Diaphragm
The diaphragm is a double doomed thin fibromuscular
and tendinous partition between thoracic and
abdominal cavities.
It is pierced by the structures that pass between the
thorax and abdomen. It is the chief muscle of
respiration, consists of a peripheral muscular part,
which arises from the margins of the thoracic
opening, and a centrally placed tendon.
The origin of the diaphragm can be divided into three
parts: a) Sternal b) Coastal c) Vertebral Origins
FEATURES
Has fibrous central tendon
Depressed in centre
Raised on right and left side as domes or cupola
Development Of
Diaphragm
It is produced when developing lungs & pleural cavities expand into the body wall
During 6th week, they fuse with dorsal mesentery of esophagus & septum
transversum, separating pleural cavities from peritoneal cavity
The diaphragm develops from:
1. Septum transversum: forms the central tendon
2. Dorsal mesentery of esophagus: forms the right & left crus
3. Muscular ingrowth from lateral body wall: posterolateral part (costal part)
4. Pleuroperitoneal membranes: small portion of diaphragm
Attachment
Origin :
• Sternal part – Inner surface of xiphoid
process
• Costal part – Lower 6 costal cartilages
Vertebral – By crura
• -right
• -left
Arcuate ligaments
• - Medial
• - Lateral
• - Median
Insertion:
Crura and Arcuate Ligaments
The right crus arises from the sides of
the bodies of the L 1-3 & IV discs; the
left crus arises from the sides of the
bodies of the L1-2 & IV disc.
Lateral to the crura the diaphragm
arises from the medial & lateral arcuate
ligament. The medial arcuate ligament
extends from the side of the body of
the second lumbar vertebra to the tip of
the transverse process of the first
lumbar vertebra.
Ligaments
• The lateral arcuate ligament extends from the tip of the
transverse process of the first lumbar vertebra to the lower
border of the 12th rib.
• The medial borders of the two crura are connected by a
median arcuate ligament which crosses over the anterior
surface of the aorta.
Openings in the Diaphragm
The diaphragm has three main openings:
The caval opening lies at the level of the T 8 vertebra in
the central tendon. Inferior vena cava & branches of
the right phrenic nerve.
The esophageal opening lies at the level of the T 10
vertebra in a sling of muscle fibers derived from the
right crus at the left of median plane.
Esophagus, the right and left vagus nerves, the
esophageal branches of the left gastric vessels, & the
lymph vessels.
The aortic opening lies anterior to the body of the T 12
vertebra between the crura.
Aorta, thoracic duct, & azygos vein.
Other Openings
Superior epigastric vessels – sternal and costal origin
Subcostal nerve & vessel – posterior to lateral arcuate lig
Sympathetic trunk - posterior to medial arcuate lig
Splanchnic nerves - pierce crura
Left phrenic n - pierce left dome
Relations
Superior- Lung & pleura on dome
Pericardium on central tendon
Inferior-lined by peritonium
Right – right lobe of liver, right kidney, right suprarenal glands
Left- fundus of stomach, spleen, left kidney,left suprarenal
Blood Supply
Pericardiophrenic
Musculophrenic
Inf phrenic
Action
Increases vertical diameter of thoracic cavity
Functions
Muscle of inspiration
Muscle of abdominal straining
Thoracoabdominal pump – forcing blood from IVC to rt. Atrium
Weight- lifting muscle
Diaphragm Innervation
Motor nerve supply:
The right and left phrenic
nerves(C3, 4, 5)
Sensory nerve supply:
The parietal pleura and peritoneum
covering the central surfaces of the
diaphragm are from the phrenic
nerve and the periphery of the
diaphragm is from the lower six
intercostal nerves.
Functions of the Diaphragm
Muscle of inspiration: On contraction the diaphragm pulls its central tendon down and increases
the vertical diameter of the thorax. The diaphragm is the most important muscle used in
inspiration.
Muscle of abdominal straining: The contraction of the diaphragm assists the contraction of the
muscles of the anterior abdominal wall in raising the intra-abdominal pressure for micturition,
defecation, and parturition.
Hiccup
Hiccup is the involuntary spasmodic contraction of the diaphragm accompanied by the
approximation of the vocal folds and closure of the glottis of the larynx.
It is a common condition in normal individuals and occurs after eating or drinking as a result of
gastric irritation of the vagus nerve endings. It may, however, be a symptom of disease such as
pleurisy, peritonitis, pericarditis, or uremia.
Functions
• Weight lifting muscle: In a person taking a deep breath and holding
it (fixing the diaphragm), the diaphragm assists the muscles of the
anterior abdominal wall in raising the intra-abdominal pressure.
Before doing this make sure that a person have adequate
sphincteric control of the bladder and anal canal under these
circumstances.
• Thoracoaabdominal pump: The descent of the diaphragm decreases
the intrathoracic pressure & increases the intra-abdominal pressure.
This compresses the blood in the inferior vena cava and forces it
upward into the right atrium of the heart. Within the abdominal
lymph vessels is also compressed, and its passage upward within the
thoracic duct is aided by the negative intrathoracic pressure. The
presence of valves within the thoracic duct prevents backflow.
CLINICAL APPLICATIONS
Diaphragmatic hernias
Acquired
Congenital
Due to defect in development
Bochdalek’s hernia – lumbocostal gap
Reterosternal hernia-through foamen of Morgagni
Clinical notes
• Paralysis of the Diaphragm
A single dome of the diaphragm may be paralyzed by crushing or
sectioning of the phrenic nerve in the neck. Occasionally, the
contribution from the fifth cervical spinal nerve joins the phrenic nerve
late as a branch from the nerve to the subclavius muscle this is known as
the accessory phrenic nerve. To obtain complete paralysis under these
circumstances, the nerve to the subclavius muscle must also be
sectioned.
• Penetrating Injuries of the Diaphragm
Any penetrating wound to the chest below the level of the nipples
should be suspected of causing damage to the diaphragm until proved
otherwise. The arching domes of the diaphragm can reach the level of
the fifth rib (the right dome can reach a higher level).
