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Diaphragm and posterior abdominal wall
Diaphragm
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Double domed, musculotendinous partition separating the thoracic
and abdominal cavities
Convex superior surface, concave inferior surface
Chief muscle of inspiration; central part descends but periphery is
attached to the inferior margin of the thoracic cage and lumbar
vertebrae
Pericardium lies on central part, depressing it slightly
Right and left domes; right higher than left due to the liver
On inspiration, right dome ascends to 5th rib and left to 5th intercostal
space
Level of domes varies according to phase of respiration, posture and
size and degree of extension of abdominal viscera
Muscular part is peripheral, fibres converge on central tendon
Central tendon divided into three leaves, and slightly anterior
Three parts are
o Sternal part: two muscle slips attach to xiphoid process
o Costal part: wide muscle slips attach to inferior 6 costal cartilages
and adjoining ribs
o Lumbar part: medial and lateral arcuate ligaments and three
superior lumbar vertebrae
Crura are musculotendinous bands arising from anterior part of the
three superior lumbar vertebrae, anterior longitudinal ligament and IV
discs
o Right crus is larger and longer; extends to left to form
oesophageal hiatus
Aortic hiatus formed from right crus, left crus and median arcuate
ligament (unites crura)
Caval opening is where the IVC passes (vena caval foramen), also
aortic hiatus and oesophageal hiatus
Diaphragm attached on each side by
o Medial arcuate ligament – thickening of psoas major fascia
o Lateral arcuate ligament – thickening of quadratus lumborum
fascia
Superior aspect of central tendon continuous with pericardial sac

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition
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Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition
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Muscles
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Main paired muscles are
o Psoas major: inferolaterally
o Iliacus: lateral side of inferior part of psoas major
o Quadratus lomborum: adjacent to transverse processes of L
vertebrae and lateral to superior part of psoas

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition
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Vessels
Abdominal aorta
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Most arteries supplying the posterior abdominal wall arise from the
abdominal aorta
Begins at aortic hiatus (T12) and ends at L4 (right and left common
iliacs)
Common iliacs rum inferolateral following medial border of the psoas
muscles to the pelvic brim; then divide into internal and external iliacs
Internal iliac enters the pelvis
External iliac gives rise to inferior epigastric and deep circumflex iliac
(supply anterolateral abdominal wall)

Relations
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From superior to inferior
o Celiac plexus and ganglion
o Body of pancreas and splenic vein
o Left renal vein
o Duodenum
o Small intestine
Anterior to T12-L4 vertebrae
Left lumbar veins pass posterior to aorta to reach IVC
Right side – azygos, cisterna chi, thoracic duct, right crus, right celiac
ganglion
Left side – left crus, left celiac ganglion

Branches
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Paired parietal branches serve the diaphragm and posterior
abdominal wall
Median sacral artery (unpaired), plus its branches (small lumbars and
lateral sacrals)

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition
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Lymphatics
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Lie along aorta, IVC and iliac vessels
Common iliac nodes receive lymph from external and internal iliac
nodes
Lymph from common iliac nodes passes to right and left lumbar nodes
Lymph from the GIT, liver, spleen and pancreas pass to pre-aortic
(celiac and superior and inferior mesenteric) nodes
o Vessels from these nodes form the intestinal lymphatic trunks,
which give rise to the thoracic duct
Right and left lumbar (caval and aortic) nodes get lymph from the
posterior abdominal wall, kidneys, ureters, testes/ovaries, uterus, uterine
tubes
o Also from descending colon, pelvis, lower limbs via inferior
mesenteric and common iliac nodes
o Efferents from the lumbar nodes form lumbar lymphatic trunks
Inferior end of the thoracic duct lies at L1-L2, between right crus of
diaphragm and aorta
o Begins with convergence of abdominal ducts forming the
cisterna chyli

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Thoracic duct ascends through aortic hiatus into posterior
mediastinum, and empties into junction of left subclavian and left
internal jugular

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition
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MRI

Taken from Moore et al, Clinically Oriented Anatomy, Seventh Edition
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Moore et al
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Seventh Edition

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