ABDOMINAL VISCERAL

CONTD

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 DIAPHRAGM
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• The diaphragm is a thin musculotendinous structure
that fills the inferior thoracic aperture and separates
the thoracic cavity from the abdominal cavity.
• It is attached peripherally to:
o the xiphoid process of the sternum;
o the costal margin of the thoracic wall;
o the ends of ribs XI and XII;
o ligaments that span across structures of the posterior
abdominal wall; and
o vertebrae of the lumbar region.
• From these peripheral attachments, muscle fibers
converge to join the central tendon.
• The pericardium is attached to the middle part of the
central tendon.
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• Structures traveling between the thorax and abdomen pass
through the diaphragm or between the diaphragm and its
peripheral attachments:
 the inferior vena cava passes through the central tendon at
approximately vertebral level TVIII (8th thoracic vertebra);
 the esophagus passes through the muscular part of the
diaphragm, just to the left of midline, approximately at
vertebral level TX;
 the vagus nerves pass through the diaphragm with the
esophagus;
 the aorta passes behind the posterior attachment of the
diaphragm at vertebral level TXII;
 the thoracic duct passes behind the diaphragm with the
aorta;
 the azygos and hemiazygos veins may also pass through
the aortic hiatus or through the crura of the diaphragm.

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• Other structures outside the posterior
attachments of the diaphragm lateral to the
aortic hiatus include the sympathetic trunks
and the least splanchnic nerves.
• The greater and lesser splanchnic nerves
penetrate the crura.

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• The muscular fibres of diaphragm are arranged
in three parts.
1. A vertebral part from the crura and from the
arcuate ligaments.
• The right crus arises from the front of the
bodies of the upper three lumbar vertebrae
and intervertebral discs; the left crus is only
attached to the first two vertebrae.

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• The arcuate ligaments are a series of fibrous
arches, the medial being a thickening of the
fascia covering psoas major and the lateral of
fascia overlying quadratus lumborum.
• The fibrous medial borders of the two crura
form a median arcuate ligament over the front
of the aorta

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2. A costal part is attached to the inner aspect of
the lower six ribs and costal cartilages.
3. A sternal portion consists of two small slips
from the deep surface of the xiphisternum.
• The central tendon, into which the muscular
fibres are inserted, is trefoil in shape and is
partially fused with the undersurface of the
pericardium.

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 Arterial supply of the diaphragm
• The arterial supply to the diaphragm is from vessels
that arise superiorly and inferiorly to it.
• From above, pericardiacophrenic and musculophrenic
arteries supply the diaphragm.
• These vessels are branches of the internal thoracic
arteries.
 Superior phrenic arteries, which arise directly from
lower parts of the thoracic aorta, and small branches
from intercostal arteries contribute to the supply.
 The largest arteries supplying the diaphragm arise
from below it. These arteries are the inferior phrenic
arteries, which branch directly from the abdominal
aorta.
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 Venous drainage of the diaphragm

• Venous drainage of the diaphragm is by veins

that generally parallel the arteries.
• The veins drain into: the brachiocephalic veins
in the neck;
• the azygos system of veins; or
• abdominal veins (left suprarenal vein and
inferior vena cava).

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 NERVE SUPPLY
• The diaphragm receives its entire motor supply
from the phrenic nerve (C3, 4, 5) whose long
course from the neck follows the embryological
migration of the muscle of the diaphragm from
the cervical region.
• Injury or operative division of this nerve results in
paralysis and elevation of the corresponding half
of the diaphragm.
• The peripheral part of the diaphragm, including
the crura, receives sensory fibres from the lower
intercostal nerves.
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 Openings in the diaphragm
• The three main openings in the diaphragm are:
1. The aortic (at the level of T12) which transmits the
abdominal aorta, the thoracic duct and often the azygos
vein;
2. The oesophageal (T10) which is situated between the
muscular fibres of
• the right crus of the diaphragm and transmits, in addition
to the oesophagus, branches of the left gastric artery and
vein and the two vagi;
3. The opening for the inferior vena cava (T8) which is placed
in the central tendon and also transmits the right phrenic
nerve.
• In addition to these structures, the greater and lesser
splanchnic nerves pierce the crura and the sympathetic
chain passes behind the diaphragm deep to the medial
arcuate ligament.
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• Describe the formation and contents of rectus sheath.
Add a note on applied significance
• Describe the inguinal canal. What are its mechanism
• Describe in brief the bed and blood supply of stomach
• Describe the nerve supply and lymphatic drainage of
stomach
• Describe the position relations, blood supply,
development of appendix
• Describe the small intestine, blood supply and nerve
supply
• Enumerate the differences between large and small
intestine
• Enumerate the relations of visceral surface of liver and
notes on liver segments
Test on abdomen
1. Describe the formation and contents of
rectus sheath.
2. Discuss the arterial supply of the anterior
abdominal wall
 ASSIGNMENT
Discuss the development of the diaphragm and
the anatomy of diaphragmatic herniae

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 GOODMORNING

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