16 Lung Development Flashcards

1
Q

Q: What is the function of the lung? what else is needed? What can a better understanding in lung development lead to?

A

A: Function of lung is to produce a large gas exchange area [100m2] in a relatively small volume
-good pulmonary vasculature

may help treat and repair damaged lungs in later life (and diagnostics)

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2
Q

Q: What can affect lung growth? (3) What effect can abnormalities have?

What determines normal lung development?

A

A: Conditions of conception, in utero and in infancy affect lung growth and abnormalities may have life long impact

Crucial interaction between the airways and pulmonary vessels throughout development (send chemical messengers to and from structures)

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3
Q

Q: Timeline for lung development. Explain 5 stages- time and what grows.

What’s happening along side this growth?

A

A: 4 stages in utero

Embryonic phase – 0-7 weeks
lung buds (pushing out into mesenchymal tissue)
main bronchi (trachea branching into them)
Pseudoglandular – 5-17 weeks
conducting airways
bronchi & bronchioli (ongoing branching/ bifurcations)
Canalicular – 16-27 weeks
respiratory airways (laying down of)
blood gas barrier (basic components start developing)
Saccular/Alveolar -28-40 weeks
Alveoli appear
stage where infants become viable

Postnatal – adolescence
Alveoli multiply and enlarge in size with chest cavity (Alveoli appear before birth and continue to grow in early childhood)

blood vessel development

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4
Q

Q: 3 stages of blood vessel development (of lungs). Include what stage of lung development they coincide with.

A

A: Vasculogenesis // Branching morphogenesis

  • occur along the skeleton that airway creates
  • during embryonic and pseudoglandular phase (1 and 2)

Blood gas barrier
- during canalicular phase (phase 3)

Alveologenesis (formation of new alveoli) and angiogenesis (new blood vessels form from old ones)
- during saccular/adolescence phase (phase 4)

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5
Q

Q: Branching during embryogenesis. (3)

A

A: determines lobes-> can see branching buds growing into mesenchymal tissue

begins as asymmetric

can see by 56 days 3 lobes of right and 2 of left

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6
Q

Q: When does the pseudoglandular phase occur? Main process occurring? What is present by the end of it? What continues to develop? (3) in what phase?

A

A: 2nd phase, 5-17 weeks

Branching morphogenesis of airways into mesenchyme

Pre-acinar airways (conducting airways, not part of gas exchange) all present by 17 weeks

Development of cartilage, gland and smooth muscle tissue – continues into canalicular phase

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7
Q

Q: What determines branching morphogenesis? 3 examples. Describe the involvement of 2 cells.

What pattern does branching occur in humans?

A

A: Communication between epithelial cells in distal branching lung buds and surrounding mesenchyme (Epithelial-mesenchymal interaction) eg growth factors, cytokines and receptors

  • Epithelial cells at tips of buds are highly proliferative multipotent progenitor cells
  • Cells behind the tip divide and differentiate into the various cell types

bifurcation pattern

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8
Q

Q: What factors are involved in early lung bud formation? (2) Later?

A

A: Genetic and Transcription factors [TTF-1]

Later a variety of growth factors are important

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9
Q

Q: Name 4 growth factors in lung development. Include role. Balance?

A

A: Inductive/stimulating
FGF- branching morphogenesis, subtypes found in epithelium and mesenchyme
EGF - epithelial proliferation and differentiation

Inhibitory
TGFb - matrix synthesis, surfactant production, inhibits proliferation of epithelium and blood vessels
Retinoic acid - inhibits branching

without inhib you get overgrowth/malignancies

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10
Q

Q: Describe the process of endothelial differentiation. Where? (2) what makes them visible? What can happen to some? process? What stimulates endothelial differentiation?

End result?

A

A: (blood vessels)

CD31 (brown) demonstrates endothelial cells -> see them growing around lung bud-> along skeleton created by branching airways (act as structural template)

These differentiate in the mesenchyme around the lung bud

They coalesce to form capillaries – a process known as vasculogenesis

VEGF produced by epithelial cells (at tip of lung bud)

get pulmonary vasculature-> where blood vessels grow around alveoli = capillary beds -> where most gas exchange occurs

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11
Q

Q: When does the canalicular phase occur? What occurs? (4)

A

A: 16-27 weeks

  • The airspaces at the periphery enlarge
  • Thinning of epithelium by underlying capillaries allows gas exchange (Blood gas barrier)
  • Epithelial differentiation into Type I and II cells (I produces surfactant)
  • Surfactant first detectable at 24-25 wks (TGFb)
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12
Q

Q: Role of surfactant?

A

A: prevent airways sticking together with you breathe out

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13
Q

Q: Describe the 3 stage formation of the alveolar walls. Draw associated image. When does this occur? How does the interstitium change?

A

A: 1. Saccule wall, epithelium on both sides with double capillary network. Myofibroblast (produces elastin) and elastin fibres at intervals along wall (interstitium quite thick)

  1. Secondary septa develop from wall led by elastin produced by myofibroblast. Capillary lines both sides with matrix between
  2. Capillaries have coalesced to form one sheet alveolar wall, thinner and longer with less matrix. Muscle and elastin still at tip (thinned interstitium)

last 10 weeks (saccular/alveolar phase)

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14
Q

Q: How does the number of alveoli change as we grow? Diagram.

A

A: REFER

at 40 weeks when we’re born= 150 million -> 1/3 of the amount we are to have in adulthood

continues until late adolescence or early adulthood

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15
Q

Q: Infants born at term. Describe the lungs. What is present? (4)

A

A: small lung volume and related to body weight

  • All airways present and differentiated (cartilage, glands, muscle, nerves)
  • 33-50% alveoli allow normal gas exchange
  • Blood gas barrier as in adult
  • Most arteries and veins (pulmonary vascular system) present
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16
Q

Q: Changes at birth in blood vessels. Pulmonary vascular resistance? Pulmonary blood flow? Arterial lumen and wall?

What happens after arterial wall changes? Result? (2)

A

A: Decrease in pulmonary vascular resistance (at point of delivery)

10 fold rise in pulmonary blood flow

Arterial lumen increases and wall thins rapidly via change in cell shape and cytoskeletal organisation not loss of cells

Once thinning has occurred, arteries grow and maintain a relatively thin wall

Low pressure, low resistance pulmonary vascular system (very different to systemic)

17
Q

Q: 4 possible mechanisms to increase flow after birth? What is the increase?

A

A: 10 fold rise in pulmonary blood flow

Expansion of alveoli dilates arteries - direct physical effect

Expansion stimulates release of vasodilator agents (NO, PGI2)

Inhibition of vasoconstrictors present during fetal life (ET)

Direct effect of oxygen on smooth muscle cells (causing relaxation and vasodilation that’s needed)

18
Q

Q: Child and adolescence airway growth. How does lung volume change? Max? Growth type? (2) What else increases?

A

A: Lung volume increases x30,

Maximum lung volume at 22years in males

Airways increase in length and width x 2-3 by symmetrical growth

Dysanaptic growth during the early period - alveoli growing more than airways (airways relatively large in infants)

Structural elements of the wall increase

19
Q

Q: Child and adolescence growth of alveoli. How does alveoli number change? Adult? Changes until? What else changes along side?

A

A: Alveoli increase in number up to 2-3 years**

Adult alveolar number (300-600 million)

Alveoli increase in size and complexity to increase surface area until body growth complete after adolescence(x20)

Arteries, veins and capillaries increase alongside the alveoli (cap volume x35)

20
Q

Q: Summarise the landmarks in lung development. (5)

A

A: 6 weeks- lobar airways

16 weeks- pre acinar airway complete

30 weeks-respiratory airways present and alveoli first appear

newborn- 1/3-1/2 adult alveoli number present

3 years old- most alveoli present

21
Q

Q: Not everyone has normal ciliary beat function. Condition? Impact?

A

A: Primary Ciliary Dyskinesia = genetic mutation

big impact on mucous clearance from lungs

normal arrangement= 9+2 -> with dynein arms = in this condition both inner and outer are gone -> cilia are static

22
Q

Q: Describe bronchial cartilage. What can happen to them? (4)

A

A: Incomplete rings posteriorly / Irregular plates

complete rings are bad-> can cause extreme resp distress -> needs reconstruction
Calcify with age
Can be malacic= abnormal softening of a tissue:
Generalised – laryngotracheomalacia
Localised – malacic segment

23
Q

Q: What is Laryngomalacia?

A

A: softening of larynx to give omega shaped epiglottis and aryepiglottic folds that can fold into airway = block

24
Q

Q: 3 lung growth abnormalities.

A

A: Agenesis – complete absence of lung and vessel (rare-> all body content shifts-> could be caused by lack of blood flow during development)

Aplasia – blind ending bronchus, no lung or vessel

Hypolasia – bronchus and rudimentary lung are present, all elements are reduced in size and number (relatively common -> secondary to lack of space)

25
Q

Q: What can cause hypoplasia of lung? (5)

A

A: 1. Lack of space

Intrathoracic or extrathoracic

Hernia (L = 75 – 90%)
Chest wall pathology
Oligohydramnios (less amniotic fluid)
Lymphatic or cardiac mass

  1. lack of growth

Congenital Thoracic malformation (lots of conditions- CPAM, CPAM II, CLHL, Intralobar Sequestration)

26
Q

Q: What is CPAM? Diagnosis? Pathogenesis? (2)

A

A: Congenital Thoracic malformation

Cystic Pulmonary Airway Malformation

Mostly diagnosed on antenatal US

Pathogenesis:

  • Defect in pulmonary mesenchyma, abnormal differentiation 5-7th week
  • Normal blood supply
27
Q

Q: Type II CPAM. Describe. Associated with? Histology shows?

A

A: Congenital Thoracic malformation

Multiple small cysts

May be associated with other congenital defects- renal agenesis, cardiovascular defects, diaphragmatic hernia and syryngomyelia

Histologically bronchiolar epithelium with overgrowth, separated by alveolar tissue which was underdeveloped

28
Q

Q: What is CLHL? Describe. Underlying cause? (4) Common in? (2) Association with?

A

A: Congenital Thoracic malformation

(Congenital Lobar Emphysema) Congenital Large Hyperlucent Lobe (CLHL)

Progressive lobar overexpansion

  • Weak cartilage
  • Extrinsic compression
  • One way valve effect
  • Alveoli expand (not disrupted)

Left Upper Lobe > RML >RUL
Males > females

CHD association

29
Q

Q: Intralobar Sequestration. What is it? (2) Predominance? Cause? (2) Treatment?

A

A: Congenital Thoracic malformation

  • Abnormal segment share visceral pleural covering of normal lung
  • No communication to tracheobronchial tree but abnormal blood supply

Lower lobe predominance, L > R

Due to chronic bronchial obstruction and chronic post-obstructive pneumonia

treat by occluding abnormal blood vessel

30
Q

Q: Scimitar syndrome. Classic SS includes? (4)

A

A: - Anomalous pulmonary venous drainage of the right lung to the IVC , usually close to the junction of the right atrium

  • Associated right lung and right pulmonary artery hypoplasia
  • Dextrocardia where heart points to right side of heart instead
  • Anomalous systemic arterial supply.