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Cardiopulmonary > Embryo respiratory system > Flashcards

Embryo respiratory system Flashcards

1
Q

What is the septum transversum?

A

Part of mesoderm above buccopharyngeal membrane that develops into mesenchymal cell mass below the heart, forming the majority of the diaphragm and contributing to mesenchyme of liver, etc.

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2
Q

2 general EARLY steps of lung development

A
  1. Position lung primordium

2. Primary lung bud formation

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3
Q

General LATE step of lung development

A

Bronchial branching and cellular differentiation

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4
Q

Txn factor that determines location of initial lung development

Linked to increase of what molecule produced by mesoderm

A

TBX4

Retinoic acid

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5
Q

When does lung development begin?

From what structure do the lungs/trachea form from?

A

Week 4

Off of the foregut - to become the esophagus

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6
Q

Very first step in tracheal development

What does the original opening become?

A

Bulging of laryngeotracheal (respiratory) diverticulum from the endoderm (foregut/esophagus)

The laryngeal orifice

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7
Q

What forms just below the laryngeal orifice (split off of the trachea from the esophagus)?

A

Tracheoesophageal septum

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8
Q

What tissue layer is directly covering the esophagus and start of the trachea?

What is covering that?

A

Endoderm

Splanchnic mesoderm

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9
Q

SO, the opening of the trachea and start of it is called what again?

A

Laryngeotracheal diverticulum

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10
Q

Most common malformation during lung/esophageal development

What is it?

A

Tracheoesophageal fistula

Improper formation of TE septum leads to an esophagus dead end, and the esophagus continuing down from off the trachea

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11
Q

What’s the name of an esophagus dead?

What’s the name of the esophagus that branches down from off the trachea (comes w/ a dead end higher up)?

Root cause?

A

Esophageal atresia

TE fistula

Malformation of TE septum

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12
Q

The esophageal atresia (dead end) fills with air and causes what?

A

An anterior displacement of the trachea

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13
Q

How is esophageal atresia diagnosed/presented?

A

Infant w/ excessive salivation, frequently w/ choking, coughing, sneezing

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14
Q

How is swallowing vs. movement of food to stomach affected in these cases?

A

Swallowing = normal

Immediate coughing as fluid returns up through nose and mouth (goes into trachea, causing the cough)

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15
Q

W/ esophageal atresia and TE fistula, how might the skin of the infant present?

Why?

A

Cyanotic (blue)

Overflow of fluid into trachea and lungs prevents breathing

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16
Q

How to surgically fix TE fistula?

A

Cut distal esophagus from trachea, fix the hole, then suture the esophagus to the proximal (upper) atresia portion to make a normal esophagus

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17
Q

What is a laryngeal cleft?

Due to what?

Common when?

A

Space between esophageal opening and tracheal opening, causing food to pass into airways

Difficulty w/ cartilage separating trachea from esophagus

Associated w/ TE fistula, etc.

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18
Q

Other tracheal structural abnormality associated w/ TE fistula, etc.?

What is it?

Treatments?

A

Tracheal stenosis

Abnormal narrowing

Balloon dilation and tracheal stents

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19
Q

When do the primary bronchi begin to form?

Start as what?

A

Week 5

Bronchial buds

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20
Q

How is bronchial branching developed?

A

Sequential budding of primary, secondary, tertiary bronchii, bronchioles, etc.

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21
Q

Name of lining around lungs themselves

Comes from what layer?

Name of lining around pulmonary cavities

Comes from what layer?

A

Visceral pleura - splachnic mesoderm

Parietal pleura - somatic mesoderm

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22
Q

When do the tertiary bronchial buds form?

A

Week 6

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23
Q

The splanchnic mesoderm differentiates into the ___, ___, and ___ of the lungs

A

Smooth muscle

Nerves

Blood vessels

24
Q

The ___ regulates the pattern of branching of lung endoderm (inner lining)

A

Surrounding mesenchyme

25
Q

Bronchioles and alveoli are designed to maximize ___ while minimizing ___

A

Surface area for gas exchange

Resistance to air flow

26
Q

According to what equation, increased alveolar surface area (more branches) should ___ resistance due to decreased diameter

SO, an airway segment is never more than ___ its diameter

A

R = L/r4

Increase

3x

27
Q

5 main stages of lung development (w/ time periods)

At what stage is a fetus technically viable for birth?

A 
Embryonic - weeks 4-7
Glandular - weeks 8-16
Canalicular - weeks 17-26
Terminal sac - weeks 26-birth
Postnatal (alveolar)

Canalicular

28
Q

What happens in the embryonic stage of lung development?

Weeks?

A

Form diverticulum –> form major bronchopulmonary segments

Lungs grow into pleural cavities

4-7

29
Q

What happens in the glandular stage of lung development?

Weeks?

A

Duct systems w/in BP segments form

8-16

30
Q

Induction of vasculogenesis of pulmonary veins is mediated by what txn factor?

Expressed where?

When?

A

VEGF

Epithelium of terminal buds of fetal lung

Late glandular stage

31
Q

What happens in the canalicular stage of lung development?

Weeks?

A

Respiratory bronchioles, terminal sacs form

Increased vascularization, capillaries in walls

17-26

32
Q

2 main cell types in alveoli differentiate from what common cell type?

A

Epithelial lining of alveoli

33
Q

Two cell types w/in alveoli (w/ functions)

A

Type 1 pneumocyte - blood-air barrier

Type 2 pneumocyte - secrete surfactant to reduce surface tension and expand alveoli w/ the liquid

34
Q

Which surfactant type forms first?

Which types come later?

A

Surfactant C

A and B

35
Q

Why is lung surfactant so important in development?

A

Allows easy expansion of alveoli while reducing surface tension

36
Q

What % of alveoli form before birth?

Mechanism of alveolar growth/division?

A

10%

Septation of pre-existing alveoli

37
Q

Which alveolar cell type develops first?

During what stage?

When does the other cell type form?

A

Type 2

Glandular

Canalicular

38
Q

What is a supernumary bronchus?

Main type?

Symptoms?

A

Abnormal division, leading to extra primary/secondary bronchioles

Main = bronchus to right upper lobe is directly from trachea, NOT from right primary bronchus

NONE (usually)

39
Q

An additional respiratory bud from the foregut can cause the formation of what irregularity?

Generally via misexpression of what txn factor?

A

Ectopic lung lobe

FGF10

40
Q

What is infant respiratory distress syndrome (IRDS)?

Can cause what?

A

Labored breathing due to lack of surfactant

Atelectasis - incomplete expansion or collapse of parts or whole lung

41
Q

If an alveolus collapses, what happens around it?

Why is this bad?

A

Other alveolus gets bigger

Bigger radius = worse surface area for gas exchange

42
Q

If alveoli are collapsed, what else would be seen?

A

Dilated bronchioles

43
Q

W/in collapsed alveolar spaces, what accumulates?

A

Debris, edema, RBCs

44
Q

What would you see in alveolar ducts near a collapsed alveolus?

A

Fibrin-rich hyaline membrane from damaged alveolar cells

45
Q

Hyaline membrane disease

X-ray appearance?

A

Alveoli filled w/ debris

“Ground glass” appearance in chest x-ray

46
Q

Congenital neonatal
emphysema

Developmental cause?

A

Collapsed bronchi cause over-distention of one or more lobes w/ air caught inside

Bronchial cartilage doesn’t develop

47
Q

Congenital bronchial cysts

Increased incidence of what?

Radiograph appearance?

A

Destruction and dilation of large airways, filled w/ mucous pockets

Infection

Honeycomb appearance

48
Q

Pulmonary agenesis

Developmental cause?

A

Complete lack of lung

Bronchial bud doesn’t develop

49
Q

Pulmonary hypoplasia

Cause?

Secondary result?

External structural result?

A

Poorly developed bronchial tree due to insufficient amniotic fluid (oligohydramnios)

Renal agenesis, causing lack of fluid to help develop renal system

Limb defects b/c not enough room in amniotic sac to move limbs around

50
Q

Potter syndrome

A

Pulmonary hypoplasia and kidney failure due to lack of amniotic fluid

51
Q

Polyhydramnios

Cause?

A

High volume of amniotic fluid

Infant can’t swallow fluid

52
Q

The intraembryonic coelom (initial body cavity) is first partitioned into the thoracic and abdominal portions via what?

A

Formation of the septum transversum and pleuroperitoneal membranes, forming the diaphragm

53
Q

The thoracic cavity is further divided into pericardial and pleural cavities via what?

What nerves run through this structure?

A

Pleuropericardial membranes

Phrenic and vagus

54
Q

When does the diaphragm become innervated by the phrenic nerve?

When does it move down to L1?

A

Week 4

Week 8

55
Q

Congenital diaphragmatic hernia

Caused by what?

Most commonly where?

A

Hole in diaphragm, causing leaking of abdominal viscera into the thoracic cavity

Failure of pleuroperitoneal membranes to fuse

Left posterolateral side

56
Q

Clinical signs of a congenital diaphragmatic hernia

A

Unusually flat abdomen, breathlessness and cyanosis (compressed lungs)

57
Q

Common surgical tx for diaphragmatic hernia

A

Tie of trachea so fluid builds up in lungs and causes herniated organs to be pushed out

Then untie trachea, let baby breathe, and cut umbilical cord

Cardiopulmonary (8 decks)

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