DIAPHRAGM & MECHANICS OF BREATHING

DR. BORHANUDDIN AHMAD

OBJECTIVES
At the end of this session, you should be able to
describe the location and shape of the diaphragm describe the attachments of the diaphragm explain the functions of the diaphragm correlate your knowledge of the diaphragm with certain clinical conditions Understand the different weak points in the diaphragm

Diaphragm
It is a musculo fibrous septum between the thoracic and abdominal cavity. It has two dome or cupola or horns and a central tendon. Peripherally it is muscular and centrally it is tendinous. It is attached to the pericardum as both of them develop from the septum transversum.

Right Dome
Above, it is covered by diaphragmatic pleura which separate it from the base of the right lung. Below it is lined by parietal peritoneum which separates it from the right lobe of the liver supra renal gland and the right kidney.

Left Dome
Above it is covered by the left part of diaphragmatic pleura, which separate it from the base of left lung Below it is lined by parietal peritoneum, which separates it from the fundus of the stomach, oseophagus, spleen, left supra renal and left kidney.

Level of the diaphragm

In full expiration
The right dome lies against the 4th I.C. space The left dome lies against the 5th rib The central tendon is at the level of the 6th costal cartilage

Attachment of the diaphragm

3 origins
Sternal by 2 slips from the back of the xiphi sternum. Costal by 6 slips from the inner surface of lower six ribs and cartilages. Lumbar by a) 2 crura, right and left b) 2 arcuate ligament medial & lateral c) median arcuate ligament Insertion Central tendon Central tendon looks like a trefoil leaf lies under the heart and pericardium.

Openings of the diaphragm

3 openings
From above down
Vena caval at the level of T8 (lower border) Oesophageal at the level of T10 Aortic at the level of T12

Nature of the opening

Vena caval Tendinous Oesophageal Muscular Aortic - Osseoaponeurotic

Structures passing through the opening

3 Structures in each opening
Vena caval Inferior vena cava, right phrenic nerve and some lymaphatics. Oesophageal Oesophagus, vagus nerve, short gastric vessels. Aortic Aorta, Azygos vein, thoracic duct.

Blood supply
Arterial supply Superior surface of the diaphragm:
pericardiacophrenic & musculophrenic arteries superior phrenic arteries

Inferior surface of the diaphragm:

inferior phrenic arteries

Innervation
Motor - phrenic nerves (C3, 4, 5) Sensory - phrenic nerves - lower 6 thoracic nerves

Actions
Principal muscle of respiration All expulsive acts, such as coughing, laughing, shouting, defecation and parturition, etc. Sphincter for the lower end of oesophagus

Applied anatomy
Hiccough - spasmodic contraction of the diaphragm Shoulder tip pain - referred pain Unilateral paralysis of diaphragm - lesion of the phrenic nerve Diaphragmatic hernia - congenital or acquired