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Anatomy 206 > Diaphragm > Flashcards

Diaphragm Flashcards

1
Q

Shape

A
  1. Large dome shaped fibromuscular partition separating thoracic from abdominal cavities
  2. Convex upwards
  3. Its right cupola is higher than its left cupola due to underlying large liver right lobe
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2
Q

Origin

A

Wide origin from whole circumference of thoracic outlet inner aspect and vertebral column:
1. Sternal
2. Costal
3. Vertebral

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3
Q

Sternal origin

A

Xiphoid process back by 2 fleshy slips

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4
Q

Costal origin

A

Lower 6 costal cartilages deep surface by fleshy slips interdigitating with transversus abdominis origin

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5
Q

Vertebral origin

A
  1. 2 crura: right and left
  2. 5 arcuate ligaments:
    - Median arcuate ligament
    - 2 medial arcuate ligaments
    - 2 lateral arcuate ligaments
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6
Q

Right crus

A
  1. From upper 3 lumbar vertebrae bodies
  2. Larger than left crus (as it has to contract against liver)
  3. Its fibers extend up to surround esophagus lower end forming physiological sphincter around stomach cardiac end
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7
Q

Left crus

A

Smaller from upper 2 lumbar vertebrae bodies

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8
Q

Median arcuate ligament

A

Lies in median plane, extending between both crura and arches over aorta

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9
Q

2 medial arcuate ligaments

A

Extends from crus to tip of 1st lumbar vertebra transverse process and arches over Psoas major

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10
Q

2 lateral arcuate ligaments

A

Extends from tip of 1st lumbar vertebra transverse process to last rib and arches over the quadratus lumborum

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11
Q

Defects

A

Small defects between different parts of diaphragm origin, filled with loose areolar tissue:
1. Foramen of morgagni
2. Foramen of bockdalek (vertebrocostal triangle)

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12
Q

Foramen of morgagni

A
  1. Between sternal and costal origins transmitting superior epigastric vessels
  2. May be site of anterior (parasternal) diaphragmatic hernia
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13
Q

Foramen of bockdalek

A
  1. Triangular gap mainly on left side between costal and vertebral origins where pleura costodiaphragmatic recess comes in contact with kidney posterior surface but separated from it by areolar tissue
  2. May be site of posterior diaphragmatic hernia
  3. It is pleuroperitoneal canal remnant in fetus
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14
Q

Insertion

A
  1. No bony insertion, but all fibers converge to be inserted into a central tendon which is strong semilunar aponeurosis formed of 1 median and 2 lateral folia (trifoliate)
  2. Median lobe is related to pericardium and heart
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15
Q

Nerve supply

A
  1. Sensory
  2. Motor
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16
Q

Motor

A

Right and left phrenic nerves (C3, 4, and 5) arise in cervical region and descend to ramify on diaphragm inferior (abdominal) surface due to embryo folding

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17
Q

Sensory

A
  1. Lower 6 thoracic spinal nerves to peripheral parts
  2. Phrenic nerves to central part
18
Q

Action

A
  1. Chief muscle of respiration
  2. Used to increase intra-abdominal pressure in parturition, coughing, defecation, and micturition
19
Q

Relations: superior surface

A
  1. Right cupola
  2. Left cupola
  3. Central tendon
20
Q

Right cupola

A

Related to right pleura and lung

21
Q

Left cupola

A

Related to left pleura and lung

22
Q

Central tendon

A

Related to heart base and pericardium

23
Q

Relations: inferior surface

A
  1. Stomach fundus
  2. Spleen
    Right:
  3. Liver right lobe
  4. Right kidney
  5. Right Suprarenal gland
    Left:
  6. Liver left lobe
  7. Left kidney
  8. Left Suprarenal gland
24
Q

Openings

A

Major and minor

25
Q

Major openings

A
  1. Aortic opening
  2. IVC opening
  3. Esophageal opening
26
Q

Aortic opening site

A

In middle line behind median arcuate ligament, T12 vertebra

27
Q

Structures passing through aortic opening

A
  1. Aorta to left
  2. Azygous vein to right
  3. Thoracic duct in between
28
Q

IVC opening site

A

1 inch to right of middle line in central tendon T10 vertebra

29
Q

Structures passing through IVC opening

A
  1. IVC
  2. Right phrenic nerve
  3. Lymphatics
30
Q

Esophageal opening site

A

1 inch to left of middle in right crus T10 vertebra

31
Q

Esophageal

A
  1. Esophageal
  2. 2 vagi
  3. Esophageal branches of left gastric vessels
32
Q

Minor openings

A
  1. Superior epigastric artery
  2. Musculophrenic artery
  3. Lower 5 intercostal nerves and vessels
  4. Subcostal nerve
    And vessels
  5. Quadratus lumborum
  6. Sympathetic chain
  7. Psoas major
  8. Greater and lesser splanchnic nerves
  9. Hemiazygous vein
  10. Left phrenic nerve
33
Q

Superior epigastric artery

A

Between sternal and costal origins

34
Q

Musculophrenic artery

A

Between slips of origin from 7th and 8th costal cartilage

35
Q

Lower 5 intercostal nerves and vessels

A

Between costal digitations

36
Q

Subcostal nerves and vessels and quadratus lumborum

A

Behind lateral arcuate ligament

37
Q

Sympathetic chain and Psoas major

A

Behind medial arcuate ligament

38
Q

Greater and lesser splanchnic nerves

A

Pierce corresponding crus

39
Q

Hemiazygous vein

A

Pierces left crus to enter chest

40
Q

Left phrenic nerve

A

Pierces left cupola

41
Q

Arterial supply

A
  1. Musculophrenic: internal thoracic artery
  2. Pericardiophrenic: internal thoracic artery
  3. Lower intercostals: thoracic aorta
  4. Subphrenic: thoracic aorta
  5. Inferior phrenic: abdominal aorta
42
Q

Applied anatomy

A
  1. Parasternal hernia of morgagni: between sternal and costal origin
  2. Hernia of bockdalek: between costal and vertebral origins
  3. Hiatus hernia: stomach passes through esophageal opening

Anatomy 206 (98 decks)

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