Dr.

Masong, BS-Bio|1

DIAPHRAGM 2. Costal part:: consisting of wide muscular slips that

attach to the internal surfaces of the inferior six
 a double-domed,
domed, musculotendinous partition separating the
costal cartilages and their adjoining ribs on each
thoracic and abdominal cavities
side; the costal parts form the right and left domes.
 convex superior surface faces the thoracic cavity,, and its
3. Lumbar part:: arising from two aponeurotic arches,
concave inferior surface faces the abdominal cavity
the medial and lateral arcuate ligaments, and the
 is the chief muscle of inspiration (actually, of respiration
three superior lumbar vertebrae; the lumbar part
altogether, because expiration is largely passive)
forms
rms right and left muscular crura that ascend to
 descends during inspiration; however, only its central part
the central tendon
moves
 The pericardium, containing the heart, lies on the central
 Crura of the diaphragm are musculotendinous bands that
part of the diaphragm, depressing it slightly
arise from the anterior surfaces of the bodies of the superior
 The diaphragm curves superiorly into right and left domes;
domes
three lumbar vertebrae, the anterior longitudinal ligament,
normally the right dome is higher than the left dome owing
and the IV discs
to the presence of the liver
 right crus,, larger and longer than the left crus, arises
 During expiration, the right dome reaches as high as the 5th VESSELS and NERVES of the DIAPHRAGM
from the fi rst three or four lumbar vertebrae
rib and the left dome ascends to the 5th intercostal space.
space
 left crus arises from the fi rst two or three lumbar
vertebrae  The arteries of the diaphragm form a branchbranch-like pattern on
The level of the domes of the diaphragm varies according to the:
 the esophageal hiatus is a formation of the right crus both its superior (thoracic) and inferior (abdominal) surfaces
1. Phase of respiration (inspiration or expiration)
(eventhough it lies on the left midline) because if the  arteries supplying the superior surface of the diaphragm
diaphragm:
2. Posture (e.g., supine or standing).
fibers are traced inferiorly, it pass to the right side of the 1) pericardiacophrenic
3. Size and degree of distension of the abdominal viscera aortic hiatus 2) musculophrenic arterie
 The right and left crura and the fibrous brous median arcuate 3) superior phrenic arteries
 muscular part of the diaphragm is situated peripherally with ligament, which unites them as it arches over the  arteries supplying the inferior surface of the diaphragm
diaphragm:
fibers that converge radially on the trifoliate central anterior aspect of the aorta, form the aortic hiatus 1) inferior phrenic arteries (1st branch of the abdominal aorta)
aponeurotic part, the central tendon  The diaphragm is also attached on each side to the medial  veins draining the superior surface of the diaphragm
diaphragm:
 It has no bony attachments and is incompletely divided and lateral arcuate ligaments 1. pericardiacophrenic
into three leaves, resembling a wide cloverleaf  medial arcuate ligament is a thickening of the fascia 2. musculophrenic veins
 is closer to the anterior part of the thorax covering the psoas major, spanning between the th lumbar  which empty into the internal thoracic veins and, on the
 The caval opening (vena caval foramen),, through which vertebral bodies and the tip of the transverse process of right side, a superior phrenic vein,, which drains into the
the terminal part of the IVC passes to enter the heart,
L1 IVC
perforates the central tendon
 lateral arcuate ligament covers the quadratus lumborum  veins from the posterior curvature of the diaphragm drains
 The continuous sheet that the muscular part of the
muscles, continuing from the L12 transverse process to into the:
diaphragm forms is divided into three:
the tip of the 12th rib 1. azygos
1. Sternal part:: consisting of two muscular slips that
 The superior aspect of the central tendon of the diaphragm is 2. hemi-azygos veins
attach to the posterior aspect of the xiphoid process;
fused with the inferior surface of the fibrous pericardium
this part is not always present.

 veins draining the inferior surface of the diaphragm:
1. inferior phrenic veins
 right inferior phrenic vein opens into the IVC
 left inferior phrenic vein is usually double:
 one branch passing anterior to the esophageal
hiatus to end in the IVC
 the other, more posterior branch joining the left
suprarenal vein
 lymphatic plexuses on the superior and inferior surfaces of
the diaphragm communicate freely
 lymphatic nodes on the superior surface of thee diaphragm:
a) anterior
b) posterior diaphragmatic lymph nodes
 these nodes drains into the parasternal, posterior
mediastinal, and phrenic lymph nodes
 Lymphatic vessels from the inferior surface of the diaphragm
drain into the:
a) anterior diaphragmatic
b) phrenic
c) superior lumbar (caval/aortic) lymph node
 motor supply to the diaphragm is from:
a) right phrenic nerves
b) left phrenic nerves
 each of which arises from the anterior rami of C3–C5 C3
segments of the spinal cord and is distributed to the
ipsilateral half of the diaphragm from its inferior surface
 sensory supply to the diaphragm is from phrenic nerves
---- for pain and proprioception
DIAPHRAGMATIC APERTURES
 a.k.a OPENINGS or HIATUS
 permit structures (vessels, nerves, and lymphatics) to pass
between the thorax and abdomen
 There are three large apertures for the:
a) Inferior vena cava
b) Esophagus
c) Aorta
 CAVAL OPENING
 is an aperture in the central tendon primarily for the
IVC; most superior of the three.
 also passing through it are terminal branches of the
right phrenic nerve and a few lymphatic vessels on
their way from the liver to the middle phrenic and
mediastinal lymph nodes
 is located to the right of the median plane at the
junction of the central tendon’s right and middle
leaves
 lies at the level of the IV disc between the T8 and T9
vertebrae

The IVC is adherent to the margin of the
SMALL OPENINGS in the Diaphragm
opening;; when the diaphragm contracts
during inspiration it widens the opening and
an
dilates the IVC.
Dr. Masong, BS-Bio|2
 ESOPHAGEAL HIATUS
 is an oval opening for the esophagus in the muscle of
the right crus of the diaphragm at the level of the
T10 vertebra
 also transmits the anterior and posterior vagal
trunks, esophageal branches of the left gastric
vessels, and a few lymphatic vessels
 The esophageal hiatus is superior to and to the left
of the aortic hiatus
 In most individuals (70%), both margins of the hiatus
are formed by muscular bundles of the right crus. In
others (30%), a superfifi cial muscular bbundle from the
left crus contributes to the formation of the right
margin of the hiatus
 AORTIC HIATUS
 is the opening posterior in the diaphragm for the
descending aorta
 the aorta does not pierce the diaphragm, thus
contraction of the diaphragm does not affect the
blood flow through the aorta
 The aorta passes between the crura of the
diaphragm posterior to the median arcuate
ligament, which is at the level of the inferior border
of the T12 vertebra.
 The hiatus also lso transmits the thoracic duct and
sometimes the azygos and hemi--azygos veins.
 That is, the sternocostal triangle (foramen), between the
sternal and costal attachments of the diaphr
diaphragm
 transmits lymphatic vessels from the diaphragmatic
surface of the liver and the superior epigastric vessels
 Dr. Masong, BS-Bio|3

 There are two small apertures in each crus of the diaphragm: YOU CAN PUT YOUR SIDENOTES HERE :)
 one transmits the greater splanchnic nerve
 the other the lesser splanchnic nerve

ACTIONS OF DIAPHRAGM

 When the diaphragm contracts, its domes are pulled

inferiorly so that the convexity of the diaphragm is somewhat
flattened
 a.k.a the “descent of the diaphragm,” but only the domes of
the diaphragm descend
 As the diaphragm descends, it pushes the abdominal viscera
inferiorly ...
 This increases the volume of the thoracic cavity and
decreases the intrathoracic pressure, resulting in air
being taken into the lungs
 the volume of the abdominal cavity decreases slightly and
intra-abdominal pressure increases somewhat
 When the diaphragm contracts, compressing the abdominal
viscera, blood in the IVC is forced superiorly into the heart

 The diaphragm is at its most superior level when a person is

supine (with the upper body lowered, the Trendelenburg
position)
 the abdominal viscera push the diaphragm superiorly in
the thoracic cavity
 when a person lies on one side, the hemidiaphragm rises to a
more superior level because of the greater push of the viscera
on that side
 the diaphragm assumes an inferior level when a person is
sitting or standing
 For this reason, people with dyspn ea (diffi cult breathing)
prefer to sit up, not lie down; non-tidal (reserve) lung
volume is increased, and the diaphragm is working with
gravity rather than opposing it