Membranes and Diaphragm

[inaudible] greetings, my name is Gil Hedley and I'd like to thank you for your interest in the integral anatomy series I intend to reveal and explore with you in this volume the layers of the human form which follow and build on our discoveries in volume one skin and superficial Fascia and volume two deep Fascia and muscle. The human form is an integrated whole. There are no parts to the living form. Parts are merely the renderings of the inquiring mind and artifacts of the anatomist scalpel which reduced the form to its bare bones and the quest for understanding what lay beneath his skin. My ultimate goal is to create a deeper felt and lived experience of the whole more so than to measure the parts.

As we sharpen our perception and appreciation of the details of whole body layers, continuity's of texture and the repeating patterns of our form, we increase our range of motion and maximize the potential of our human experience. We take a moment now to express our gratitude to the donors and their families who make study at this level possible. The relentless stream of abundance which blesses our creative endeavors here, waits only for our readiness to step into it and receive what is prepared for us. One form follows upon another and there is truly nothing to fear and what lies ahead or in what has been left behind. In volume one of the integral anatomy series, I introduced the onion tree as a way of modeling the textural continuity's of the human body which you encounter as you drop in layer by layer.

I suggested the body could be understood as a series of thin fibrous covering layers and thicker fluffy layers all related and interpenetrated by tree-like neurovascular branchings. So the skin would be the relatively thin outermost covering layer overlying the relatively fluffy superficial Fascia, which itself over lies that thin fibrous deep Fascia, which in turn covers and invests the relatively fluffy muscle layer. Superficial Fascia and muscle are shaping layers of the body, the massive, which can change considerably over a lifetime. These thicker layers can grow and and thickness substantially so that any given person's overall shape is defined by them more or less. In the membernation wrappings of the Oregon's and central nervous tissues and in these viscera themselves, we have yet another reiteration of the pattern of thin covering layer and a relatively thick covered layer.

The membranes are thin, the Oregon's relatively thick or fluffy and greatly changeable in dimension over time. Of course, every layer actually consists of multiple layers at a cellular level. And to hear this is so even at a gross level, the multiple wrappings of our organs and central nervous tissues share common textures and patterns and defined several important potential spaces within our form. These fibrous and membranous layers of the cranial and visceral spaces have earned their very own volume in this series due to their relative complexity as a layer and due to the fact that they have gotten so little clear attention. Otherwise it is very difficult to figure out these truly bag like balloon, like layers from book descriptions and still imagery. And even in the dissection lab, they're easy enough to miss and the pursuit of structures whose fame surpasses them. Yet, these tissues are incredibly important to our experience of overall health, and they are easily affected by our every movement and touch.

I present them here as an invitation to integrate them into your general understanding and vision of the whole human body and your internal experience of yourself. Let's introduce the fibers and membranous layers of the visceral spaces with a diagram. Now I use the word visceral generally to even include the brain. The, the word viscous is from the Latin. It means a large organ. So I speak, uh, for simplicity generally of the Viscera and include the, uh, central nervous system when I do so, uh, embryologically it's a little different, but in terms of the basic anatomical Schema, it's very similar and that's why I diagram it in this way.

So far we've explored the layers of the skin, then the superficial Fascia on volume one, the deep fascia and dropping in deeper the muscle on volume two. Uh, at the end of that volume we encountered the bony layer, uh, as well as the fibrous coverings of the viscera themselves. Now it's our turn to explore those. And because they're slightly more complicated in their layering, uh, I've decided to diagram it here for you, uh, to make understanding more simply. So let's look at this black layer here. The black layer will represent, uh, that first, uh, fibrous layer of Fascia that one encounters.

It's like a balloon, a one counter, sort of a fiber spoke, just literally just like a balloon, a, we take a balloon here and we can imagine as we're dropping in skin, superficial Fascia, deep fascia muscle. And then, uh, we saw for instance, the, the, the posterior rectus sheath that, that uh, fibers Fascia or, um, in the chest area we have the endo thoracic fashion, that cranium, we have the Dura or surrounding the heart, the fibers pericardium. Now immediately deep to that, it's like balloons within balloons. So immediately deep to the fibers layer, whatever it's called in whichever visceral space we have here, you see immediately adhering, stuck to literally stuck to the fibrous layer. We have a cirrus membrane. Now the Sirus membrane has slightly different anatomical and physiological properties relative to the fibrous membrane. And again, it will have a different name depending upon which visceral space we're in.

But for now, let's just get the lay of the land. The idea that there are these one, two, three, uh, fascicle and membranous layers surrounding each of our visceral spaces. So we have the fibrous layer, then the membrane, this layer. Now it's interesting about the membranous layers as sort of double backs upon itself. So it's like if you had a balloon, you push your fist into it, uh, you could imagine that. Then there would be sort of two balloon shapes. Uh, so the outer balloon would be the, uh, outer layer of the cirrus membrane. And then this inner layer, I call it the well, the inner cirrus membrane or the skin of the organ.

When you're doing dissection, you cut deeply into the body and you encounter the organs, whether it's the brain or the heart or the or the lungs or the abdominal viscera, the abdominal organs. And when you see those organs, what you're actually seeing is they're covering layer and they're covering layer is the doubling back of the cirrus membrane. So we see the Oregon layer here in blue, and we'll call the inner Sirus membrane, the skin of the Oregon. It doesn't matter what you are. Again, the skin of the organ and the skin of the organ immediately adheres to the Oregon. But the Oregon itself with its skin does not adhere to the outer cirrus membrane. It's actually a slick sliding surface. So we'll let this little white area here represent the place where the cirrus fluids lie and creating, which creates a sliding surface between these two cirrus layers that the organs can, can move, uh, happily between themselves.

So we have here the outer layer. The outer crs layer is adhered to the fibrous layer, and then we have a sliding surface between the two cirrus layers, the outer and the inner. Now the outer layer, well you can see how it sort of hugs the perimeter or hugs the wall. So it's like the wall layer, we'll call it Latin. We use the word parietal to reference the wall layer. So this layer could be the parietal pericardium or the parietal peritoneum or the parietal Pleura, meaning the outer layer or the wall layer of the cirrus membrane.

And then this layer here, we would call it the visceral layer because that adheres to the viscus, the Oregon. It adheres to the, to the Oregon. So this visceral layer, this could be the visceral peritoneum in the belly or the visceral pericardium, that surface of the heart, the skin of the heart or the visceral Pleura, the skin of the lung. So, and in the case of the brain, we have the PIA [inaudible]. Now it's one thing to demonstrate and grasp the idea of the factional and membranous layers, which surround the viscera on the whiteboard and it's another altogether to demonstrate them on the cadaver form. Following the careful dropping down through the layers, I decided to remove as a unit the bony rib basket and shoulder girdle to expose as much of the sacking around the organs as possible. In doing so, I had to work through some of the fibers, inner lining of the thorax, the Endo Thoracic Fascia here, focusing our attention on the space between the 11th and 12th ribs. From the back, I reflect the outer layer of muscle from between the ribs, the intercostal muscle. Deep to that, we see the very fibrous layer of the endo thoracic fashion.

The end of thoracic fashion invests and coats all of the ribs and the muscle between the ribs from the inside, just as the fibrous deep fascia coats the outside of the rib cage coming from the outside into the body. Then the endo thoracic fashion is that first fibrous fascia layer inside the thorax, which surrounds the contents of the thorax and contains them within itself. So this fibrous inner lining of the thorax, it's not an independent structure. It invests the inner layer of the intercostal muscles here. This orange layer is invested within it, so we encounter the Endo Thoracic Fascia.

We've also encountered the inner layer of the intercostal muscles immediately deep to this fibrous Endo Thoracic Fascia. We encounter the parietal layer of the Pleura, the outermost cirrus membrane of the thorax within which the lungs enjoy their motion. So this is parietal Pleura. And if we could really get fancy because we're local to the ribs, we call it the Costco Pleura can. So I'm going to cut away this, this, this layer of Pleura that we've identified. Now when I do sell, I'm dropping into a thoracic space. Yeah, of course. I'm just cutting a little strip out of the Pleura.

The pleura is a balloon that coats the entire space there. So we can see the Pleura here. It's tough. Uh, it's not fight tough like the end of thoracic fat fashion in the sense that it's, it's not filled with, um, with strapping tape at the same time. It has a definite integrity. If you punctured it with a needle, you'd feel a little pop as you went through it. Um, it's a, it's a, it's a durable bag because you breathe 20,000 times a day and this thing is going with the flow of that breath here though, we look inside and what do we see? You can say, hey, that doesn't look like a long, well, it's not a along any more, any more than than, than, than when we look over here, we see like instead we see the diaphragm, but the diaphragm is covered with Pleura as well. Remember, the Pleura is folding its way and coding every surface inside the thorax. So this is plural here and I can't pass my finger through from the 12th rib into the abdominal space or vice versa. See, I get stuck. I can't go through.

So is this like a balloon that's stuck to the ribs or is it in between? Is it like, do you know what I'm saying? The balloon inflates. If you, if you had a mister bones model and you, and you stuck a balloon in and go and you blew it up from the inside, there would be no place that the Pleura doesn't cover the balloon would completely fill the thorax. So yes, the, the, I, I, if I stroke here on the inside margin of the rib, I'm touching the pleura. If I stroke here, I'm touching the Pleura. And when I come to the 12th Irv, I'd have barrier. I have to turn in a doubles back on itself. I'm coding the outside coating of the rib cage here, coding that with Pleura, and then I come down to the 12th rib and it doubles back on itself.

It turns back up and then covers the diaphragm. It goes this way and then rule it comes back this way. Okay. From this angle we can see the parietal Pleura backlit where a doubles back at the 12th. Rip Structural distortion in the relative position here will consequently have a direct impact in the shape of the thoracic space and the dynamics of breathing a parietal floor because that, that wall is a complicated one and has many surfaces. Uh, we divide those surfaces geographically to help indicate exactly which area of the parietal Pleura that we're talking about. So these are the four areas of the costal Pleura, the diaphragmatic Pleura, the media Steinle Pleura and the Pleura of the couple.

So those would be the four regions. The couple of would be the, the peak or dome, uh, of, of the, of the thorax here. Like the Dome of a church, the couple of St Peter's Cathedral here we have the couple of our, of our thorax. So so the cupola the Pleura on the couple of would indicate in this, this region within our body. Uh, then the Madea Steinle Pleura at, well all of these structures within the middle which aren't lung is lung, here's lung. And then on within we have the heart and the aorta coming from it in the the thoracic doctor [inaudible] and all sorts of other structures in that it will explore later. So all those things which stand in the middle or in the media Steinle space and the media Steinem references the space that's created by the non, the non touching of the Pleura on either side.

So the Pleura does the two Pleura, the two pleural sex, one for each side don't actually touch each other, but they, there's a space in between them and everything that's within that space. Those structures aren't media Steinle. So the structure, the spaces, the media, Steinem, and the structures within it are media Steinle structures. And the Pleura which is surfacing those structures as it as it comes around would be the media Steinle Pleura. Now finally we have a costal pleura and that's the Pleura which we've already encountered in the dissection. As we dropped through the end of thoracic fashion, encountered that Pleura and we've even seen the light passing through.

That would be the Pleura that surfaces all the rib surfaces. So we have costal Pleura, the diaphragmatic Pleura, the, the, the Pleura that's surfacing the domes of the diaphragm, the media Stein up Pleura, the Pleura that brushes up against the structures in the middle and, and uh, and creates the media style space. And then finally the Pleura of a couple of [inaudible]. I've taken away the intercostal muscles, the Endo Thoracic Fascia, the fibrous layer as well. And now I've got my fingers on the diaphragm, but the diaphragm itself is coated with the Pleura pleura coats, everything on in the thoracic space.

And this a potential space realized, although my fingers for that can fit in here. Now in the living, there is no space here. There's no space. The Oregon's fill the space. We breathe and we fill the space. This the air fills the lung, not the intervening space. If you had space in here, it would hurt. We can see how round and dome shape the diaphragm, as I say.

What do you mean the diaphragm? That can't be the dark, right? Well that is the shape of the diaphragm. The diaphragm is filled like bubbles on either side. With the contents of the abdominal [inaudible] space, the abdominal viscera bulging upward, they're bulging upward into thoracic space. Uh, they don't pass into thoracic space because the balloons prevent the contents of the balloons and the muscle prevent the contents of the diaphragm. The contents below the diaphragm from entering there lift up a little higher on the lung who go over the hill here and it's just round and around.

It's like a pair of shoe on either side. A parachute of diaphragm here is covered with a film. That film is the of the diaphragmatic poorer because we're looking at the diaphragm from the thoracic space. So on the northern side, on the head side, on the thoracic side of the diaphragm, the diaphragm is painted over, covered with a cirrus membrane called the pleura there. It's called the Coryell player because it's covering all the wall and more particularly at that point, it's called the diaphragmatic floor, but it's all just the same skin ballooned skin. Either way, you slice it to the line of the 12th rib, where the Pleura here, the Pleura is, is covering the diaphragm. And then scrolling back like an ocean wave here, like an ocean, wave the curls back over and paints the paints to the end of the Thoracic Fascia of the, uh, the fibrous covering of the rib cage.

Uh, so that's the, that's the terminus of the thoracic space right there. That's the end of the road. That's the end of the thorax. And on the far side of it, we have the abdominal territory here. I say sweet in my hand, in, I come over the diaphragm on either side, over the diaphragm in this. Great, great arch. And then of course we have our lungs and the lungs are huge.

Your pulleys are ribs back. You can see we're on the right side. All right. We have this big joint. There's a joint in the lungs. I had enabled it to spiral on itself and the breadth of motion and down here we see the Pura come off in a sheet. Which weekend, which will I anticipate our anterior view.

The rest of it we cut away as we went through the ribs and the other tissues to be able to see the immensity of the lungs from the side here and inside you see these giant lobes. When you get an anterior view, it's a very superficial, you only see the superficial projection of the lungs, but pleura means side, Pleura, mean side. It's a Greek word pleura and so it's really a side organ and it fills in your whole size. Huge along the huge, the parietal peritoneum here, which we can see out puffing when I move the organs around. This filmy layer here puffing up and down that layer. How's the kidney underneath it? Whenever he marked out the border over our liver.

And then our kidney care, we had our spleen, spleen here. So the shape of the spleen to the diaphragm and the shape of the great liver here, leaving the kidneys, he's running down the middle [inaudible]. We're looking at the transverse Salads Fascia here. That's a great sheet of Fascia and we can see that this sheet of fashion doesn't go over the rib cage. It actually goes, goes under it because this trans ourselves Fascia that invests the transversus abdominis muscle, this layer here filling in the groove, attaching to the 12th rib, again along the margin of the rib cage here, uh, this muscle, this muscle layer with its great tendon that passes over the belly here, which is now like a loose bag, it's trans or Salice fashion has. And here it on its opposite side. On his deep side is adhered the peritoneum, the parietal peritoneum, the wall layer of the peritoneum that cirrus seq in which the abdominal organs are, are carried. Um, so we see these, see the action of, uh, just moving things around here so you can see these, this fringe of muscle fibroids. It's great. She on, on both sides. It's a little green here because of the gallbladder.

So I can pull across here and we can see how the shortening of the fibers of the transversus abdominis muscle would, um, create a tension in this sheet over the guts, over the viscera of the abdomen. It's this rib here and these ribs are going to be three now, cause they're freed from their muscular attachment here and in the back. They're freed from the spine as well. So I pry up here and see. Cool. See that the continuity of the transversus abdominis muscle with the diaphragm. This is my diaphragm. This is my trans versus have down.

It's look like one big bag. The only difference that the, the diaphragmatic pleura that's covering here has come down to this point and doubled back here. We've cut through the PLEURA. What I just did was cut through the Pleura that was attaching here and cutting away the attachment of the diaphragm to the ribcage. So, uh, although it appears to be a complete continuity [inaudible] what we can't tell basically as well, if you let the Pleura, the Pleura has been cut. All right? The pleura has been cut here and that's what defines this space in terms of the continuity of the material under the diaphragm. And the, and the transversus abdominis are, are a you a union. But I'm wanting to pull the Pura, see, I'm pulling the fora away from the, no, lay it back down. If I can see that's Clara and the Pleura, is that here to the rib cage right now?

I'm just, can you hear that? That's the, that's, and then he's done. That belongs there. So now we're looking at the, the abdominal contents, right? Held back by the diaphragm from emerging to thoracic space. This is great. This is about the coolest way I've ever done this. As I worked to peel back as much of the parietal Pleura as possible, I encounter areas of scar tissue adhesions, the aftermath of an old bypass surgery, ultimately with the ribs disarticulated from behind and the chest wall and shoulder girdle freed as a whole.

Okay. We have a unique insight into the intimate relationship of our arms with the whole basket of breath as it were. Okay. This approach also affords us a chance to look at the chest wall literally from the inside out, while also preserving all of the organs in their relationship to each other and to the respiratory. Looking now at the chest wall from the inside we see the internal thoracic artery and vein coming into view, also known as the mammary artery and vein which circulate blood to the anterior chest and the breasts.

These vessels are now commonly borrowed to bypass coronary vessels during an open heart surgery. The surgeons peel them from the chest wall and sew them onto the heart. Scar tissue will then cause the injured layers to add here. Can we see some lung tissue against the Thoracic Wall? It was adhered the Pleura, not only the parietal Pleura but also the visceral pleura. Uh, the long ones stuck to the wall of the thorax, which can happen during inflammatory processes, gets stockmen.

Then the lung gets carried along with the movements of the ribcage in a way that it really would have a sliding surface. As we look inside the wall here, we've seen the fibrous layer covering the intercostal muscles and exactly covering the intercostal walls as well as the bone [inaudible]. So in the same way that the fibers deep fascia covers the outside of the thorax, the fibrous end, a thoracic fascia surfaces the inside of the thorax [inaudible]. So we've worked our way now through the bony form and the fibrous lining of the thorax and can turn our attention at last to the membranous layers surrounding the lungs. While we dissected the parietal Pleura away in the back in the front, we've tried to peel it away as best we can from the Endo Thoracic Fascia and demonstrate this first layer of cirrus membrane in relationship to the visceral pleura and lungs deep to it.

At the belly. We still have the entire trans or Salus fashion at the fibrous layer still intact to explore a bit later. So we have our F r fibers transverse Sal's Fascia here. The peritoneum is adhere to the other side. And here we have our, now at this point I can see that the, this parietal Pleura, there's wall layer of the pleura that was peeled from the thorax. It was peeled from the end of the Thoracic Fascia.

Look at that. See how it's tacked down onto the lung. I can pick up the lung. That shouldn't be. This is a sliding surface. There's two serious membranes. The parietal layer and the visceral layer are designed to be slick against each other. Just like my two gloves with a little bit of butter between them. So the cirrus fluid is minimal but sufficient to create a slick sliding surface between the parietal layer and the visceral layer.

But here we have a adhesion. They're stuck to each other. Do we have more lung over here and [inaudible]. These layers are, are stuck down and I can peel, peel it away. See how I peeled away those, uh, that adhesion one layer to the next. This is not the skin of the lung. This is the parietal core.

This is the skin of the lung. Here. I haven't broken into the lung tissue at all here, and we shouldn't be surprised that there would be adhesions here as along the parietal layer to the visceral layer because here, in fact, the lung tissue itself has been broken, right? We saw it on the back of the, on the, on the chest wall, and it was stuck so that the skin of the lawn actually was torn away, stuck to the rib cage because the skin of the lung was adhered to this and this was adhere to that. And the three of them all stuck to each other and taking it apart yielded a rip. That shouldn't happen. It should be a smooth, uh, point of contact.

But again, there was a massive chest surgery. We can see, see how the long bounces back. It's very elastic along as in an inlet and elastic structure. It should be elastic. This is good. Also, when you press down and you're pressing air out, when you let go and it's intruded like this, the air fills in again. I create a vacuum and it fills in again.

So the lungs should be elastic and responsive to pressure, right? Like the pressure haunted chest or something. So, so this is, this is good. At same time we see a lot of black and a blackness on the tissue represents the patterning of the, of the lymphatic vessels filled with carbon dip deposition. So here we have some remnants of the parietal layer of the pleura. And then this layer here, this is the visceral layer. This is the skin of the lung. When I lift up this layer, then I'm, I'm, I'm actually exposing little Alveoli and things like that. So this is the, the visceral layer just to prove there is one. This is the visceral pleura.

Casey didn't believe me, visceral Pleura, but it doesn't come off in it in a sheet. Oh Wow. Look at that. So there I have the visceral layer of the [inaudible] as opposed to the parietal layer. Parietal Pleura, the visceral Pleura, and then the actual parents [inaudible] lung tissue. So now we have some sense of the textures, qualities and relationships of the Endo Thoracic Fascia approached first from the outside in and then viewed interiorly. We've encountered the parietal pleura from the outside in.

We've encountered it where it adheres to the diaphragm and when differentiated away from the Endo Thoracic fashion inside the rib cage. Okay. Then we've encountered the visceral Pleura, understood as the skin of the lung from the rear as well as from the front and up. Close the time that we have a look at the parietal parrots and Niamh on an inside layer here. So I'm going to lift up this bag and kind of both flop it over. So find a good space down here, close to the of the, uh, the Trans or south stashing and start all the way back here by the transversus abdominis fibers. And it's not so critical exactly where I get into the bag just as long as I get into somewhere. It's a big, it's a big steer. So if I lift up on that sphere somewhere now already I'm seeing that it's possible to differentiate this transfer south Spanish off of the, off of the a parietal peritoneum. So this is very good news.

He's his, um, okay. His belly wasn't intruded upon in the same way as his chest in life. So as I separate here, I'm differentiating the, I believe I'm differentiating the cirrus bag away from the fibers bag. That's pretty neat. See, look, I just cut through the fibers bag. Where have I gotten? I've gotten to on other bag, the fibers bag of the transverse Alice Stasha overlying the cirrus bag over the parietal peritoneum. Our our guts are well, well bagged. Yeah. If I keep pressing here, it's all very slick.

I'll be able to press down and draw. See the, the peritoneum really has a lot of integrity. It's not just see that fibrous bag. Cirrus bag will air in there. Now that's inside the peritoneum. Normally we don't have any gases free floating in the peritoneum. I note how, how thin at this point, so you can see right through the fibers, back transmitter, south stashes super thin here.

It's thickest up here. It drops a layer here, it gets thinner and then it gets thinner still here. So this is the weakest point of the whole trans or Salads Fascia. And sure enough we ended up getting there. Cutting and as I do [inaudible] differentiating the fibers bag away from the cirrus back and we'll recognize that when we finally do get to these organs, and here, there really aren't organs in here, folks, but we have to go through this skin, this superficial Fascia, the deep Fascia, the multiple muscle layers, the deeper deep Fascia, this transverse house fashion and then the parents to them, and then we get to see what [inaudible] knows. Whatever is in here. You see actually these organs are so familiar to us.

They are our life. We breathe them 20,000 times a day. Our heart is beating 100,000 times a day echoing through the organs of your abdomen. This is a miracle, folks. I've never done this in my 11 years of dissection to actually peel off the, I mean I, I've known a tear. I've talked about it. I Brag about it, I tell people about it. Look at that. I mean, now I'm, I've got the diaphragm by the throat here. This is the diaphragm freed from the abdominal surface covering terms. You see the muscle fibers here of the diaphragm right now that I've peeled the parietal peritoneum away from the diaphragm.

Well, let these black fibers represent the fibers of the transversus abdominis muscle forming a fringe at right angles with the costal margin here and all around the belly wall on both sides. This large white area would represent the app neurosis that we see on the cadaver and let these orange fibers here in there up and down a direction represent the fibers of the diaphragm as they to find their way to the edge of the costal margin and meet at right angles with that of the transversus abdominis muscle. So if I draw down this fabric, this fabric of the Trans are Sal's fashion, which represents the, the fibrous investment, both of the transversus abdominis muscle as well as the backside of the diaphragm. We can see this grand continuity of the structure and get a sense of the balloony quality of the whole bag together, as well as its relationship with the diaphragm. So the diaphragm really represents this portion of this more general fabric, which, uh, whose fiber direction terminates at the costal margin and represented in red here. And then, uh, again the transversus abdominis muscle meeting at uh, at the right angles. This bowl, this place here would represent the fibrous pericardium wrapping around the heart, uh, space, which itself is in, ah, exact continuity and blended with the tendinous portion of the diaphragm up top here. So we have the diaphragm in this region of this large balloon bag, the transversus abdominis muscle here, and more generally the whole trans or Sallus Fascia creating this circumference around the abdominal organs. So I can take my instruments here and just like on the cadaver form, find a place lift up and begin to differentiate this fabric.

And as I do so, I reveal through it what will be modeled. Parietal peritoneum. Again, of course it's not adherent, it's just a pillow case. But if I continue to cut away in this manner, eventually you'll see that I'm creating a diaphragm here that I can put my hand under and grab. And as I come across the front and differentiated away along this margin as we did with the cadaver form, we create a larger and larger window on the underlying wall layer of the cirrus membrane. That being the parietal peritoneum, I've created this cutaway just as I did in the cadaver. So as I lift up the Trans Ourselves Fasher, we see the fibers of the transversus abdominis muscle and the fires fibers of the diaphragm being lifted along with it to reveal the underlying parietal peritoneum that great sac around the organs which we were able to differentiate so the organs remain within their sac.

Although the transverse Sallus Fascia has been differentiated away because the normal relations of the diaphragm include the complete adhesion of the parietal peritoneum to its abdominal surface and the complete adhesion of the parietal Pleura to its thoracic surface. I enjoy renaming the respiratory diaphragm as the pleural peritoneal muscle to emphasize the impact upon those great membranous Sachs of each and every breath we take the contraction of the muscle fibers of the diaphragm, arrhythmic lees stretching and releasing the fashional and membranous visceral sacs 20,000 times a day for a lifetime deserves clear acknowledgement and continuous inquiry. If we are to understand our embodied life experience more deeply. So I'm feeling up here as diaphragmatic Pleura. Never doubt the ability of Mr Gabay to real reveal another layer of himself.

That's my new motto. So I'm peeling up the diaphragmatic Pleura. That is to say the parietal Pleura in the region of the diaphragm. Okay, I'm, that's what's being lifted here. Diaphragmatic pleura and never doubted that there is this layer. It's here, it's here.

So of course it started disintegrating in my hand as I pull it. But you are having the benefit of seeing it, a lift up like this. So that's a full contact tissue with the diaphragm. It's adhered to it as surely as we can call it the pleural peritoneal muscle. We could also call the diaphragm the transversus abdominis. Verticality, which we see here clearly interdigitating at the costal margin with what we may as well call the trans versus a, but dominous horizontality is while the fiber directions of the muscle proteins are antagonistic to each other, they are in sheathed in the very same fibrous transverse Salice Fascia in the abdominal surfaces.

[inaudible] keeps sweeping and sweeping. And if I dig far enough, I'll fall. I'll come to a famous muscle here. [inaudible] see I'm, I'm underneath the parents and am sweeping, sweeping the peritoneum off of the, so as here now we have to remember that the transverse Salus Fascia here on the inside of the Ilium is the fibrous bag, the continuation of the transversus abdominis muscle fascia behind the bag here. If I sweep through that fiber's covering at this point, I can lift it and I find myself coming here underneath this what's now the inguinal ligament, right? Because I've cut away the abdominal wall.

That's all that's left and look at me. Now I'm, I'm on the, so as from the front, but I haven't, I haven't touched the visceral look. I have the whole, the, the viscera in its giant here. The Sec of the V. Can you see that? Oh my gosh. This is cool. I just, I just, I'm overwhelmed by, I look at that [inaudible] you're peeling away diaphragm from the drive from [inaudible]. You can go from there all the way around and back down again. All the way around the SEC.

You can follow that diaphragm player over the bell shape. Oh my gosh. Awesome. Keep going and going. Look at how big diamonds, gold and silver has muscle. So look at that. [inaudible] it's easy. It's actually easy to get to. You just go, what were the ILIAC crest? Mike Patrona where are you on that grass in the slide.

And when the person lifts their leg, it actually pops up. Yeah, the muscle pumps and activates. You can feel it and you can compare to telling us of it to the other side. You can repair the sill as muscle. Let me see. I'll see if one of them is twisted out to the side or has it tough trouncy skinny hedge or maybe it's a big flat. Well telling them the edge.

What I love is this relationship with the diaphragm. That edge right there, that's the edge of the diaphragm. Interdigitating like a tendinous insertion right there on your finger is the tenderness insertion that you, that where the done the diaphragm and the size yield to one another. Now, lift up a sec. Wow. We've got the entire entire diaphragm peeling off of the Ryan's. All right.