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General Surgery
Diaphragm
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
9 sections · 164 slides
Overview
- Scope of this topic
Embryogenesis
- Four embryonic sources of the diaphragm
- Embryonic and adult diaphragm compared
- Transverse septum
- Formation of the transverse septum
- Mediastinum as dorsal mesentery of the foregut
- Pleuroperitoneal membranes
- Muscular contribution from the body wall
- Origin of the diaphragmatic muscle fibres
- Descent of the diaphragm
- Levels of diaphragmatic descent in the embryo
- Phrenic nerve and the descending diaphragm
Congenital anomalies
- Origin of congenital diaphragmatic defects
- Diaphragmatic agenesis
- Accessory and duplicate diaphragms
- Timing of mechanical stress on the fetal diaphragm
- Evidence on congenital diaphragmatic hernia
- Management context in congenital diaphragmatic hernia
- Characteristics of Diaphragmatic Hernias - anatomy of the defect
- Characteristics of Diaphragmatic Hernias - anatomy of the defect (continued)
- Characteristics of Diaphragmatic Hernias - anatomy of the defect (continued)
- Characteristics of Diaphragmatic Hernias - sac and herniated organs
- Characteristics of Diaphragmatic Hernias - sac and herniated organs (continued)
- Characteristics of Diaphragmatic Hernias - sac and herniated organs (continued)
- Characteristics of Diaphragmatic Hernias - remarks
- Characteristics of Diaphragmatic Hernias - remarks (continued)
- Characteristics of Diaphragmatic Hernias - remarks (continued)
- Parasternal (Morgagni) defects
- Laparoscopic experience with Morgagni hernia
- Sites of weakness in the diaphragm from below
- Posterolateral (Bochdalek) defects
- Epidemiology of Bochdalek hernia
- Variants and outcome in Bochdalek hernia
- Intestinal herniation through the foramen of Bochdalek
- Traumatic hernia
- Peritoneopericardial hernia
- Congenital eventration of the diaphragm
- Congenital versus acquired eventration
- Eventration of the left diaphragm
- Complications and reported associations of eventration
- Sliding and paraesophageal hiatal hernia as congenital lesions
- Sliding and paraesophageal hernia seen from the left
- Congenital short esophagus
- Congenital short esophagus
- The debate on short esophagus
- Anomalies associated with diaphragmatic defects
Surgical anatomy of the muscle
- Respiratory mechanics of the newborn diaphragm
- Bellows and piston: newborn versus adult diaphragm
- Rib cage and diaphragmatic insertion from birth to adulthood
- General architecture of the adult diaphragm
- Muscular attachments of the diaphragm from below
- Sternal portion of the diaphragm
- Costal portion of the diaphragm
- Lumbar portion and the crura
- Tendinous and muscular composition of the crura
- Patterns of the crural arms at the esophageal hiatus
- Common patterns of the diaphragmatic crura
- Arcuate ligaments
- Central tendon
- Area of diaphragm in contact with the pericardium
Openings of the diaphragm
- The three major apertures at a glance
- Hiatus of the inferior vena cava
- Caval calibre during inspiration: an unsettled question
- Esophageal hiatus
- Portosystemic communication at the esophageal hiatus
- Apertures of the diaphragm seen from below
- The three apertures seen from the left
- Aortic opening and median arcuate ligament
- Median arcuate ligament and the celiac trunk
- Median arcuate ligament in hiatal repair
- Other openings in the diaphragm
Esophageal hiatus and the gastroesophageal junction
- Abdominal esophagus and sphincter competence
- Suture tension targets in the Hill procedure
- Role of the abdominal esophagus in preventing reflux
- Phrenoesophageal ligament
- Insertion level of the phrenoesophageal ligament
- Development of the phrenoesophageal membrane
- Age-related change in the phrenoesophageal ligament
- Esophageal hiatus in sagittal section, normal and herniated
- Definition and classification of hiatal hernia
- Sliding hiatal hernia
- Secondarily fixed and incarcerated sliding hernia
- Paraesophageal and combined hiatal hernia
- Structures at the gastroesophageal junction and hiatus
- Gastroesophageal junction: four definitions
- Endoscopic and anatomic gastroesophageal junction
- Internal gastroesophageal junction and junctional epithelium
- The gastroesophageal junction from four points of view
- Diagnosis of hiatal hernia
- Radiological signs of hiatal hernia
- Endoscopic findings in hiatal hernia
- Endoscopic appearances at the distal esophagus
Relations of the diaphragm
- Diaphragmatic-pleural-mediastinal relations
- Structures of the inferior right mediastinum
- Structures of the inferior left mediastinum
- Pleural relations of the distal esophagus
- Diaphragmatic pleura and the pleural recesses
- Blood supply and venous drainage of the diaphragmatic pleura
- Peritoneal reflections related to the diaphragm
- Falciform, coronary and triangular ligaments
- Peritoneal reflections and the bare area of the diaphragm
- Hepatogastric ligament
- Gastrosplenic ligament
- Gastrophrenic ligament
- Hepatogastric, hepatoduodenal, gastrosplenic and gastrophrenic ligaments
Vessels, lymphatics and nerves
- Arterial supply of the diaphragm
- Arterial supply of the diaphragm from below
- Left inferior phrenic and left gastric arteries
- Variations in blood supply to the distal esophagus and hiatus
- Aberrant left hepatic artery
- Venous drainage of the diaphragm
- Venous drainage of the diaphragm from below
- Left gastric (coronary) vein
- Lymphatic drainage of the diaphragm
- Lymphatic drainage of the diaphragm from above
- Diaphragmatic nodes in malignancy
- Hepatic lymphatic pathways across the diaphragm
- Lymph Nodes Draining Pleural Structures in the Human
- Thoracic duct and cisterna chyli
- Innervation: entry of the phrenic nerves
- Motor trunks of the phrenic nerve
- Major branches of the phrenic nerves seen from below
- Additional innervation of the diaphragm
- Vagal trunks at the hiatus
- Terminology of the vagal structures at the hiatus
- Variant vagal arrangements at the hiatus
- Celiac ganglia and crural suture placement
Subphrenic spaces and surgery
- Bare area and the subphrenic compartments
- Boundaries of the right subphrenic space
- Boundaries of the left subphrenic space
- Compartmentalisation by pseudomembranes
- Right subphrenic fluid collections in parasagittal section
- Left subphrenic fluid collections in parasagittal section
- Surgical approach to subphrenic collections
- Pleural risk during the posterior approach
- Histology and physiology of the diaphragm
- Surgery of the diaphragm
- Sites of diaphragmatic herniation
- Anatomic complications of diaphragmatic surgery
- Incisions that spare phrenic nerve branches
- Key operative points to remember
- Key anatomical numbers
- Embryology to pathology in one line
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- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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