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 The diaphragm is a curved musculo fibrous
sheet that separates the thoracic from the
abdominal cavity.
 pierced by stru...
 muscular part arises from the margins
of the thoracic opening and gets inserted
into the central tendon.
 attachments t...
EMBRYOLOGY
 ORGIN IN VERTEBRAL , COSTAL
AND SPINAL ATTACHMENTS FROM
WHICH MUSCULAR FIBERS CURVE
UPWARDS AND INWARDS FROM
...
 Develops from 4 sources
 Septum transversum
 Pleuroperitoneal membrane
 Medial dorsal portion of primary oesophageal
...
Septum transversum
 Third week of devpt.
 Mass of mesoderm situated cranially to
the pericardial cavity
 Contributes to...
Pleuroperitoneal membrane
 Is a paired dorsolateral portion
 Fuses with dorsal mesentry of oesophagus
and dorsal portion...
Medial portion of the diaphragm
 From the medial dorsal portion of
primary oesophageal mesentry.
 Fuses with septum tran...
 At 9-12 th week , the souce is
contributed by – the marginal outgrowth
of the body wall.
 these contibutions from thora...
 At the 5 th week , nerve fibers from the
3rd, 4th & 5th cervical segments of spinal
cord grow into septum transversum, v...
 At the 8th week – diaphragm attached to
dorsal body of 1st lumbar vertebrae,
giving rise to the domed contour
character ...
Origin of the diaphragm
 sternal part- arising from the posterior
surface of the xiphoid process.
 costal part arising f...
 vertebral/lumbar part arising from upper
three lumbar vertebrae; forms the right &
left crura & the arcuate ligaments.
...
 Arcuate ligaments:Lateral to the crura
on both sides.
 Medial arcuate ligament is thickened
upper margin of fascia that...
Shape of the Diaphragm
 It is studied as
(a)Central tendon
(b)Right & left crus
(c)Right & left dome
Insertion of the Diaphragm
 The diaphragm is inserted into the central
tendon that is trifoliate (like three leaves).
 O...
 These fibers appear to act as a
sphincter and possibly assist in the
prevention of regurgitation of the
stomach contents...
Anatomic positions
 After forced expiration the right dome is
level anteriorly with the fourth costal
cartilage and there...
 With maximal inspiration, the dome
will descend as much as 10 cm, and on
a plain chest radiograph the right dome
coincid...
 Overinflation of the lung, as occurs for
example in emphysema, causes marked
depression of the diaphragm.
Functions of the Diaphragm
 Muscle of inspiration: On contraction the
diaphragm pulls its central tendon down
and increas...
 Muscle of abdominal straining: The
contraction of the diaphragm assists the
contraction of the muscles of the anterior
a...
 Weight lifting muscle: In a person taking a
deep breath and holding it (fixing the
diaphragm), the diaphragm assists the...
 Thoraco-abdominal pump: The descent of
the diaphragm decreases the intrathoracic
pressure & increases the intra-abdomina...
 three main openings.
 The caval opening lies at the level of the
T 8 vertebra in the central tendon.
 It transmits the...
 The esophageal opening lies at the level
of the T 10 vertebra in a sling of muscle
fibers derived from the right crus at...
 The aortic opening lies anterior to the body of
the T 12 vertebra between the crura.
 transmits aorta, thoracic duct an...
Other minor openings
 Sympathetic trunk (pass posterior to the
medial arcuate ligament on both sides).
 Superior epigast...
 Left phrenic nerve (pierces the left dome
of diaphragm)
 Neurovascular bundles of lower six intercostal
spaces (pass be...
Vascular supply
 Lower five intercostal and subcostal
arteries- supply the costal margins of
the diaphragm
 Phrenic arte...
Nerve supply of diaphragm
 sensory supply of the central tendon of
diaphragm that is covered by parietal and
peritoneal p...
Phrenic nerve
 descends anterior to the pulmonary hilum,
between the fibrous pericardium and
mediastinal pleura, to the d...
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
The diaphragm  anatomy & embryology
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The diaphragm anatomy & embryology

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diaphragm anatomy and its embryology- a short concise

Publié dans : Santé & Médecine
  • A comprehensive assessment of low back pain must involve an analysis of diaphragm function. The diaphragm contracts every time we breathe, approximately 18,000 to 20,000 times a day. Look at where its "legs" attach - to the lumbar vertebrae in the low back! Thus, how you breathe directly affects how your low back feels and functions. Notice also that the diaphragm does not have symmetrical attachments to the spine. The most effective physical therapy plan of care addresses the biomechanical influences of breathing deficits, diaphragm and spine position, and anatomical asymmetries on back pain.
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The diaphragm anatomy & embryology

  1. 1.  The diaphragm is a curved musculo fibrous sheet that separates the thoracic from the abdominal cavity.  pierced by structures that pass between these two regions of the body.  primary muscle of respiration.  dome shaped and consists of a peripheral muscular part and central tendinous part.
  2. 2.  muscular part arises from the margins of the thoracic opening and gets inserted into the central tendon.  attachments to the thoracic wall are low posteriorly and laterally, but high anteriorly.  Rarely affected by intrinsic diseases  complex embryological development is subject to number of congenital anomalies
  3. 3. EMBRYOLOGY  ORGIN IN VERTEBRAL , COSTAL AND SPINAL ATTACHMENTS FROM WHICH MUSCULAR FIBERS CURVE UPWARDS AND INWARDS FROM PERIPHERY TO BE INSERTED INTO THE FIBROUS SHEET CALLED CENTRAL TENDON
  4. 4.  Develops from 4 sources  Septum transversum  Pleuroperitoneal membrane  Medial dorsal portion of primary oesophageal mesentry  Marginal ingrowths of the body wall
  5. 5. Septum transversum  Third week of devpt.  Mass of mesoderm situated cranially to the pericardial cavity  Contributes to the ventral portion like the sternal and costal parts
  6. 6. Pleuroperitoneal membrane  Is a paired dorsolateral portion  Fuses with dorsal mesentry of oesophagus and dorsal portion of the septum transversum to complete the partition between thorax & abdomen.  Forms the primitive diaphragm at 7th wk of development.
  7. 7. Medial portion of the diaphragm  From the medial dorsal portion of primary oesophageal mesentry.  Fuses with septum transversum & pleuroperitoneal membrane.  Curves of diaphragm – develop from growth of muscle fibres into the dorsal mesentry of the oesophagus.
  8. 8.  At 9-12 th week , the souce is contributed by – the marginal outgrowth of the body wall.  these contibutions from thoracic myotome contain nerve fibers of lower six or seven intercostal nerves - distribute the sensory fibers to periphery of diaphragm.
  9. 9.  At the 5 th week , nerve fibers from the 3rd, 4th & 5th cervical segments of spinal cord grow into septum transversum, via the pleuropericardial membrane to form the PHRENIC NERVE
  10. 10.  At the 8th week – diaphragm attached to dorsal body of 1st lumbar vertebrae, giving rise to the domed contour character of the diaphragm.
  11. 11. Origin of the diaphragm  sternal part- arising from the posterior surface of the xiphoid process.  costal part arising from the deep surfaces of the lower six ribs and their costal cartilages & forms the right & left domes.
  12. 12.  vertebral/lumbar part arising from upper three lumbar vertebrae; forms the right & left crura & the arcuate ligaments.  Crura:The right crura is from the bodies of first three lumbar vertebrae. The left crus, from the bodies of first two lumbar vertebrae.
  13. 13.  Arcuate ligaments:Lateral to the crura on both sides.  Medial arcuate ligament is thickened upper margin of fascia that covers the psoas muscle.  Lateral arcuate ligament is thickened upper margin of the fascia covering the quadratus lumborum muscle.
  14. 14. Shape of the Diaphragm  It is studied as (a)Central tendon (b)Right & left crus (c)Right & left dome
  15. 15. Insertion of the Diaphragm  The diaphragm is inserted into the central tendon that is trifoliate (like three leaves).  On the superior side, the surface of the tendon is partially fused with the pericardium.  Some of the muscle fibers of the right crus pass up to the left and surround the esophageal orifice in a slinglike loop.
  16. 16.  These fibers appear to act as a sphincter and possibly assist in the prevention of regurgitation of the stomach contents into the thoracic part of the esophagus.
  17. 17. Anatomic positions  After forced expiration the right dome is level anteriorly with the fourth costal cartilage and therefore the right nipple, whereas the left dome lies approximately one rib lower.
  18. 18.  With maximal inspiration, the dome will descend as much as 10 cm, and on a plain chest radiograph the right dome coincides with the tip of the sixth rib.  body is lying on one side, the dependent half of the diaphragm will be considerably higher than the uppermost one.  higher in short, fat people than in tall, thin people.
  19. 19.  Overinflation of the lung, as occurs for example in emphysema, causes marked depression of the diaphragm.
  20. 20. Functions of the Diaphragm  Muscle of inspiration: On contraction the diaphragm pulls its central tendon down and increases the vertical diameter of the thorax. The diaphragm is the most important muscle used in inspiration.
  21. 21.  Muscle of abdominal straining: The contraction of the diaphragm assists the contraction of the muscles of the anterior abdominal wall in raising the intra-abdominal pressure for micturition, defecation, and parturition.
  22. 22.  Weight lifting muscle: In a person taking a deep breath and holding it (fixing the diaphragm), the diaphragm assists the muscles of the anterior abdominal wall in raising the intra-abdominal pressure.
  23. 23.  Thoraco-abdominal pump: The descent of the diaphragm decreases the intrathoracic pressure & increases the intra-abdominal pressure.  This compresses the blood in the inferior vena cava and forces it upward into the right atrium of the heart.  Within the abdominal lymph vessels is also compressed, and its passage upward within the thoracic duct is aided by the negative intrathoracic pressure. The presence of valves within the thoracic duct prevents backflow.
  24. 24.  three main openings.  The caval opening lies at the level of the T 8 vertebra in the central tendon.  It transmits the inferior vena cava and terminal branches of right phrenic nerve. Openings in the Diaphragm
  25. 25.  The esophageal opening lies at the level of the T 10 vertebra in a sling of muscle fibers derived from the right crus at the left of median plane.  transmits esophagus, left and right vagus nerves, esophageal branches of the left gastric vessels and lymphatics from lower third of the esophagus.
  26. 26.  The aortic opening lies anterior to the body of the T 12 vertebra between the crura.  transmits aorta, thoracic duct and azygous vein.
  27. 27. Other minor openings  Sympathetic trunk (pass posterior to the medial arcuate ligament on both sides).  Superior epigastric vessels (pass between the sterna and costal origins of the diaphragm on each side).
  28. 28.  Left phrenic nerve (pierces the left dome of diaphragm)  Neurovascular bundles of lower six intercostal spaces (pass between the muscular slips of costal origin of diaphragm)
  29. 29. Vascular supply  Lower five intercostal and subcostal arteries- supply the costal margins of the diaphragm  Phrenic arteries- supply the main central portion of the diaphragm.  The phrenic veins follow the corresponding arteries on the inferior diaphragmatic surface.
  30. 30. Nerve supply of diaphragm  sensory supply of the central tendon of diaphragm that is covered by parietal and peritoneal pleura is from phrenic nerve.  Sensory supply to the periphery of diaphragm is from lower six intercostal nerves.  The motor nerve supply of diaphragm is only from the phrenic nerve.
  31. 31. Phrenic nerve  descends anterior to the pulmonary hilum, between the fibrous pericardium and mediastinal pleura, to the diaphragm, accompanied by the pericardiophrenic vessels.  supplies sensory branches to the mediastinal pleura, fibrous pericardium and parietal serous pericardium.  The right phrenic nerve is shorter and more vertical than the left

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