Diaphragm, Respiration, and Pericardium

Question 1

What does the diaphragm separate?

Answer 1

thorax and abdomen

Question 2

Why is the right dome higher than the left dome of the diaphragm?

Answer 2

it overlies the liver

Question 3

What are the two parts of the diaphragm?

Answer 3

muscular and central tendon

Question 4

What are the points of origin of the muscular part of the diaphragm?

Answer 4

sternal: xiphoid process
costal: lower 6 costal cartilages
lumbar: lumbar vertebrae 1-3, medial and lateral arcuate ligaments

Question 5

What are the three openings in the diaphragm?

Answer 5

caval opening, esophageal hiatus, and aortic hiatus

Question 6

What vertebral level is the caval opening and what are its contents?

Answer 6

tv 8 and the inferior vena cava and the right phrenic nerve

Question 7

What is firmly attached to the central tendon around the caval opening and facilitates venous return to heart during inspiration?

Answer 7

inferior vena cava

Question 8

What is the vertebral level of the esophageal hiatus and what are its contents?

Answer 8

tv 10 and the esophagus, and anterior/posterior vagal trunks

Question 9

What is the vertebral level of aortic hiatus and what are its contents?

Answer 9

tv 12 and the aorta, thoracic duct, and the azygos vein

Question 10

What is the blood supply to the diaphragm?

Answer 10

musculophrenic, pericardiacophrenic, superior phrenic, and inferior phrenic arteries

Question 11

What is the innervation to the diaphragm?

Answer 11

Phrenic nerve (C3,4,5) and intercostal nerves

Question 12

What causes a hiatial hernia?

Answer 12

weakness in the diaphragmatic wall around the esophageal hiatus

Question 13

What causes a hiatal hernia?

Answer 13

weakness in the diaphragmatic wall around the esophageal hiatus

Question 14

What happens when the upper part of the stomach slides up into the thoracic cavity through the esophageal hiatus?

Answer 14

hiatal hernia

Question 15

What is a major cause of gastroesophageal reflux, including belching and epigastric pain?

Answer 15

hiatal hernia

Question 16

What movement is when the diaphragm contracts, pulling the domes inferiorly into the abdomen, resulting in an increase in the vertical diameter of the thorax?

Answer 16

piston movement

Question 17

Which movement elevates the lower ribs (7-10) about an antero-posterior axis, resulting in an increase in the transverse diameter of the thorax?

Answer 17

bucket handle movement

Question 18

What does the pump handle movement do?

Answer 18

elevates upper ribs (2-6) about a transverse axis, resulting in an increase in antero-posterior diameter of thorax

Question 19

The elevation of the ribs in both the bucket handle and pump handle movements are due to the contraction of what muscles?

Answer 19

external intercostal muscles

Question 20

What happens in normal expiration?

Answer 20

diaphragm and external intercostal muscles relax and air is expelled passively

Question 21

What happens in forced expiration?

Answer 21

the internal intercostals, innermost intercostals, and muscles of the anterior abdominal wall contract

Question 22

What happens to the intrathoracic volume and pressure in inspiration?

Answer 22

volume increases, pressure decreases

Question 23

What happens to the intrathoracic volume and pressure in expiration?

Answer 23

volume decreases, pressure increases

Question 24

What happens to the abdominal volume and pressure when the diaphragm is contracted during inspiration?

Answer 24

volume is decreased, pressure increased

Question 25

What are hiccups a result of?

Answer 25

spasmodic contraction of diaphragm

Question 26

What is the pericardium?

Answer 26

fibroserous sac which encloses the heart and great vessels

Question 27

What are the layers of the pericardium?

Answer 27

fibrous pericardium, parietal layer of the serous pericardium, and visceral layer of the serous pericardium

Question 28

What is a potential space between the parietal and visceral layers of the serous pericardium that contains serous fluid?

Answer 28

pericardial cavity

Question 29

What is another name for the sternopericardial ligaments that attach the fibrous pericardium to the back of the sternum?

Answer 29

cardiac seat belt

Question 30

What are the layers of the pericardium of the heart?

Answer 30

epicardium, myocardium, endocardium, chambers

Question 31

What is a cardiac temponade?

Answer 31

fluid leaks rapidly into pericardial cavity compressing the heart and superior vena cava making the external jugular veins become enlarged and prominent

Question 32

What are the pericardial sinuses?

Answer 32

transverse pericardial sinus and the oblique pericardial sinus

Question 33

What is the blood supply to the pericardium?

Answer 33

pericardiacophrenic (main supply), bronchial, esophageal, and coronary (visceral layer) arteries

Question 34

What nerves innervate the heart?

Answer 34

phrenic nerve (sensory), sympathetic trunk (vasomotor), and the vagus nerve

Question 35

Where is pericardial pain felt?

Answer 35

behind the sternum, although less sensitive to pain than pleura

Question 36

What is inflammation to the pericardium?

Answer 36

pericarditis (very life threatening)

Question 37

When listening to the heart and holding their breath, what should you hear for percardial friction rub?

Answer 37

The sound will continue when breath is held, if sound stops then it is pleural friction rub