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Anatomy of Diaphargma

Bentuk diafragma
double-domed, musculotendinous
right dome
left dome
*right dome is higher
Ketinggian diaphragm (dome)
1. Phase of respiration
2. Posture
3. Size and degree of distention of the abdominal viscera
Otot-otot diafragma
*converge radially = central tendon
*no bony attachment
Caval opening = foramen vena cava
1. Sternal part
2. Costal part
3. Lumbar part
Sternal part = dua otot yang slip (two muscular slip), terkait ke aspek posterior xiphoid
Costal part = wide muscular slip
Lumbar part = muncul dua ligamentum
1. Medial arcuate ligament
2. Lateral arcuate ligament
*berada di sisi samping
Medial arcuate ligament = thickening of the fascia covering the psoas major, spanning between the
lumbar vertebral bodies and the tip of the transverse process of L1
Lateral arcuate ligament = covers the quadratus lumborum muscles, continuing from the L12
transverse process to the tip of the 12th rib.
Crura diafragma
musculotendinous bands
*arise from the anterior surfaces of the bodies
Right crus = arises from the fi rst three or four lumbar vertebrae
Left crus = first two or three lumbar vertebrae
Esophageal hiatus = merupakan bentukan right crus
Aortic hiatus = right, left crus, dan median arcuate ligament
*The superior aspect of the central tendon of the diaphragm is fused with the inferior surface of the
fibrous pericardium (fibroserous pericardial sac)
Fungsi diafragma
is the chief muscle of inspiration (actually, of respiration altogether, because expiration is largely passive)
It descends during inspiration
*only its central part moves
Vaskularisasi diafragma
superior (thoracic) and inferior (abdominal) surfaces.
arteries supplying the superior surface of the diaphragm = pericardiacophrenic and musculophrenic
arteries, branches of the internal thoracic artery, and the superior phrenic arteries (arise from aorta)
arteries supplying the inferior surface of the diaphragm = inferior phrenic arteries, which typically are
the first branches of the abdominal aorta (arise from celiac trunk)
veins draining the superior surface of the diaphragm = pericardiacophrenic and musculophrenic veins
 internal thoracic veins
= superior phrenic vein = IVC
veins draining the inferior surface of the diaphragm = inferior phrenic veins
right inferior phrenic vein usually opens into the IVC
left inferior phrenic vein is usually double, with one branch passing anterior to the esophageal hiatus to
and in the IVC and the other, more posterior branch usually joining the left supra renal vein
Drainase limfatik
lymphatic plexuses on the superior and inferior surfaces of the diaphragm
anterior and posterior diaphragmatic lymph nodes  parasternal, posterior mediastinal, and phrenic
lymph nodes
Inervasi diafragma
motor supply to the diaphragm = right and left phrenic nerves (C3–C5 segments of the spinal cord)
Sensory innervation (pain and proprioception) to the diaphragm = phrenic nerves,
*Peripheral parts of the diaphragm receive their sensory nerve supply from the intercostal nerves (lower
six or seven) and the subcostal nerves.
Diaphragmatic apertures
= openings, hiatus
three large apertures for the IVC, esophagus, and aorta and a number of small ones.
1. Caval opening
2. Esophageal hiatus
3. Aortic hiatus
4. Small openings in diaphragm
Cava opening
= IVC, terminal branches of the right phrenic nerve and a few lymphatic vessels on their way from the
liver to the middle phrenic and mediastinal lymph nodes
level of the IV disc between the T8 and T9 vertebrae
*The IVC is adherent to the margin of the opening; consequently, when the diaphragm contracts during
inspiration, it widens the opening and dilates the IVC  These changes facilitate blood fl ow through this
large vein to the heart.
Esophageal hiatus
= an oval opening for the esophagus in the muscle of the right crus of the diaphragm at the level of the
T10 vertebra.
1. Esophagus
2. anterior and posterior vagal trunks,
3. esophageal branches of the left gastric vessels, and
4. a few lymphatic vessels.
*fibers of the right crus of the diaphragm decussate (cross one another) inferior to the hiatus, forming a
muscular sphincter for the esophagus that constricts it when the diaphragm contracts
*superior to and to the left of the aortic hiatus
*margin hiatus formed by right crus
Aortic Hiatus
opening posterior in the diaphragm for the descending aorta
*the aorta does not pierce the diaphragm, movements of the diaphragm do not affect blood flow through
the aorta during respiration.
Action of Diaphragm
1. Kontraksi
2. Pergerakan
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