Aperture

aperture
Aperture (below): 1 - sternal part;
2 - esophageal opening; 3 - rib section; 4 - lumbar-rib triangle; 5 - aortic hole; b - medial foot, 7 - lumbar part; 8 - the opening of the inferior Vena cava; 9 - tendon centre.

Aperture (synonym of the chest-abdominal obstacle) - musculoaponeurotic plate that separates the chest cavity from the abdominal; has the shape of a dome, convex upwards (Fig.). The muscular part of the diaphragm starts from the sternum, lower (VII) of the ribs and lumbar spine. Muscle bundles converge on the radii by the middle and end of the tendon centre. Through the hole in the tendon Central aperture passes the lower hollow vein, through the holes in the muscle Department - aorta and thoracic lymphatic duct, esophagus and wandering nerves. Through a single slit on each side of the diaphragm are sympathetic nerve trunks, splanchnic nerve, unpaired Vienna on the right and polurama Vienna on the left. Above the diaphragm is covered with pleura and pericardium, bottom - peritoneum. The height of standing of the variable diaphragm. On average, an adult is the highest point right dome of the diaphragm is in the horizontal plane passing through the place of attachment IV rib cartilage to the breastbone, left - to one edge below. The blood supply of the diaphragm is made of upper and lower respiratory and musculoskeletal and pericard-diaphragmatic arteries. They are accompanied by the same vein. Innerviruetsya aperture phrenic nerve.

aperture on the part of the abdominal cavity
Fig. 1. Aperture on the part of the abdominal cavity: 1 and 18 m. psoas major; 2 - v. azygos; 3 - eras lat. (BNA); 4 - eras intermed. (BNA); 5 - cras med. (BNA); 6 - n. spianchnicus major; 7 - a. phrenica dext.; S - vv. phrenicae dext.; 9 - v. cava inf.; 10 - vv. phrenicae sin.; 11 - centrum tendineum; 12 - esophagus; 13 - a. phrenica sin.; 14 - glandula suprarenalis sin.; 15 - aorta; 16 - ren sin.; 17 - v. hemiazygos.
aperture from the chest cavity
Fig. 2. Aperture from the chest cavity: 1 - aorta; 2 and 15-aa. pericardiacophrenicae sin. et dext.; 3 and 13 - nn. phrenici sin. et dext.; 4 and 14 - vv. pericardiacophrenicae sin. et dext.; 5 - diaphragmatic part of the pericardium; 6 and 12-vv. musculophrenicae sin. et dext.; 7 and 11 - a. musculophrenica; 8 - esophagus; 9 - sternum strap; 10 - v. cava inf.

The main physiological function of the diaphragm breathing. In the basis of rhythmic contractions of the diaphragm breathing lie reflex mechanisms (see the Breath). The impulses coming on phrenic nerves that lead to the reduction and flattening of the diaphragm, resulting in a breath.
Closed damage the diaphragm arise when sdavljenia chest, by blows with blunt objects. Open injuries, often stab, are located in the rear-lateral sides of the diaphragm; in wartime damage to the diaphragm most often occur when a gunshot injuries of the chest wall or abdomen. Damage to the diaphragm often combined with injury of the thoracic and abdominal cavities, may be followed by loss of abdominal organs (gland, stomach, large intestine, spleen and other) in the pleural cavity, and at the gaping wound of the chest wall - outside (see the Thoraco-abdominal injuries). The symptoms of a corrupted aperture: pain in the abdomen and chest radiating to the shoulder, dyspnea, cyanosis, frequent heartbeat; often damage the diaphragm accompanied by shock. A sure sign of damage aperture detection of abdominal cavity organs in the chest cavity (with x-ray examination), loss from the wounds of the chest wall or the expiration of the contents of the abdominal cavity.
First aid: if the wound abdominal or chest wall produce toilet and place dry sterile dressing. At loss of the wounds of the chest wall of the abdominal organs of the reset of them do not produce, limited to the imposition of an aseptic bandage. The patient is injected subcutaneously heart funds (camphor, caffeine), give breathe humidified oxygen. Drugs are prohibited, as they may obscure the clinical picture of the damage. The patient immediately transported (lying down) to a health facility.
Treatment in the surgical Department: operation protivosokovh activities, starting with car-cervical sympathetic blockade (see Blockade procaine). Expand the wound of the chest wall, reduce fallen organs in the abdominal cavity and suture on the diaphragm, then do a laparotomy (the revision of the abdominal cavity and the necessary intervention).
Hernia aperture arise in pathological natural extension of the holes where it passes through the aperture of the aorta, esophagus, inferior Vena cava (congenital hernias). Often the formation of disk contribute former injured aperture (traumatic hernia). Symptoms of a hernia aperture: zagrudinnaya pain, belching and vomiting due to the movement of the stomach into the chest, shortness of breath, palpitations and cyanosis due to compression of a light, displacement of the heart, and limit the movements of the diaphragm. Hernia apertures may be impaired, causing symptoms of intestinal obstruction (see bowel Obstruction). Important in the diagnosis of hernias of the diaphragm is x-ray examination. Treatment for traumatic rupture of the diaphragm operational; in congenital hernia regarding operation is decided individually.
Tumors of the diaphragm most often secondary due to the spread of its neighboring organs (liver, stomach).
Inflammation of the iris, as a rule, occurs when distributing the process of subphrenic space (see Subphrenic abscess) or from the chest cavity (purulent diseases of the lungs, pleura, pericardium).