DIAFRAGMA Bentuk diafragma double-domed, musculotendinous Dome 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 process 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 Arteri 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) Vena 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 3.