By-

Dr. Praveen Kumar Banjare

Final yr PG (MD Anatomy)

Pt.JNM Medical College Raipur(C.G.)

Contents1. Introduction

2. Origin

3. Insertion

4. Nerve supply

5. Bloodsupply

6. Actions

7. Positions of Diaphragm

8. Relations of Diaphragm

9. Openings of Diaphragm 10. Development of Diaphragm

11. Applied

Introduction

•Greek, from dia 'through, apart' + phragma 'a fence'.

•Fibro-muscular sheet

•Separates the thoracic cavity from the abdominal cavity

• Performs an important function in respiration.

Origin

3 parts:-

1. Sternal

2. Costal

3. lumbar

Insertion

Central tendon of diaphragm

Central tendon :

trilobar in shape

3 leaflets (middle, right & left)

Direction of muscle fibres

Upwards & inwards

Right and left dome

Nerve Supply

Motor – Phrenic nerve(C3,4,5)

Sensory –1.central part- phrenic nerve

2.peripheral part- lower six thoracic nerve

Blood Supply

1. Musculophrenic artery

2. Superior phrenic arteries

3. Lower 5 intercostal arteries + subcostal artey

4. Inferior phrenic artery

Actions

1. Principal muscle of Inspiration.

2. Helps in expulsive acts-

sneezing, coughing, laughing, crying, vomiting

micturition, defaecation or parturation.

3. May have sphincteric action on the lower oesophagus.

Position of Diaphragm

3 Factors :-

1.The elastic recoil of Lung

2.The pressure exerted by abdominal viscera

3.The muscles of abdominal wall

Highest- in supine position

Lowest- in sitting

Intermediate- in standing

Relations

Superiorly-pleuraepericardium

Inferiorly -peritoneumliverfundus of stomachspleenkidneyssuprarenal

Openings

Caval opening

Oesophageal opening

Aortic opening

Major openings

Minor openings

2 aperture in right crus

3 lesser aperture in left crus

under the medial lumbocostal arches

under the lateral lumbocostal arches

foramina of Morgagni

Development

The Diaphragm 'develops from the following sources.

1. Septum transversum

2. Pleuroperitoneal membranes

3. Lateral thoracic wall

4. Dorsal mesentery of oesophagus

Applied Anatomy

1. Hiccough- a)peripheral

b)central

2. Shoulder tip pain

3. Unilateral paralysis of Diaphragm

4. Eventration

5. Diaphragmatic hernia – a) Congenital

b) Acquired

Congenital Hernia

a) Morgagni hernia or Retrosternal herniab) Bochdalek hernia or Posterolateralc) Central hernia

e) Congenital hiatal hernia

d) Posterior hernia

Bochdalek hernia

Acquired Hernia

a) Traumatic hernia

b) Acquired hiatal hernia