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(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
Bronchi and Lungs State the structure that forms at the following week periods: Week 4 Week 5 Week 6 Week 7 Week 24
Week 4 : : : Lung Bud Week 5 : : : Primary Bronchial Buds Week 6 : : : Seondary Bronchi Week 7 : : : Tertiary bronchi Week 24 : : : Terminal Bronchioles
26
Stages of Lung Development What is the **pseudoglandular stage?**
**Weeks 5-17** Terminal bronchioles formed, but NO ALVEOLI Terminal bronchioles are surrounded by connective tissue these pts. CANNOT SURVIVE
27
Stages of Lung Development What is the **Canalicular stage?**
Weeks 16-25 Terminal bronchioles give rise to _respiratory bronchioles_ which give rise to **primodial alveolar ducts**
28
Stages of Lung Development What is the **Terminal Sac stage?**
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
Stages of Lung Development What is the **Alveolar stage?**
32 weeks to 8 years Form the **Alveolocapillary membrane** Mature alveoli form
30
What is the order of stages of lung development?
31
Fetal Breathing Movements (FBMs) What 3 things are essential for normal lung development?
- **Fetal breathing movement** itself - Adequate **thoracic space** in the infant - Sufficient quantity of **amniotic fluid**
32
Fetal Breathing Movements (FBMs) What do fetuses breathe in utero?
Amniotic fluid
33
Fetal Breathing Movements (FBMs) What events must occur in order to sucessfully transfer fetus from breathing amniotic fluid to breathing air upon birth?
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
\_\_\_\_\_\_\_\_\_ retards lung development and may result in pulmonary hypoplasia. Risk significantly increased prior to ______ weeks.
Oligohydramnios 26
35
CASES: What are signs and symptoms of **Hyaline Membrane Disease (Respiratory Distress Syndrome)**
Tachypnea Nasal Flaring Suprasternal, intercostal/subcostal retractions Grunting Cyanosis
36
What is your diagnosis?
Hyaline membrane disease/respiratory distress syndrome
37
What caused this presentation?
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
CASES: What do you see?
Intestines in the thorax Heart is displaced to the right because the intestines are in the thorax on the left
39
CASES: What would be seen during physical examination with this patient?
- Barrel chest - No breath sounds - Scaphoid shaped abdomen - Displaced heart sounds
40
CASES: Student doctor...What is your diagnosis?
**Congenital Diaphragmatic Hernia** (interchangeable names) **Foramen of Bochdalek**
41
CASES Infant presents with excessive secretions that cause drooling, choking, coughing, gaggling, respiratory distress and the inability to feed. What is your potential diagnosis?
Tracheoesophageal Fistula
42
CASES: What is the embryological mechanism that can explain this abnormality?
5th week tracheoesophageal septum in the 5th week was disrupted
43
CASES: What is this X-ray revealing?
Congenital lung cysts Honeycomb appearance on X-ray
44

Cardiopulmonology (22 decks)

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