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BLOCK 2 - Embryology (Grace) > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

The upper respiratory system consists of the…?

A

nose

nasopharynx

oropharynx

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2
Q

The lower respiratory consists of…?

It begin to form during which week of development?

A
  • larynx
  • trachea
  • bronchi
  • lungs

week 4

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3
Q

What is the first sign of development in the lower respiratory tract?

When and where does this form?

A

formation of the respiratory diverticulum

- ventral wall of the primitive foregut during week 4

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4
Q

The distal end of the respiratory diverticulum enlarges to form what primordial structure?

A

the lung bud

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5
Q

Initially the respiratory diverticulum is in open communication with the foregut.

What eventually separates these structures?

A

tracheoesophageal folds = indentations of mesoderm

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6
Q

When the tracheoesophageal folds fuse in the midline to form what structure?

A

the tracheoesophageal septum

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7
Q

The tracheoesophageal septum divides the foregut into what dorsal and ventral structures?

A

ventral = trachea

dorsal = esophagus

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8
Q

The opening of the respiratory diverticulum into the foregut becomes what inlet?

A

the laryngeal inlet (or orifice)

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9
Q

The laryngeal epithelium and glands derive from what type of tissue?

A

endoderm

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10
Q

The laryngeal muscles derive from what type of tissue & from what pharyngeal arches?

What nerve innervates them?

A

somitomeric mesoderm

  • pharyngeal arches 4 + 6
  • innervated by branches of the vagus nerve (CN X)
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11
Q

What are the 5 laryngeal cartilages?

What typ of tissue are they derived from?

What pharyngeal arches did they originate from?

A
  • thyroid
  • cricoid
  • arytenoid
  • corniculate
  • cuneiform

somitomeric mesoderm

  • pharyngeal arches 4 + 6
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12
Q

Laryngeal Atresia

A
  • failure of recanalization (removal of cells) of the larynx (apoptosis)
  • causing obstruction of the upper fetal airway

= CHAOS*

- distal to atresia or stenosis (narrowing) the airway dilates, the lungs enlarge and fill with fluid, the diaphragm flattenes or inverts, and there is fetal ascites and/or hydrops fetalis

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13
Q

fetal ascites

A

accumulation of fluid in the peritoneal cavity

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14
Q

hydrops fetalis

A

accumulation of serous fluid in the intracellular spaces

= severe edema

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15
Q

CHAOS

A

congenital high airway obstruction syndrome

  • obstruction of the upper fetal airway
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16
Q

The endodermal lining of the laryngotracheal tube differentiates into epithelium of what 2 areas?

A

epithelium + glands of the trachea

pulmonary epithelium

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17
Q

The splanchnic mesenchyme around the laryngotracheal tube give rise to what 3 types of tissue?

A
  • cartilage
  • connective tissue
  • muscles of the trachea
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18
Q

Tracheoesophageal Fistula (TEF)

A
  • abnormal communication between the trachea and esophagus
  • improper division of foregut by the tracheoesophageal septum
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19
Q

What is the most common anomaly of the lower respiratory tract?

What other anomalies are usually associated with this abnormality?

A

- Tracheoesophageal Fistula

  • associated with esophageal atresia + polyhydramnios
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20
Q

What are the clinical features of a Tracheoesophageal Fistula?

A
  • excessive accumulation of saliva or mucus in nose + mouth
  • episodes of gagging + cyanosis after swallowing milk
  • abdominal distention after crying (air in stomach)
  • reflux of gastric contents into lungs = pneumonitis
  • *cyanosis = a bluish discoloration of skin from poor circulation or inadequate oxygenation of the blood**
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21
Q

pneumonitis

A

inflammation of the walls of the alveoli in the lungs

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22
Q

What are some diagnostic features of a tracheoesophageal fistula?

A
  • inability to pass a catheter into the infant’s stomach
  • radiographs demonstrating air in the stomach
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23
Q

The lung bud divides into two ___________.

In week 5 of development, these enlarge to form ______________?

A

- bronchial buds

- main (primary) bronchi

24
Q

The main bronchi subdivide into what?

How many are on the right side, and how many are on the left side?

A

lobar (secondary) bronchi

right = 3; left = 2

(corresponds w. lobes of adult lungs)

25
Q

Which main bronchus is larger and more vertically oriented than the other?

What misadventures does this lead to?

A

Right main bronchus = larger, more vertical

  • foreign bodies enter more frequently
26
Q

As the bronchi develop, they expand in which directions?

A

laterally and caudally

27
Q

Visceral mesoderm covering the bronchi develops into ____________? Somatic mesoderm covering the inside of the body wall develops into___________?

The space between these 2 layers is called ____________?

A
  • visceral pleura
  • parietal pleura
  • pleural cavity
28
Q

The lobar bronchi subdivide into _________________, which also subdivide into______________?

A
  • segmental (tertiary) bronchi
  • subsegmental bronchi
29
Q

The segmental bronchi are primordia of what structures?

A

the bronchopulmonary segments

(morphologically + functionally separate respiratory units of the lung)

30
Q

Congenital Lobar Emphysema (CLE)

A

progressive overdistention of the pulmonary lobes with air

*“emphysema” is a misnomer because there is no destruction of the alveolar walls*

- etiology is unknown

(possible failure of bronchial cartilage formation = air inspired but not expired)

31
Q

Congenital Lobar Emphysema (CLE):

During the first few days of life, what is trapped in the lobe?

This produces what?

A
  • fluid is trapped
  • produces opaque, enlarged hemithorax
32
Q

Congenital Lobar Emphysema (CLE):

Later, the fluid in the lobe is resorbed. What appearance will be shown in the radiograph?

A

an emphysematous lobe with generalized radiolucency (hyperlucent)

*emphysematous lobe = as seen in emphysema*

33
Q

What are the four stages of maturation in the lungs?

A

Pseudoglandular stage

Canalicular stage

Terminal sac stage

Alveolar stage

34
Q

Pseudoglandular Stage

(6 to 16 weeks)

A
  • histologically, lungs resemble exocrine glands
  • by 16 weeks all major elements of the lungs have formed except those involved with gas exchange

fetus born during this time are unable to survive**

35
Q

Canalicular Stage

(16 to 26 weeks)

A
  • lung tissue becomes highly vascular
  • by 24 weeks, each terminal bronchiole gives rise to two or more respiratory bronchioles (each divides giving rise to the primordial alveolar ducts)
  • terminal bronchioles, respiratory bronchioles, + alveolar ducts are lined by simple cuboidal epithelium

* Fetuses born at the end of this stage may survive with appropriate care*

36
Q

Terminal Sac Stage

(26 Weeks to Birth)

A
  • more terminal sacs develop + their epithelium becomes very thin
  • capillaries bulge into the developing alveoli
  • contact between epithelial + endothelial cells establishes blood-air barrier = adequate gas exchange
  • terminal sacs lined by squamous epithelial cells of endodermal origin differentiate into type I and II pneumocytes
37
Q

Pneumocytes type I cells

A

= gas exchange

38
Q

Pneumocyte type II cells

A

= secrete pulmonary surfactant

39
Q

What type of network** **proliferates fast in the mesenchyme around the alveoli?

There is active development of __________ capillaries?

A

capillary network

lymphatic capillaries

40
Q

Surfactant production begins at what week?

It reaches adequate levels by what week?

A
  • begins by 20 weeks
  • adequate levels by 26 to 28 weeks
41
Q

The development of an adequate vasculature and sufficient surfactant is critical to what?

A

survival + neurodevelopment of premature infants

42
Q

Survival of infants born at 24 to 26 weeks has improved with the use of what treatments?

A
  • antenatal corticosteroids (induces surfactant production)
  • surfactant replacement therapy
43
Q

Alveolar stage

(32 weeks to 8 years)

A
  • terminal sacs are partitioned by secondary septa to form adult alveoli
  • mechanism for the increase in number of alveoli is formation of secondary septa that partition existing alveoli
44
Q

After birth, what is the increase in the size of the lung is due to?

A

increase in the number of respiratory bronchioles

45
Q

Aeration at birth

A

replacement of lung liquid with air in the newborn’s lungs

  • At birth, lung liquid is eliminated by a reduction in lung liquid secretion and resorption into pulmonary capillaries and lymphatics
46
Q

In the fetal state, the functional residual capacity (FRC) of the lung…

A

…is filled with liquid secreted by lung epithelium

47
Q

How can the lungs be use to determin if a baby was stillborn?

A

when placed in water the lungs will sink because they contain fluid rather than air

(if the baby has never breathes, lung liquid has never been exchanged for air)

48
Q

Respiratory Distress Syndrome (RDS) ia also know as…

A

… “hyaline membrane disease (HMD)”

49
Q

Respiratory Distress Syndrome (RDS)

A

caused by absence deficiency of surfactant

(coats the inside of alveoli to maintain alveolar patency)

  • lungs are underinflated; alveoli contain a fluid with a high protein content
  • prevalent in premature infants (50%-70% of deaths), infants of diabetic mothers, hypoxic fetuses and multiple birth infants
50
Q

What other condition is related to RDS?

A

** germinal matrix hemorrhage (GMH)**

51
Q

** germinal matrix hemorrhage (GMH) **

A
  • germinal matrix is the site of proliferation of neuronal and glial precursors in the brain
  • premature infants have increased arterial blood pressure, leading to rupture and hemorrhage into the germinal matrix
  • child might present neurologic sequelae, including cerebral palsy, mental retardation, and seizures.
52
Q

Clinical signs of RDS (Respiratory Distress Syndrome):

A
  • dyspnea (difficulty breathing)
  • tachypnea (increased respiratory rate)
  • inspiratory retractions of chest wall
  • expiratory grunting
  • cyanosis
  • nasal flaring
53
Q

Treatment of RDS (Respiratory Distress Syndrome):

A
  • administration of betamethasone (corticosteroid) to the mother for several days before delivery (increases surfactant production)
  • postnatal administration of artificial surfactant solution, and high-frequency ventilation
54
Q

Pulmonary Agenesis

A

Absence of the lungs due to failure of the respiratory bud to develop

  • agenesis of one lung = more common than bilateral agenesis
  • both conditions are rare
  • Unilateral pulmonary agenesis = compatible with life
  • heart + other mediastinal structures shifted to affected side

- Bilateral pulmonary ageneis = not compatable with life

55
Q

Pulmonary Hypoplasia (PH)

A

lung is unable to develop normally because it’s compressed by the abnormally positioned abdominal viscera

- associated w. congenital diaphragmatic hernia

  • hypertrophy of the smooth muscle in pulmonary arteries = pulmonary hypertension
56
Q

Bilateral renal agenesis can also cause what pathology?

A

PH - pulmonary hypoplasia

(insufficient amount of amniotic fluid - *oligohydramnios = *increases pressure on the fetal thorax)

BLOCK 2 - Embryology (Grace) (5 decks)

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