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CVR > First Breath > Flashcards

First Breath Flashcards

1
Q

Stages of lung development

A

Embryonic
Pseudoglandular
Cannalicular
Alveolar

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2
Q

Time period of lung development: embryonic

A

0-5 weeks

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3
Q

Time period of lung development: pseudoglandular

A

5-17 weeks

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4
Q

Time period of lung development: cannalicular

A

16-25 weeks

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5
Q

Time period of lung development: alveolar

A

25 weeks - term

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6
Q

Embryonic lung development

A

Foregut derivative - anterior outpouching
An oesophageal appendix

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7
Q

Lung buds

A

By the 5th week the lung buds enlarge to form right and left main bronchi

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8
Q

Pseudoglandular lung development

A

Exocrine gland only
Major structural units formed
Angiogenesis
Mucous Glands
Cartilage
Smooth Muscle
Cilia
Lung fluid

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9
Q

Cannalicular lung development

A

Distal Architecture
Vascularisation; i.e. formation of capillary bed
Respiratory bronchioles
Alveolar ducts
Terminal sacs

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10
Q

Alveolar lung development

A

Alveolar sacs
Type 1 and Type 2 cells
Alveoli simple with thick interstitium

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11
Q

Birth to 3-5 years lung development

A

Thinning of alveolar membrane and interstitium
↑ complexity of alveoli

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12
Q

5-17 weeks; what happens

A

Major airways defined
Nests of angiogenesis
Smaller airways down to respiratory bronchioles

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13
Q

16-25 weeks; what happens

A

Terminal bronchioles
Capillary beds
Alveolar ducts

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14
Q

25-40 weeks; what happens

A

Alveolar budding, thinning and complexification

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15
Q

What can go wrong during lung development: embryonic

A

Laryngeal, tracheal and oesophageal atresia, tracheal and bronchial stenosis, pulmonary agenesis

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16
Q

What can go wrong during lung development: Pseudoglandular

A

Bronchopulmonary sequestration, cystic adenomatoid malformations, alveolar-capillary dysplasia,

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17
Q

What can go wrong during lung development: alveolar

A

Acinar dysplasia, alveolar capillary dysplasia, pulmonary hypoplasia, respiratory disease of the newborn

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18
Q

Vasoconstrictor of systemic vessels

A

Oxygen

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19
Q

Vasodilators of systemic vessels

A

Hypoxia
Acidosis
CO2

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20
Q

Systemic vessels purpose

A

Deliver oxygen to hypoxic tissues

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21
Q

Vasodilator of pulmonary vessels

A

Oxygen

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22
Q

Vasoconstrictor of pulmonary vessels

A

Hypoxia
Acidosis
CO2

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23
Q

Fetal circulation

A

PaO2= 3.2KPa
Shunting of blood from right to left
High pulmonary vascular resistance (hypoxia)
Tissue resistance (fluid filled)
Low systemic resistance (placenta)

24
Q

Fetal airways

A

Distended with fluid
Fluid aids in lung development
Actively secreted by lungs

25
Q

Ductus arteriosus

A

Pulmonary trunk linked to the distal arch of the aorta by the ductus arteriosus, permitting blood to bypass pulmonary circulation
Muscular wall contracts to closed after birth

26
Q

What is closure of ductus arteriosus mediated by

A

Bradykinin

27
Q

Ductus venosus

A

Oxygenated blood entering the fetus also needs to bypass the primitive liver- achieved by passage through the ductus venosus

28
Q

What percentage of blood does the ductus venosus shunt from umbilical cord directly to inferior vena cava

A

30%

29
Q

Foramen ovale

A

Passage between 2 atria - responsible for bypassing the majority of the circulation

30
Q

Pathway of oxygenated blood from maternal supply

A

Umbilical vein —> bypasses primitive liver (ductus venosus) —> enters inferior vena cava —> right atrium —> (via Foramen ovale) left atrium —> left ventricle —> aorta

If blood enters pulmonary trunk, ductus arteriosus shunts blood to aorta

31
Q

Immediately after birth: ductus arteriosus

A

Constricts, allowing all blood leaving the right ventricle to travel to the lungs via the pulmonary arteries
Becomes Ligamentum arteriosum

32
Q

Immediately after birth: Foramen ovale

A

Closes, leaving a small depression called the fossa ovalis
This isolates deoxygenated and oxygenated blood within the heart

33
Q

Immediately after birth: ductus venosus

A

Degenerates and becomes the Ligamentum venosum

34
Q

First birth

A

Fluid squeezed out of lungs by birth process
Adrenaline stress leads to increased surfactant release.
Gas inhaled
Oxygen vasodilates pulmonary arteries
Pulmonary vascular resistance falls
Right atrial pressure falls, closing foramen ovale

Umbilical arteries constrict

Ductus arteriosus constricts

35
Q

What leads to increased surfactant release at birth

A

Adrenaline stress

36
Q

Surfactant - first breath

A

Surface active phospholipid and surfactant proteins A, B, C, D
Produced by Type II pneumocytes from 34 weeks gestation
Dramatic increase in 2 weeks prior to birth

37
Q

Laplace’s law

A

Pulmonary pressure needed to prevent collapse =
(2 x surface tension) / radius

If smaller radius- thicker layer of surfactant required

38
Q

What produces surfactant

A

Type II pneumocytes

39
Q

Function of surfactant

A

Virtual abolition of surface tension- prevents alveolar collapse and maintains FRC
Allows homogeneous aeration
Allows maintenance of functional residual capacity
Oxygenises bacteria—> phagocytosis

40
Q

Surfactant deficiency

A

Prematurity
+ Asphyxia
+ Cold
+ Stress
+ Twins

Respiratory Distress Syndrome
Loss of lung volume
Non-compliant lungs
Uneven aeration

41
Q

Surfactant increased by

A

Distension of alveoli
Steroids
Adrenaline

42
Q

Pulmonary interstitial emphysema (PIE)

A

Lung cysts
Ruptured alveoli

43
Q

Management of pulmonary interstitial emphysema

A

Warmth
Surfactant replacement (if intubated)
Oxygen and fluids
Continuous Positive Airway Pressure (maintain lung volumes, reduce work of breathing)
Positive pressure ventilation if needed

44
Q

Adaptive changes at birth

A

Drops R sided pressure and moves to 4 chamber system

45
Q

First breath initiates adaptation

A

Oxygen causes pulmonary vasodilation
Tissue resistance reduces
Vasoconstriction of ductus arteriosus and umbilical arteries

46
Q

Respiratory diverticulum

A

Outbranch of the foregut
Forms the trachea and lung buds in week 4

47
Q

Atresia

A

Failure of trachea and oesophagus to separate

48
Q

At what age do alveoli stop developing

A

5

49
Q

Why are developing lungs full of fluid

A

Type 2 pneumocytes contain NKCC2:
Cl- active transport to fill developing lungs with fluid

50
Q

Persistent hypoxia

A

Ductus arteriosus remains open

51
Q

How is amniotic fluid removed from lungs when born

A

Expelled (cough) or absorbed into circulation

52
Q

Why does Foramen ovale close

A

LA pressure > RA pressure

53
Q

Why does ductus arteriosus close

A

Systemic BP (aorta) > pulmonary BP (pulmonary artery)

54
Q

Eisenmenger’s syndrome

A

Ventricular septum defect forms shunt between left and right ventricle
Hypoxaemia as pulmonary circulation bypassed
Leads to cyanosis, clubbing and polycythaemia

55
Q

Which week of gestation is type 2 pneumocytes produced

A

34

56
Q

Prior to birth the lungs contain no air; at birth air is drawn into the lungs. Which statement regarding pulmonary physiology after birth is correct?

A

Persistent hypoxia will cause the ductus arteriosus to remain open

CVR (22 decks)

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