Diaphragm (Thoraco Abdominal)

DIAPHRAGPL (THORACO - ABDOMINAL)INTRODUCTIONThe thoraric outlet is closed by a large dome-shaped flatfrom abdominal cavity. it is also termed thoraco- abdominalmuscle called diaphragm. Since it separate thoracic cavitydiaphragmIt is the principal muscle of respiration It isand central fibrous part called. central tendon.dome shaped and consists of peripheral muscular part,DIMNERARYORIGINThe origin of the diaphragm is devided into 3 parts, ,viz(1) STERNAL (2) COSTAL3 VERTIBRALSTERNAL PART:- posterior Consists surface of 2 Heshy of the Slips Xiphoid which process. arise from theCOSTAL PARTI- arise On each from side, it consists of Six fleshy slips, whichnear their cartilages.costal the inner surface of lower Six ribsVERTEBRAL PART :-This pant arises by means ofDIPANKAR RAYCRURA(a) Rt and Lt Crira of diaphragm (b) Five arcuate ligamentsfrom the Right Crus:- of - It is a vertical fleshy bundle, which arisesvertebrae right and side anterior aspears of the upper 3 lumberintervening intervertebral discsLeft Crus :- It Left is side vertical of freshy bundle, which arises fromvertebrae and intervening anterior intervemebral aspects discs. of the upper 2 lumber theARCUATE LIGAMENTS:- Median Arcuare ligament:- Arched fibrousband Strenching between upper ends of 2 eruraMedial Arcuate ligament - Thickened upper margin of the psoas sheath.Lateral Extends from side of body of L2 Vert. to tip of L Vert (Transverse process)Arcuate ligament:- Thickened upper margin of fasciaExiends from the tip of transverse process of 4, vert. to 12 th Rib .covering the anterior surface of the guadratus lumborum. DIAPHRAGM (THORACO-ABDOMINAL) -INSERTIONFrom circum ferential origin the muscle fibresconverge towards the central tendon andinsert into its margins.The features of central tendon are as follows.-1Located nearer to the Stemum than to the ventebral column.2Trifoliate C Two in shape, having a An America (Central) leafletb and- tongue-shaped posterior leaflets. It resem blesRt posterior leaflet is short and Stout.an equllateral triangle.RAYIt posterior leaflet is thin and long.3It is inseparably fused with the fibrous pericandium.DIAPHRAGM (THORACO- ABDOMINAL)SURFACES AND RELATIONSSUPERIOR SURFACE :- Projects on either side as dome or capolainto the thoracic cavity .Depressed area between the 2 dones is called Central Tendon.Superior surface is covered by endothoracic fassia and isrelaved to the bases of right and left pleura on theSides and to the fibrous pericardium in the middleINFERIOR SURFACE: This surface of diaphragm is linedRAYby the diaphragmatic fasia andparieral pericardiumDIPANKAR RAYON THE RIGHT SIDE :-It is related to(1) Right lobe of Liver (2) Right kidney(3) Right Supravenal gland.ON THE LEFT SIDE:- It is rebied to(1) Left lobe of Liver (2) Fundus of Stomach(3) Spicen (4) Left Kidney (5) Left Suprarenal gland. DIAPHRGM (ABDOMINAL-THORACO)OPENINGS IN DIAPHRAGMLARGE OR MAIN OPENINGS(1) AORTIE OPENING:- (i) Circular or Round shaped.(ii) It is osseoponeurotic(iii) Sizuated in the midline behind the median concuare ligament.(iv) Lies at lower border of T12 vertebrare. DIPANKARRAY(v) It transmits - (a) Aorza (b) Thoracic duct (c) Azygous vein(2) OESOPHAGEAL OPENING:- (i) Oval or Eliptical.(ii) Situated slightly to the left of median plane (The fibres ofright cruss split around the opening and act like pincle cock)[iii] Lies at the level of T10 vertebra.(iv) It transmits 1(a) Desophagus (b) Gastric or Vagus NervesDRANDAR RAYOesophageal branches of Left gastric artery withSome oelophageal veins that accompany the arteries(3) VENA CAVAL OPENING:- is Quadrangular or Square shaped(ii) Situated in the between central tendon slightly to the right of(iii) Lies at the level of Tg verlebra.median plane the central and right posterior leaflets.(iv) It transmits - (a) Inferior vena Cava (b) Lymphatics of liver.(c) Branches of the right phrenic nerve. DIAPHRAGM (THORACO- ABDOMINAL)SMALL OR MINOR OPENINGSStructures passing through these openings are as follows- -(1) GREATER, LESSER and LEAST Splanchhic Nerves:- Passby piercing the crus of diaphragm on the corresponding side(2) HEMIAZYGOS VEIN:- - Pierces the left Crus of. the diaphragm.(3) SYMPATHETIC CHAIN: - Passes from the thorax to theabdomen behind the medial ancuateligament or medial lumbocostal arch.(4) SUBCOSTAL NERVES & VESSELS :- Pass behind the lateralancuate ligament or lateral lumbucostal arch. DIPANKAR RAY(5) SUPERIOR EPIGASTRIC VESELS & SOME LYMPHATICS:-Passbetween the origins of the diaphragm fromDIAAMORthe xiphuid This process is and the 7th costal cartilageRAY gap known as Larry's Space or Foramen of Morgagni(6) MUSCULOPHRENIC VESSELS :- Pience the diaphragm at thelevel of 9th costal Cartilage(7) LOWER AVE INTERCOSTAL NERVES & VESSELS (ie 7th-11th)Pass through the interdigital slips of the diaphragm andtransversous abdominis musele. DIAPHRAGPLABDOMINALNERVE SUPPLYThe diaphragm is supplied by-(1) Right and Left Phrenic nerves.(2) Lower five intercostal and subcostal nerves.RIGHT PHRENIC NERVE:- Both moter and sensory.Provides motor innervation to Rt half of the diaphragm up tothe right margin of oesophageal opening.Provides sensory and innervation to central tindon of the diaphragm.and pleura peritoneum related to it DIPANKARRAYLEFT PHRENIC NERVE - Both motor and sensory.Provides motor innervation to left half of the diaphragmup to the left margin of oesophageal opening.Provides sensory innervation to central tendon of diaphragm,and pleura and peritoreum related. to it.INTERCOSTAL NERVES :- The nerves supply the peripheral parts ofdiaphragm.ARTERIAL SUPPLYarteries.The diaphragm is supplied by the following1.) SUPERIOR PHRENIC ARTERIES:- From Thorasic aorta.(Also called - phrenic ameries)2) INFERIOR PHRENIC ARTERIES :- From Abdominal aorta.3) PERICARDIO PHENIC ARTERIES:- From Inumal Thoracic arteries.4) MUSCULOPHRENIC ARTERIES:-Terminal branches ofInternal Thoracic arteries.5) SUPERIOR EPIGASTRIC ARTERIES:- Terminal branches ofDIPANRAR RAYInternal Thoracic arteries.6) LOWER FIVE INTERCOSTAL AND:- From the Aorta.SUBCOSTAL ARTENES DIAPHRAGM (ABDOMINALLYMPHATIC DRAINAGEThe lymph from diaphragm is drainedinto the following groups of lymph Nodes:-1ANTERIOR DIAPHRAGMATIC LYMPH NODES :- Behind-Xiphoid Process(2) POSTERIOR DIAPHRAGMATIC LYMPH N.:- Near 1 Aortic Orifice.3Right lateral DIAPHRAGMATE NODES:- Near- Caval opening(4) Left LATERAL DIAPHRAGMATIC NODES:- Near- Oerophageal Opening.DIADHRAGM : ACTIONDIPANIAAR RAY.The diaphragm acts to subsenve the following functions 1(1) MUSCLE OF INSPIRATION:- Main/principal musele of respirationWhen it contracts - descends and increases the vertical diameterof the thoracic cavity(2) MUSCLE OF ABDOMINAL of STAINING:- Contraction of diaphragm alongwith contraction muscles of anterior abdominal wall raisesthe intra-abdominal pressure to evacuate pelvic contents(9) (voluntary MUSCLE OF expulsive WEIGHT efforts, eg-micturation, defecation, vomiting. parturition)an glottis possible to raise the intraabdominal pressure to suchthe if LIFTING:- By taking deep breath and closingprevent its flexion. This assists the postvenebral muscles inextent that it will help support the venebral column. andlifting the heavy weights.DIPANKAR RAY.(4) THORACO- MUSCULAR PUMP:- Descent of diaphragm decreases theintrathoraric pressure and at the same time increases theintra-abdominal pressure.6This pressure change compreses the inferior vena-cara and(5) SPHINCTER OF OPSOPHAGUS:-consequently its blood is formed upward into the right atrium.The control fibres over of the the right Crus of diaphrogm Subserve a sphinctericoesophageal opening.