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2. Respiratory Medicine (Lectures) > Developmental Aspects of Lung Disease COPY > Flashcards

Developmental Aspects of Lung Disease COPY Flashcards

1
Q

Stages of lung development

A
  1. Embryonic 3 - 8 weeks
  2. Psuedo-glandular 5 - 17 weeks
  3. Canalicular 16 - 26 weeks
  4. Saccular (forms acceni) - 24 - 38 weeks
  5. Alveolar (36 weeks - 2-3 years)
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2
Q

Where do the lungs develop from?

A

Primitive foregut

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3
Q

What are the lung tubes filled with when developing?

A

Liquid

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4
Q

Lung lobes

A

3 on right
2 on left

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5
Q

What happens in psuedoglandular stage?

A

Get lobes
21 branches of original trachea
Fluid secreting
Tracheal cartilage tissue
Blood vessels far away from tubes - gas exchange not possible

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6
Q

What happens in canicular stage?

A

Cuboidal epithelium
Blood vessels close to tubes - gas exchange just becoming possible
Airway thinner and more sponge like

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7
Q

What happens in saccular stage?

A

More and more saccules

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8
Q

What happens in alveolar stage?

A

Saccules develop into alveoli
Thin walled, very few cells

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9
Q

Post natal lung growth

A

Alveolar separation continues
Increased alveolar dimensions

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10
Q

Functional changes in lungs at birth

A

Change from fluid secretion to fluid absorption (first few breaths of life)
Pulmonary vasodilation

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11
Q

What is surfactant?

A

Detergent - phospholipids and lipophilic proteins

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12
Q

Function of surfactant

A

Stabilises alveoli and promotes gas exchange

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13
Q

When do surfactant proteins appear?

A

12 - 14 weeks

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14
Q

What produces surfactant?

A

Type II pneumocytes
(Lamellar bodies)

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15
Q

Congenital abnormalities from embryonic development stage

A

Tracheal, laryngeal stenosis
Pulmonary agenesis
Tracheo oesophageal fistula

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16
Q

What is pulmonary agenesis?

A

Incomplete development of the lungs

17
Q

What is a tacheo oesophageal fistula?

A

Abnormal connection between the trachea and the oesophagus

18
Q

What congenital abnormalities can occur in the pseudoglandular stage of development?

A

Pulmonary sequestration (bits of the lung are not attached to the pulmonary arterial circulation so fail to function properly)
Cyst formation
Cystadenomatoid malformation

19
Q

Types of pulmonary sequestration

A

Extralobar
Intralobar

20
Q

What is cystadenomatoid malformation?

A

Similar to pulmonary sequestration, however an entire lobe of lung is replaced by a non working cystic piece of abnormal lung tissue

21
Q

When does closure of diaphragm develop?

A

18 weeks

22
Q

Diaphragmatic abnormalities

A

Diaphragmatic hernia
Pulmonary hypoplasia
Persistent pulmonary HTN
Eventration

23
Q

Where is a diaphragmatic hernia most common?

A

Left lung

24
Q

Features of pulmonary hypoplasia

A

Incomplete development of lungs
Heart pushed into right side of chest and bowel migrates into chest
Lung on that side is really underdeveloped

25
Q

Features of persistent pulmonary HTN of the newborn

A

Failure of normal circulatory transition that occurs after birth.
Causes hypoxemia secondary to R to L shunting of blood

26
Q

What is eventration?

A

Area less tense so the diaphragm bulks into the thoracic cavity

27
Q

What is the commonest situation to go wrong with the lungs at birth?

A

Transient tachypnoea of the newborn

28
Q

What does surfactant deficiency at birth lead to?

A

Hyaline membrane disease - respiratory distress syndrome (RDS)

29
Q

Pathology of RDS

A

Less surfactant and so the smaller alveoli collapse into the larger ones

30
Q

Treatment of RDS

A

Antenatal glucocorticoids
Surfactant replacement (lasts a day or two until baby produces own)
Oxygen
CPAP
Mechanical ventilation

31
Q

How to antenatal glucocorticoids work in RDS?

A

Can rapidly mature the foetus cells to produce surfactant earlier and so have surfactant by the time they are born

32
Q

What does CPAP stand for?

A

Continuous positive airway pressure

33
Q

Examples of chronic neonatal lung disease

A

BPD
CLPD

34
Q

Antenatal risk factors for COPD

A

In utero nicotine exposure
Nutrition
LBW / prematurity
Micronutrients/vitamins

35
Q

Post natal risk factors for COPD

A

Infection (barker hypothesis)
Growth
Environmental tobacco smoke (+/- a1 AT deficiency)
Environmental pollution
Micronutrients/vitamins

36
Q

Can nicotine cross the placenta?

A

Yes

37
Q

What is airway remodelling?

A

Structural changes that occur in both small and large airways relevant to miscellaneous diseases including asthma

2. Respiratory Medicine (Lectures) (50 decks)

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