ANATOMY

1. DIAPHRAGM
AKASH T [MSC.ANESTHESIA]

2. INTRODUCTION DIAPHRAM
• It’s a musculoaponeurotic [fibrous network] partition between thorax and
abdomen
• Its upper surface is convex on right and left side and depressed in the middle. The
right dome is slightly higher than left dur to presence of liver
• The muscle takes origin from the peripheral part and is inserted into a central
tendon

3. Origin
• STERNAL ORGIN ; by two fleshy slips from posterior aspect of xyphoid process
• COSTAL ORIGIN ; from the inner surface of the lower six ribs and adjoining costal
cartilages
• LUMBAR ORIGIN ; the lumbar origin is from the lumbar vertebrae and
lumbocostal ligaments . From the lumbar vertebrae bodies by a pair of crura[right
and left]

4. Central tendon of the
diaphragm
Xiphoid process
Costal cartilages

6. ORIGIN
• The right crus is longer and arises from anterolateral aspects of upper three lumbar vertebrae .
• The left curs arises from the corresponding parts of upper two lumbar vertebrae .
• Two crura are connected by a tendinous arch in front of the aorta is called median arcuate
ligament and lumbocostal ligament
• Ligaments which connects crura
• Medial lumbocostal ligament; it extends from side of body of L1 vertebra to its transverse
process . The tendinous arch is the thickening of the fascia covering the upper part of PSOAS
MAJOR MUSCLE
• Lateral lumbocostal ligament ; it extends from transverse process of l1 vertebra to lower border
of 12th rib . The tendinous arch is the thickening of the fascia covering the upper part of
QUADEATUS LUMBORUM MUSCLE

8. insertion
• All the fibers are inserted into the central tendon , which is situated in
the median depressed part close to the sternum

9. Openings of the diaphragm

10. Major openings
• Vena cava opening
• it is situated at the central tendon of the diaphragm at the level of T8 vertebra
• Structures passing through it ;
• Inferior vena cava from the abdomen enters the right atrium through it
• Right phrenic nerve
• When the diaphragm contracts in inspiration the vena caval opening dilates and
more blood enters the rt atrium

12. Major openings
• Esophageal opening
• its is situated in the muscular part of the diaphragm at the level of T10 vertebra
• Structures passing through it ;
• Esophagus
• Right and left vagus nerve
• Esophageal branch of the gastric artery
• When the diaphragm contracts this openings is constricted and prevents
regurgitation of food from the stomach to the esophagus

14. Major openings
• Aortic openings
• It is situated behind the diaphragm and in front of the body of 12th thoracic
vertebra
• Structures passing through it
• Abdominal aorta
• Thoracic duct
• Azygos vein

17. Minor openings

18. Minor openings
• Larrey’s space
• it is the gap between the xiphoid and costal origins of the diaphragm . Its
transmits superior epigastric vessels
• subcostal vessels and nerve passing deep to the lateral arcuate ligament
• Right sympathetic chain passing to the medial arcuate ligament
• left crus pierced by left greater and lesser splanchnic nerve

20. Nerve supply
• The motor nerve supply is from phrenic nerves c 3-4-5
• The proprioceptive sensation is carried by phrenic and lower intercostal nerve
functions of the diaphragm
• This muscle, also called the thoracic diaphragm , plays an important role in
breathing as its alternating movement helps you to inhale and exhale. Other
diaphragm functions include a role in urination and bowel movements, and
assisting the lymphatic system in maintaining lymph flow through the body

21. Action
• Muscle of inspiration when its contracts it descends so that the vertical diameter
of the thorax is increased
• On further contraction it descends further downwards and the transverse
diameter of the thorax is increased
• It will also increases the intra abdominal pressure

22. Applied anatomy
• Congenital diaphragmatic hernia (CDH) occurs when there is a hole in the
diaphragm, which is the thin sheet of muscle separating the chest from the
abdomen. When this gap forms during a fetus's development in the womb, the
bowel, stomach or even the liver can move into the chest cavity.

23. Applied anatomy
• hiatal hernia occurs when the upper part of your stomach bulges through your
diaphragm into your chest cavity. A hiatal hernia occurs when the upper part of
your stomach bulges through the large muscle separating your abdomen and
chest (diaphragm

24. THE END