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Cardiopulmonology > (15) Respiratory Embryology (Keim) > Flashcards

(15) Respiratory Embryology (Keim) Flashcards

1
Q

The respiratory system primarily comes from which germ layer?

A

ENDODERM

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2
Q

Specifically, the respiratory system’s endoderm comes from…

A

the 6th paryngeal arch

*technically this is the foregut endoderm

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3
Q

What gives rise to the larynx and trachea?

A

Laryngotracheal diverticulum/groove

aka

Respiratory diverticulum

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4
Q

The inferior portion of the laryngotrachial diverticulum is also called:

A

The LUNG BUD

*Found on outside of embryo

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5
Q

What week does the respiratory system start to develop?

A

Week 4

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6
Q

What is occuring as the laryngotracheal diverticulum is forming during week 4?

A

The laryngotracheal diverticulum is forming the:

Esophagus

Stomach

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7
Q

The primitive trachea (laryngotracheal tube) and the esophagus are developing together in week 4. They need to be separated. How does this occur?

A

Tracheoesophageal folds meet the midline and form the tracheoesophageal septum.

This separates the esophagus from the laryngotracheal tube.

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8
Q

When is the tracheoesophageal septum complete?

A

Week 5

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9
Q

What type of structure is the tracheoesophageal septum?

A

Long structure longitudinally!!!

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10
Q

What does the larynx form from?

A

Foregut endoderm

6th Pharyngeal Arch

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11
Q

What are the structures you can identify to orient yourself to the 6th pharyngeal arch?

A

Bilateral arytenoid swellings

*remember! pharyngeal arch 6 is directly inferior to pharngeal arch 4

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12
Q

What are arytenoid swellings derived from?

A

Neural crest

covered with endoderm

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13
Q

What do the arytenoid swellings give rise to?

A

Cartilages in the larynx

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14
Q

What is the black wedge on top of the arytenoid swellings?

A

Glottis

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15
Q

What is the hypobranchial/hypopharyngeal eminence?

A

Region that develops the epiglottis

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16
Q

Which pharyngeal arches give rise to the hypobranchial/hypopharyngeal eminence?

A

Pharyngeal arches 3 and 4

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17
Q

When is epithelial occlusion w/ recanalization complete?

A

10th week

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18
Q

Congenital Abnormalities

What is:

Laryngeal Atresia?

A

Larynx is completly filled in as the result of failure of recanalization

Breathing is impossible; children present with asphyxia at time of birth

Requires an emergency tracheotomy

19
Q

Congenital Abnormalities

What are:

Laryngeal Webs

A

Laryngeal webs are incomplete atresia, presenting as tissue between the vocal cords which blocks the glottis

Pts present with respiratory distress and stridor

Due to failure of recanalization (week 10)

20
Q

Congenital Abnormalities

What is:

Laryngomalacia

A

Refers to a collapse of the supraglottic structures during inspiration

Most common congenital anomaly of the larynx

21
Q

The tissue of the trachea comes from?

A

2 sources!!!

Pulmonary epithelium and glands = endoderm

Cartilage, connective tissue, smooth muscle = splanchnic mesoderm

22
Q

What are tracheoesophageal (TE) fistulas?

A

Almost always associated with esophageal atresia = blind ended esophagus

Pts. struggle to feed

23
Q

What is the cause of tracheoesophageal (TE) fistulas?

A

Failure of the tracheoesophageal folds to form in week 5

24
Q

The lung bud forms out of the ____________ as the inferior portion of the ___________ at week ____.

A

The lung bud forms out of the foregut endoderm as the inferior portion of the laryngotracheal diverticulum at week 4

25
Q

Bronchi and Lungs

State the structure that forms at the following week periods:

Week 4

Week 5

Week 6

Week 7

Week 24

A

Week 4 : : : Lung Bud

Week 5 : : : Primary Bronchial Buds

Week 6 : : : Seondary Bronchi

Week 7 : : : Tertiary bronchi

Week 24 : : : Terminal Bronchioles

26
Q

Stages of Lung Development

What is the pseudoglandular stage?

A

Weeks 5-17

Terminal bronchioles formed, but NO ALVEOLI

Terminal bronchioles are surrounded by connective tissue

these pts. CANNOT SURVIVE

27
Q

Stages of Lung Development

What is the Canalicular stage?

A

Weeks 16-25

Terminal bronchioles give rise to respiratory bronchioles which give rise to primodial alveolar ducts

28
Q

Stages of Lung Development

What is the Terminal Sac stage?

A

Weeks 24-birth (32 weeks)

Type I and Type II pneumocytes formed

Surfactant is produced by Type II pneumocytes

Children born after 24 weeks will survive

29
Q

Stages of Lung Development

What is the Alveolar stage?

A

32 weeks to 8 years

Form the Alveolocapillary membrane

Mature alveoli form

30
Q

What is the order of stages of lung development?

A
31
Q

Fetal Breathing Movements (FBMs)

What 3 things are essential for normal lung development?

A
  • Fetal breathing movement itself
  • Adequate thoracic space in the infant
  • Sufficient quantity of amniotic fluid
32
Q

Fetal Breathing Movements (FBMs)

What do fetuses breathe in utero?

A

Amniotic fluid

33
Q

Fetal Breathing Movements (FBMs)

What events must occur in order to sucessfully transfer fetus from breathing amniotic fluid to breathing air upon birth?

A

Must clear the amniotic fluid at birth to start taking in air.

Assisted with vaginal canal pressure on the fetal thorax during vaginal delivery

Also occurs by draining of the amniotic fluid into pulmonary capillaries, arteries, veins as well as into lymphatics

34
Q

_________ retards lung development and may result in pulmonary hypoplasia.

Risk significantly increased prior to ______ weeks.

A

Oligohydramnios

26

35
Q

CASES:

What are signs and symptoms of Hyaline Membrane Disease (Respiratory Distress Syndrome)

A

Tachypnea

Nasal Flaring

Suprasternal, intercostal/subcostal retractions

Grunting

Cyanosis

36
Q

What is your diagnosis?

A

Hyaline membrane disease/respiratory distress syndrome

37
Q

What caused this presentation?

A

Reticulogranular ground glass appearance is due to…

LACK OF SURFACTANT that should have been produced by type II pneumocytes during the terminal sac stage

(Hyaline Membrane Disease/Respiratory Distress syndrome)

38
Q

CASES:

What do you see?

A

Intestines in the thorax

Heart is displaced to the right because the intestines are in the thorax on the left

39
Q

CASES:

What would be seen during physical examination with this patient?

A
  • Barrel chest
  • No breath sounds
  • Scaphoid shaped abdomen
  • Displaced heart sounds
40
Q

CASES:

Student doctor…What is your diagnosis?

A

Congenital Diaphragmatic Hernia

(interchangeable names)

Foramen of Bochdalek

41
Q

CASES

Infant presents with excessive secretions that cause drooling, choking, coughing, gaggling, respiratory distress and the inability to feed.

What is your potential diagnosis?

A

Tracheoesophageal Fistula

42
Q

CASES:

What is the embryological mechanism that can explain this abnormality?

A

5th week tracheoesophageal septum in the 5th week was disrupted

43
Q

CASES:

What is this X-ray revealing?

A

Congenital lung cysts

Honeycomb appearance on X-ray

44
Q
A

Cardiopulmonology (22 decks)

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