|Origin||Septum transversum, pleuroperitoneal folds, body wall|
|Artery||Pericardiacophrenic artery, musculophrenic artery, inferior phrenic arteries|
|Vein||Superior phrenic vein, inferior phrenic vein|
|Nerve||Phrenic and lower intercostal nerves|
|Anatomical terms of muscle|
The thoracic diaphragm, or simply the diaphragm (Ancient Greek : διάφραγμα, romanized: diáphragma, lit. 'partition'), is a sheet of internal skeletal muscle in humans and other mammals that extends across the bottom of the thoracic cavity. The diaphragm separates the thoracic cavity, containing the heart and lungs, from the abdominal cavity and performs an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases, creating a negative pressure there, which draws air into the lungs.
The term diaphragm in anatomy, created by Gerard of Cremona,can refer to other flat structures such as the urogenital diaphragm or pelvic diaphragm, but "the diaphragm" generally refers to the thoracic diaphragm. In humans, the diaphragm is slightly asymmetric—its right half is higher up (superior) to the left half, since the large liver rests beneath the right half of the diaphragm. There is also a theory that the diaphragm is lower on the other side due to the presence of the heart.
Other mammals have diaphragms, and other vertebrates such as amphibians and reptiles have diaphragm-like structures, but important details of the anatomy may vary, such as the position of the lungs in the thoracic cavity.
The diaphragm is a C-shaped structure of muscle and fibrous tissue that separates the thoracic cavity from the abdomen. The dome curves upwards. The superior surface of the dome forms the floor of the thoracic cavity, and the inferior surface the roof of the abdominal cavity.
As a dome, the diaphragm has peripheral attachments to structures that make up the abdominal and chest walls. The muscle fibres from these attachments converge in a central tendon, which forms the crest of the dome.Its peripheral part consists of muscular fibers that take origin from the circumference of the inferior thoracic aperture and converge to be inserted into a central tendon.
The muscle fibres of the diaphragm emerge from many surrounding structures. At the front, fibres insert into the xiphoid process and along the costal margin. Laterally, muscle fibers insert into ribs 6–12. In the back, muscle fibres insert into the vertebra at T12 and two appendages, the right and left crus, descend and insert into the lumbar vertebrae. Right crus arises from L1-L3 their intervertebral discs. Left crus from L1, L2 their intervertebral discs.
There are two lumbocostal arches, a medial and a lateral, on either side.
The left and right crura are tendons that blend with the anterior longitudinal ligament of the vertebral column.
The central tendon of the diaphragm is a thin but strong aponeurosis near the center of the vault formed by the muscle, closer to the front than to the back of the thorax, so that the posterior muscular fibers are the longer.
There are a number of openings in the diaphragm through which structures pass between the thorax and abdomen. There are three large openings—the aortic, the esophageal, and the caval opening—plus a series of smaller ones.
The inferior vena cava passes through the caval opening, a quadrilateral opening at the junction of the right and middle leaflets of the central tendon, so that its margins are tendinous. Surrounded by tendons, the opening is stretched open every time inspiration occurs. However, there has been argument that the caval opening actually constricts during inspiration. Since thoracic pressure decreases upon inspiration and draws the caval blood upwards toward the right atrium, increasing the size of the opening allows more blood to return to the heart, maximizing the efficacy of lowered thoracic pressure returning blood to the heart. The aorta does not pierce the diaphragm but rather passes behind it in between the left and right crus.
The thoracic spinal levels at which the three major structures pass through the diaphragm can be remembered by the number of letters contained in each structure:
|! Description||Vertebral level||Contents|
|caval opening||T8||The caval opening passes through the central tendon of the diaphragm. It contains the inferior vena cava, and some branches of the right phrenic nerve [ citation needed ].|
|esophageal hiatus||T10||The esophageal hiatus is situated in the posterior part of the diaphragm, located slightly left of the west central tendon through the muscular sling of the right crus of the diaphragm.|
It contains the esophagus, and anterior and posterior vagal trunks.
|aortic hiatus||T12||The aortic hiatus is in the posterior part of the diaphragm, between the left and right crus.|
It contains the aorta and the thoracic duct.
|two lesser apertures of right crus||greater and lesser right splanchnic nerves and the azygos vein|
|two lesser apertures of left crus||greater and lesser left splanchnic nerves and the hemiazygos vein|
|behind the diaphragm, under the medial lumbocostal arch||sympathetic trunk|
|areolar tissue between the sternal and costal parts (see also foramina of Morgagni)||the superior epigastric branch of the internal thoracic artery and some lymphatics from the abdominal wall and convex surface of the liver|
|areolar tissue between the fibers springing from the medial and lateral lumbocostal arches||This interval is less constant; when this interval exists, the upper and back part of the kidney is separated from the pleura by areolar tissue only.|
The diaphragm is primarily innervated by the phrenic nerve which is formed from the cervical nerves C3, C4 and C5.While the central portion of the diaphragm sends sensory afferents via the phrenic nerve, the peripheral portions of the diaphragm send sensory afferents via the intercostal (T5–T11) and subcostal nerves (T12).
Arteries and veins above and below the diaphragm supply and drain blood.
From above, the diaphragm receives blood from branches of the internal thoracic arteries, namely the pericardiacophrenic artery and musculophrenic artery; from the superior phrenic arteries, which arise directly from the thoracic aorta; and from the lower internal intercostal arteries. From below, the inferior phrenic arteries supply the diaphragm.
The diaphragm drains blood into the brachiocephalic veins, azygos veins, and veins that drain into the inferior vena cava and left suprarenal vein.
The sternal portion of the muscle is sometimes wanting and more rarely defects occur in the lateral part of the central tendon or adjoining muscle fibers.
The thoracic diaphragm develops during embryogenesis, beginning in the third week after fertilization with two processes known as transverse folding and longitudinal folding. The septum transversum, the primitive central tendon of the diaphragm, originates at the rostral pole of the embryo and is relocated during longitudinal folding to the ventral thoracic region. Transverse folding brings the body wall anteriorly to enclose the gut and body cavities. The pleuroperitoneal membrane and body wall myoblasts, from somatic lateral plate mesoderm, meet the septum transversum to close off the pericardio-peritoneal canals on either side of the presumptive esophagus, forming a barrier that separates the peritoneal and pleuropericardial cavities. Furthermore, dorsal mesenchyme surrounding the presumptive esophagus form the muscular crura of the diaphragm.
Because the earliest element of the embryological diaphragm, the septum transversum, forms in the cervical region, the phrenic nerve that innervates the diaphragm originates from the cervical spinal cord (C3,4, and 5). As the septum transversum descends inferiorly, the phrenic nerve follows, accounting for its circuitous route from the upper cervical vertebrae, around the pericardium, finally to innervate the diaphragm.
The diaphragm is the main muscle of respiration and functions in breathing. During inhalation, the diaphragm contracts and moves in the inferior direction, enlarging the volume of the thoracic cavity and reducing intra-thoracic pressure (the external intercostal muscles also participate in this enlargement), forcing the lungs to expand. In other words, the diaphragm's movement downwards creates a partial vacuum in the thoracic cavity, which forces the lungs to expand to fill the void, drawing air in the process.
Cavity expansion happens in two extremes, along with intermediary forms. When the lower ribs are stabilized and the central tendon of the diaphragm is mobile, a contraction brings the insertion (central tendon) towards the origins and pushes the lower cavity towards the pelvis, allowing the thoracic cavity to expand downward. This is often called belly breathing. When the central tendon is stabilized and the lower ribs are mobile, a contraction lifts the origins (ribs) up towards the insertion (central tendon) which works in conjunction with other muscles to allow the ribs to slide and the thoracic cavity to expand laterally and upwards.
When the diaphragm relaxes, air is exhaled by elastic recoil process of the lung and the tissues lining the thoracic cavity. Assisting this function with muscular effort (called forced exhalation) involves the internal intercostal muscles used in conjunction with the abdominal muscles, which act as an antagonist paired with the diaphragm's contraction.
The diaphragm is also involved in non-respiratory functions. It helps to expel vomit, feces, and urine from the body by increasing intra-abdominal pressure, aids in childbirth,and prevents acid reflux by exerting pressure on the esophagus as it passes through the esophageal hiatus.
In some non-human animals, the diaphragm is not crucial for breathing; a cow, for instance, can survive fairly asymptomatically with diaphragmatic paralysis as long as no massive aerobic metabolic demands are made of it.
If either the phrenic nerve, cervical spine or brainstem is damaged, this will sever the nervous supply to the diaphragm. The most common damage to the phrenic nerve is by bronchial cancer, which usually only affects one side of the diaphragm. Other causes include Guillain–Barré syndrome and systemic lupus erythematosus.
A hiatus hernia is a hernia common in adults in which parts of the lower esophagus or stomach that are normally in the abdomen pass/bulge abnormally through the diaphragm and are present in the thorax. Hernias are described as rolling, in which the hernia is beside the oesophagus, or sliding, in which the hernia directly involves the esophagus. These hernias are implicated in the development of reflux, as the different pressures between the thorax and abdomen normally act to keep pressure on the esophageal hiatus. With herniation, this pressure is no longer present, and the angle between the cardia of the stomach and the oesophagus disappear. Not all hiatus hernias cause symptoms however, although almost all people with Barrett's oesophagus or oesophagitis have a hiatus hernia.
Hernias may also occur as a result of congenital malformation, a congenital diaphragmatic hernia. When the pleuroperitoneal membranes fail to fuse, the diaphragm does not act as an effective barrier between the abdomen and thorax. Herniation is usually of the left, and commonly through the posterior lumbocostal triangle, although rarely through the anterior foramen of Morgagni. The contents of the abdomen, including the intestines, may be present in the thorax, which may impact development of the growing lungs and lead to hypoplasia.This condition is present in 0.8 - 5/10,000 births. A large herniation has high mortality rate, and requires immediate surgical repair.
Due to its position separating the thorax and abdomen, fluid abnormally present in the thorax, or air abnormally present in the abdomen, may collect on one side of the diaphragm. An X-ray may reveal this. Pleural effusion, in which there is fluid abnormally present between the two pleurae of the lungs, is detected by an X-ray of the chest, showing fluid collecting in the angle between the ribs and diaphragm.An X-ray may also be used to reveal a pneumoperitoneum, in which there is gas in the abdomen.
An X-ray may also be used to check for herniation.
The adoption of a deeper breathing pattern typically occurs during physical exercise in order to facilitate greater oxygen absorption. During this process the diaphragm more consistently adopts a lower position within the body's core. In addition to its primary role in breathing, the diaphragm also plays a secondary role in strengthening the posture of the core. This is especially evident during deep breathing where its generally lower position increases intra-abdominal pressure, which serves to strengthen the lumbar spine. [ better source needed ]
The key to real core stabilization is to maintain the increased IAP while going through normal breathing cycles. […] The diaphragm then performs its breathing function at a lower position to facilitate a higher IAP.
[ better source needed ]
Therefore, if a person's diaphragm position is lower in general, through deep breathing, then this assists the strengthening of their core during that period. This can be an aid in strength training and other forms of athletic endeavour. For this reason, taking a deep breath or adopting a deeper breathing pattern is typically recommended when lifting heavy weights.
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The existence of a membrane separating the pharynx from the stomach can be traced widely among the chordates. Thus the model organism, the marine chordate lancelet, possesses an atriopore by which water exits the pharynx, which has been claimed (and disputed) to be homologous to structures in ascidians and hagfishes.The tunicate epicardium separates digestive organs from the pharynx and heart, but the anus returns to the upper compartment to discharge wastes through an outgoing siphon.
Thus the diaphragm emerges in the context of a body plan that separated an upper feeding compartment from a lower digestive tract, but the point at which it originates is a matter of definition. Structures in fish, amphibians, reptiles, and birds have been called diaphragms, but it has been argued that these structures are not homologous. For instance, the alligator diaphragmaticus muscle does not insert on the esophagus and does not affect pressure of the lower esophageal sphincter. [ citation needed ] An explanation for this (put forward in 1905), is that lungs originated beneath the diaphragm, but as the demands for respiration increased in warm-blooded birds and mammals, natural selection came to favor the parallel evolution of the herniation of the lungs from the abdominal cavity in both lineages.The lungs are located in the abdominal compartment of amphibians and reptiles, so that contraction of the diaphragm expels air from the lungs rather than drawing it into them. In birds and mammals, lungs are located above the diaphragm. The presence of an exceptionally well-preserved fossil of Sinosauropteryx , with lungs located beneath the diaphragm as in crocodiles, has been used to argue that dinosaurs could not have sustained an active warm-blooded physiology, or that birds could not have evolved from dinosaurs.
However, birds do not have diaphragms. They do not breathe in the same way as mammals and do not rely on creating a negative pressure in the thoracic cavity, at least not to the same extent. They rely on a rocking motion of the keel of the sternum to create local areas of reduced pressure to supply thin, membranous airsacs cranially and caudally to the fixed-volume, non-expansive lungs. A complicated system of valves and air sacs cycles air constantly over the absorption surfaces of the lungs so allowing maximal efficiency of gaseous exchange. Thus, birds do not have the reciprocal tidal breathing flow of mammals. On careful dissection, around eight air sacs can be clearly seen. They extend quite far caudally into the abdomen.
The rib cage is the arrangement of ribs attached to the vertebral column and sternum in the thorax of most vertebrates, that encloses and protects the heart and lungs. In humans, the rib cage, also known as the thoracic cage, is a bony and cartilaginous structure which surrounds the thoracic cavity and supports the shoulder girdle to form the core part of the human skeleton. A typical human rib cage consists of 24 ribs in 12 pairs, the sternum and xiphoid process, the costal cartilages, and the 12 thoracic vertebrae.
The thorax or chest is a part of the anatomy of humans, mammals, other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the creature's body, each of which is in turn composed of multiple segments.
The phrenic nerve is a mixed motor/sensory nerve which originates from the C3-C5 spinal nerves in the neck. The nerve is important for breathing because it provides exclusive motor control of the diaphragm, the primary muscle of respiration. In humans, the right and left phrenic nerves are primarily supplied by the C4 spinal nerve, but there is also contribution from the C3 and C5 spinal nerves. From its origin in the neck, the nerve travels downward into the chest to pass between the heart and lungs towards the diaphragm.
In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right arm, with some branches supplying the head and thorax. On the left side of the body, the subclavian comes directly off the aortic arch, while on the right side it arises from the relatively short brachiocephalic artery when it bifurcates into the subclavian and the right common carotid artery.
The abdominal internal oblique muscle, also internal oblique muscle or interior oblique, is an abdominal muscle in the abdominal wall that lies below the external oblique muscle and just above the transverse abdominal muscle.
The thoracic inlet, also known as the superior thoracic aperture, refers to the opening at the top of the thoracic cavity. It is also clinically referred to as the thoracic outlet, in the case of thoracic outlet syndrome; this refers to the superior thoracic aperture, and not to the lower, larger opening, the inferior thoracic aperture.
The thoracic outlet is the lower opening of the thoracic cavity whose edges are the lowest ribs. It is closed by the diaphragm, which separates the thoracic cavity from the abdominal cavity. The thoracic outlet or inferior thoracic aperture is much larger than the thoracic inlet.
The abdominal external oblique muscle is the largest and outermost of the three flat abdominal muscles of the lateral anterior abdomen.
The descending thoracic aorta is a part of the aorta located in the thorax. It is the third and last part of the thoracic aorta and is a continuation of the aortic arch. It is located within the posterior mediastinal cavity. The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic hiatus in the diaphragm where it becomes the abdominal aorta.
The abdomen is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the trunk. The area occupied by the abdomen is called the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax.
The inferior phrenic arteries are two small vessels which supply the diaphragm. They present much variety in their origin.
The pericardiacophrenic artery is a long slender branch of the internal thoracic artery. It anastomoses with the musculophrenic and superior phrenic arteries.
In human anatomy, the esophageal hiatus is an opening in the diaphragm through which the esophagus and the vagus nerve pass. It is located in the right crus, one of the two tendinous structures that connect the diaphragm to the spine. Fibers of the right crus cross one another below the hiatus.
The intercostal arteries are a group of arteries that supply the area between the ribs ("costae"), called the intercostal space. The highest intercostal artery is an artery in the human body that usually gives rise to the first and second posterior intercostal arteries, which supply blood to their corresponding intercostal space. It usually arises from the costocervical trunk, which is a branch of the subclavian artery. Some anatomists may contend that there is no supreme intercostal artery, only a supreme intercostal vein.
Bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni hernia. A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant's diaphragm, allowing normally intra-abdominal organs to enter into the thoracic cavity. In the majority of people, the affected lung will be deformed, and the resulting lung compression can be life-threatening. Bochdalek hernias occur more commonly on the posterior left side.
The muscles of respiration are those muscles that contribute to inhalation and exhalation, by aiding in the expansion and contraction of the thoracic cavity. The diaphragm and, to a lesser extent, the intercostal muscles drive respiration during quiet breathing. Additional 'accessory muscles of respiration' are typically only used under conditions of high metabolic demand or respiratory dysfunction. However, in instances where these accessory muscles become stiff and hard, expansion of the rib cage can be restricted. Maintenance of the elasticity of these muscles is crucial to the health of the respiratory system and to maximize its functional capabilities.
The following outline is provided as an overview of and topical guide to human anatomy:
Diaphragmatic rupture is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. Most commonly, acquired diaphragmatic tears result from physical trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk.
The development of the digestive system concerns the epithelium of the digestive system and the parenchyma of its derivatives, which originate from the endoderm. Connective tissue, muscular components, and peritoneal components originate in the mesoderm. Different regions of the gut tube such as the esophagus, stomach, duodenum, etc. are specified by a retinoic acid gradient that causes transcription factors unique to each region to be expressed. Differentiation of the gut and its derivatives depends upon reciprocal interactions between the gut endoderm and its surrounding mesoderm. Hox genes in the mesoderm are induced by a Hedgehog signaling pathway secreted by gut endoderm and regulate the craniocaudal organization of the gut and its derivatives. The gut system extends from the oropharyngeal membrane to the cloacal membrane and is divided into the foregut, midgut, and hindgut.
The pulmonary pleurae are the two layers of the invaginated sac surrounding each lung and attaching to the thoracic cavity. The visceral pleura is the delicate membrane that covers the surface of each lung, and dips into the fissures between the lobes of the lung. The parietal pleura is the outer membrane which is attached to the inner surface of the thoracic cavity. It also separates the pleural cavity from the mediastinum. The parietal pleura is innervated by the intercostal nerves and the phrenic nerve.
This article incorporates text in the public domain from page 404 of the 20th edition of Gray's Anatomy (1918)