أسئلة الـ ICM, diaphragm (ريتين ثانية أناتومي)
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Questions and Answers

What is the primary action of the external intercostal muscles?

Inspiration.

Describe the direction of the internal intercostal muscles.

Downward and backward.

Where do the external intercostal muscles originate?

From the lower border of the rib above.

What is the insertion point for the internal intercostal muscles?

<p>Upper border of the rib below.</p> Signup and view all the answers

What distinguishes the action of the transversus thoracic muscle from the other intercostal muscles?

<p>It primarily aids in expiration.</p> Signup and view all the answers

Identify the origin of the sterno-costalis muscle.

<p>The inner surface of the xiphoid process and lower body of the sternum.</p> Signup and view all the answers

What action do the sub-costalis muscles perform?

<p>Expiration.</p> Signup and view all the answers

Explain how the orientation of the innermost intercostal muscles differs from the external intercostals.

<p>The innermost intercostal muscles run downward and backward, whereas the external intercostals run downward, forward, and medially.</p> Signup and view all the answers

Where does the typical intercostal nerve originate?

<p>The typical intercostal nerve originates from the ventral rami of thoracic spinal nerves, specifically the 3rd to 6th nerves.</p> Signup and view all the answers

What is the insertion point of the intercostal muscle?

<p>The insertion point of the intercostal muscle is the inner surface of 2 or 3 ribs below the origin.</p> Signup and view all the answers

What is the primary action of the intercostal muscles?

<p>The primary action of the intercostal muscles is expiration.</p> Signup and view all the answers

Identify two branches of the typical intercostal nerve.

<p>Two branches of the typical intercostal nerve are the anterior cutaneous branch and the lateral cutaneous branch.</p> Signup and view all the answers

What ligament connects the two crura of the diaphragm?

<p>The median arcuate ligament connects the two crura of the diaphragm.</p> Signup and view all the answers

From which vertebrae does the right crus of the diaphragm originate?

<p>The right crus of the diaphragm originates from the upper 3 lumbar vertebrae.</p> Signup and view all the answers

What anatomical area lies behind the kidney, filled with fat?

<p>The vertebra-costal triangle lies behind the kidney and is normally filled with fat.</p> Signup and view all the answers

What is the consequence of an intercostal nerve block?

<p>An intercostal nerve block can provide relief from pain in the thoracic region by blocking sensory input.</p> Signup and view all the answers

What nerve supplies motor function to the diaphragm?

<p>The phrenic nerve, originating from spinal roots C3, C4, and C5.</p> Signup and view all the answers

Identify the main structures passing through the vena caval opening of the diaphragm.

<p>The inferior vena cava and the right phrenic nerve.</p> Signup and view all the answers

At what vertebral level does the esophageal opening in the diaphragm occur?

<p>The esophageal opening occurs at vertebral level T10.</p> Signup and view all the answers

What is the arterial supply to the diaphragm?

<p>The diaphragm is supplied by the pericardiophrenic and musculophrenic arteries from the internal thoracic artery, as well as the superior phrenic artery from the descending thoracic aorta and the inferior phrenic artery from the abdominal aorta.</p> Signup and view all the answers

Describe the condition of a hiatus hernia related to the diaphragm.

<p>A hiatus hernia occurs when there is a wide esophageal opening, allowing abdominal viscera to pass into the thorax.</p> Signup and view all the answers

Where does the typical intercostal nerve end after piercing the internal intercostal muscle?

<p>It continues as the anterior cutaneous nerve.</p> Signup and view all the answers

List the three main origins of the diaphragm.

<p>Sternal, costal, and vertebral origins.</p> Signup and view all the answers

What is the role of the rami communicantes associated with the typical intercostal nerve?

<p>They connect with the sympathetic chain, providing a white ramus and receiving a gray ramus.</p> Signup and view all the answers

Identify the only intercostal nerves that share in the brachial plexus.

<p>The 1st intercostal nerve.</p> Signup and view all the answers

What are the main structural components of the diaphragm's vertebral origin?

<p>The right crus from the upper 3 lumbar vertebrae and the left crus from the upper 2 lumbar vertebrae.</p> Signup and view all the answers

Name the ligament that connects the two crura of the diaphragm.

<p>The median arcuate ligament.</p> Signup and view all the answers

Describe the anatomical area known as the vertebro-costal triangle.

<p>It lies between the costa origin, vertebral origin, and last rib, and is normally filled with fat.</p> Signup and view all the answers

What sensory function does the lateral cutaneous branch of the intercostal nerve supply?

<p>It supplies sensation to the side and back of the thorax.</p> Signup and view all the answers

What is the role of the phrenic nerve in diaphragm function?

<p>The phrenic nerve supplies motor innervation to the diaphragm, enabling its contraction and thus respiratory movements.</p> Signup and view all the answers

Which structures pass through the aortic opening of the diaphragm?

<p>The aortic opening allows the passage of the aorta, thoracic duct, and azygous vein.</p> Signup and view all the answers

What are the three major openings of the diaphragm, and which structures do they permit to pass?

<p>The major openings are the vena caval opening (inferior vena cava &amp; right phrenic nerve), esophageal opening (esophagus, vagi, left gastric branches), and aortic opening (aorta, thoracic duct, azygous vein).</p> Signup and view all the answers

At which vertebral level do the structures passing through the esophageal opening align?

<p>The esophageal opening is located at the T10 vertebral level.</p> Signup and view all the answers

How does a hiatus hernia relate to the diaphragm, and what causes it?

<p>A hiatus hernia occurs due to a widened esophageal opening in the diaphragm, allowing abdominal contents to move into the thorax.</p> Signup and view all the answers

What is the primary function of the external intercostal muscles during respiration?

<p>Inspiration.</p> Signup and view all the answers

How do the internal intercostal muscles contribute to the breathing process?

<p>Expiration.</p> Signup and view all the answers

What direction do the fibers of the sterno-costalis muscle run?

<p>Upward and laterally.</p> Signup and view all the answers

What is the anatomical importance of the innermost intercostal muscles?

<p>They assist in expiration.</p> Signup and view all the answers

Where does the origin of the sub-costalis muscle occur?

<p>Posterior part of the intercostal space.</p> Signup and view all the answers

Describe the orientation of the transversus thoracic muscles.

<p>They extend from the sternum to the ribs.</p> Signup and view all the answers

What role does the anterior intercostal membrane play in relation to the external intercostal muscles?

<p>It continues the extension of the external intercostals.</p> Signup and view all the answers

In terms of rib attachment, where do the internal intercostal muscles insert?

<p>Upper border of the rib below.</p> Signup and view all the answers

Flashcards

External Intercostal Muscle

A muscle located between the ribs, extending from the tubercle to the costo-chondral junction, then continuing as the anterior intercostal membrane. It runs downwards, forwards, and medially.

Internal Intercostal Muscle

A muscle that runs downwards, backwards, and medially, located between the ribs, extending from the sternal margin to the angle of the rib, then continuing as the posterior intercostal membrane.

Innermost Intercostal Muscle

Located in the middle part of the intercostal space, this muscle runs downwards, backwards, and medially, aiding in exhalation.

Sternocostalis Muscle

Part of the innermost intercostal muscle group, this muscle extends in the anterior part of the intercostal space, running upwards and laterally. It aids in exhalation.

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Subcostalis Muscle

Located in the posterior part of the intercostal space, this muscle runs downwards and medially, aiding in exhalation.

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Inspiration

The action of breathing in. This is facilitated by the contraction of muscles like the external intercostal muscles.

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Expiration

The action of breathing out, involving the contraction of muscles like the internal intercostal muscles.

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Intercostal Space

The space between two ribs.

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Intercostal Nerve

A nerve that travels along the ribs, responsible for sensation and motor control.

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Typical Intercostal Nerve

The third to sixth intercostal nerve is considered typical because it follows a consistent pattern.

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Atypical - 1st Intercostal Nerve

The first intercostal nerve contributes to the brachial plexus, a network of nerves that supplies the upper limb.

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Atypical - 2nd Intercostal Nerve

The second intercostal nerve has a special branch called the intercostobrachial nerve that supplies the armpit.

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Atypical - Lower 5 Intercostal Nerves

The lower five intercostal nerves help to supply the abdominal wall.

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Diaphragm

A dome-shaped muscle that plays a major role in breathing, separating the chest cavity from the abdomen. It has a sternal, costal, and vertebral origin.

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Vertebrocostal Triangle

A triangular space located behind the kidney, formed by the costal origin, vertebral origin, and last rib of the diaphragm. It's often filled with fat.

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Nerve Supply of the Diaphragm

The Phrenic nerve (C3, 4, 5) provides motor innervation to the diaphragm, enabling its movement for breathing. Sensory innervation is supplied by lower six intercostal nerves (ICNs) for pain and sensation.

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Diaphragm Arterial Supply

Several arteries contribute to supplying blood to the diaphragm. The primary ones are the Pericardio-phrenic and Musculo-phrenic branches of the Internal Thoracic artery. Other contributors are the Superior Phrenic from the descending thoracic aorta and the Inferior Phrenic from the Abdominal aorta.

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Vena Caval Opening

A large opening in the diaphragm for the inferior vena cava to pass through, allowing blood from the lower body to return to the heart. It's located on the right side of the central tendon and at the level of the 6th costal cartilage and T8 vertebra.

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Esophageal Opening

The esophageal opening in the diaphragm permits the esophagus, vagus nerves, and left gastric vessels to pass through. It's located on the left side of the central tendon, within the right crus, at the level of the 7th costal cartilage and T10 vertebra.

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Course of a Typical Intercostal Nerve

The intercostal nerve passes between the pleura and the posterior intercostal membrane, then between the internal intercostal and innermost intercostal muscles. It runs within the costal groove, accompanying the intercostal vessels.

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Termination of Typical Intercostal Nerve

The intercostal nerve pierces the internal intercostal muscle and anterior intercostal membrane before continuing as the anterior cutaneous nerve, which supplies the front of the thorax.

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Rami Communicantes of Intercostal Nerve

The intercostal nerve provides branches that communicate with the sympathetic chain. It gives off white rami communicantes and receives gray rami communicantes.

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Atypical Intercostal Nerve - 1st ICN

The first intercostal nerve contributes to the brachial plexus, which supplies the upper limb.

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Atypical Intercostal Nerve - 2nd ICN

The 2nd intercostal nerve has a lateral cutaneous branch called the intercostobrachial nerve, which supplies the armpit.

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Atypical Intercostal Nerve - Lower 5 ICN

The lower 5 intercostal nerves supply the anterior abdominal wall, contributing to its innervation.

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What innervates the diaphragm?

The phrenic nerve (C3, 4, 5) controls the diaphragm's movements for breathing, while sensory information comes from the lower six intercostal nerves (ICNs).

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What are the major openings of the diaphragm?

The diaphragm has three major openings: the vena caval opening, the esophageal opening, and the aortic opening. These openings allow passage of important structures between the thoracic and abdominal cavities.

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What is the vena caval opening?

This opening in the diaphragm allows the inferior vena cava and the right phrenic nerve to pass through from the abdomen to the thorax. It's located on the right side of the central tendon at the level of the 6th costal cartilage and T8 vertebra.

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What supplies blood to the diaphragm?

The diaphragm is supplied by several arteries. These include the pericardiophrenic and musculophrenic arteries from the internal thoracic artery, the superior phrenic from the descending thoracic aorta, and the inferior phrenic from the abdominal aorta.

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What is the esophageal opening?

This opening allows the esophagus, two vagus nerves, and esophageal branches of the left gastric artery to pass through the diaphragm. It's found on the left side of the central tendon within the right crus at the level of the 7th costal cartilage and T10 vertebra.

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Study Notes

Intercostal Muscles

  • External intercostals extend from the tubercle to the costochondral junction and continue as the anterior intercostal membrane.

  • They run downward, forward, and medially.

  • Origin: lower border of the rib above.

  • Insertion: upper border of the rib below.

  • Action: inspiration.

  • Internal intercostals extend from the sternal margin to the rib angle.

  • Continue as the posterior intercostal membrane.

  • They run downward, backward.

  • Origin: costal groove of the rib above.

  • Insertion: upper border of the rib below.

  • Action: expiration.

  • Innermost intercostals extend through the middle part of the intercostal space.

  • They run downward and backward.

  • Origin: lower border of the rib above.

  • Insertion: upper border of the rib below.

  • Action: expiration.

Sternocostalis

  • Extension: anterior part of intercostal space.
  • Direction: upward and laterally.
  • Origin: inner surface of xiphoid process and lower body of sternum.
  • Insertion: inner surface of ribs 2-6.
  • Action: expiration.

Subcostalis

  • Extension: posterior part of intercostal space.
  • Direction: downward and medially.
  • Origin: inner surface of the rib near the angle.
  • Insertion: inner surface of 2 or 3 ribs below.
  • Action: expiration.

Intercostal Nerve

  • Number: 3rd to 6th.
  • Course: passes between pleura and posterior intercostal membrane, internal intercostal, and innermost intercostal.
  • Passes in costal groove below intercostal vessels (VAN).
  • Ends by piercing the internal intercostal muscle and anterior intercostal membrane, continuing as anterior cutaneous nerves.
  • Branches: Rami communicants with the sympathetic chain (white and gray rami), muscular branches (upper and lower parts of intercostal muscles), collateral branches, sensory branches to parietal pleura, anterior cutaneous branches (front of thorax), and lateral cutaneous branches (side and back of thorax). Rami communicants receive gray rami.
  • Atypical Intercostal Nerve (ICN): some share in brachial plexus (upper limb), some supply the axilla, and the lower 5 supply the anterior abdominal wall. Some intercostal nerves (2nd) may have a lateral cutaneous nerve called an intercostobrachial nerve. The lowest 5 intercostal nerves supply the anterior abdominal wall.

Diaphragm

  • Origin: Sternal origin (back of xiphoid process), costal origin (inner surface of lower 6 ribs), and vertebral origin (upper 3 lumbar vertebrae for right crus, upper 2 for left crus).
  • Median arcuate ligament connects the two crura; medial connects crura to T1 vertebra; and lateral connects T1 transverse process to the last rib.
  • Vertebra-costal triangle: located between costal, vertebral and last rib. Larger on the left side and often filled with fat; it is a common place for internal hernias.
  • Insertion: central tendon.
  • Action: Main respiratory muscle.
  • Nerve supply: Motor - phrenic nerve (C3, 4, 5). Sensory from lower 6 intercostal nerves.
  • Arterial supply: Pericardiophrenic and musclophrenic from internal thoracic artery, superior phrenic from descending thoracic aorta, inferior phrenic from abdominal aorta.

Diaphragmatic Openings

  • Major openings: Vena caval opening (costal level 6, vertebral level T8), esophageal opening (costal level 7, vertebral level T10), and aortic opening (costal level 8, vertebral level T12). Structures passing through these openings include inferior vena cava and right phrenic nerve, esophagus and 2 vagi, and aorta, thoracic duct, and azygous vein, respectively.
  • Minor openings: Superior epigastric and musclo-phrenic vessels, inferior hemiazygous vein, lower 6 intercostal nerves, left phrenic nerve, quadratus lumborum. Also, the psoas major, sympathetic chain, and splanchnic nerves pass behind the medial arcuate ligament. Quadratus lumborum muscle passes behind the lateral arcuate ligament.

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