Anat of diaphragm Flashcards
What are the intercostal muscles?
External intercostals
Internal intercostals
Innermost intercostals
What nerves supply the intercostal spaces?
Intercostal nerves from the anterior rami of T1-T11
T12 becomes subcostal N
What is the arrangement of structures that pass along the costal groove superior to inferior?
Vein
Artery
Nerve
What arteries supply the intercostal spaces?
Posterior intercostal
Pair of anterior intercostal arteries
What branches of the axillary artery supply the thoracic wall?
Superior thoracic
Lateral thoracic
What branches of the subclavian A supply the thoracic wall?
Internal thoracic
Superior intercostal
What is the venous drainage of the thoracic wall?
Posterior intercostals drain into azygos and hemiazygos Vs
Anterior intercostals drain into internal thoracic Vs
What characterizes the pump handle movement of the ribs?
When the upper ribs are elevated increasing the AP diameter
What characterizes the bucket handle movement of the ribs?
Middle parts of lower ribs move laterally when elevated, increasing transverse diameter
Where is the needle inserted for an intercostal N block?
Upper end of the intercostal space around an intercostal N
What is required to achieve complete anesthesia in an intercostal N block and why?
Two or more adjacent intercostal spaces have to be anesthetized because of overlapping dermatomes
What are the attachments of the diaphragm?
Posterior part of xiphoid process
Lower six ribs and their costal cartilages
Upper 3 lumbar vertebrae
From what do the diaphragmatic crura arise?
From lumbar vertebra, IV discs, and anterior longitudinal ligaments
What connects the two diaphragmatic crura?
Median arcuate ligament
What passes through the caval opening of the diaphragm?
IVC
R phrenic N
Some lymphatics from the liver
What vertebral level corresponds with the caval opening in the diaphragm?
T8
What changes are seen in the IVC when the diaphragm contracts?
It dilates
What passes through the esophageal hiatus in the diaphragm?
Esophagus
Anterior and posterior vagal trunks
Esophageal branches of L gastric vessels
Lymphatics
What changes are seen in the esophagus when the diaphragm contracts?
It is constricted
What passes through the aortic hiatus of the diaphragm?
Descending aorta
Azygos V
Thoracic duct
Are the structures that pass through the aortic hiatus affected by diaphragmatic contraction?
No
What structures pass through the sternocostal foramen of the diaphragm?
Lymphatic vessels of liver
Superior epigastric vessels
What is the location of the sternocostal foramen of the diaphragm?
Between the sternal and costal attachments of the diaphragm
Where do the greater and lesser splanchnic nerves pass through the diaphragm?
Through the crura
What is the motor innervation of the diaphragm?
R and L phrenic N (C3-C5)
What is the sensory innervation of the diaphragm?
Phrenic N - central
Lower 6 intercostal Ns - periphery
What is the arterial supply of the diaphragm?
Superior phrenic branches of thoracic aorta
Musculophrenic and pericardiophrenic branches of internal thoracic A
What is the venous drainage of the diaphragm?
Musculophrenic and pericardiophrenic Vs drain into internal thoracic Vs
Superior phrenic on R drains into IVC
Where does irritation over the peripheral diaphragm refer to?
Skin over costal margins of anterior abdominal wall
Where does irritation over the center part of the diaphragm refer?
Referred to the shoulder region, C3-C5 dermatomes
