12
Anatomy I (MSAT 213) For PT & RT 2012-2013 Respiratory System Diaphragm Prepared by: Dr. Kamal Motawei

Lec.9 diaphragm pt&rt

Embed Size (px)

DESCRIPTION

Anatomy course for Physical therapy and Respiratory care under-graduate students

Citation preview

Page 1: Lec.9 diaphragm pt&rt

Anatomy I (MSAT 213)

For PT & RT

2012-2013

Respiratory System

Diaphragm

Prepared by: Dr. Kamal Motawei

Page 2: Lec.9 diaphragm pt&rt

� The diaphragm is a:

� sheet-like

� dome-shaped (when relaxed)

� skeletal muscle,

� separating the thoracic cavity above from the cavity above from the abdominal cavity below.

� It is the most important muscle of respiration

Page 3: Lec.9 diaphragm pt&rt

� It has:� Right dome:

� It reaches the upper border of the 5th rib

� Left dome: � It reaches the lower border of the

5th rib

� Central tendon: It lies at the level of the � It lies at the level of the xiphisternal joint.

� N.B.:1) The right dome is higher than the left

dome because of the liver.

2) The central tendon lies between the domes and at a lower level.

3) The central tendon is fused above with the pericardium.

Page 4: Lec.9 diaphragm pt&rt

OriginIt has three parts:

� Sternal part: arises from the deep surface of the xiphoid process.

� Costal part: arises from the deep surfaces of the lower 6 ribs and costal cartilages.costal cartilages.

� Vertebral part: arises by:� Crura:

� Right crus: from L1, L2 & L3

� Left crus: from L1 & L2

� Arcuate ligaments:� Median arcuate lig.

� Medial arcuate lig.

� Lateral arcuate lig.

Insertion: the central tendon

Page 5: Lec.9 diaphragm pt&rt

� Motor: phrenic nerves (C3, 4 & 5)

� Sensory:

� Central part: phrenic nerves (C3, 4 & 5)

� Peripheral part: lower six intercostal nerves

Page 6: Lec.9 diaphragm pt&rt

� Arterial Supply:

� Branches from the internal thoracic artery

� Inferior phrenic arteries (from the abdominal aorta)

� Lower intercostal arteries.� Lower intercostal arteries.

� Veins:

� Accompany the arteries

Page 7: Lec.9 diaphragm pt&rt
Page 8: Lec.9 diaphragm pt&rt

Name Level Structures Passing through

1. Aortic opening T12(in the median plane)

i. Aorta ii. Thoracic ductiii. Azygos vein

2. Esophageal opening T10

(to the left side of the median plane)

i. Esophagusii. Right and left vagus nervesiii. Left gastric vessels iv. Lymphatics from the lower third of the esophagus

3. Caval opening T8

(to the right side of the median plane)

i. Inferior vena cava ii. Right phrenic nerve

3. Caval opening the median plane)

ii. Right phrenic nerve

Page 9: Lec.9 diaphragm pt&rt

� Superiorly:� Pleura and lungs: rest on

the corresponding dome

� Heart and pericardium: rests on the central tendon

� Inferiorly:Inferiorly:� Liver: under the right

dome and central tendon

� Stomach and spleen: under the left dome

� Right and left Kidneys: under the corresponding dome

Page 10: Lec.9 diaphragm pt&rt

� Contraction of the diaphragm leads to:

� Decrease in the intrathoracic pressure which leads to:

� Suction of air into the lungs i.e. inspiration

� Suction of venous blood in the thorax then into right atrium, i.e.

increases venous return.

� Increase in the intra-abdominal pressure: which is helpful in� Increase in the intra-abdominal pressure: which is helpful in

� Defection

� Micturation

� Child birth

� Constant contraction of the diaphragm and abdominal muscles helps support of the vertebral column during weight lifting

Page 11: Lec.9 diaphragm pt&rt

� Referred pain:

� Pain caused by pleurisy or peritonitis in the central area of the diaphragm is referred to the shoulder tip.

� While, pain caused by pleurisy or peritonitis in the peripheral area of the diaphragm is referred to the anterior abdominal wall.wall.

(see the sensory nerve supply of the diaphragm)

� Hiccup:

� Involuntary spasmodic contraction of the diaphragm due to gastric irritation of the vagus nerve

Page 12: Lec.9 diaphragm pt&rt

� Diaphragmatic hernia: Herniation of part of the stomach in to the thoracic cavity due to weakness of the muscle around esophageal opening in the diaphragm.