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CVPR > CVPR First Aid: Respiratory embryology > Flashcards

CVPR First Aid: Respiratory embryology Flashcards

1
Q

Describe lung development

A

Occurs in 5 stages Initial development of lung bud from distal end of respiratory diverticulum during week 4 Every Pulmonologist Can See Alveoli

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2
Q

Stages of lung development mnemonic

A

Every Pulmonologist Can See

Alveoli Embryonic Pseudoglandular Canalicular Saccular Alveolar

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3
Q

The embryonic stage of lung development occurs during

A

4-7 weeks

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4
Q

Describe the embryonic stage of lung development

A

Lung bud → trachea → bronchial buds → mainstem bronchi → secondary (lobar) bronchi → tertiary (segmental) bronchi

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5
Q

Embryonic stage of lung development key features

A

Errors at this stage can lead to tracheoesophageal fistula

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6
Q

The pseudoglandular stage of lung development occurs during

A

5-17 weeks

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7
Q

Describe the pseudoglandular stage of lung development

A

Endodermal tubules → terminal bronchioles Surrounded by modest capillary network

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8
Q

Pseudoglandular stage of lung development key features

A

Respiration impossible Incompatible with life

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9
Q

The Canalicular stage of lung development occurs during

A

16-25 weeks

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10
Q

Describe the canalicular stage of lung development

A

Terminal bronchioles → respiratory bronchioles → alveolar ducts Surrounded by prominent capillary network

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11
Q

Canalicular stage of lung development key features

A

Airways increase in diameter Respiration capable at 25 weeks Pneumocytes develop starting at 20 weeks

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12
Q

Errors at this stage can lead to tracheoesophageal fistula

A

Embryonic stage of lung development 4-7 weeks

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13
Q

The saccular stage of lung development occurs during

A

Week 26-birth

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14
Q

Describe Saccular stage of lung development

A

Alveolar ducts → terminal sacs Terminal sacs separated 1° septae

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15
Q

The alveolar stage of lung development occurs during

A

36 weeks to 8 years

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16
Q

Describe the alveolar stage of lung development

A

Terminal sacs → adult alvoeli (due to 2° septation) In utero “breathing occurs via aspiration and expulsion of amniotic fluid → ↑ vascular resistance through gestation At birth fluid gets replaced with air → ↓ in pulmonary vascular resistance

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17
Q

Describe the key feature of the alveolar stage of lung development

A

At birth: 20 - 70 million alveoli By 8 years: 300 - 400 million alveoli

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18
Q

Lung development diagram

A

642

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19
Q

List of congenital lung malformations

A

Pulmonary hypoplasia Bronchogenic cysts Club cells

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20
Q

What is pulmonary hypoplasia

A

Poorly developed bronchial tree with abnormal histology

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21
Q

Pulmonary hypoplasia is associated with

A

Congenital diaphragmatic hernia (usually left-sided)

Bilateral renal agenesis (Potter sequence)

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22
Q

What are Bronchogenic cysts?

A

Discrete, round, sharply defined, fluid-filled densities on CXR (air-filled if infected) caused by abnormal budding of the foregut and dilation of terminal or large bronchi Generally asymptomatic but can drain poorly, causing airway compression and/or recurrent respiratory infections

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23
Q

Describe Type II pneumocytes

A
  • Secrete surfactant from lamellar bodies → ↓ alveolar surface tension which prevents alveolar collapse ↓ lung recoil ↑ compliance
  • Cuboidal and clustered
  • Serve as precursors to Type I pneumocytes and other Type II cells
  • Proliferate during lung damage
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24
Q

Bronchogenic cysts are caused by?

A

Caused by abnormal budding of the forgut and dilation of terminal or large bronchi

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25
Q

Symptoms of bronchogenic cysts

A

Generally asymptomatic but can drain poorly, causing airway compression and/or recurrent respiratory infections

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26
Q

What are club cells?

A

Nonciliated; low columnar/cuboidal with secretory granules located in the bronchials Degrade toxins; secrete component of surfactant Act as reserve cells

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27
Q

List of alveolar cell types

A

Type I pneumocytes Type II pneumocytes Alveolar macrophages

28
Q

Describe Type I pneumocytes

A

97% of alveolar surfaces Line the alveoli Squamous; thin for optimal gas diffusion

29
Q

Importance of surfactant to the alveoli

A

Secrete surfactant from lamellar bodies → ↓ alveolar surface tension which prevents alveolar collapse ↓ lung recoil ↑ compliance

Collapsing pressure = 2(surface tension) / radius

Alveoli have ↑ tendency to collapse on expiration as radius is lower ↓ (law of Laplace)

30
Q

When does surfactant synthesis begin?

A

≈ week 20 of gestation But mature levels are not achieve until around week 35

31
Q

Corticosteroids and lung development

A

Corticosteroids are important for surfactant production and lung development

32
Q

What is surfactant composed of?

A

Pulmonary surfactant is a complex mix of lecithins, the most important of which is dipalmitoylphosphatidylcholine (DPPC)

33
Q

Describe alveolar macrophages

A

Phagocytose foreign materialls

Release cytokines and alveolar proteases

Hemosiderin-laden macrophages may be seen in pulmonary hemorrhage

34
Q

What is neonatal distress syndrome?

A

Surfactant deficiency → ↑ surface tension → alveolar collapse

35
Q

Neonatal distress syndrome imaging

A

Ground-glass appearance on CXR

36
Q

Risk factors of neonatal distress syndrome

3 listed

A
  • Prematurity
  • Maternal diabetes (due to ↑ fetal insulin)
  • C-section delivery (↓ release of fetal glucocorticoids: less stressful than vaginal delivery)
37
Q

Complications of neonatal distress syndrome

A

PDA

Necrotizing enterocolitis

38
Q

Treatment of neonatal distress syndrome

A
  • Maternal steroids before birth
  • Exogenous surfactant for infant
  • Therapeutic O2 can result in (RIB)
    • Retinopathy of prematurity
    • Intraventricular hemorrhage
    • Bronchopulmonary dysplasia
39
Q

Screening tests for fetal lung maturity

A
  • Lecithin-sphingomyelin (L/S) ratio in amniotic fluid (≥ 2 is healthy; < 1.5 is predictive of NRDS)
  • Foam stability index
  • Surfactant-albumin ratio
40
Q

Describe the main zones of the respiratory tree

A

Conducting zones

Respiratory zones

41
Q

Conducting zones

A

Large airways consist of

Nose

Pharynx

Larynx

Trachea

Bronchi

42
Q

Area of greatest resistance in the respiratory tree

A

Tertiary bronchioles

43
Q

Area of least resistance in the respiratory tree

A

Terminal bronchioles because large numbers in parallel (1/R)

44
Q

Small airways consist of?

A

Bronchioles that further divide into terminal bronchioles

45
Q

Function of the conducting zone of the respiratory tree

A

Warms

Humidifies

Filters air but does not participate in gas exchange = anatomical dead space

Cartilage and goblet cells extend to the end of the bronchi

46
Q

Lung cellular content

A

Pseudostritified ciliated columnar cells primarily make up the epithelium of bronchus and extend to the beginning of terminal bronchioles, then transition to cuboidal cells which clear mucus and debris from the lungs (mucociliary escalator)

Airway smooth muscle cells extend to the end of terminal bronchioles (sparse beyond this point)

47
Q

Describe the respiratory zone of the respiratory tree

A

Lung parenchyma; consists of respiratory bronchioles, alveolar ducts and alveoli

Participates in gas exchange

Mostly cuboidal cells cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli

Cilia terminate in respiratory bronchioles

Alveolar macrophages clear debris and participate in immune response

48
Q

Respiratory tree diagram

A

644

49
Q

Lung lobes

A

Right lung has 3 lobes

Left lung has 2 lobes and lingula

50
Q

What is a lingula

A

The homolog of the right middle lobe in the left lung, instead of a middle lobe the left lung has a space occupied by the heart

51
Q

Describe the relation of the pulmonary artery to the bronchus at each lung hilum

A

Described by RALS - Right Anterior, Left Superior

52
Q

carina location

A

Carina is posterior to ascending aorta and anteromedial to descending aorta

53
Q

What is the most common site for inhaled foreign bodies

A

The right lung because the right main stem is wider, more vertical and shorter than the left

54
Q

If you aspirate peanut while supine

A

usually enters the right lower lobe

55
Q

If you aspirate peanut while laying on the right side

A

usually enters the right upper lobe

56
Q

If you aspirate peanut while upright

A

usually enters the right lower lobe

57
Q

Lung anatomy pictures

A

645

58
Q

Describe structures that perforate the diaphragm

A

At T8: IVC, right phrenic nerve

At T10: esophagus, vagus (CN 10; 2 trunks)

At T12: aorta (red), thoracic duct (white), azygous vein (blue), “At T-1-2 it’s the red white and blue)

Identify structures that perforate the diaphragm

59
Q

Describe the innervation of the diaphragm

A

Diaphragm is innervated by C3, 4 and 5 (phrenic nerve)

Pain from diaphragm (air, blood, pus in peritoneal cavity) can be referred to shoulder (C5) and trapezius ridge (C3, 4)

60
Q

Structures that perforate the diaphragm mnemonic

A

Number of levels

T8: Vena Cava

T10: Oesophagus

T12: Aortic hiatus

At T12: aorta (red), thoracic duct (white), azygous vein (blue), “At T-1-2 it’s the red white and blue)

I (IVC) ate (8) ten (10) eggs (esophagus) at (aorta) twelve (12)

61
Q

Errors at this stage can lead to tracheoesophageal fistula

A

Embryonic stage

62
Q

Pneumocytes develop starting at? in what phase?

A

Pneumocytes develop starting at 20 weeks in the canalicular phase of respiratory development

63
Q

Respiration capable at? in what phase?

A

25 weeks

in the canalicular phase

64
Q

Therapeutic O2 in neonatal distress syndrome can result in?

3 listed

A

Therapeutic O2 can result in (RIB)

  • Retinopathy of prematurity
  • Intraventricular hemorrhage
  • Bronchopulmonary dysplasia
65
Q

Persistent low O2 tension →

A

risk of PDA

CVPR (93 decks)

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