PAW: Diaphragm Flashcards

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1
Q

Enumerate types of origins of Diaphragm

A
  • Sternal origin
  • Costal origin
  • Vertebral origin
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1
Q

Explain why diaphragm right copula is higher than left copula

A

Due to underlying large right lobe of Liver

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2
Q

Describe sternal origin of Diaphragm

A

at back of Xiphoid process by 2 fleshy slips

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3
Q

Describe costal origin of Diaphragm

A

at Lower 6 costal cartilages, interdigitating with origin of transversus abdominus

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4
Q

Describe Vertebral Origin of Diaphragm

A

by 2 crura & 5 Arcuate ligaments
* Right Crus (largest of the 2): attached to bodies of upper 3 lumbar vertebra, it extends upwards to surround eosophagus, thus forming physiological sphincter around Cardiac end of stomach
* Left Crus: attached to upper 2 lumbar vertebrae
* Median Arcuate ligament: extending between both crura & arches over Aorta
* 2 medial Arcute ligaments: extends from on of the crus to tip of transverse process of 1st lumbar vertebrae, and arches over psoas Major
* 2 Lateral Arcute ligaments: extends from TP of 1st LV to Last rib 7 Arches over Quadratus Lumborum

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5
Q

Defects found in origins of Diaphragm are filled with

A

Loose areolar CT

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6
Q

Enumerate defects found in origins of Diaphragm

A
  • Foramen of Morgagni
  • Foramen of Bockdalek (Vertebrocostal triangle)
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7
Q

foramen of Morgagni is located between____, it transmittes ____Vessels, it is site of ____Hernia

A
  • Costal & sternal origins
  • Superior epigastric vessels
  • Anterior (parasternal) diaphragmatic hernia
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8
Q

foramen of Bockdalek is located between____, it’s site of contact between ____, it is site of ____Hernia, it is ____remnant in fetus

A
  • Costal & Vertebral origins
  • Costodiaphragmatic recess of Pleura & Posterior surface of kindey ( with loose areolar CT between them)
  • Posterior Diaphragmatic hernia
  • Pleuroperitoneal remnant
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9
Q

Describe Insertion of Diaphragm

A
  • No bony insetion
  • A central tendon which is a strong Semilunar Aponeurosis
  • formed of 1 median folia & 2 lateral Folia (trifolate)
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10
Q

Superior surface of Medina folia (median Lobe) of Central tendon of diaphragm is related to

A

Pericardium & heart

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11
Q

Describe Nerve supply of Diaphragm

A
  • Motor: Phrenic Nerve
  • Sensory: Lower 6 thoracic spinal Nerves (peripheral), Phrenic Nerve (Central)
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12
Q

Action of Diaphragm

A
  • Main muscle for respiration
  • Increases Intraabdominal pressure for:
    1. Coughing
    2. Defecation
    3. micturation
    4. parturation (labour)
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13
Q

Superior relations of Diaphragm

A
  • Right Copula: to right pleura & lung
  • Left Copula: to left pleura & Lung
  • Central Part: Heart & pericardium
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14
Q

Inferior Relations of Diaphragm

A

Right Side:
* Right Kidney
* Liver right Lobe
* Right Suprarenal Gland

Left side:
* Left kidney
* Liver left lobe
* Left suprarenal Gland
* (fundus of )Stomach
* Spleen

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15
Q

Site of Aortic opening of diaphragm

A
  • at midline
  • Behind median Arcute ligament
  • at T12 level
16
Q

Site of IVC opening of diaphragm

A
  • one inch right to midline
  • At T8 Level
17
Q

Site of eosophageal opening of diaphragm

A
  • One inch left to midline
  • in right crus
  • At T10 Level
18
Q

Structures passing through Aortic Opening of Diaphragm

A
  • Aorta (left)
  • Azygous Vein (right)
  • Thoracic Duct (in between)
19
Q

Structures passing through IVC opening of Diaphragm

A
  • IVC
  • Right Phrenic N
  • Lymphatics
20
Q

Structures passing through Eosophageal Opening of Diaphragm

A
  • Eosophagus
  • 2 Vagi N
  • Eosophageal branches of left Gastric Vessels
21
Q

Enumreate minor openings in diaphragm

A
  1. Superior Epigastric vessels (Foramen of Morgagni)
  2. Musculophrenic Artery
  3. Lower 5 Intercostal Nerves & vessels
  4. Subcostal Nerves & vessels + Quadratus lumborum
  5. Sympathetic Chain + psoas Major
  6. Greater & lesser Splanchnic Nerves
  7. Hemiazygous Vein
  8. Left Phrenic Nerve
22
Q

Describe Arterial Blood Supply of Diaphragm

A

5 Arteries
From Internal Thoracic Artery (internal Mammaliry A):
* Musculophrenic A
* Pericardiophrenic A

From Thoracic Aorta:
* Lower Intercostal Arteries
* Superior phrenic A

From Abdominal Aorta:
* Inferior Phrenic A