THE CLINICAL ANATOMY OF THE DIAPHRAGM

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THE MYSTERY OF SOUND(TMS)

Seminar Written by Ukiri Prosper
May 18th TMS Seminar Material

Title: The clinical anatomy of the diaphragm

Introduction

The diaphragm is a musculo-tendinous structure lying transversely between the thoracic cavity and the abdominal cavity.  It extends from the 7th to the 11th thoracic vertebra(T7-T11).

Embryology

It develops from four structures in fetal life. These are:
1.   Septum transversum
2.   Mesenchyme from the C3-C5 segments.
3.   Mesentery of the oesophagus.
4.   Two pleuroperitoneal membranes, embryonic sheets covering the primitive openings between thorax and abdomen.

Structure

It is domed-shaped in the living body. The diaphragm is composed of a central tendon and peripherally arranged muscular fibers. The muscles form the crura of the diaphragm. There are basically two crura, the right and the left crura, formed from the mesentery of the oesophagus.
Piercing through the diaphragm are three openings through which several structures pass. these openings are  as follows:
1.   Opening for the vena cava: this opening lies at the level of the T8 vertebra. It also transmits the phrenic nerve. The opening lies most anteriorly (towards the front) in the right dome of the diaphragm.
2.   Opening for the oesophagus: this opening transmits the oesophagus. It also transmits the vagus nerves.

3.   The opening for the aorta: the aorta begins in the heart and descends all through the thorax, pierces the diaphragm and enters the abdomen. The thoracic lymphatic duct also accompanies the aorta through its diaphragmatic opening.




Blood Supply
It is supplied by the right and left phrenic arteries, musculophrenic arteries and drained by veins with corresponding names.
Nerve supply
It is supplied by the phrenic nerve (C3-C5). It is believed that during embryonic life, the mesenchyme of the third to fifth cervical segments gave rise to the muscular part and thus supplied by the nerve components C3-C5.

Clinical correlates
1.   Abnormal openings or foramina in the diaphragm: this result from failure of the diaphragm to completely fuse leading to persistence of other openings other than the 3 mentioned above.
2.   Paralysis of the diaphragm: Lesion of the phrenic nerve either congenitally or traumatically can lead to loss of action of the muscles of the diaphragm. This deformity is highly fatal and is has a high incompatibility with life because it greatly hampers respiration. Since the diaphragm is a primary muscle of respiration.
3.   Persistent opening can result in movement of the abdominal content into the thoracic cavity.


References
Moore Clinically Oriented Anatomy, 7th ed- Moore et al
Atlas of Human Anatomy, 6th ed- Frank H. Netter, MD
Langman’s Medical Embryology, 12th ed- T.W Sadler


TMS Contact: themysteryofsound1@gmail.com
Elmond Isaiah
08067370005




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