Lecture 15: Respiratory Diaphragm

Question 1

Peripheral attachments of diaphragm

Answer 1

1. Anterior: xiphoid process
2. Lateral: Costal cartilage and ribs 5-10
3. Posterior: L1-3 lumbar vertebrae and floating ribs
   - allows diaphragm to “dome out” during exhalation and straighten during inhalation

Question 2

Deep attachments of diaphragm

Answer 2

central tendon

-self insertion

Question 3

Major organs SUPERIOR to diaphragm

Answer 3

1. Pericardium
   - heart is lifted when you exhale because it is attached to the diaphragm
2. Right and Left pleura
   - elastic, so diaphragm doesn’t have that much influence on lung placement

Question 4

What happens to the organs superior to diaphragm during exhalation?

Answer 4

Diaphragm pushes them up

Question 5

Organs INFERIOR to diaphragm

Answer 5

1. Liver (anterior R side)
2. Stomach and Spleen (anterior L side)
3. kidneys (posterior)
   - not directly attached like others

Question 6

What happens to the organs inferior to diaphragm during respiration?

Answer 6

they are pulled up when exhaling and pushed down when inhaling

Question 7

The organs superior and inferior to diaphragm can affect respiration if ______

Answer 7

enlarged

Question 8

What muscles pass through the diaphragm?

Answer 8

1. paired psoas major under medial arcuate ligaments

2. paired quadratus lumborum under lateral arcuate ligaments

Question 9

Blood and lymph vessels and nerves passing through diaphragm

Answer 9

1. Descending aorta (via aortic hiatus formed by L and R crus)
2. Inferior vena cava (via caval opening in central tendon)
3. Superior epigastric A’s & V’s (via sternocostal triangle)
4. Azygos and Hemiazygos veins (via aortic hiatus)
5. Thoracic duct (via aortic hiatus)

Question 10

What does Schuppin call the “wow factor”

Answer 10

superior epigastric arteries are a continuation of internal thoracic artery

Question 11

Esophagus passes diaphragm via

Answer 11

esophageal hiatus

Question 12

Nerves passing across the diaphragm

Answer 12

1. sympathetic trunks at level of vertebral column
2. anterior and posterior vagus via esophageal hiatus
   - esophageal plexus

Question 13

What nerve innervates the diaphragm?

Answer 13

Phrenic nerve (comes down lateral pericardia)

Question 14

Vasculature of the diaphragm

Answer 14

1. Superior surface
   a) thoracic aorta–> superior phrenic arteries
   b) internal thoracic–> musculophrenic & pericardiophrenic arteries
   c) veins names for arteries–> drain into IVC and internal thoracic veins
2. Inferior surface
   a) abdominal aorta–> inferior phrenic arteries
   b) veins named for arteries–> drain into IVC

Question 15

Actions of diaphragm

Answer 15

1. inhale= contracts

2. exhale= relaxes