 This is going to be a demonstration of the domino thoracic diaphragm. So we can see the right dome of the diaphragm here and we can see the left dome of the diaphragm here. That brings me to the major orifices or the hiatus in the diaphragm. The rule of thumb to be remembered is 8, 10, 12. We can see this opening here, this big opening. This is the cable hiatus which gives passage to the inferior vena cava. This is at the level of T8. Then we have this orifice here. This is the esophageal hiatus which gives passage to the esophagus and this is the level of T10. And this is the aortic hiatus bridged over by the median archivate ligament and the two crew round either side. And this is at the level of T12 and this gives passage to the abdominal aorta. Now let's go a little deeper into each of these hiatus. Let's start again with the cable hiatus which is at the level of T8. We can see one cut portion of the inferior vena cava here as it is passing and we can see the other cut portion of the inferior vena cava here. The intervening segment of the inferior vena cava was inside the liver which has been removed with the liver. So once the inferior vena cava enters through the bare area of the liver into the diaphragm, thereafter it is not visible and it goes straight into the right atrium. Apart from the inferior vena cava, we also have this same hiatus gives passage to the branches of the right phrenic nerve and some lymphatics which go from the bare area of the liver to the posterior medistinal lymph nodes on the right side. So that's what passes through the cable hiatus. Now let's come to the esophageal hiatus which is at the level of T10. Apart from the esophagus, it also gives passage to the posterior and the anterior vagus nerves and we can see them here. We have lifted up the posterior vagus and in front we have the anterior vagus. This is the anterior vagus. This is the cut end of the esophagus. After this, the abdominal segment of the esophagus which is seen here is only half an inch and it was covered by disperitonium which has been removed. So this is about the esophageal hiatus and I have already mentioned the pinch cock mechanism of the right crust of the diaphragm which acts as a lower esophageal sphincter. Now let's come to the aortic hiatus which is at the level of T12. Apart from the aorta, it also gives passage to the azygous vein. Here we can see the beginning of the azygous vein. The azygous vein is formed by the union of the ascending lumbar vein on the right side which unites with the subcostal vein on the right side and it forms the azygous vein. You can see the beginning of the azygous vein also passing through the esophageal hiatus. And apart from that, the thoracic duct which arises from the cisterna chile which is not shown here also passes through the aortic hiatus. So from right to left, we have the azygous vein, thoracic duct, aorta, ADA. So these are the structures which pass through the major hiatus. Now let's mention a quick word about some minor hiatus. Between the sternal and the coastal fibres of the diaphragm, we have the sternocostal triangle or the antrolateral cap of Larry which I mentioned is also called the hiatus of Morgagni. And passing through that, we have this on the right side, this is the right superior epigastric artery and on the left side, we have the left superior epigastric artery. So this passes through the antrolateral cap of the sternocostal triangle of Larry and as I mentioned, this can rarely be a site of hernia called the hernia of Morgagni. Then we have some other minor hiatus passing through the crura of the diaphragm. The right crust and the left crust, we have the greater lesser and least splantic nerves. We cannot see them on the right side, but we can see them on the left side. Now we are on the left side, the camera person is on the left side and we can see passing through the left crust of the diaphragm are these nerve fibres. These are the greater, lesser and least splantic nerves. The least splantic nerve may not always be present. These are the ones which carry the sympathetic and which synapse in the celiac ganglion and the supply, the foreguard structures. Apart from that, these minor hiatus may be present on the left side which gives passes to the hemiasagus vein. So these are the minor hiatus. Now let's mention a few other clinical correlations. We can have herniation of part of the stomach through the esophageal hiatus and that is referred to as the hiatus hernia. There can be two types of hiatus hernia. In this case, the stomach has been removed so therefore we cannot show the stomach. If the esophageal gastric junction is distorted and it moves up then it is referred to as the sliding hiatus hernia. On the other hand, if the esophageal gastric junction is intact and only a part of the greater curvature of the stomach pushes up on the left side that is referred to as the rolling or paraisophageal hiatus hernia. The first variety, the sliding esophageal gastric hiatus hernia is associated with reflexes of the gitis while reflexes of the gitis is not a prominent feature in the rolling variety of hiatus hernia. This is a variant swung to show a sliding esophageal gastric hiatus hernia with loss of gastroesophageal junction. Now let me mention some of the reflexes which are visible on the diaphragm. I have picked up the left inferior-frenetic artery and the vein and this is the right inferior-frenetic artery and the vein. The artery comes out from the abdominal area at the left of T12 just above the serial trunk and it ramifies all the other surfaces of the diaphragm. The vein on either side drains into the inferior-frenetic artery. The left inferior-frenetic vein also communicates with the left suprarenal vein and it also communicates with the left renal vein. The inferior-frenetic arteries, they also give branches to the suprarenal glands and this is the right suprarenal gland and we can see it is receiving a branch from the right inferior-frenetic artery. So this is the right superior-suprarenal artery which then ramifies into the suprarenal gland. Likewise, we have the left suprarenal gland here which is also attached and which also receives a branch from the left inferior-frenetic artery which is the left superior-suprarenal artery. Apart from that, there are two other things which I wanted to draw your attention to. On either side, we see an aberrant vein vessel. On the right side, we can see this vessel which is going all the way. It was travelling in the extra petonial fascia from the suprarenal gland and is joining with the gonadal vein on the right side. This is an aberrant communication and similarly, on the left side also, we can see an aberrant vein and this is that aberrant vein which is coming from the left side. And on the left side also, this was not going into the gonadal vein. Instead, it was going into the rectum and it was communicating with the superior rectal vein. So, in this particular cadaver, this cadaver had a lot of anatomical variations and here also, we can see a normal variation on both the sides. Apart from that, there was another thing which I wanted to mention to you pertaining to the suprarenal gland. We can see that the suprarenal gland is attached to the fascia on the under surface of the diaphragm. That is the suprarenal fascia which merges with the end abdominal fascia on the right side and similarly, it merges with the end abdominal fascia on the left side. And that is what holds the suprarenal gland in place. This has got an important function significance. There is a septum of the same fascia separating the suprarenal gland from the respective kidneys. So, therefore, whenever if there is any descent of the kidney on either side, the condition being called nephroptosis, the suprarenal glands do not descend down. They remain attached to the diaphragm in their respective locations. And that is what we are seeing here in this condition also. Now that we have removed the kidneys, still the suprarenal glands are still in their normal locations. So, this is another point which I wanted to mention pertaining to the relationship of the diaphragm and the suprarenal gland. That's all for now about the diaphragm. Thank you very much for watching. Dr. Sanjay Sanyal is signing out. If you have any questions or comments, please put them in the comment section below. Have a nice day. Mr. Kendall is the camera person.