Hello everyone,how are you all? Hope you all are doing well.we are learninh about abdomen anatomy and we learned about basics and its layers and clinical significance.now we are going to learn about very important structure named as **Diaphragm**.

# DIAPHRAGM

[Diaphragm](https://en.m.wikipedia.org/wiki/Thoracic_diaphragm) is a musculotendinous structure which separates thoracic cavity from the abdominal cavity.it helps in respiration.

![Respiratory_system.svg.png](https://files.peakd.com/file/peakd-hive/salomijale/23xLN5cSHMjiRXNBiM7YKKCBkUMoooZrjy5DEYDfeUYSQiLRKxK8Aj3HppeT9SEorJqwo.png)
[Image source](https://en.m.wikipedia.org/wiki/Thoracic_diaphragm#/media/File%3ARespiratory_system.svg)

You can see in the below image i  just marked with an arrow pointing diaphragm.
![3D_Medical_Animation_Diaphragm_Structure__01.jpg](https://files.peakd.com/file/peakd-hive/salomijale/23wMYj31T8R3BHQ2Jg3PbseP7grfDCXvKm3b7R8RAvX8rfYnxCnMTBJQ9B13ie9VuXbp7.jpg)
[Image source](https://en.m.wikipedia.org/wiki/Thoracic_diaphragm#/media/File%3A3D_Medical_Animation_Diaphragm_Structure.jpg)

The thoracic cavity has esophagus,heart and few nerves and arteries and they have to pass through diaphragm to enter into abdominal cavity.so, as the diaphragm has openings for these structures to pass through it.these are major openings and minor openings.

**MAJOR OPENINGS**

There are 3 major openings in the diaphragm

1)**Vena caval opening** at T8 level

2)**Oesphageal opening** at T10 level

3)**Aortic opening** at T12 level


Structures passing through major openings are -
|Major openings|Structures passing through openings| |
|-|-|-|
|Vena caval opening|Inferior vena cava, right phrenic nerve| |
|Oesophageal opening|Oesophagus, Vagus nerve, Oesophageal branch of left gastric artery| |
|Aprtic opening|Aorta, Thoracic duct, Azygous vein| |


You can see in the below image the major openings and the structures passing through it.


![1113_The_Diaphragm.jpg](https://files.peakd.com/file/peakd-hive/salomijale/EptfqFZwzXTj2gCU6GXJ38wYnxGVAJw1bhsgcCLLvzJUsSFi2XpwRFqy6Nxoc8mUVEw.jpg)
[Image source](https://en.m.wikipedia.org/wiki/Thoracic_diaphragm#/media/File%3A1113_The_Diaphragm.jpg)

**Nerve supply**
The diaphragm is primarily innervated by the **phrenic nerve** which is formed from the cervical nerves C3, C4 and C5.

Below is link of a small video of diaphragm movement during breathing

https://en.m.wikipedia.org/wiki/File:Real-time_MRI_-_Thorax.ogv

# Clinical significance

**HIATUS HERNIA**

A [hiatal hernia](https://en.m.wikipedia.org/wiki/Hiatal_hernia) or hiatus hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest.it results into GERD.

We learned that oesophagus pass through one of the major opening which is **oesophageal opening**.

![Hiatal_Hernia.png](https://files.peakd.com/file/peakd-hive/salomijale/23x1Yc1gjL2aaECFb1BAVrEte5DMLENsG6vsUuGWSYsvieRKwkKUZyNjKuGcSFWBR7CSB.png)
[Image source](https://en.m.wikipedia.org/wiki/Hiatal_hernia#/media/File%3AHiatal_Hernia.png)


![1356px-HiatusHernia10.jpeg](https://files.peakd.com/file/peakd-hive/salomijale/23wC5ZoNnjLFyjoAhX8yPKbByQ7kUmj6gvo8skv3eJNGHRuNP8u1Ry6m5iMUbRfiChKxk.jpeg)
[Image source](https://commons.m.wikimedia.org/wiki/File:HiatusHernia10.JPG#mw-jump-to-license)


![Hiatus-hernia.jpg](https://files.peakd.com/file/peakd-hive/salomijale/23tvgW1R6Xcw2x8CLgLRWb8MaxZ4TyWgZSH4Y79m98duN66zpLAWDKr76rRziV69hpMQR.jpg)
[Image source](https://commons.m.wikimedia.org/wiki/File:Hiatus-hernia.jpg#mw-jump-to-license)

Below is link of video of hiatus hernia.watch it for better understanding.

https://en.m.wikipedia.org/wiki/File:Hernia_de_hiato.ogv

**Types of hiatus hernia**

A: Normal anatomy
B: Pre-stage
C: Sliding hiatus hernia
D: Paraesophageal hiatus

![720px-Hiatus_hernia.svg.png](https://files.peakd.com/file/peakd-hive/salomijale/23tmBC4zfnhNHgB7uRtDGss2gGjWufDaHCGXboKTSWMkikfGyEV2EGZeUfkGuCAbNfV9y.png)

[Types of hiatus hernia](https://commons.m.wikimedia.org/wiki/File:Hiatus_hernia.svg#mw-jump-to-license)


![Type_1_hiatus_hernia_on_retroflexion_with_fundic_gland_polyps.jpg](https://files.peakd.com/file/peakd-hive/salomijale/48SMbVEUZx69afi3wt5ZCqHpzd9yuix2cwYAiS1q2XfNtxKtqTgh3NhG329TkPDJPq.jpg)
[Type 1 hiatus hernia](https://commons.m.wikimedia.org/wiki/File:Type_1_hiatus_hernia_on_retroflexion_with_fundic_gland_polyps.jpg#mw-jump-to-license)

**CONGENITAL DIAPHRAGMATIC HERNIA**

[Congenital diaphragmatic hernia (CDH)](https://en.m.wikipedia.org/wiki/Congenital_diaphragmatic_hernia)  is a birth defect of the diaphragm. The most common type of CDH is a **Bochdalek hernia** and other type is **morgagni type**

*Morgagni type*

it is characterized by herniation through the foramina of Morgagni(anterior defect) which are located immediately adjacent and posterior to the xiphoid process of the sternu.

![Hernia_de_Morgani.jpeg](https://files.peakd.com/file/peakd-hive/salomijale/EoyMzSTS2SCtC5QiJ7d1skTAjmXpC1tpnaDA6n8D1mUhCMkAraQ8pnsr2vCjkP994j9.jpeg)
[Image source](https://commons.m.wikimedia.org/wiki/File:Hernia_de_Morgani.JPG#mw-jump-to-license)

*Bochdalek type*

Its is most common type of congenital diaphragmatic hernia.most common on posterolateral side.

![Diaphragma.png](https://files.peakd.com/file/peakd-hive/salomijale/23zm3cY1v4NgsSiT6R8V7ZixUVs1aCjFrLV7bV13uEp9GzqeZPFCu451gWS7JD42Wfbrx.png)
[Image source](https://en.m.wikipedia.org/wiki/Bochdalek_hernia#/media/File%3ADiaphragma.png)

# REFERENCES

- Grays's Anatomy:The Anatomical Basis of Clinical Practice,41st Edition page no 899,972,973,980

- SRB Manual of surgery,6th edition Page no 799



This is all about diaphragm and its openings and its clinical significance.hope you understood very well.please go through my previous posts.if you have any doubts please ask.

Thanks for reading,

With regards,