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ESA 3 - Respiratory > Session 1.1h- TeachMeAnatomy - Diaphragm > Flashcards

Session 1.1h- TeachMeAnatomy - Diaphragm Flashcards

https://teachmeanatomy.info/thorax/muscles/diaphragm/

1
Q

What is the diaphragm?

A

A double-domed sheet of skeletal muscle

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2
Q

What type of muscle is the diaphragm?

A

Skeletal muscle

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3
Q

Where is the diaphragm located?

A

At the inferior-most aspect of the rib cage.

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4
Q

What are the functions of the diaphragm?

A

It serves two main functions:

  • separates the thoracic cavity from the abdominal cavity (Greek = ‘partition’)
  • undergoes contraction and relaxation, altering the volume of the thoracic cavity and the lungs, producing inspiration and expiration.
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5
Q

The diaphragm separates which structures?

A

The thoracic cavity from the abdominal cavity

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6
Q

What does diaphragm mean?

A

The word diaphragm is derived from the Greek ‘diáphragma’, meaning partition

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7
Q

The diaphragm undergoes contraction and relaxation to do what?

A

Alter the volume of the thoracic cavity and the lungs

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8
Q

The diaphragm alters the volume of the thoracic cavity and lungs how?

A

By undergoing contraction and relaxation

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9
Q

The diaphragm undergoes contraction and relaxation, altering the volume of the thoracic cavity and the lungs, producing what?

A

Inspiration and expiration

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10
Q

What does the diaphragm fill?

A

The INFERIOR THORACIC APERTURE

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11
Q

What does the diaphragm act as borders for?

A

It acts as the floor of the thoracic cavity and the roof the abdominal cavity.

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12
Q

How can the attachments of diaphragm be divided?

A

Into PERIPHERAL and CENTRAL ATTACHMENTS.

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13
Q

Describe the diaphragm’s peripheral attachments.

A

It has three:

  • lumbar vertebrae and arcuate ligaments
  • costal cartilages of ribs 7-10 (attach directly to ribs 11-12)
  • xiphoid process of the sternum
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14
Q

The parts of the diaphragm that arise from the vertebrae are ________ in structure

A

tendinous

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15
Q

The parts of the diaphragm that arise from the vertebrae are known as ___?

A

The RIGHT AND LEFT CRURA

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16
Q

Where does the right crus arise from?

A

L1-L3 and their intervertebral discs.

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17
Q

What do some fibres from the right crus surround?

A

The oesophageal opening

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18
Q

What is the function of the right crus surrounding the oesophageal opening?

A

It acts as a physiological sphincter to prevent reflux of gastric contents into the oesophagus.

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19
Q

The right crus acts as what sort of muscle when it surrounds the oesophageal opening?

A

A physiological sphincter

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20
Q

What does the right crus reflux of?

A

Gastric contents

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21
Q

The right crus prevents reflux of gastric contents where?

A

Into the oesophagus.

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22
Q

Where does the left crus arise from?

A

L1-L2 and their intervertebral discs.

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23
Q

The muscle fibres of the diaphragm combine to form what?

A

A CENTRAL TENDON

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24
Q

The central tendon of the diaphragm ascends to do what?

A

This tendon ascends to fuse with the inferior surface of the fibrous pericardium.

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25
Q

What happens to the diaphragm at the level of the pericardium?

A

Either side of the pericardium, the diaphragm ascends to form left and right DOMES.

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26
Q

Which dome of the diaphragm lies higher?

A

At rest, the right dome lies slightly higher than the left.

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27
Q

Why does one dome of the diaphragm lie higher than the other?

A

At rest, the right dome lies slightly higher than the left - this is thought to be due to the presence of the liver.

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28
Q

What is the significance of the diaphragm dividing the thoracic and abdominal cavities?

A

Any structures that pass between the two cavities will pierce the diaphragm.

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29
Q

What are the openings in the diaphragm?

A

There are three openings that act as conduit for various structures:

  • Caval Hiatus (T8)
  • Oesophageal Hiatus (T10)
  • Aortic Hiatus (T12)
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30
Q

At what vertebral level is the caval hiatus?

A

T8

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31
Q

What opening of the diaphragm is at T8?

A

Caval hiatus

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32
Q

The caval hiatus is a conduit for which structures?

A
  • Inferior vena cava

- Terminal branches of right phrenic nerve

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33
Q

The inferior vena cava and terminal branches of right phrenic nerve pass through the diaphragm where?

A

Caval hiatus

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34
Q

At what vertebral level is the oesophageal hiatus?

A

T10

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35
Q

What opening of the diaphragm is at T10?

A

Oesophageal hiatus

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36
Q

The oesophageal hiatus is a conduit for which structures?

A
  • Oesophagus
  • Right and left vagus nerves
  • Oesophageal branches of left gastric artery/vein
37
Q

The oesophagus, right and left vagus nerves, and oesophageal branches of left gastric artery/veinpass through the diaphragm where?

A

Oesophageal hiatus

38
Q

At what vertebral level is the aortic hiatus?

A

T12

39
Q

What opening of the diaphragm is at T12?

A

Aortic hiatus

40
Q

The aortic hiatus is a conduit for which structures?

A
  • Aorta
  • Thoracic duct
  • Azygous vein
41
Q

The aorta, thoracic duct and azygous vein pass through the diaphragm where?

A

Aortic hiatus

42
Q

Name a tip for remembering the vertebral levels of the diaphragm.

A
  • Vena cava has eight letters (T8)
  • Oesophagus has ten letters (T10)
  • Aortic hiatus has twelve letters (T12)
43
Q

What is the primary muscle of respiration?

A

The diaphragm is the PRIMARY MUSCLE of respiration.

44
Q

What does the diaphragm do during inspiration?

A

It contracts and FLATTENS, increasing the vertical diameter of the thoracic cavity.

45
Q

The diaphragm contracts and flattens during ___?

A

Inspiration

46
Q

The diaphragm contracts and flattens during inspiration to ___?

A

Increase the vertical diameter of the thoracic cavity.

47
Q

What is the relation of the diaphragm to the lung in inspiration?

A

It produces lung expansion, and air is drawn in.

48
Q

What happens to the diaphragm during expiration?

A

It passively relaxes and returns to its original dome shape.

49
Q

The diaphragm relaxes and returns to its original dome shape during expiration. Why?

A

This reduces the volume of the thoracic cavity.

50
Q

What is the innervation of the diaphragm?

A

The halves of the diaphragm receives motor innervation from a PHRENIC NERVE.

51
Q

The phrenic nerve supplies the _____ innervation of the diaphragm.

A

Motor

52
Q

What is half of the diaphragm known as?

A

A HEMIDIAPHRAGM

53
Q

What is each half of the diaphragm innervated by?

A

The left half of the diaphragm is innervated by the left phrenic nerve, and vice versa.

54
Q

Where is the phrenic nerve formed?

A

In the neck within the CERVICAL PLEXUS

55
Q

The phrenic nerve contains fibres from where?

A

Spinal roots C3-C5.

56
Q

What delivers the majority of the arterial supply to the diaphragm?

A

The INFERIOR PHRENIC ARTERIES

57
Q

Where do the inferior phrenic arteries arise from?

A

Directly from the abdominal aorta.

58
Q

Other than the inferior phrenic arteries, what is the remainly supply to the diaphragm?

A

The superior phrenic, pericardiacophrenic, and musculophrenic arteries.

59
Q

What are the draining veins of the diaphragm?

A

The draining veins follow the aforementioned arteries (inferior phrenic, superior phrenic, pericardiacophrenic, musculophrenic).

60
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is diaphragmatic paralysis caused by?

A

An interruption in its nervous supply.

61
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What structures can be damaged to cause diaphragmatic paralysis?

A

Interruption in the nervous supply, which can occur in the

  • PHRENIC NERVE
  • cervical spinal cord
  • or the brainstem
62
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is the most common cause of diaphragmatic paralysis?

A

It is most often due to a lesion of the phrenic nerve.

63
Q

(Clinical Relevance: Paralysis of the Diaphragm)

How can a lesion to the phrenic nerve occur?

A
  • MECHANICAL TRAUMA
  • COMPRESSION
  • MYOPATHIES
  • NEUROPATHIES
64
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What kind of mechanical trauma can occur to damage the phrenic nerve?

A

Ligation or damage to the nerve during surgery.

65
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What sort of compression can occur to damage the phrenic nerve?

A

Due to a tumour within the chest cavity.

66
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What myopathies can occur to damage the phrenic nerve?

A

Such as myasthenia gravis

67
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What neuropathies can occur to damage the phrenic nerve?

A

Such diabetic neuropathy

68
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What does paralysis of the diaphragm do?

A

Produces a PARADOXICAL MOVEMENT

69
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is the paradoxical movement on paralysis of the diaphragm?

A

The affected side of the diaphragm moves upwards during inspiration, and downwards during expiration.

70
Q

(Clinical Relevance: Paralysis of the Diaphragm)

How does the diaphragm move during paralysis?

A
  • Upwards during inspiration

- Downwards during expiration

71
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What occurs in a unilateral diaphragmatic paralysis?

A

It is usually asymptomatic.

72
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What sort of diaphragmatic paralysis is asymptomatic?

A

Unilateral diaphragmatic paralysis

73
Q

(Clinical Relevance: Paralysis of the Diaphragm)

How is unilateral diaphragmatic paralysis usually diagnosed?

A

It is most often an incidental finding on x-ray.

74
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What symptoms will the patience experience if both sides of the diaphragm are paralysed?

A

The patient may experience

  • poor exercise tolerance
  • orthopnoea (SOB when lying flat)
  • fatigue
75
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What will lung function tests show?

A

A RESTRICTIVE DEFICIT

76
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is the treatment for diaphragmatic paralysis?

A

Management is two-fold:

1) underlying cause must be identified and treated
2) symptomatic relief

77
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is the first thing you do to treat diaphragmatic paralysis?

A

Firstly, the underlying cause must be identified and treated.

78
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is the second thing you do to treat diaphragmatic paralysis?

A

The second part of treatment deals with symptomatic relief.

79
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What sort of symptomatic relief is provided for diaphragmatic paralysis?

A

This is usually via non-invasive ventilation, such as a CPAP (continuous positive airway pressure) machine.

80
Q

(Clinical Relevance: Paralysis of the Diaphragm)

Give an example of non-invasive ventilation.

A

CPAP (continuous positive airway pressure) machine.

81
Q

(Clinical Relevance: Paralysis of the Diaphragm)

What is a CPAP machine?

A

CPAP = continuous positive airway pressure

A type of non-invasive ventilation.

82
Q

Fig. 1

Label and caption the image

A
  • Right Dome
  • Left Dome
  • Right crus
  • Left crus

The diaphragm is split into two lobes, left and right. Note the vertebral attachments of the diaphragm are the left and right crura.

(Note: Right dome at 4th rib, left dome at 5th ICS
Right crus from L1-L3 & intervertebral discs, left crus from L1-L2 & intervertebral discs)

83
Q

Fig. 2

Label and caption the image

A
  • Sternal attachment
  • Central tendon
  • Caval hiatus
  • Oesophageal hiatus
  • Aortic hiatus
  • Vertebral attachment

View of the inferior surface of the diaphragm. Note the three openings.

(Caval T8; Oesophageal T10; Aortic T12)

84
Q

Fig. 3

Label and caption the image

A
  • Pericardium
  • Left phrenic nerve
  • Right dome of the diaphragm

The anatomical course of the phrenic nerves, which innervate the diaphragm

85
Q

Fig. 4

Caption the image

A

Chest x-ray, showing paralysis of the right hemidiaphragm.

86
Q

Which structure does the central tendon of the diaphragm fuse with?

A. Pericardium
B. Greater omentum
C. Intercostal muscles
D. Ribs 7-12

A

A. Pericardium

The central tendon fuses with the fibrous pericardium

87
Q

At what vertebral level is the oesophageal hiatus situated?

A. T8
B. T10
C. T12
D. L2

A

B. T10

Correct - the oesophageal hiatus is situated at T10.

88
Q

What is the innervation of the diaphragm?

A. Intercostal nerves
B. Vagus nerves
C. Phrenic nerves
D. Thoracodorsal nerve

A

C. Phrenic nerves

The right and left phrenic nerves each innervate one half of the diaphragm.

ESA 3 - Respiratory (28 decks)

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