Crus of diaphragm

• 1 Anatomical Position and Attachments • 2 Pathways through the Diaphragm • 3 Actions • 4 Innervation and Vasculature • 5 Clinical Relevance: Paralysis of the Diaphragm The diaphragm is a double-domed musculotendinous sheet, located at the inferior-most aspect of the rib cage. It serves two main functions: • Separates the thoracic cavity from the abdominal cavity (the word diaphragm is derived from the Greek ‘diáphragma’, meaning partition). • Undergoes contraction and relaxation, altering the volume of the thoracic cavity and the lungs, producing inspiration and expiration. In this article, we shall look at the anatomy of the diaphragm – its attachments, actions and associated neurovascular structures. Anatomical Position and Attachments The diaphragm is located at the inferior-most aspect of the ribcage, filling the inferior thoracic aperture. It acts as the floor of the thoracic cavity and the roof of the abdominal cavity. The attachments of diaphragm can be divided into peripheral and central attachments. It has three peripheral attachments: • Lumbar vertebrae and arcuate ligaments. • Costal cartilages of ribs 7-10 (attach directly to ribs 11-12). • Xiphoid process of the sternum. The parts of the diaphragm that arise from the vertebrae are tendinous in structure, and are known as the right and left crura: • Right crus – Arises from L1-L3 and their intervertebral discs. Some fibres from the right crus surround the oesophageal opening, acting as a physiological sphinct...

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Ligament of Treitz (anterior view) The ligament of Treitz is a popular eponym that is used for the suspensory muscle of the duodenum. The ligament of Treitz is actually made up of two separate structures according to the description given in 1853 by Dr. Wenzel Treitz (an Austrian physician). While this is a relatively small structure, it has clinical implications in surgical procedures and in rare cases of small bowel obstruction. It is one of several so-called “ligaments” within the abdominal cavity that support the By formal definition, a Key facts about the ligament of Treitz Anatomy Made up of two parts: - The suspensory muscle of the duodenum - Hilfsmuskel (accessory muscle) Suspensory muscle of the duodenum Originates from the duodenojejunal flexure Inserts at the celiac artery Contains smooth muscle fibers The lower half of the complex Hilfsmuskel (accessory muscle) Originates from the right crus of the diaphragm Inserts at the celiac artery Contains skeletal muscle fibers The upper half of the complex Function A landmark for the duodenojejunal flexure Marks transition from foregut to the midgut Helps gastric motility Clinical significance Guide for malrotation syndromes A rare cause of superior mesenteric artery syndrome Synonyms: Duodenojejunal junction The Hilfsmuskel component of the ligament of Treitz (the first part of the ligament) extends from the right crus of the The second part of the ligament arises as a connective tissue band from the para-aortic co...

Synonyms: Respiratory diaphragm, Thoracoabdominal diaphragm , The diaphragm is an unpaired, dome shaped The diaphragm is the primary muscle that is active in The diaphragm is much more than just a sheath separating your thoracic and abdominal cavities. This article will examine this intricate and crucial muscle in detail, looking at its Key facts about the diaphragm Origin Sternal part: Posterior aspect of xiphoid process Costal part: Internal surfaces of lower costal cartilages and ribs 7-12 Lumbar part: Medial and lateral arcuate ligaments (lumbocostal arches), bodies of vertebrae L1-L3 (+intervertebral discs), anterior longitudinal ligament Insertion Central tendon of diaphragm Relations Pleural cavities, pericardial sac, liver, right Openings Aortic hiatus (aorta, azygos vein, thoracic duct), esophageal hiatus (esophagus, vagus nerve), caval foramen (inferior vena cava) Mnemonic: Â I 8Â 10 EGGS AT 12 Greater, lesser, least splanchnic nerves, superior epigastric vessels Innervation Phrenic nerves (C3-C5) (sensory innervation of peripheries via 6th-11th intercostal nerves) Mnemonic:Â C3, 4, 5 keeps the diaphragm alive! Blood supply Subcostal and lowest 5 intercostal arteries, inferior phrenic arteries, superior phrenic arteries Functions Depresses costal cartilages, primary muscle of breathing (inspiration) Muscle anatomy reference charts Read article Structure and relations The diaphragm is a musculotendinous sheet. It has three muscular parts (sternal, costal, and lumb...

Article: • • • • • • • • • • • Images: • Terminology On chest imaging, in particular left and right hemidiaphragms. The hemidiaphragms are purely descriptive terms and are not discrete anatomical structures. Gross anatomy The muscular fibers of the diaphragm originate around the circumference of the inferior thorax and converge to a common insertion point of the central tendon. The muscle slips can be grouped according to their origins: • sternal: arise from two strips under the • costal: arise from the inner surfaces of the lower six • lumbar: arise from the aponeurotic arches (lumbocostal arches) and from the lumbar vertebrae (a.k.a. crura) There are two paired tendinous lumbocostal arches: • medial lumbocostal arch ( medial arcuate ligament): a tendinous arch from the superior anterior thickened • lateral lumbocostal arch ( lateral arcuate ligament): covers th rib; this may be discontinuous on CT in up to 11% of people and hence may mimic 8 The crura are tendinous structures that blend with the • right crus is longer and broader than the left, and arises from the anterior surfaces of the bodies of L1-3 • left crus arises from the corresponding portions of L1-2 The medial margins of the two crura pass forwards and medially. They meet in the midline to form an arch in front of the median arcuate ligament. All these muscles insert into the Through the diaphragm are a series of three major and some minor • • • • formed mainly by the large right crus and its muscular fibers,...

Celiac artery compression syndrome, also known as median arcuate ligament syndrome, Dunbar syndrome, celiac axis syndrome or Harjola-Marable syndrome, is a rare condition characterized by upper abdominal pain in the setting of compression of the Although well-recognized as a clinical entity, there remains some controversy regarding this condition due to the relatively high prevalence of celiac artery narrowing in asymptomatic patients and autopsy studies 7. Article: • • • • • • • • • Images: • Epidemiology • more common in females (4:1 female/male ratio) 7 • average age 30-50 years old 7 • thought to be more common in thin patients 7 Clinical presentation • chronic abdominal pain, especially postprandial 7 • can be relieved by positional changes, e.g. standing position • can be aggravated by supine position • nausea/vomiting • weight loss Pathology The There is considerable variation in positioning of both the celiac trunk and the diaphragm 7. In some, the ligament is positioned more inferiorly relative to the celiac artery, resulting in compression. The degree of compression typically varies with respiration, most accentuated during end-expiration when the two structures move closer together. The etiology of abdominal pain is hypothesized to be ischemic, due to impaired flow secondary to compression. Alternatively, the contribution of a neuropathic component related to the effect on the 7. Radiographic features It is important to note that narrowing of the celiac trunk at...

• 1 Anatomical Course • 2 Anatomical Structure • 2.1 Oesophageal Sphincters • 3 Anatomical Relations • 4 Vasculature • 5 Innervation • 6 Lymphatics • 7 Clinical Relevance: Disorders of the Oesophagus • 7.1 Barrett’s Oesophagus • 7.2 Oesophageal Carcinoma • 7.3 Oesophageal Varices The oesophagus is a fibromuscular tube, approximately 25cm in length, that transports food from the It originates at the inferior border of the In this article we shall examine the anatomy of the oesophagus – its structure, vascular supply and clinical correlations. Anatomical Course The oesophagus begins in the neck, at the level of C6. Here, it is continuous superiorly with the laryngeal part of the It descends downward into the oesophageal hiatus (an opening in the right crus of the diaphragm) at T10. The abdominal portion of the oesophagus is approximately 1.25cm long – it terminates by joining the cardiac orifice of the stomach at level of T11. Anatomical Structure The oesophagus shares a similar structure with many of the organs in the alimentary tract: • Adventitia – outer layer of connective tissue. • Note: The very distal and intraperitoneal portion of the oesophagus has an outer covering of serosa, instead of adventitia. • Muscle layer – external layer of longitudinal muscle and inner layer of circular muscle. The external layer is composed of different muscle types in each third: • Superior third – voluntary striated muscle • Middle third – voluntary striated and smooth muscle • Inferio...

[ The crus of diaphragm (pl. crura), refers to one of two leg in Latin. Structure [ ] The crura originate from the front of the bodies and • The right crus, larger and longer than the left, arises from the front of the bodies and • The left crus arises from the corresponding parts of the upper two lumbar vertebrae only. The medial tendinous margins of the crura pass anteriorly and medialward, and meet in the middle line to form an arch across the front of the From this series of origins the fibers of the diaphragm converge to be inserted into the The fibers arising from the The medial fibers of the right crus ascend on the left side of the References [ ] This article incorporates text in the (1918) External links [ ] •

Article: • • • • • • • • • • • Images: • Gross anatomy The adrenal glands are located superior and anteromedial to the kidneys, within the 7. Axially, the right adrenal gland is linear or V-shaped with larger medial limb and smaller lateral limb, while left adrenal gland is triangular shaped 1,11. The right adrenal gland has a maximum width of 6.1 mm and the left adrenal gland has a maximum width of 7.9 mm 6. Proportionately, the adrenal size is larger in neonates and infants, being almost one-third of the size of the kidney 2-4. The adrenal gland consists of two portions: an outer cortex and an inner medulla. The outer cortex is derived by mesoderm while the inner medulla is derived from neural crest cells 11. The gland is covered by a fibrous capsule. The cortex is subdivided into three zones (from outer to inner) 5,7: • zona glomerulosa • zona fasciculata • zona reticularis The medulla (chromaffin cells) produces catecholamines (epinephrine, norepinephrine) and dopamine. Locations The adrenal glands lie superior and anteromedial to the kidneys 1. The right adrenal gland is lower and more medial to the spine than the left adrenal gland 11. Relations Right adrenal gland • medial: right crus of the • lateral: right lobe (bare area) of the • anterior: • posterior: right 3,6,7 Left adrenal gland • medial: left crus of the diaphragm, left inferior phrenic artery • lateral: spleen • anterior: • posterior: left kidney 3,6,7 Arterial supply The arterial supply is via three 5: • ...

• 1 Anatomical Location and Relations • 2 Anatomical Structure • 2.1 Cortex • 2.2 Medulla • 3 Vasculature • 4 Innervation • 5 Lymphatics • 6 Clinical Relevance: Pheochromocytoma The adrenal (or suprarenal) glands are paired endocrine glands situated over the medial aspect of the upper poles of each They secrete steroid and catecholamine hormones directly into the blood. In this article, we shall look at the anatomy of the adrenal glands – their location, structure and vascular supply. Anatomical Location and Relations The adrenal glands are located in the posterior abdomen, between the superomedial kidney and the diaphragm. They are retroperitoneal, with parietal peritoneum covering their anterior surface only. The right gland is pyramidal in shape, contrasting with the semi-lunar shape of the left gland. Perinephric (or renal) fascia encloses the adrenal glands and the kidneys. This fascia attaches the glands to the crura of the diaphragm. They are separated from the kidneys by the perirenal fat. The adrenal glands sit in close proximity to many other structures in the abdomen: Right adrenal gland Left adrenal gland Anterior Posterior Anterior Posterior • Inferior vena cava • Right lobe of the liver • Right crus of the diaphragm • Stomach • Pancreas • Spleen • Left crus of the diaphragm Anatomical Structure The adrenal glands consist of an outer connective tissue capsule, a cortex and a medulla. Veins and lymphatics leave each gland via the hilum, but arteries and nerves ...