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KCUMB Anatomy II > Embryology EXAM I > Flashcards

Embryology EXAM I Flashcards

1
Q

What occurs during the early and late phase of lung development?

A

Early - positioning of lung primordium and primary lung bud formation

Late - mechanism of bronchial branching and cytodifferentiation

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2
Q

What week does development form and what forms during this in lung development?

A

Week 4

Laryngeotracheal/respiratory diverticulum via Tbx4 gene (endoderm of foregut)

Outgrowth of foregut (future esophagus) into surrounding splanchnic mesoderm

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3
Q

What direction does the laryngeotracheal diverticulum grow and what does it separate from, and what structure separates them?

A

Distally from the esophagus by the tracheoesophageal septum

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4
Q

Tracheoesophageal Fistula, Esophageal Atresia; what fetal anomally is this related to?

A

Abnormal connection b/w trachea and esophagus

Improper formation of tracheoesophageal septum

Feeding tube cannot move beyond upper esophageal pouch

Related to: polyhydramnios (too much amniotic fluid)

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5
Q

Polyhydramnios

A

High volume of amniotic fluid

Baby is not swallowing enough amniotic fluid

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6
Q

Symptoms of esophageal atresia (occlusion) and tracheoesophageal fistula

Treatment?

A

Infant is drooling, with choking, coughing, sneezing

When fed infant swallows but begins to cough and struggle as fluid is regurgitated

Infant may become cyanotic (blue), stop breathing as overflow of fluid from blind pouch is aspirated in trachea and lungs

Treatment: Surgical fix

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7
Q
A
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8
Q

At what week do the bronchial buds form? What will be their final fate?

A

Week 5; left and right buds form

Will become main primary bronchi

After, a series of branchings will occur to become respiratory bronchioles (secondary)

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9
Q

What does the splanchnic mesoderm differentiate into?

A

Smooth muscle

Nerves

Blood vessels of lungs

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10
Q

What are the 5 stages of lung development? At which stage is the infant born viable?

A

EGCTP

Embryonic (4-7)

Pseudoglandular (8-16)

Canalicular (17-26) = viable

Terminal sac (27-birth)

Postnatal (Alveolar)

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11
Q

What occurs during the embryonic stage of lung development?

A

(4-7)

Initial formation of respiratory diverticulum —> formation of major bronchopulmonary segments

Lungs grow into pleural cavities

Pleural differentiation

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12
Q

What occurs during the pseudoglandular stage of lung development?

A

(8-16)

Formation and growth of duct systems within bronchopulmonary segments

No respiratory components or gas exchange

Resembles a gland

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13
Q

What occurs during the canalicular stage of lung development?

A

(17-26)

Formation of respiratory bronchioles & terminal sacs (primitive alveoli)

Increase in vascularization, capillaries = gas exchange = viable

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14
Q

What occurs during the terminal sac stage of lung development?

A

(27-birth)

Alveoli/terminal sacs develop from the respiratory bronchioles

Alveoli differentiates in Type I and Type II

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15
Q

Type I pneumocyte

Type II pneumocyte

A

Type I = blood-air barrier

Type II = produce surfactant (facilitates alveolar expansion)

For viability = capillaries, alveoli, surfactant

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16
Q

What occurs in postnatal/alveolar stage of lung development?

A

Alveoli differentiation

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17
Q

Infant respiratory distress syndrome

A

Deficiency/absence of surfactant

Immature/damaged Type II pneumocytes

60% born less than 28 weeks

5% born less than 37 weeks

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18
Q

Pulmonary agenesis

A

Complete absence of lungs, bronchi, and vasculature

Bilateral or Unilateral

Bronchial buds don’t develop

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19
Q

Pulmonary hypoplasia

A

Poorly developed bronchial tree

Partial or total (entire lung)

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20
Q

Congenital diaphragmatic hernia; which membranes is involved? Signs?

A

Abdominal contents herniated into pleural cavity; can cause pulmonary hypoplasia

Stomach, bowel can be in the thoracic cavity

Failure of pleuroperitoneal membranes to fuse with other components (i.e. septum transversum)

Signs: flat abdomen, breathlessness, cyanosis

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21
Q

What are the major trends of cardiovascular development? (4)

A

Converted into a 2 —> 4 chambered structure

Embryonic vascular system separates into systemic and pulmonary portions

Systemic arterial outflow —> Left

System venous retun —> Right

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22
Q

Describe the vascular circuit of the embryo

A

Series of aortic arches connect to dorsal aortae

= Cardinal, Vitelline, Umbilical

Dorsal aortae subdivide into smaller vessels to supply the embryo

Blood is drained by anterior and posterior cardinal veins

Common cardinal vein is formed by the left, right, anterior and posterior cardinal veins = embryonic circuit

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23
Q

What are the nutritional circuits for the embryo? What does the vitelline system do?

A

Umbilical and Vitelline

Nutritional circuits = Vitelline veins and arteries; supply and drain the yolk sac “nursery for blood cells”

Umbilical/placental arteries and veins

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24
Q

Name the adult structure from each of the embryonic structures

A

Truncus Arteriosus = Aorta, pulmonary trunk

Bulbus cordis = smooth part of right (conus cordis) and left ventricle (aortic vestibule)

Primitive ventricle = trabeculated part of right and left ventricles

Primitive atrium = trabeculated part of right and left atria (auricles)

Sinus venousus = smooth part of right atrium, coronary sinus, oblique vein of left atrium

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25
Heart bends towards left
26
Heart loops ventrally around fulcrum
27
Dextrocardia
Positional abnormality Heart bends to the left instead of the right Usually not an issue
28
Function of endocardial cushions? When do they form? What does it initially sit in between?
**Separates Atrium from Ventricles** Forms after ventral folding and **dorsal and ventral blocks of tissue fold towards midline = endocardial tissue** Divides the **single AV canal into separate right and left AV canals** (which regulate blood blow from atria to ventricles)
29
Atrioventricular communis
Failure of the endocardial tissues to fuse you end up with a **large communication between the left and right AV canals causing abnormal mixture of oxy- and deoxy- blood**
30
What is the critical first step in the development of the 4-chambered heart?
Formation and fusion of endocardial cushions
31
What does growth of the bulbar region and muscular portion of the heart form?
Downward growth of bulbar region and upward growth of muscular portion towards the endocardial cushions forms the **IV septum**
32
Ventricular septal defects (VSDs)
**Opening between the left and right ventricles** Associated with shunting of blood Require surgical correction
33
Describe the formation of the atrial septum
The initial foramen between the atrium is the **foramen primum; between the septum primum and dorsal endocardial cushions.** Septum primum grows downward and via apotosis forms the **foramen secundum**, developing septum primum from the endocardial cushion **fuses with septum primum closing the foramen primum.** **Septum secundum upper limb** is developing from the top into the foramen ovale and eventually connects with the valve of foramen ovale (derived from septum primum) At birth, high pressure on left atrium causes the **septum primum to close valve = _fossa ovalis_**
34
Atrial Septal Defects
**Ostium/foramen primum -** similar to endocardial cushion defects **Secundum type -** involves foramen ovale and septum primum Sinus venosus - usually near opening of SVC Common atrium
35
Where do sinus venouses initially open into?
Dorsal wall of primitive atrium Changes occur when right horn enlarges as blood is shunted from L --\> R **Moves all systemic inflow to the right side** Shunts are created: vascular/nutritional circuit (vitelline & umbilical), embryonic circuits (cardinal)
36
What does the Vitelline Veins shunt turn into? Initially from the sinus venousus
Veins become incorporated into liver as hepatic sinusoids, hepatic veins, part of IVC and some GI veins Loss at birth
37
What is the umbilical shunt that is derived from the sinus venosus?
Umbilical shunt bypasses liver and diverts oxygenated blood to heart Loses direct connection with heart (ligamentum teres hepatis) Joins the large venous shunt = **ductus venosus =** bypasses liver and diverts oxygenated blood to heart **Connects umbilical vein w/ IVC**
38
What does the right anterior cardinal and common cardinal veins turn into after birth?
Anterior left and right cardinal veins connect and become the **left brachiocephalic vein** ## Footnote **Right anterior cardinal and common cardinal become the SVC**
39
40
What do cardiac neural crest cells form?
Bulbus cordis Truncus arteriosus
41
What problems are associated with tetralogy of fallot?
**Pulmonary stenosis** **VSD** **Overriding aorta** **Right Ventricular hypertophy** (large aorta, small pulmonary trunk)
42
43
Patent ductus arteriosus
No closure of the ligamentum arteriosum Abnormal connection b/w aorta and pulmonary artery
44
45
What initiates specification of the gut tube formation?
**RA gradient** that causes TFs to be expressed in diff regions SOX2 - esophagus PDX1 - duodenum & pancreas CDXC - small intestine CDXA - large intestine **SHH** initiates endoderm & mesenchyme/splanchnic mesoderm interaction
46
Where do post-ganglionics follow in hindgut innervation?
Arteries in addition to IMA
47
Esophageal replacement options
**Colon interposition** **Gastric tube esophagoplasty** **Gastric transposition**
48
Describe how the esophagus and stomach develop, what do they begin as?
Straight tubes suspended by dorsal and ventral mesentery **Dorsal grows rapidly (towards left) with a simultaneous 90 degree rotation** Left side of stomach = anterior Right side = posterior Left vagus = anterior vagal trunk Right vagus = posterior vagal trunk
49
Hypertrophic pyloric stenosis
Food never enters duodenum ## Footnote **Projectile vomiting/no bile**
50
Duodenal atresia
Occluded lumen (2-3 part) **Double bubble sign = Gas distended stomach, no gas in proximal duodenum** Duodenal atresia, duodenal duplication cysts
51
Extrahepatic biliary atresia; symptoms, treatment
Incomplete canalization of the bile duct Jaundice, Dark urine, pale stool surgical correction or transplant
52
What are the signals involved in pancreatic development?
**PDX1 - pancreas & duodenum** **PAX4 - insulin, somatostatin, pancreatic polypeptide** **PAX6 - glucagon** 3rd month = islets of langerhan 5th month = insulin
53
54
Annular pancreas
Ventral and dorsal pancreatic buds form a ring around the duodenum ## Footnote **Duodenal obstruction**
55
Accessory ectopic pancreatic tissue
Most common in stomach or ileum (Meckle's diverticulum) Found in the distal esophagus thru the primary intestinal loop
56
Describe the rotation and fixation of the midgut
Rapid growth about 6 weeks Normal physiologic herniation Gut loops into umbilical cord and **rotates 90 degrees counterclockwise around the SMA** 10th week - **returns to abdominal cavity and rotates an additional 180 degrees (270)**
57
Malrotation of the midgut What is it, symptoms Volvulus
Partial rotation; **abnormally positioned viscera** Increased risk of entrapment of portions of the intestine Usually present **within first week as duodenal obstruction with _bilious vomiting_** **Recurrent abdominal pain, intestinal obstruction, malabsorption/diarrhea** **Volvulus = abnormal twisting of intestine causing obstruction** Bilious Emesis
58
Omphalocele
**Herniation** **of abdominal contents thru enlarged umbilical ring** **Midgut loop fails to return to abdominal cavity** **Normal if temporary** **Covered by a membranous sac**
59
Gastroschisis
**Failure of anterior abdominal wall musculature to close during folding** **_Guts NOT surrounded by membrane_**
60
Meckel's diverticulum
Remnant of vitelline duct Asymptomatic Gastric or pancreatic tissue Ileal diverticulum Fecal discharge through umbilicus
61
Hirschsprung's Disease; HD
**Congenital aganglionic megacolon** Failure of migration of neural crest cells **Functional intestinal obstruction, no parasympathetic innervation (colon cannot relax or do peristalsis)** Vagal neural crest cells invade anterior foregult and migrate to foregut, midgut, hindgut = enteric system Surgical treatment

KCUMB Anatomy II (5 decks)

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