Aortic Diaphragm Opening Diaphragmatic Hernia General Histology

Aortic Diaphragm Opening Diaphragmatic Hernia General Histology May 2, 2023 by Marksparks arkansas Leave a Comment

Diaphragm Table of Contents   

Diaphragm Referred Pain Diaphragmatic Hernia

Question – 1: Structures passing through the aortic opening of the diaphragm.

Answer:   

Descending Thoracic Aorta on left side (DTA).

Thoracic duct in the middle.

Azygos vein on right side.

Read And Learn More: General Histology Question And Answers

Referred Pain It is the area of the skin where pain is felt of the disease of the organ which is away Referred pain:

Question – 2: Describe the diaphragm under following heads 1. Gross anatomy 2. Openings in the diaphragm 3. Development, and 4. Applied anatomy.

Answer:

Diaphragm Introduction: It is the musculotendinous partition which separates thoracic cavity from abdominal cavity. It is described as a muscle under origin, insertion, nerve supply and action.

1. Gross Anatomy: 1. Proximal attachments of diaphragm:   

Costal fibres arise from inner surface of lower 6 costal cartilages and adjacent parts of the ribs (C).

Vertebral fibres arise from upper two lumbar vertebrae by two crura (V).

Sternal fibres arise from posterior surface of the xiphoid process (S).

2. Diaphragm Distal attachments: The muscles insert into trilobed central tendon.

3. Diaphragm Relations:

 o o  o o o o o o

Superiorly: Pleurae, and Pericardium.

Inferiorly: Peritoneum Live Fundus of stomach Spleen Kidneys, and Suprarenals.

4. Diaphragm Actions: The actions of the diaphragm are

  

Inspiration: Diaphragm is the principal muscle of the inspiration.

It acts in all expulsive act,example sneezing, coughing, laughing, crying, vomiting, micturition, defaecation and parturition.

It acts as a partition between thoracic and abdominal cavity.

5. Diaphragm Blood supply:

 o o o 

Arterial supply: Inferior phrenic artery, 1st branch of the abdominal aorta.

Musculophrenic, a terminal branch of the internal thoracic artery.

Lower 5 or 6 Posterior intercostal, branches of thoracic aorta.

Venous drainage:

o o o

Inferior phrenic vein drains into inferior vena cava.

Musculophrenic vein drains into internal thoracic vein.

Posterior intercostal vein drains into azygos vein.

6. Diaphragm Nerve supply : Sensory and motor

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Sensory: It is divided into The sensations of the central part are carried by phrenic nerve (C3, C4 and C5).

The sensations from the peripheral part are carried by lower intercostal nerves (T6 to T11).

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Motor: Phrenic nerves (C3, C4 and C5)

2. Opening In The Diaphragm: The major opening in the diaphragm

Link Memory:

Linking of position of letters in words with position of structures in the opening

Note: All the unpaired Iredlcoloured structures, i.e. arteries are on the left side. All the unpaired |blue colour and red structures, i.e. veins are on right side.

The minor openings in the diaphragm are as follows:    

The superior epigastric vessels (and some lymphatics) pass between the xiphoid and costal (7th costal cartilage) origin of the diaphragm.

This gap is known as Larry’s space or foramen of Morgagni.

The musculophrenic vessels pierce the diaphragm at the 8th or 9th costal cartilage.

Several small veins pass through minute apertures in the central tendon.

3. Development Germ layer: It develops from the mesoderm.

Site: Lateral plate mesoderm.

Sources: 1. Septum transversum forms the principal components of the definitive diaphragm. It forms 1. Central tendon 2. Anteromedian part 3. Vena caval opening, and 4. Oesophageal opening.

2. Pleuroperitoneal membranes: It also forms a major contribution to the development of the diaphragm. It gives rise to circumferential part in the ventrolateral region.

3. Dorsal mesentery of the oesophagus forms  

The posterior part of the diaphragm is between the oesophageal and the aortic openings.

Crura of the diaphragm 4. Left and right body walls. They form tissue on the periphery of the diaphragm.

Anomalies: 1. Diaphragmatic hernias: It is one of the common anomalies of the diaphragm. The incidence is 1/2000 newborns.

The diaphragmatic hernia may be of the following types depending upon the situation.    

Posterolateral Posterior Retrosternal, and Central.

2. Accessory diaphragm.

3. Congenital eventration (elevation of the dome of diaphragm) of the diaphragm.

4. Applied Anatomy: 1. Hiatus hernia is relatively common (1%) accounting for 98% of the all diaphragmatic hernia.

2. It is HARD to diagnose. Its manifestations are denoted by each letter of the word “HARD”

   

Hiccough Anaemia Regurgitation Dysphagia—difficulty in swallowing.

3. The lesion of the phrenic nerve results into the paralysis of the dome of the diaphragm and the affected dome is pushed upwards.

4. Irritation of the diaphragm may cause referred pain in the shoulder.

5. The phrenic nerve, nerve of diaphragm and supraclavicular nerve supplying the skin of shoulder have same root value.

Diaphragmatic Hernia It is protrusion of abdominal contents through the thoracoabdominal diaphragm. It is divided into: Congenital and acquired.

1. Congenital:     

Retrosternal: It is through foramen of Morgagni of space of Larry.

Posterolateral: Commonest type. It is through foramen of Bockdalech.

Posterior hernia: It is due to failure of development of posterior part of the diaphragm.

Central: It is rare.

Hiatal hernia 2. Acquired:

 

Traumatic Hiatal