Trauma - thorax anatomy revision

Question 1

From which anatomical structures does the diaphragm arise?

Answer 1

Multiple points of attachment including:
* Crura
* Right L1-3
* Left L1-2

The crura are muscular extensions that anchor the diaphragm to the spine.

Question 2

What is the role of the median arcuate ligament?

Answer 2

Allows room for the coeliac artery to come off at level of T12

The median arcuate ligament connects the sides of the body of the diaphragm to vertebrae L1.

Question 3

What do the medial arcuate ligaments connect?

Answer 3

They run from the body of the diaphragm to transverse process

These ligaments support the diaphragm by connecting it to the vertebral column.

Question 4

What do the lateral arcuate ligaments connect?

Answer 4

Run from transverse process to tips of 12th ribs

These ligaments help stabilize the diaphragm.

Question 5

What are the other attachments of the diaphragm?

Answer 5

Includes:
* Tip of 12th rib
* Forwards to 11th rib
* Each rib to 7th costal cartilage
* Posterior surface of xiphoid process

These attachments provide structural integrity and support to the diaphragm.

Question 6

What is the structure of the central tendon in the diaphragm?

Answer 6

Has one anterior and two posterior parts

The central tendon is the central connective tissue structure of the diaphragm.

Question 7

Which side of the diaphragm is positioned higher?

Answer 7

Right side

The right dome of the diaphragm is typically higher than the left due to the presence of the liver.

Question 8

How much movement does the diaphragm account for during inspiration?

Answer 8

70% of inspiration with 5cm of movement

The diaphragm’s movement is crucial for effective breathing.

Question 9

What are the three openings of the diaphragm?

Answer 9

Includes:
* Caval - T8
* Oesophagus - T10
* Aortic - T12

These openings allow structures such as blood vessels and the esophagus to pass between the thorax and abdomen.

Question 10

At what vertebral level does the caval opening occur?

Answer 10

T8

The caval opening allows the inferior vena cava to pass through the diaphragm.

Question 11

At what vertebral level does the oesophageal opening occur?

Answer 11

T10

This opening is for the esophagus and the vagus nerve.

Question 12

At what vertebral level does the aortic opening occur?

Answer 12

T12

The aortic opening allows the aorta to pass behind the diaphragm.

Question 13

Answer 13

Question 14

What is the fibrous part of the diaphragm derived from?

Answer 14

Septum transversum (tendinous)

The septum transversum is an embryological structure that contributes to the formation of the diaphragm.

Question 15

How many embryological origins does the diaphragm have?

Answer 15

Four

The diaphragm has four distinct embryological origins that contribute to its structure.

Question 16

What are the two pleuroperitoneal membranes responsible for in the diaphragm?

Answer 16

Muscular part

The pleuroperitoneal membranes contribute to the muscular component of the diaphragm.

Question 17

The peripheral body wall muscle of the diaphragm originates from which embryological source?

Answer 17

Somaties (muscular part)

Somatic mesoderm contributes to the muscular part of the diaphragm.

Question 18

What embryological structure contributes to the crura of the diaphragm?

Answer 18

Mesentery of the oesophagus

The crura are extensions of the diaphragm that anchor it to the vertebral column.

Question 19

List the four embryological origins of the diaphragm

Answer 19

Fibrous part comes from septum transversum (tendinous)

Two pleuroperitoneal membranes (muscular part)

Peripheral body wall muscle- Somaties (muscular part)

Mesentry of oesophagus (crura of diaphragm)

Question 21

What are the anterior congenital defects of the diaphragm?

Answer 21

Parasternal, Septum transversum and peripheral body wall muscle, Defect of Morgani

Question 22

What are the posterior congenital defects of the diaphragm?

Answer 22

Defect of Bochdalek, Pleuroperitoneal membrane hernia, Oesophageal hiatus, Dome of diaphragm

Question 23

Fill in the blank: The defect of __________ is one of the anterior congenital defects of the diaphragm.

Answer 23

Morgani

Question 24

True or False: The defect of Bochdalek is an anterior congenital defect of the diaphragm.

Answer 24

False

Question 25

What is a pleuroperitoneal membrane hernia?

Answer 25

A posterior congenital defect of the diaphragm ## Footnote This defect involves a herniation through the pleuroperitoneal membrane.

Question 26

Fill in the blank: The __________ hiatus is a posterior congenital defect of the diaphragm.

Answer 26

Oesophageal

Question 27

List the congenital defects of the diaphragm from most common to least common

Answer 27

Question 28

What is the primary nerve supply of the diaphragm?

Answer 28

Phrenic nerve C3,4,5

Question 29

What portion of the phrenic nerve is sensory, and what does it supply?

Answer 29

1/3rd of phrenic nerve is sensory to heart, pleura, and peritoneum beneath

Question 30

What is the blood supply of the diaphragm?

Answer 30

Inferior phrenic arteries, superior phrenic arteries, musculophrenic arteries, pericardiacophrenic arteries ## Footnote The inferior phrenic arteries arise from the aorta just beneath the diaphragm, while the superior phrenic arteries arise from the aorta in the thorax.

Question 31

Where do the inferior phrenic arteries arise from?

Answer 31

Aorta just beneath the diaphragm ## Footnote These arteries provide blood supply to the diaphragm from below.

Question 32

What are the terminal branches of the internal thoracic arteries that supply the diaphragm?

Answer 32

Musculophrenic and pericardiacophrenic arteries ## Footnote These branches play a role in the vascularization of the diaphragm.

Question 33

True or False: The superior phrenic arteries are larger than the inferior phrenic arteries.

Answer 33

False ## Footnote The superior phrenic arteries are smaller than the inferior phrenic arteries.

Question 34

What is the location of the caval opening?

Answer 34

T8 ## Footnote Contains the inferior vena cava (IVC) and right phrenic nerve.

Question 35

What contents are found in the caval opening?

Answer 35

IVC, Right phrenic nerve ## Footnote The left phrenic nerve passes through at T8.

Question 36

What is the location of the oesophageal opening?

Answer 36

T10 ## Footnote Contains the oesophagus and associated nerves and vessels.

Question 37

List the contents of the oesophageal opening.

Answer 37

* Oesophagus * Left and right vagus nerves * Oesophageal branches of left gastric artery and vein * Lymphatics ## Footnote Important for the passage of food and nerve supply.

Question 38

What is the location of the aortic opening?

Answer 38

T12 ## Footnote Strictly behind the diaphragm.

Question 39

List the contents of the aortic opening.

Answer 39

* Aorta * Azygos vein * Hemiazygos from ascending lumbar * Thoracic duct ## Footnote The thoracic duct begins at the cisterna chyli.

Question 40

What are the minor diaphragmatic openings?

Answer 40

Crura and anterior hiatus ## Footnote These openings allow structures to pass through the diaphragm.

Question 41

What is the location of the crura?

Answer 41

T12 ## Footnote Right originates from L1, L2, L3; left from L1, L2.

Question 42

What structures are associated with the right crus?

Answer 42

Encircles the oesophagus ## Footnote Also associated with greater, lesser, and least splanchnic nerves.

Question 43

What is the location of the anterior hiatus?

Answer 43

T9 ## Footnote Provides passage for the superior epigastric artery and vein.

Question 44

What structures pass through the anterior hiatus?

Answer 44

Superior epigastric artery and vein ## Footnote Important for blood supply to the diaphragm and upper abdominal wall.

Question 45

What is located superior to the diaphragm?

Answer 45

Pericardium and basal lung segments ## Footnote The diaphragm separates the thoracic cavity from the abdominal cavity and is involved in respiration.

Question 46

What structures are found inferior to the right side of the diaphragm?

Answer 46

Liver, suprarenal gland, kidney ## Footnote These organs are positioned directly below the right hemidiaphragm.

Question 47

What structures are found inferior to the left side of the diaphragm?

Answer 47

Stomach, suprarenal gland, kidney, spleen ## Footnote The left hemidiaphragm has different anatomical relationships compared to the right.

Question 48

What structures are located posterior to the diaphragm?

Answer 48

Aorta, azygos vein, oesophagus, vagus nerves ## Footnote These structures pass behind the diaphragm, connecting the thoracic and abdominal cavities.

Question 49

What is located behind the medial arcuate ligament of the diaphragm?

Answer 49

Sympathetic chain ## Footnote The medial arcuate ligament is a fibrous band that supports the diaphragm.

Question 50

What is located behind the lateral arcuate ligament of the diaphragm?

Answer 50

Subcostal T12 neurovascular bundle ## Footnote The lateral arcuate ligament provides support and is associated with neurovascular structures.

Question 51

What is the nerve supply for the diaphragm?

Answer 51

Phrenic nerve C3,4,5 ## Footnote The phrenic nerve is primarily responsible for motor control of the diaphragm.

Question 52

What portion of the phrenic nerve is sensory and what does it supply?

Answer 52

1/3rd of phrenic nerve is sensory to heart, pleura, and peritoneum beneath ## Footnote This sensory supply plays a role in the perception of pain and other sensations from these structures.

Question 53

What are the arteries that supply blood to the diaphragm?

Answer 53

* Inferior phrenic arteries * Superior phrenic arteries * Musculophrenic arteries * Pericardiacophrenic arteries ## Footnote The inferior phrenic arteries arise from the aorta just beneath the diaphragm, while the superior phrenic arteries are smaller and also arise from the aorta in the thorax.

Question 54

Where do the inferior phrenic arteries originate?

Answer 54

Aorta just beneath the diaphragm ## Footnote These arteries provide the primary blood supply for the diaphragm.

Question 55

Where do the superior phrenic arteries arise from?

Answer 55

Aorta in thorax ## Footnote These smaller arteries also contribute to the blood supply of the diaphragm.

Question 56

What are the terminal branches of the internal thoracic arteries that supply the diaphragm?

Answer 56

* Musculophrenic arteries * Pericardiacophrenic arteries ## Footnote These arteries provide additional blood supply to the diaphragm, particularly in the thoracic region.

Question 57

What is the vertebral level of the Caval opening?

Answer 57

T8 ## Footnote The Caval opening allows passage of the inferior vena cava.

Question 58

What structures pass through the Caval opening?

Answer 58

* IVC * Right phrenic nerve (left passes through at T8) ## Footnote The Caval opening is primarily associated with venous return and nerve pathways.

Question 59

What is the location of the Oesophageal opening?

Answer 59

T10 ## Footnote The Oesophageal opening allows passage of the esophagus and associated nerves and vessels.

Question 60

What contents are found at the Oesophageal opening?

Answer 60

* Oesophagus * Left and right vagus nerves * Oesophageal branches of left gastric artery and vein * Lymphatics ## Footnote These structures are crucial for digestive and autonomic functions.

Question 61

What is the vertebral level of the Aortic opening?

Answer 61

T12, strictly behind diaphragm ## Footnote The Aortic opening allows passage of major vascular structures.

Question 62

What contents are found at the Aortic opening?

Answer 62

* Aorta * Azygos vein and hemiazygous from ascending lumbar * Thoracic duct begins at cisterna chyli ## Footnote The Aortic opening is vital for systemic and lymphatic circulation.