Anat of diaphragm

Question 1

What are the intercostal muscles?

Answer 1

External intercostals
Internal intercostals
Innermost intercostals

Question 2

What nerves supply the intercostal spaces?

Answer 2

Intercostal nerves from the anterior rami of T1-T11
T12 becomes subcostal N

Question 3

What is the arrangement of structures that pass along the costal groove superior to inferior?

Answer 3

Vein
Artery
Nerve

Question 4

What arteries supply the intercostal spaces?

Answer 4

Posterior intercostal
Pair of anterior intercostal arteries

Question 5

What branches of the axillary artery supply the thoracic wall?

Answer 5

Superior thoracic
Lateral thoracic

Question 6

What branches of the subclavian A supply the thoracic wall?

Answer 6

Internal thoracic
Superior intercostal

Question 7

What is the venous drainage of the thoracic wall?

Answer 7

Posterior intercostals drain into azygos and hemiazygos Vs
Anterior intercostals drain into internal thoracic Vs

Question 8

What characterizes the pump handle movement of the ribs?

Answer 8

When the upper ribs are elevated increasing the AP diameter

Question 9

What characterizes the bucket handle movement of the ribs?

Answer 9

Middle parts of lower ribs move laterally when elevated, increasing transverse diameter

Question 10

Where is the needle inserted for an intercostal N block?

Answer 10

Upper end of the intercostal space around an intercostal N

Question 11

What is required to achieve complete anesthesia in an intercostal N block and why?

Answer 11

Two or more adjacent intercostal spaces have to be anesthetized because of overlapping dermatomes

Question 12

What are the attachments of the diaphragm?

Answer 12

Posterior part of xiphoid process
Lower six ribs and their costal cartilages
Upper 3 lumbar vertebrae

Question 13

From what do the diaphragmatic crura arise?

Answer 13

From lumbar vertebra, IV discs, and anterior longitudinal ligaments

Question 14

What connects the two diaphragmatic crura?

Answer 14

Median arcuate ligament

Question 15

What passes through the caval opening of the diaphragm?

Answer 15

IVC
R phrenic N
Some lymphatics from the liver

Question 16

What vertebral level corresponds with the caval opening in the diaphragm?

Answer 16

T8

Question 17

What changes are seen in the IVC when the diaphragm contracts?

Answer 17

It dilates

Question 18

What passes through the esophageal hiatus in the diaphragm?

Answer 18

Esophagus
Anterior and posterior vagal trunks
Esophageal branches of L gastric vessels
Lymphatics

Question 19

What changes are seen in the esophagus when the diaphragm contracts?

Answer 19

It is constricted

Question 20

What passes through the aortic hiatus of the diaphragm?

Answer 20

Descending aorta
Azygos V
Thoracic duct

Question 21

Are the structures that pass through the aortic hiatus affected by diaphragmatic contraction?

Answer 21

No

Question 22

What structures pass through the sternocostal foramen of the diaphragm?

Answer 22

Lymphatic vessels of liver
Superior epigastric vessels

Question 23

What is the location of the sternocostal foramen of the diaphragm?

Answer 23

Between the sternal and costal attachments of the diaphragm

Question 24

Where do the greater and lesser splanchnic nerves pass through the diaphragm?

Answer 24

Through the crura

Question 25

What is the motor innervation of the diaphragm?

Answer 25

R and L phrenic N (C3-C5)

Question 26

What is the sensory innervation of the diaphragm?

Answer 26

Phrenic N - central
Lower 6 intercostal Ns - periphery

Question 27

What is the arterial supply of the diaphragm?

Answer 27

Superior phrenic branches of thoracic aorta
Musculophrenic and pericardiophrenic branches of internal thoracic A

Question 28

What is the venous drainage of the diaphragm?

Answer 28

Musculophrenic and pericardiophrenic Vs drain into internal thoracic Vs
Superior phrenic on R drains into IVC

Question 29

Where does irritation over the peripheral diaphragm refer to?

Answer 29

Skin over costal margins of anterior abdominal wall

Question 30

Where does irritation over the center part of the diaphragm refer?

Answer 30

Referred to the shoulder region, C3-C5 dermatomes