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?

22
Q

Diaphragmatic abnormalities

A

Diaphragmatic hernia
Pulmonary hypoplasia
Persistent pulmonary HTN
Eventration

23
Q

Where is a diaphragmatic hernia most common?

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
Features of persistent pulmonary HTN of the newborn
Failure of normal circulatory transition that occurs after birth. Causes hypoxemia secondary to R to L shunting of blood
26
What is eventration?
Area less tense so the diaphragm bulks into the thoracic cavity
27
What is the commonest situation to go wrong with the lungs at birth?
Transient tachypnoea of the newborn
28
What does surfactant deficiency at birth lead to?
Hyaline membrane disease - respiratory distress syndrome (RDS)
29
Pathology of RDS
Less surfactant and so the smaller alveoli collapse into the larger ones
30
Treatment of RDS
Antenatal glucocorticoids Surfactant replacement (lasts a day or two until baby produces own) Oxygen CPAP Mechanical ventilation
31
How to antenatal glucocorticoids work in RDS?
Can rapidly mature the foetus cells to produce surfactant earlier and so have surfactant by the time they are born
32
What does CPAP stand for?
Continuous positive airway pressure
33
Examples of chronic neonatal lung disease
BPD CLPD
34
Antenatal risk factors for COPD
In utero nicotine exposure Nutrition LBW / prematurity Micronutrients/vitamins
35
Post natal risk factors for COPD
Infection (barker hypothesis) Growth Environmental tobacco smoke (+/- a1 AT deficiency) Environmental pollution Micronutrients/vitamins
36
Can nicotine cross the placenta?
Yes
37
What is airway remodelling?
Structural changes that occur in both small and large airways relevant to miscellaneous diseases including asthma