Developmental aspects of lung disease Flashcards
Stages of lung morphogenesis + Gestational age
Embryonic ( 3-8wks)
Pseudogladular ( 5-17wks)
Canalicular (16-26wks)
Saccular (24-38wks)
Alveolar (36wks -2/3yrs)
Postnatal lung growth
Alveolar septation continues + increased alveolar dimensions thereafter
State the common congenita abnormalities in Upper + Lower
Upper (Tracheo-brachial)
- tracheal agenesis + stenosis
- tracheomalacia
- tracheo-oesphhageal fistula
Lower ( Broncho-pulmonary)
- Lung agenesis/pulmonary hypoplasia
- Bronchogenic cyst
- CPAM
- Congenital diapgragmatic hernia
State the presenting features in : antenatal scanning, newborn, childhood, asympomatic
Antenatal scanning:
-ultrasound
Newborn:
- tachypnoea
- respiratory distress
- feeding issues
Childhood
- stridor/wheeze
- recurrent pneumonia
- cough
- feeding issues
Asymptomatic
-incidental finding
Presentation of tracheal agenesis
- presents at birth with acute respiratory distress and inabiity to intubate
Tracheal stenosis
- Complete tracheal rings, may generalised or segmental
- present at birth/within first
Tracheomalacia
-Dynamic abnormal collapse of tracheal
Presentation of tracheomalacia
- Barking cough
- recurrent ‘croup’
- breathless on exertion
- stridor/wheeze
Management of tracheomalacia
physiotherapy + antiobiotics(unwell)
Causes of tracheomalacia
- associated with genetic conditions
- may be caused by external compression ( eg vessels, tumour)
What is tracheo-oeasophageal fistula?
- Abnormal connection between trachea and oesophagus
- association with genetic conditions
Diagnosis of tracheo-oesophageal fistula
-antenatally or postnatally
Presentation of tracheo-oesophageal fistula
- choking
- color change
- cough with feeding
- unable to pass NG
Treatment and complications of tracheo-oesophageal fistula
- surgical repair
- tracheomalacia, strictures, leak + refliux
Congenital pulmonary airway malformation (CPAM)
- abnormal non-functioning lung tissue
- sporadically
-risk of malignant change
CPAM treatment
- can be resolved spontaneously in utero
- surgical intervention maybe
Diaphragm development
- develops from multiple tissues around 7wks
- Innervated by phrenic nerve
- Closure by 18wks
Congenital diapgragmatic hernia
- mainly bochdalek + usually LHS
- prognosis depends on degree of lung hypoplasia
Congenital diapgramatic hernia diagnosis + treatment
- antenatally or late
- Surgical repair
Changes in lungs after birth
- occurs after first breath
- lungs inflate and fluid in lungs is absorbed
-Transient tachypnoea of newborn (associated with C section)
Type 2 pneumocutes differentiates when?
24-34 wks
Treatment of IRDS
- antenatal steroids
- surfactant replacement
- appopriate ventilation + nutrition
Neonatal lung disease ( bronchopulmonary dysplasia)
-chronic LD associated with prematuririty where ongoing oxygen requirement at term
-multifactorial causes
-associated with increased childhood respiratory morbidity
-
Relationship between fetal/paediatric + adult lung disease
ANTENATAL
- Nicotine exposure
- Infection
- Maternal nutrition
- Maternal micronutrients/vitamins
- Low birth weight/prematurity
- Antenatal steroids
POSTNATAL
- Barker hypothesis
- Infection
- Growth
- Tobacco exposure
- Environmental pollution
- Micronutrients/vitamins
Describe remodelling
-alteration of airway structure following external influence:
- Environmental exposures
- Chronic diseases of childhood
- Infection
- Causes interference of inter-ceular signaling
Remodelling ( asthma )
Chronic inflammation
- increased bronchial responsiveness
- Increase mucous secretion
- airway oedema
- airway narrowing
Remodelling ( chronic lung disease)
- chronic inflammation
- interference inter-cellular signalling
- treatment toxicity
