionally and clinical?
They act as potential spaces for the lungs to expand into during forced inspiration. Pleural effusions collect in the costodiaphragmatic recess when in the standing position. Pleural taps often work in this space as there is a decreased risk of puncturing the lung.
What is the innervation of the diaphragm and how might irritation of the diaphragm present as referred pain in a patient and why?
Phrenic nerve. Originates from nerve roots C3-5. C3 and C4 also supply supraclavicular nerves, C5 forming the upper root of the brachial plexus sensory to the lateral arm and shoulder region so irritation of the diaphragmatic pleura or peritoneum can present as pain in the region above the clavicle and shoulder tip.
Irritation of the peripheral regions of the diaphragm, innervated by the inferior intercostal nerves, is more localized, by referred to the skin over the costal margins and the anterolateral abdominal wall.
What hiatuses come from where?
I 8, 10 eggs at 12
Oesophagous - T8
IVC - T10
Aorta - 12
THIS SET IS OFTEN IN FOLDERS WITH...
Upper airway respiratory anatomy
Anterior thoracic wall and osteology of the thorax
Anterior and posterior triangles of the neck
The lungs and pleura
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