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Diaphragm
Diaphragm
• Separates
– Thoracic & abdominal
cavity
• Principle muscle of
respiration
– Peripheral muscular part
– Central fibrous part
• Central tendon
Diaphragm
Thorax
Abdomen
Surfaces & parts
• Superior
– Features
• Dome or Cupola
– Projection on either side
• Central tendon
– Depression in centre
– Relations
• Rt. & Lt. Pleura & fibrous pericardium
• Inferior
– Lined by peritoneum
– Rt. Side
• Liver, kidney, suprarenal gland
– Lt. side
• Liver, fundus, spleen, kidney, suprarenal gland
1)Sternal part
“post. Xiphiod process”
2) Costal part lower 6 rips
3)Vertebral part
2 crura and ligaments
Has 3 origin:
Sternal part
• Arises by 2 fleshy slips
– From back of the
xiphoid process
Costal part
• 6 muscular slips on each
Side
– From
• Inner surfaces of
– Lower 6 cartilages &
adjacent parts of ribs
Vertebral part
• Arises by
– 2 crura
– 5 arcuate ligaments
Crura
• Right & Left crus
– Right crus
• Right side of anterior
aspect of upper 3 lumbar
– Left crus
• Left side of anterior
aspect of upper 2 lumbar
vertebrae
1
2
3
Right crus
1st 3 lumbar
Left crus
1st 3 lumbar
Arcuate ligaments
• Median arcuate ligament
– Tendinous ligament
– Between upper ends of
two crura
– At T-12 level
Arcuate ligaments
• Medial arcuate ligament
– Thickened upper psoas
fascia
– Extends
• From
– Side of body of L2
vertebra
• To
– Tip of transverse
process of L1
2
1
Medial arcuate ligament
L2 to TP of L1
Arcuate ligaments
• Lateral arcuate ligament
– Thickened upper margin of
fascia
• Covers Quadratus
lumborum muscle (anterior
layer of thoracolumbar
fascia)
• Extends
– From
• Tip of transverse process of
L1
– To
• 12th rib
2
1
Lateral arcuate ligament
L1 to TP 12th rib
Insertion
• Central tendon
– Muscle fibres converge from
circumferential origin
• Features of central tendon
– Trifoliate in shape
• An anterior
• Two tongue shaped posterior
– Fused with fibrous
pericardium
Nearer to sternum than vertebral
column
central tendon
Openings in diaphragm
• 2 types
– Major
– Minor
Major openings
• Aortic
• Oesophageal
• Venacaval
Location of the 3
main Openings
Aortic opening
• Osseo aponeurotic
• Lies behind diaphragm (median
arcuate ligament)
• Features
– Level - T 12
– Shape – round
– Boundaries
• Front – median arcuate ligament
• Behind – body of 12th thoracic
vertebra
• On sides – crus
– Structures passing
• Aorta
• Thoracic duct
• Azygos vein
Oesophageal opening
• Lies in muscular part
• Fibres from right crus
encircle it
• Level - T10
• Shape – Elliptical
• Structures passing
– Oesophagus
– Gastric or Vagus nerves
– Oesophageal branches of left
gastric artery
– Phreno- oesophageal ligament
– Lymphatics from liver
Venacaval opening
• Situation - central tendon
of diaphragm
• Level – T 8
• Shape - Quadrilateral
• Structures passing
– Inferior vena cava
– Right phrenic nerve
– Few lymph vessels from
liver
Minor openings
• 8 openings
– Behind
• Medial arcuate ligament
• Lateral arcuate ligament
– Piercing crura
• Right & left crus
– Between origins of
• Sternal & costal
• Costal & transverse
abdominis
• Costal orgins
Space of Larry
• Gap between
– Muscular slips from
• Xiphoid process & 7th costal
cartilage
• Structure passing
– Superior epigastric vessels
Other structures
• Musculophrenic
– Between 7th & 8th ribs
• Lower 5 intercostal nerves
and vessels
– Between adjacent costal slips
(7th to 11th )
• Subcostal
– Deep to lateral arcuate
• Sympathetic
– Deep to medial arcuate
• Greter, lesser and least
splanchnic
– Piercing crus
Nerve supply
 Motor
 Phrenic nerve (C3-5)
 Sensory
 Central part
 Phrenic nerve
 Peripheral part
 Lower 6 intercostal nerves
Arterial supply
• Superior phrenic
– Throcic aorta
• Inferior phrenic
– Abdominal aorta
• Pericardiophrenic
– Internal thoracic
• Musculo phrenic
– Internal thoracic
• Superior epigastric
– Internal thoracic
• Lower five intercostal
– Throcic aorta
• Subcostal
– Throcic aorta
Development
• Develops from 4 sources
• Septum transversum
• Pleuroperitoneal
membrane
• Medial dorsal portion of
primary oesophageal
mesentry
• Marginal ingrowths of the
body wall
Applied anatomy
• Hiccups
– Due to involuntary
spasmodic contraction
– Accompanied by closure
of glottis
• Hernia
– Hiatal hernia
• Sliding hernia
– Cardiooesophageal
junction & cardiac end of
stomach pass into
posterior mediastinum
Suprarenal glands
• Ductless gland
• Yellowish retroperitoneal
organ
• Located at upper poles of
each kidney
– At the level of T12
• Component of hypothalamic-
pituitary-suprarenal axis
– Responsible for coordinating
stress response and metabolism
Right suprarenal gland - Features
• Pyramid( )shaped
• Caps the upper pole of right kidney
• Apex
• Base
• 3 borders
– Anterior
• Has hilum for suprarenal vein
– Medial
– Lateral
• 3 surfaces
– Anteromedial
– Anterolateral
– Posterior
• Relations
– Anterior
• Right lobe of liver and inferior vena cava
– Posterior
• Diaphragm
Left suprarenal gland - Features
• Crescentic in shape
• Extends along the
medial border of
left kidney
– From upper pole
to hilus
• 2 poles
– Upper & lower
• 2 borders
– Medial & lateral
• 2 surfaces
– Anterior
• Hilum for
suprarenal vein
– Posterior
• Relations
– Anterior
• Pancreas, lesser sac and stomach
– Posterior
• Diaphragm
Left suprarenal gland
Arterial supply
• Each gland is supplied by
– 3 arteries from
– 3 distinct sources
• Superior suprarenal artery
– A branch of inferior phrenic
artery
• Middle suprarenal artery
– A branch of the abdominal aorta
• Inferior suprarenal artery
– A branch of the renal artery
Venous drainage
• Each gland is emptied
only by just one vein
– Which comes from the
hilus of the gland
• Right suprarenal vein
empties into
– Inferior vena cava
• Left suprarenal vein
empties into
– Left renal vein
Sheath
• Encircled by 2 sheaths
– Immediate covering of loose
areolar tissue consisting of a
large amount of perirenal fat
– Outer to this renal fascia
encloses the suprarenal gland
along with the kidney but the
gland is divided from the
kidney by a septum
Development
• Cortex
– From coelomic epithelium
(mesothelium) derived from
mesoderm
• Medulla
– From Neural crest cells
Mechanism of
respiration
• Increase in
– vertical diameter by
diaphragmatic contraction
– Anteroposterior diameter
by pump handle movement
of sternum
– Transverse diameter by
bucket handle movements
of lower ribs

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diaphragm.pptx

  • 2. Diaphragm • Separates – Thoracic & abdominal cavity • Principle muscle of respiration – Peripheral muscular part – Central fibrous part • Central tendon Diaphragm Thorax Abdomen
  • 3. Surfaces & parts • Superior – Features • Dome or Cupola – Projection on either side • Central tendon – Depression in centre – Relations • Rt. & Lt. Pleura & fibrous pericardium • Inferior – Lined by peritoneum – Rt. Side • Liver, kidney, suprarenal gland – Lt. side • Liver, fundus, spleen, kidney, suprarenal gland
  • 4. 1)Sternal part “post. Xiphiod process” 2) Costal part lower 6 rips 3)Vertebral part 2 crura and ligaments Has 3 origin:
  • 5. Sternal part • Arises by 2 fleshy slips – From back of the xiphoid process
  • 6. Costal part • 6 muscular slips on each Side – From • Inner surfaces of – Lower 6 cartilages & adjacent parts of ribs
  • 7. Vertebral part • Arises by – 2 crura – 5 arcuate ligaments
  • 8. Crura • Right & Left crus – Right crus • Right side of anterior aspect of upper 3 lumbar – Left crus • Left side of anterior aspect of upper 2 lumbar vertebrae 1 2 3 Right crus 1st 3 lumbar Left crus 1st 3 lumbar
  • 9. Arcuate ligaments • Median arcuate ligament – Tendinous ligament – Between upper ends of two crura – At T-12 level
  • 10. Arcuate ligaments • Medial arcuate ligament – Thickened upper psoas fascia – Extends • From – Side of body of L2 vertebra • To – Tip of transverse process of L1 2 1 Medial arcuate ligament L2 to TP of L1
  • 11. Arcuate ligaments • Lateral arcuate ligament – Thickened upper margin of fascia • Covers Quadratus lumborum muscle (anterior layer of thoracolumbar fascia) • Extends – From • Tip of transverse process of L1 – To • 12th rib 2 1 Lateral arcuate ligament L1 to TP 12th rib
  • 12. Insertion • Central tendon – Muscle fibres converge from circumferential origin • Features of central tendon – Trifoliate in shape • An anterior • Two tongue shaped posterior – Fused with fibrous pericardium Nearer to sternum than vertebral column central tendon
  • 13. Openings in diaphragm • 2 types – Major – Minor
  • 14. Major openings • Aortic • Oesophageal • Venacaval
  • 15. Location of the 3 main Openings
  • 16. Aortic opening • Osseo aponeurotic • Lies behind diaphragm (median arcuate ligament) • Features – Level - T 12 – Shape – round – Boundaries • Front – median arcuate ligament • Behind – body of 12th thoracic vertebra • On sides – crus – Structures passing • Aorta • Thoracic duct • Azygos vein
  • 17. Oesophageal opening • Lies in muscular part • Fibres from right crus encircle it • Level - T10 • Shape – Elliptical • Structures passing – Oesophagus – Gastric or Vagus nerves – Oesophageal branches of left gastric artery – Phreno- oesophageal ligament – Lymphatics from liver
  • 18. Venacaval opening • Situation - central tendon of diaphragm • Level – T 8 • Shape - Quadrilateral • Structures passing – Inferior vena cava – Right phrenic nerve – Few lymph vessels from liver
  • 19. Minor openings • 8 openings – Behind • Medial arcuate ligament • Lateral arcuate ligament – Piercing crura • Right & left crus – Between origins of • Sternal & costal • Costal & transverse abdominis • Costal orgins
  • 20. Space of Larry • Gap between – Muscular slips from • Xiphoid process & 7th costal cartilage • Structure passing – Superior epigastric vessels
  • 21. Other structures • Musculophrenic – Between 7th & 8th ribs • Lower 5 intercostal nerves and vessels – Between adjacent costal slips (7th to 11th ) • Subcostal – Deep to lateral arcuate • Sympathetic – Deep to medial arcuate • Greter, lesser and least splanchnic – Piercing crus
  • 22. Nerve supply  Motor  Phrenic nerve (C3-5)  Sensory  Central part  Phrenic nerve  Peripheral part  Lower 6 intercostal nerves
  • 23.
  • 24. Arterial supply • Superior phrenic – Throcic aorta • Inferior phrenic – Abdominal aorta • Pericardiophrenic – Internal thoracic • Musculo phrenic – Internal thoracic • Superior epigastric – Internal thoracic • Lower five intercostal – Throcic aorta • Subcostal – Throcic aorta
  • 25. Development • Develops from 4 sources • Septum transversum • Pleuroperitoneal membrane • Medial dorsal portion of primary oesophageal mesentry • Marginal ingrowths of the body wall
  • 26. Applied anatomy • Hiccups – Due to involuntary spasmodic contraction – Accompanied by closure of glottis • Hernia – Hiatal hernia • Sliding hernia – Cardiooesophageal junction & cardiac end of stomach pass into posterior mediastinum
  • 27. Suprarenal glands • Ductless gland • Yellowish retroperitoneal organ • Located at upper poles of each kidney – At the level of T12 • Component of hypothalamic- pituitary-suprarenal axis – Responsible for coordinating stress response and metabolism
  • 28. Right suprarenal gland - Features • Pyramid( )shaped • Caps the upper pole of right kidney • Apex • Base • 3 borders – Anterior • Has hilum for suprarenal vein – Medial – Lateral • 3 surfaces – Anteromedial – Anterolateral – Posterior
  • 29. • Relations – Anterior • Right lobe of liver and inferior vena cava – Posterior • Diaphragm
  • 30. Left suprarenal gland - Features • Crescentic in shape • Extends along the medial border of left kidney – From upper pole to hilus • 2 poles – Upper & lower • 2 borders – Medial & lateral • 2 surfaces – Anterior • Hilum for suprarenal vein – Posterior
  • 31. • Relations – Anterior • Pancreas, lesser sac and stomach – Posterior • Diaphragm Left suprarenal gland
  • 32. Arterial supply • Each gland is supplied by – 3 arteries from – 3 distinct sources • Superior suprarenal artery – A branch of inferior phrenic artery • Middle suprarenal artery – A branch of the abdominal aorta • Inferior suprarenal artery – A branch of the renal artery
  • 33. Venous drainage • Each gland is emptied only by just one vein – Which comes from the hilus of the gland • Right suprarenal vein empties into – Inferior vena cava • Left suprarenal vein empties into – Left renal vein
  • 34. Sheath • Encircled by 2 sheaths – Immediate covering of loose areolar tissue consisting of a large amount of perirenal fat – Outer to this renal fascia encloses the suprarenal gland along with the kidney but the gland is divided from the kidney by a septum
  • 35. Development • Cortex – From coelomic epithelium (mesothelium) derived from mesoderm • Medulla – From Neural crest cells
  • 36. Mechanism of respiration • Increase in – vertical diameter by diaphragmatic contraction – Anteroposterior diameter by pump handle movement of sternum – Transverse diameter by bucket handle movements of lower ribs