 So 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. The right dome of the diaphragm, as we know, is once intercostal space higher than the left dome because of the presence of the liver. The liver has been removed from under the right dome of the diaphragm and the stomach and the spleen have been removed from under the left dome of the diaphragm. And this is the spleen that we have put here. We have also removed the two kidneys and put them aside. What we have still attached here are the left supramilu gland and the right supramilu gland because the relationship is important for us. These dominoes of the diaphragm were covered by the parietal peritoneum which we have removed and under that was the endocardominal fascia, which is the continuation of the fascia and nasolabiasis. And then also we have removed. And now we can see the muscle fibres and the central tendon. This Chinese structure that we see here on this side and then it is continuing to the other side. This is the central tendon of the diaphragm. The central tendon is like a clover leaf. It's like this. It goes in front and then it again goes on the left side. This central tendon provides attachment to three sets of muscle fibres and those other muscles of the diaphragm itself. Starting from the front, this is the sternum. So we have some slits of muscle fibres going from the sternum to the central tendon. They are the sternum part of the diaphragm. Between the two sternum parts on either side, there's a small gap which is known as an angiomedial gap. Then we have these larger portion of the muscle fibres that we can see on the right side and the larger portion of the muscle fibres that we can see on the left side. These are the costal fibres. They take attachment from the under surface of the ribs on both the sides and as you can see the diagonal fibres, they are going and they're getting inserted onto the central tendon from all the sides. So these are known as the costal fibres. Between the sternum part and the costal part again, there's a small gap which is called the anterolateral gap or the sternum costal gap of the lage also called the hiatus of the organ. And that gives passage to these vessels that we can see here. The superior epigastric on this on the right side and the superior epigastric artery on the left side. Also reported as the hiatus of the mortgagney and rarely the sternum costal gap of lage can also be the site of herniation. Let us continue with the muscle fibres. Then if we look further medially, see some muscle fibres coming from the lumbar region. These are the muscle fibres here. These are on the right side and now if we look at the left side, we will see a similar set of muscle fibres coming from the lumbar region and getting inserted onto the central tendon. These are the lumbar part of the muscles. So therefore we have three sets of muscle fibres, the sternum fibres, the costal fibres and the lumbar fibres and all of them get inserted onto the central tendon. So therefore when these muscles contract, they pull on the central tendon and bring the dome of the diaphragm down. Once the dome of the diaphragm is pulled down, the vertical diameter of the chest increases and therefore air entry occurs. And that is how we have abdominal thoracic respiration. In this correction we can mention what clinical correlation is if there is heavy paralysis of the diaphragm. On that side, the dome of the diaphragm will not descend down. Only one side will descend down. And instead of descending down because of the increase in diaphragm pressure, the parallel side diaphragm will move up and that will lead to what is known as paradoxical respiration. So that is about the action of these muscles. Now let's take a look at SCAP, which is present between the lumbar and the costal fibres, which is more prominent of the legs. So we can see these muscle fibres here. These are the left side lumbar fibres. And these muscle fibres that are going up, these are the costal fibres. We see a triangular area between the lumbar part and the costal part. This is referred to as the left lumbar costal trigon or the left lumbar costal triangle. This area of the diaphragm is bereft of muscle fibres. Here only the endodomnal fascia is fused with the endothoracic fascia and the thoracic side. And therefore this is a potential area of weakness. This is also referred to as the hiatus of bog dalek. In embryonic life, this is the passage to the pedicardio-peritoneal channel. And if that fails to fuse, then we can have a persistent defect and that can lead to congenital diaphragmatic hernia, where the child is born with the intestinal contents up in the thorax. So that is more prominent on the left side. This is a plain x-ray of a stillborn fetus to show congenital diaphragmatic hernia on the left side. Similarly, in traumatic injuries, blunt injury to the abdomen to the chest, especially in the steering wheel injury, this portion, the lumbar costal triangle can rupture and that can lead to traumatic diaphragmatic hernia. If we were to take a look at the same thing on the right side, now we are showing the right side and we can see that the lumbar costal triangle is not so prominent on the right side. So therefore, right side, traumatic or congenital diaphragmatic hernia through the hiatus of bog dalek is extremely rare on the right side. One reason being, apart from the fact that the trigone itself is very small, the other reason being that the liver is present on the right side. So that is about the lumbar costal triangle. Now I am going to describe this circular structure that we see in the midline here. This is referred to as the median arcuate ligament. The median arcuate ligament is a fibromuscular structure which is bridging over the abdominal aorta and on the right side it is merging with the right crust of the diaphragm which is seen here and on the left side it merges with the left crust of the diaphragm which we should show on the left side and this provides attachment to the diaphragm muscle fibres in the middle. If you look deep inside on the right side, we see a tendinous structure here which has been lifted up by my force instrument. This is known as the medial arcuate ligament which is the upper free margin of the saw's sheath which has been removed here and further laterally we can see this ligament here. This is the lateral arcuate ligament and we can also see the subcostal nerve is running just in the region of that attachment. The lateral arcuate ligament is the upper free margin of the quadratus lumborum sheath and this is the quadratus lumborum muscle. Therefore the lateral arcuate ligament, the medial arcuate ligament and the medial arcuate ligament all of them provide attachment to the diaphragm. So this is what we see from the right side. Now we shall see the same thing on the left side. Here also we can see medial arcuate ligament in the midline attached to the right crust of the diaphragm and to the left crust of the diaphragm. Then we can see these fibres here. This is the medial arcuate ligament which is the upper free margin of the saw's sheath. And then we have these fibres here. This is the lateral arcuate ligament which is the upper free margin of the quadratus lumborum sheath. So therefore these also provide attachment to the diaphragm. So that brings me to the next point, that is the crura of the diaphragm. Since the camera person is already on the left side, let me first demonstrate the left crust and then we shall come to the right crust. This is the left crust of the diaphragm. The left crust of the diaphragm is smaller than the right crust. It extends from L1 to L2. There are minor openings in the left crust of the diaphragm through which past these nerves that we can see here, these are the greater, lesser and the least splanknic nerves. Now we shall come to the right side. Now the camera person is on the right side and we can see this is the right crust of the diaphragm and it is crossed over by some veins. The right crust of the diaphragm is longer than the left crust and it extends from L1 to L3. And again here also we can see that the two crura are joined together by the median archivate ligament which I have already mentioned. The right crust has got certain important points to be mentioned and we shall see them just now. If you trace the muscle fibers of the right crust of the diaphragm, we find that some of the muscle fibers are going up and some of the muscle fibers are splitting to go around the esophagus and this is the cut end of the esophagus and we can see they go around the esophagus and then they come back again and they join the ascending fibers. So therefore the right crust of the diaphragm muscle fibers they split to enclose the esophagus and they constitute the esophageal hiatus. And therefore the muscles of the right crust of the diaphragm act as a pinch cock mechanism and they act as the lower esophageal sphincter. And just like the left crust, the right crust also gives passage to the fibers of the greater, lesser and least splanknic nerve which has been removed here. So that is about the crura of the diaphragm. That's all for now about the diaphragm. Thank you very much for watching. Dr. Sanjay Sanyal signing out. If you have any questions or comments, please put them in the comments section below. Have a nice day. Mr. Kendall is the camera person.