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Respiratory System > Developmental aspects of lung disease > Flashcards

Developmental aspects of lung disease Flashcards

1
Q

Name the 5 stages of lung morphogenesis

A 
Embryonic
Pseudo-glandular
Canalicular
Saccular
Alveolar

THERE ARE MAJOR OVERLAPS

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2
Q

What happens during post natal lung growth

A
  • Alveolar separation continues
  • 100-150 million at birth to 200-600 million at 3-8 years
  • Increased alveolar dimensions thereafter
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3
Q

Summarise what happens in lung development during the embryonic and pseudoglandular stages

A
  • Formation of major airways
  • Formation of bronchial tree and portions of respiratory parenchyma
  • birth of the acinus
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4
Q

Summarise what happens in lung development during the canalicular stage

A
  • Last generations of the lung and periphery formed
  • Epithelial differentiation
  • Air-blood brain barrier formed
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5
Q

Summarise what happens in lung development during the Saccular stage

A
  • Expansion of air spaces

- Surfactant detectable in amnionic fluid

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6
Q

Summarise what happens in lung development during the alveolar stage

A
  • Secondary septation
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7
Q

What are the structural changes that can happen in the early stages include?

A
  • Airway stenosis
  • Airway Malacia
  • Pulmonary agenesis/hypoplasia
  • Tracheo-oesophageal fistula
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8
Q

What are the structural changes that can happen in the later stages include?

A
  • Bronchogenic cyst

* Congenital pulmonary anomalies

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9
Q

Name 3 types of Congenital pulmonary anomalies

A
  • Lobar emphysema
  • Cystadenomatoid malformation
  • Sequestration
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10
Q

What are the presenting features of Lung disease within childhood?

A
  • Stridor/wheeze
  • Recurrent pneumonia (same region of lung)
  • Incidental finding
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11
Q

What are the presenting features of Lung disease within new borns?

A
  • Tachypnea

- Respiratory distress (chest wall retraction)

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12
Q

What % of features are presented in different stages of life?

A

Foetal ultrasound - 75%
Newborn - 10%
Childhood - 15%

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13
Q

Name two common congenital lung diseases

A
  • Tracheo-bronchomalacia

- Pulmonary adenomatoid malformation

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14
Q

What are the characteristics of Tracheo-bronchomalacia

A
  • Barking/seal-like cough
  • Breathless on exertion
  • Stridor (inspiratory) /wheeze (expiratory)
  • Early onset of croup
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15
Q

What is age does early onset croup typically refer to when discussing Tracheo-bronchomalacia?

A

2/3 years of age

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16
Q

What forms of management is required for Tracheo-bronchomalacia?

A
  • Airway clearance physiotherapy
  • Antibiotics
  • Natural history resolution with time
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17
Q

What forms of management should be avoided when suffering from Tracheo-bronchomalacia and why?

A

Avoid “asthma” treatment (especially bronchodilators) – may worsen

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18
Q

What form of common congenital lung disease may resolve spontaneously in utero?

A

Pulmonary adenomatoid malformation

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19
Q

If Pulmonary adenomatoid malformation is asymptomatic, what form of management will it require?

A

Conservative management

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20
Q

What form of common congenital lung disease has a risk of malignant change?

A

Pulmonary adenomatoid malformation

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21
Q

What tissue contributes to diaphragm development?

A

Primitive tissue

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22
Q

What week of gestation does closure of the diaphragm occur?

A

week 18

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23
Q

Name two types of diagphragmatic abnormalities

A
  • Evantration

- Diaphragmatic hernia

24
Q

What are the characteristics of diaphragmatic hernia?

A
  • More common in L>R
  • pulmonary hypoplasia
  • persistent pulmonary hypertension
25
Q

What are the structural features of Evantration?

A

Structurally abnormal diaphragm, the right is higher than

it should be.

26
Q

Why is Evantration known said to be an incidental find?

A

It is asymptomatic

27
Q

What are the functional changes in lungs that occur at birth?

A

Change from fluid secretion to fluid absorption

28
Q

What is that most common respiratory problem that can occur at birth?

A

Transient tachypnea of newborn

29
Q

What type of delivery is transient tachynpea of the new born associated with?

A

Caesarean section

30
Q

What does transient tachnpea of the newborn consist of?

A

A period of rapid breathing due amniotic fluid remaining in the lungs after birth.

31
Q

How long does transient tachypnea of the newborn usually take to resolve?

A

24-48hr

32
Q

Why is transient tachypnea usually associated with C sections and not natural birth?

A

Usually is removed through natural birth due to compression via birth canal. In C-section there is no compression and fluid may be retained

33
Q

What does a chest x ray show in an infant that has transient tachypnea?

A
  • hyperinflation of the lungs including prominent pulmonary vascular markings
  • flattening of the diaphragm, and fluid in the horizontal fissure of the right lung.
34
Q

What is surfactant and what does it do?

A 
o	detergent (phospholipids and lipophilic proteins)
- mechanical vasodilator
o	stabilises alveoli and promotes gas exchange
35
Q

What secretes surfactant?

A

Type ll pneumonocytes

36
Q

What is Hyaline membrane disease (Respiratory Distress Syndrome)?

A

a condition in newborn babies in which the lungs are deficient in surfactant
- prevents their proper expansion and causes the formation of hyaline material in the lung spaces.

37
Q

What is the treatment for RDS/Surfactant deficiency?

A
  • Antenatal glucocorticoids
  • Surfactant replacement
  • Supportive
38
Q

On what day is endogenous surfactant produced?

A

day 5

39
Q

Other names for chronic neonatal lung disease are?

A
  • Bronchopulmonary Dysplasia

- CLD Prematurity

40
Q

What is factors contribute to the aetiology o f chronic neonatal lung disease?

A
  • Antenatal infection
  • Barotrauma/oxygen toxicity
  • PDA (Patent ductus arteriosus)
  • Genetics
41
Q

What can chronic neonatal lung disease lead to?

A
  • increased childhood respiratory morbidity

* ? possible set up for future COPD

42
Q

What are the foetal origins of adult lung disease (COPD)?

A 
o	in utero nicotine exposure
o	fetal infection
o	maternal nutrition
o	low birth weight/prematurity (antenatal steroids) 
o	maternal micronutrients/vitamins
43
Q

What are the post-natal origins of adult lung disease (COPD)?

A

o infection (Barker hypothesis) -
- growth
- ETS (+/- alpha 1 AT deficiency) – maternal smoking?
- environmental pollution
- micronutrients/vitamins
(All above influenced by gene-environment interactions and are a set up for respiratory diseases later on)

44
Q

What is meant by the term ‘remodelling’?

A

alteration of structure following an external influence

45
Q

How are the lungs ‘remodelled’ when undergone pre natal nicotine exposure?

A
  • Lung hypoplasia
  • Reduced alveolarisation
  • Reduced lung function (small airways)
  • Increased susceptibility to infection
46
Q

Name two factors that cause remodelling of the lung

A
  • Pre-natal nicotine exposure

- Interference of inter-cellular signalling

47
Q

A reduction in lung function leads to an increase in what syndrome?

A

wheezing

48
Q

What occurs in remodelling (asthma)

A

Chronic inflammation which causes:

  • Increased bronchial responsiveness
  • Increase mucus secretion
  • Airway oedema
  • Airway narrowing
49
Q

What occurs in remodelling (CNLD)

A
  • Chronic inflammation
  • Interference inter-cellular signalling
  • Treatment toxicity
50
Q

What is the 3rd leading cause of death in the world?

A

COPD

51
Q

Antenatal programming/environmental exposures/gene interactions lead to what?

A

Remodelling of the airway/ lung parenchyma

52
Q

what weeks of gestation refer to the embryonic stage of lung morphogenesis?

A

3-8

53
Q

what weeks of gestation refer to the pseudo-glandular stage of lung morphogenesis?

A

5-17

54
Q

what weeks of gestation refer to the canalicular stage of lung morphogenesis?

A

16-26

55
Q

what weeks of gestation refer to the saccular stage of lung morphogenesis?

A

24-38

56
Q

what weeks of gestation refer to the alveolar stage of lung morphogenesis?

A

36 weeks - 2/3 years

Respiratory System (4 decks)

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