B4-034 Development of the Respiratory System Flashcards
oral and nasal regurgitation
tracheoesophageal fistula
tests for evaluation of tracheoesophageal fistula
4
- NG tube
- CR
- KUB
- bronchoscopy
due to failure of developmental separation of esophagus and trachea
tracheoesophageal fistula
infants with tracheoesophageal fistula are at an increased risk of
- vertebral anomalies
- anal atresia
- cardiac, renal and limb anomalies
[VACTERL anomalies]
the most common type of tracheoesophageal fistula occurs with
proximal atresia with distal fistula
[Type C]
which type of trachoesophageal fistula is the only one that would result in the NG tube ending in the stomach
H type
what condition may be seen during pregnancy as a result of tracheoesophageal fistula?
polyhydramnios
VACTERL
V- vertebral anomalies
A-anal atresia
C- CV anomalies
T-tracheoesophageal fistula
E-esophageal atresia
R-renal anomalies
L- limb defects
VACTERL is diagnosed as a
non random association of three or more affected organs
- broncial variation arising from the tracha directed toward upper lung lobe
- near carina
tracheal bronchus
- scaphoid abdomen
- barrel shaped chest
- respiratory distress
- diminished left lung sounds, cardiac shift
congential diaphagmatic hernia
pleuriperitoneal membrane does not close off pleuroperitoneal canal
congential diaphragmatic hernia
results in:
* pulmonary hypoplasia
* fewer branches of respiratory tree
* increased muscularization of pulmonary arteries –> pulmonary hypertension
congenital diaphragmatic hernia
absence of surfactant
neonatal respiratory distress syndrome
diffuse ground glass apperance with air bronchograms
infantile respiratory distress syndrome
ground glass appearance of plain film imaging is due to
atelectasis
infants born to diabetic mothers can have an increased risk of
neonatal respiratory distress syndrome
high insulin inhibits corticosteroids that lead to surfactant production
treatment for neonatal RDS
- administer surfactant
- CPAP
- dx patent ductus arteriosus
- fluconanzole (candida)
preventative steps for neonatal RDS
- antenatal corticosteroids
- intratracheal surfactant replacement therapy right after birth
severe neonatal respiratory distress is caused by a […] membrane
hyaline
made of debris
less urine out= less fluid
oligohydramnios
less swallowing = more fluid
polyhydramnios
second most common cause for oligohydramnios
kidney anomalies
associated with lung hypoplasia (potter sequence)
pulmonary hypoplasia develops secondarily to
3
CDH
oligohydramnios
renal agenesis
first most common cause of oligohydramnios
amniotic fluid leaking
restricts “infant breathing”
polyhydramnios can be secondary to
TEF
collapsed bronchi occur because of weakened or absent cartilage in bronchi
congenital lobar emphysema
initial establishment of blood-air barrier occurs during
terminal sac period
differentiation of capillary endothelium and type I pneumocytes occurs during
terminal sac stage
increase in number of alveoli occurs during the
alveolar period
- branching of terminal bronchioles into respiratory bronchioles
- branching of respiratory bronchcioles into alveolar ducts
occurs during
canalicular phase
- overlaps with pseudogladular stage
- 5th-10th weeks of pregnancy
embryonic stage
characterized by exocrine glandular appearance with diffuse capillary network
pseudoglandular stage
hyperglycemia and hyperinsulinemia can disrupt
surfactant synthesis
RDS
maternal diabetes and C section are risk factors for
infant RDS
GI contents pushed into thoracic cavity resulting in pulmonary hypoplasia and pulmonary hypertension
congenital diaphragmatic hernia
bronchial cartilage does not differentiate normally from splanchnic mesoderm
congenital emphysema
results in mucus secretions from the mouth and nose after feeding
TEF
- induces bud formation
- primary inducer of branching process
FGF10
expressed mostly in epithelium and increased at branch tips
BMP4
- signaling to mesenchyme modulates FGF signaling
- determines sites of lung bud formation
SHH
- FGF10 antagonist
- limits branching at tips
sprouty
inhibits branching
TGF beta
in CDH, heart sounds are usually increased on the […] side
right
shifts right
infants with CDH get worse with which resuscitation measure?
BMV
bag mask ventilation
hyaline cartilage is derived from the
splanchic mesoderm
pulmonary hypoplasia is commonly associated with
oligohydramnios
as inspiration occurs, a deficiency of bronchial cartilage inhibits normal expiration
congenital emphysema
occurs in TEF, duodenal atresia, and esophageal atresia
polyhydramnios
why are newborn lungs denser than adult on CXR?
fewer mature alveoli
fluid-filled, blind-ending pouch lined by respiratory epithelium
bronchogenic cyst
what stage is associated with the formation of the respiratory diverticulum
embryonic
what stage is associated with the formation of the terminal bronchioles
pseudoglandular
what stage is associated with the formation of the respiratory bronchioles
canalicular
what stage is associated with the formation of the terminal sacs
saccular
what stage is associated with the maturation of the alveoli
alveolar
what stage
epithelium becomes squamous and there is intimate association with the capillaries allowing gas exchanges
alveolar stage
formation of the germ layers occurs during
gastrulation
differentiates into the GI tract, lungs, pharynx and GU system
endoderm
formation of the epidermis, hair, nails, and external sense organs
ectoderm
develops into connective tissues: cartilage, bone muscle and blood vessels
mesoderm
separates the layers of the lateral plate mesoderm
intraembryonic coelom
forms lateral and cardiogenic mesoderm
intraembryonic coelom
lateral plate mesoderm is divided into
2
- splanchnic
- somatic
via intraembryonic coelom
forms blastocyst
blastocele
contains the fluid in which the embryo floats
chorionic cavity
differentiation of the splanchic mesoderm results in
3
- bronchial smooth muscle
- hyaline cartilage
- connective tissue
forms the diaphragm
septum transversum
development of […] is the first sign of respiratory development
respiratory diverticulum
critical in driving branching processes in the lung
FGF10
promotes proliferation and differentiation of the mesoderm
SHH
inhibits branching by inhibiting FGF
sprouty
the inducer for determining the derivatives of endoderm is found in the
mesenchyme
caused by failure in differentiation of the pleuroperitoneal membranes
CDH
abnormal positioning of the tracheoesophageal septum may lead to
TEF
respiratory distress caused by failure of differentiation of cartilage
congential emphysema
