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The Diaphragm – Anatomy, Nerve Supply, Functions

The diaphragm in the thorax is called the thoracic diaphragm and serves as an important anatomical landmark that separates the thorax, or chest, from the abdomen. It functions during breathing when it contracts to enlarge the thoracic cavity and reduce the intrathoracic pressure so that lungs may expand and fill their alveoli with air. It is a dome-shaped muscle and tendon that functions as the main muscle of respiration and is essential to the breathing process. It is a fibromuscular sheet that has a convex upper surface that forms the floor of the thoracic cavity and a concave under surface to form the roof of the abdominal cavity. The esophagus, phrenic, and vagus nerves, descending aorta, and inferior vena cava pass through the diaphragm between the thoracic and abdominal cavities. The diaphragm is asymmetric with the left side slightly more inferior than the right, chiefly because of the presence of the liver located on the right. The left side may also be partially inferiorly located because of the push by the heart.,

The thoracic diaphragm, or simply the diaphragm, is a sheet of internal skeletal muscle[rx] 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.[rx]

Structure of The Diaphragm

Functions of the Diaphragm
Muscle of Inspiration

The diaphragm pulls its central tendon down during contraction and then increases the vertical diameter of the thorax. This increases the negative pressure inside the thoracic cavity, which draws in air. Thus, the diaphragm is the most important muscle used in inspiration. During inhalation, the diaphragm contracts and is pushed inferiorly into the abdominal cavity where it appears flat. Simultaneously the external intercostal muscles located in between the ribs raise the anterior chest wall like the handles of a bucket. This results in the chest cavity becoming larger and wider, which allows air in from the outside. During exhalation, the rib cage and chest wall start to sag and revert to the original position. At the same time, there is relaxation and elevation of the diaphragm. This motion forces the air within the lungs to push out of the body.,

Muscle of Abdominal Straining

The contraction of the diaphragm will assist in the contraction of the muscles of the anterior abdominal wall in raising the intra-abdominal pressure will normal processes like micturition, defecation, and parturition.

Weightlifting Muscle

When a person takes and holds a deep breath, the diaphragm will assist the muscles of the anterior abdominal wall to raise the intra-abdominal pressure. This maneuver is also called as Valsalva maneuver and is used to augment heart murmurs and classify them whether they are clinically right-sided or left-sided.

Thoracoabdominal Pump

When people breathe in, the diaphragm descends, which decreases the intrathoracic pressure and improves the intra-abdominal pressure. This compresses the blood in the inferior vena cava (IVC) and forces it upward into the right atrium and helps to fill the heart. When abdominal lymph vessels are also compressed, its passage upward within the thoracic duct is aided by the negative intrathoracic pressure. Furthermore, valves in the thoracic duct prevent the backflow of the lymph in the thoracic duct.

Diaphragm Formation
  • Septum transversum
  • Pleuro-peritoneal membrane
  • Mesentery of esophagus
  • Mesoderm of the body wall
Insertion

The diaphragm inserts into a central tendon. The top surface of the tendon is partially connected to the lower surface of the fibrous pericardium. Muscle fibers arising from the right crus traverse up on the left side and encircle the orifice of the esophagus in a sling-like loop. These fibers act as a sphincter and likely assist in preventing the regurgitation of the stomach contents into the thoracic part of the esophagus.

Origin of Diaphragm of The Diaphragm

Sternal

The sternal part originates as 2 fleshy slips from the back of the xiphoid process.

Costal

The costal part originates from inner surfaces of the cartilages, adjacent parts of the lower sixth ribs on each side. It interdigitates with transversus abdominis.

Lumbar
  • The medial lumbocostal arch is a tendinous arch in fascia covering psoas major. Medially, it attaches to the side of the body of vertebra L1. Laterally, it connects to the front of the transverse process of vertebra L1.\
  • The lateral lumbocostal arch is a tendinous arch in fascia covering the upper part of quadratus lumborum. Medially, attach to the front of the transverse process of vertebra L1. Laterally, it connects to the lower border of the 12th rib.
  • The right crus arises from the anterolateral surface of the bodies of the upper three lumbar vertebrae and also the intervening intervertebral disc
  • The left crus arises from the corresponding parts of the upper 2 lumbar vertebrae.

Medial margin of two crura forms a tendinous arc across the front of the aorta called the median arcuate ligament.

Blood Supply of The Diaphragm

Major Arteries Supplying the Diaphragm

  • Musculophrenic artery branch of the internal thoracic artery
  • Superior phrenic artery branch of the aorta
  • Lower five intercostal arteries and subcostal artery
  • Inferior phrenic artery

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.[rx]

The diaphragm drains blood into the brachiocephalic veins, azygos veins, and veins that drain into the inferior vena cava and left suprarenal vein.

Nerves of The Diaphragm

Motor Nerve Supply

Right and left phrenic nerves (C3 through C5)

The diaphragm is primarily innervated by the phrenic nerve which is formed from the cervical nerves C3, C4 and C5.[rx] 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).

Sensory Nerve Supply

The phrenic nerve innervates the parietal pleura and peritoneum covering the central surfaces of the diaphragm. The lower 6 intercostal nerves supply the periphery of the diaphragm.

When the diaphragm contracts, the large-sized myelinated phrenic afferents fire. On the other hand, the smaller diameter nerves continue to discharge throughout the respiratory cycle. It is now well established that activation of both non-myelinated and myelinated phrenic sensory nerves modulate respiratory output during each breathing cycle. However, the activation of the phrenic afferents does increase significantly as the diaphragm continues to work and develops fatigue. Once the phrenic afferents are activated, they also modulate the sympathetic motor outflow. Furthermore, the phrenic afferents also contribute to somatosensation of the diaphragm and make one aware of the sensation of breathing while awake. The exact influence of the spinal and supraspinal nerves and synapses between the non-myelinated and myelinated phrenic nerves is not known.

The use of deep muscle training contributed to a significant change in the position of the body in the sagittal plane and the increase in the amplitude of breathing.

Muscles Attachment of The Diaphragm

One can find the origins of the diaphragm along the lumbar vertebrae of the spine and the inferior border of the ribs and sternum.

The superior diaphragm origin is continuous from the xiphoid process anteriorly to lower 6 costal cartilages of the thorax laterally and first 2 lumbar vertebrae posteriorly. The musculoskeletal fibers radiate from all angles to the center of the body and converge into a central tendon which is the inferior attachment or muscular-skeletal point.

The diaphragm has a dome-like structure with the peripheral segment attached to the chest wall and abdominal cavity. The muscle fibers from these attachments converge in a central tendon, which forms the crest of the dome. The periphery of the diaphragm is made of strong muscular fibers that have their origin from the surroundings of the inferior thoracic aperture. These muscle fibers than converge and insert into the central tendon.

Surgical Considerations

Diaphragmatic Hernia

A diaphragmatic hernia is a congenital disability that occurs when one or more of a person’s abdominal organs (stomach, spleen, liver, intestines) move upward into the chest through a defect in the diaphragm. It is usually congenital but can be acquired. Congenital hernias are considered a medical emergency and require prompt surgery.

Congenital Diaphragmatic Hernia (CDH)

A CDH is an abnormal development of the diaphragm during fetal life. The herniation leads to the passage of one or other abdominal organ in the chest leading to the pulmonary hypoplasia which is usually unilateral. The most common subtype of congenital diaphragmatic hernias is Bochdalek Hernia. Other types include Morgagni a hernia, diaphragm eventration, and central tendon defects of the diaphragm.

Acquired Diaphragmatic Hernia (ADH)

An ADH happens due to penetrating or blunt injury. Falls and motor vehicle accidents are major causes of blunt injury while stabs and gunshot wounds lead to penetrating injuries. Penetrating injuries are the more common cause than the blunt injuries as a cause of the diaphragmatic rupture. Further, there can be accidental damage to the diaphragm from the surgical causes. Infrequently, a diaphragmatic hernia may result without any identifiable cause and remain undiagnosed for an undetermined amount of time, until the herniation of abdominal organs in the chest start to cause symptoms.

Treatment

Both acquired, and congenital diaphragmatic hernias usually require immediate surgery. Surgery requires the return of the abdominal organs from the chest cavity back into their original location in the abdominal cavity. The diaphragm should be repaired with staples or permanent sutures with or without a prosthetic patch.

Clinical Significance

The diaphragm has 3 major openings and 5 minor openings.

Major

  • The vena cava trunk lies at the level of the T8 vertebra in the central tendon. It allows passage of the Inferior vena cava and some branches of the right phrenic nerve.
  • The esophageal hiatus lies at the level of the T10 vertebra in a sling of muscle fibers derived from the right crus at the left of the median plane. It allows passage of the esophagus, the right and left vagus trunks, the esophageal branches of the left gastric vessels, and the lymph vessels.
  • The aortic hiatus lies anterior to the body of the T12 vertebra between the crura. It allows passage of the aorta, thoracic duct, and azygos vein.

Minor

  • The lesser aperture of right crus (permits lesser and greater splanchnic nerves)
  • The lesser aperture of left crus (permits hemizygous vein; and lesser and greater splanchnic nerves)
  • The sympathetic trunk runs posteriorly below the medial lumbocostal arches.
  • Foramen of Morgagni is found in the areolar tissue between the sternal and costal part of the diaphragm contains the superior epigastric branch of the internal thoracic artery and the lymphatics of the abdominal wall.
  • The medial and lateral lumbocostal arches can contain areolar tissue that, when present, separates the superior and posterior surface of a kidney from the pleura.

The figure below shows the openings in the diaphragm: A=vena cava, B=esophagus, C=aorta. The muscular diaphragm surrounds the central tendon in the periphery.

References

 

Are you Feel Sad, Stressed, Depressed Again? Answer is here.

Are you Feel Sad, Stressed or Depressed Again? Dopamine is necessary for your happiness and well-being. It is a neurotransmitter that helps with the control of your brain’s pleasure and reward center, regulation of your emotional response, movement of your body and it allows you to take action to move forward your dreams.

Sad, Stressed

Sounds pretty cool, right? Dopamine also affects your perception – healthy dopamine levels help you to see life in a positive light. Low dopamine levels promote sadness, depression, negativity and other emotional issues.

 Natural ways you can increase your dopamine levels without medication.

Don’t Get Addicted for Sad, Stressed

Addictions, including drug-, alcohol-, sex-, shopping-addictions and any other addictive behaviors, often develop to receive an instant gratification. But this instant fix doesn’t actually solve your problems. For a while, addictive behaviors can relieve your pain, but they don’t offer long-term solutions. Addictions lead to less-rewarding lifestyles, to lifestyles all about looking for fulfillment from the source of your addictions.

Sad, Stressed

To decrease the likelihood of addictions, aim to live a more fulfilling life with more life-rewarding pleasures. Fill your day with things, activities and people that inspire or uplift you. Have fulfilling conversations, go for walks, read a good book, take a job you love (or learn to love your job), play with animals or buy yourself flowers.

Since addictions often stem from past traumas; you want to look for ways of emotional release, letting go and forgiveness. If you need to, don’t be afraid to seek help from a therapist, counselor or life coach.

Checklist Small Tasks of Sad, Stressed

25.1Have you ever wondered why you feel happy when you finish a task or get organized? It is because your dopamine levels increase when you’ve completed something. Your dopamine levels rise even more when you are able to check something physically off your list versus mentally.

According to the Principles of Self-Management, if a task involves 25% or greater change in your routine, you will feel overwhelmed, incapable or completing it and you may start to self-sabotage or give up. If the task involves less than 10% change, you will likely not do it, because it will feel easy and meaningless. The best way to balance the scale is to look for goals between 10 and 25% of new behaviors and actions in order to create the highest likelihood of success.

Create Something

As a writer, I can tell you that when I am in a creative mode, I enter the beautiful flow of a new world. Creative activity creates more dopamine levels in your brain, putting you into a hyper-focused state of happy flow.

You don’t have to be a professional artist to be creative. Writing, painting, sculpturing, playing with legos, drawing, coloring, dancing, singing, knitting, making crafts, photography, making a vision board, auto repair, cooking, baking, or anything else that seems fun and interesting for you can become a creative activity. Even designing a new program for your job, organizing your home, or planning a trip can be a creative activity.

Exercise

25.2I am a runner. To me, running is more than just exercise or a sport. In a way, it is a form of art and self-expression. But, regardless of what form of exercise you choose, it can very likely boost your dopamine levels, as well as your endorphins and serotonins, relieving stress and creating joy.

Though exercise is important, make sure it doesn’t become an addiction. Find a form of exercise you enjoy, but don’t overdo it. Don’t place value on exercise either. It is a part of healthy living, self-care and happiness, but it is not a way to measure your self-worth.

Get A Streak Going

Getting a streak going is similar to creating a checklist and accomplishing your steps. It increases your dopamine levels and helps you to feel good and accomplished.

Set a goal: it can be a new workout routine, a habit that’s part of a lifestyle or dietary change, a self-love routine, or an activity with a loved one. Check off every Meatless Monday you’ve accomplished. Decide to take yoga or to to go for a run every Monday, Wednesday and Friday. Journal every morning. Go out for date nights every second Saturday with your partner. Experiment with a new recipe every Sunday. Check off your accomplishment and smile at your streak.

Though having a streak is something to celebrate, it has some downsides to it. It may become so routine that you forget to celebrate. Routines are good, but don’t forget to mix things up – mix in new recipes into Meatless Mondays instead of making the same old easy pasta marinara, try different types of yoga classes, use new recipe books or new cooking methods for you recipes, do a variety of journaling exercises, try new things for date night besides a dinner or a movie.

Increase Tyrosine

25.3Tyrosine is the most important out of all the chemicals that make up dopamine – in fact, it is dopamine’s main building block. Tyrosine is one of the 22 key amino acids that are used for building proteins around the body. It not only increases dopamine levels, but norepinephrine as well. This makes it important for you to get enough proteins.

There are a large variety of foods that can increase tyrosine in your body. Plant-based varieties of these tyrosine enhancing foods include almonds, bananas, avocados, green tea, watermelon and dark chocolate.

 Listen To Music

Do you know that feeling when you jam comes on, where the world stops and all you want to do is dance and sing along? It feels good, right? Guess what, listening to good music increases your dopamine levels and creates a good feeling.

This is, however, only a temporary increase. Listening to music can make you feel good temporarily, but will not lead to lasting fulfillment in life (unless you are a musician, singer, DJ, music producer, or music is your passion in a similar way). Popular music today is created in a way to create chemical dependency in your brain – just like substance addiction.

Meditate

25.4If you are leading a busy life in today’s world, you may be feeling overwhelmed. There is so much to do, your to-do list is endless and there are so many other spontaneous impulses of needs and wants. With so many options, it can even be overwhelming to select a box of granola or to pick up a healthy apple. Your brain is puzzling about the past and already working on the future. Overthinking may even be more of a compulsion that you cannot seem to stop.

One of the benefits of meditation is to slow down your monkey mind. Even if it is only for a few minutes, it can help you to slow down your thinking, or better yet, to stop thinking. Through meditation, you can learn to be present.

Meditation increases your dopamine levels, but differently than cardiovascular exercise. It calms your mind, centers your being, helps you feel good, creates more mental energy and helps you to reach more fulfillment in life. If you practice meditation regularly, eventually you will be able to transfer your skills to real life and get back to the present moment in stressful situations.

Take Supplements

There are many great ways to increase your dopamine levels, both through lifestyle choices, daily activities and food. However, if you’ve been dealing with sadness, lack of motivation, lack of energy, or an illness that’s holding you back, you can use all the help you can get. Some days you may also simply be facing a time crunch to get in all your dopamine-friendly activities.

Thankfully, there are some great natural supplements that can help you increase your dopamine levels.

  • Acetyl-l-tyrosine is a building block of dopamine and a healthy dose can help make your brain’s job of dopamine production easier.
  • Ginkgo Biloba is a popular supplement that is believed to increase dopamine levels and keep them up for longer.
  • L-theanine increases neurotransmitters – such as dopamine – in your brain. Green tea is a wonderful source of l-theanine.
  • Curcumin – this one is my favorite. It is the active ingredient of turmeric that is not only a potent anti inflammatory, antifungal, antibacterial and antiviral superspice, but it also increases dopamine levels in your brain. FitLifeTV just came out with its new and powerful turmeric supplement – you can find it in our shop.

Remember that though taking a supplement is helpful and beneficial, it is not a replacement for happy, healthy and dopamine-enhancing lifestyle and dietary choices. Life is complex, but also magical, it is much more than simply taking a pill. Get your turmeric or other supplements in, but practice all the other 9 tips from this article as well for ideal results.

Toxic Cleaning

When your body is loaded with toxins and bacteria, everything gets out of whack. Your immune system weakens, your body becomes acidic, giving opportunities for disease to grow and your dopamine production can be constrained too. In other words, if you are filled with junk, you will feel like junk too.

First, it is very important what you bring into your body. You have enough toxin build-up already – stop taking in more. Focus on nourishing, organic, whole foods, mostly plants. Reduce – or preferably stop – eating processed foods.

Organic vegetables and fruits are definitely your friends. Green juices and green smoothies are excellent ways to bring in a large amount of nutrients into your body quickly. If you are on the go, use Green Juice Powders, or simply add them to your juices or smoothies for extra benefits.Sad, Stressed

Overall, be sure to get enough sleep. Sleep allows your body to recover and your mind to rest. It is super important, don’t let yourself forget about it. Besides sleep, find time to relax, laugh, nap and do all the fulfilling activities you need to in order to keep yourself lifted, happy and positive.

Above all, friend, follow your heart and keep creating joy in your life.

What do you do on a regular basis to increase dopamine, to create more joy and more fulfillment in your life? What are you going to try from your list? Share your tips and wisdom below. We would love to hear from you.

References

Sad, Stressed

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