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R9 > Chapter 2 - Embryology > Flashcards

Chapter 2 - Embryology Flashcards

1
Q

Anomalies of SVC (2 types)

A

Double SVC

Left sided SVC

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2
Q

What does the embryonic endoderm secrete to induce vessel formation of the splanchnic mesoderm

A

Bone morphogenic protein TGF-beta This happens by day 18

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3
Q

What are the stimulating factors to trigger vasculogenesis

A

Indian hedgehog Bone morphogenic protein TGF-beta They induce the yolk sac’s mesoderm to form hemangioblastic aggregates

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4
Q

Embryologic venous development: umbilical veins

A

R umbilical vein regress

L umbilical vein form anastomosis with ductus venosus

After birth L umbilical vein becomes ligamentum teres (hepatis) inside falciform ligament

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5
Q

Figure: Proangiogenic and antiangiogenic factors

A
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6
Q

Renal vein anomalies in embryology

A

Retro-aortic L renal vein (if anterior component regresses)

L circum-aortic renal vein (if both anterior and posterior renal vein persist)

Both due to persistent posterior renal vein

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7
Q

Define: Dysphagia luroria

A

Difficulty swallowing due to compression from retroesophageal right subclavian artery

only occurs in 5% with this anomaly

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8
Q

At day 60, what organs take over as the source of blood

A

Liver, spleen, thymus, bone marrow

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9
Q

Which angiogenic factors lead to endothelial specificity

A

VEGF: fenestrated endothelium in endocrine glands and kidneys Angiopoietin-1: tight junctions at blood-brain barrier

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10
Q

At which day does hemangioblastic aggregates form in the connecting stalk and chorion

A

Day 17 These form the extraembryonic umbilical vessels

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11
Q

Double aortic arch: etiology, symptoms

A

Failure of the R dorsal aorta distal to R 7th intersegmental artery to involute

Passes posterior to esophagus and joins L aortic arch that passes anterior to trachea

Symptoms of esophageal and tracheal compression

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12
Q

Coarctation of the aorta: common location, etiology, findings

A

Location: distal to ligamentum arteriosum
preductal type immediate proximal to ligamentum

Etiology: hypothesis is similar to obliteration of ductus arteriosus with oxygen sensitive smooth muscle contraction leading to eventual fibrosis

Findings: collateral vessels, notching of ribs 3-8 because of increased intercostal arteries size
Figure 3 sign: prestenotic dilatation of aortic arch and L subclavian; poststenotic dilataion of descending

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13
Q

Embryological venous development: cardinal veins

A

Anterior cardinal veins join posterior cardinal veins = short common cardinal veins

Anterior cardinal veins = SVC (junction of L and R brachiocephalic veins)
Cranial portion becomes IJ; parts join with venous plexuses of face to form EJ
Subclavian veins (venous plexuses of limb bud) empty into ACV
Anastomosis of L and R ACV become L brachiocephalic vein
R atrium = enlargement of R ACV and R CCV
Coronary sinus = L CCV

Posterior cardinal veins, subcardinal veins, supracardinal veins = IVC, tributaries, azygos system

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14
Q

Right aortic arch: two types

etiology and symptoms

A

Involution of the L dorsal aorta and persistence of the R dorsal aorta

Ligamentum arteriosum from distal R 6th arch

Right aortic arch with aberrant L subclavian (or retroesophageal component): Arch passes to L side posterior to esophagus
Vascular ring formed because of ligamentum arteriosum

Right aortic arch with mirror image branching: arch passes anterior to esophagus and trachea
- higher incidence of malformations, infants almost all cyanotic (inc. ToF)

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15
Q

Figure: arterial and venous fated angioblast pathways

A
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16
Q

Fate of segmental arteries from segments/somites

Cervical, thoracic, lumbar

Ventral and dorsal for each

A

Cervical: dorsal = vertebral artery, deep cervical, ascending cervical

Thoracic: dorsal = intercostal
ventral = superior thoracic artery, internal thoracic, superior epigastric

Lumbar: dorsal = lumbar arteries; 5th lumbar pair = common iliac
ventral = allantoic (umbilical, internal iliac) and vitelline (celiac, SMA, IMA for foregut, midgut, hindgut)

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17
Q

Normal vascular development of the lower extremity

A

Ventral branch of 5th lumbar intersegmental artery becomes internal iliac artery gives rise to axial artery

Second branch of the 5th lumbar intersegmental artery becomes the EIA and develops into iliofemoral artery

Axial artery regress (8th week) but parts persist as sciatic (ischiadic) artery, popliteal artery and peroneal artery

Rest develop as sprouts of EIA

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18
Q

Angiogenic sprouting from existing vessels is facilitated by this factor

A

Hypoxia this in term upregulates the following: VEGF, angiopoietin-1 and 2, nitric oxide synthase

19
Q

Embryologic venous development: vitelline veins

A

Vitelline veins form venous plexus (liver hepatic sinusoids) before entering sinus venosus

L vitelline vein regress forcing blood to go through liver
R vitelline vein = ductus venosus

Cranial portion of R vitelline = IVC
Caudal potion of R vitelline = portal and SMV
L to R vitelline anastomoses = splenic, IMV

After birth ductus venosus becomes ligamentum venosum

20
Q

Popliteal entrapment syndrome: embryological cause

A

Attachment of the medial head of the gastrocnemius before maturation of the popliteal artery

Compression of the popliteal artery against the medial condyl of femur

21
Q

Gene responsible for correct patterning and integrity of lymphatic vessels

A

Angiopoietin-2

lacking this gene results in misshapen, leaky and lack typical association of smooth muscle cells

22
Q

Cause and problems of patent ductus arteriosus

A

Most common vascular anomaly

Constricts due to response of oxygen-sensitive smooth muscle cells in its walls to exposure of high O2

Obliterates by 1 month to become ligamentum arteriosum

If patent = pulmonary hypertension

23
Q

Define: Kommerell diverticulum

A

Aneurysm formation from a retroesophageal right subclavian artery

Unclear rate of occurance

24
Q

Normal connection between lymphatic and venous system in adults (2)

A

Thoracic duct to L subclavian vein

R lymphatic duct to R subclavian vein

25
Q

Popliteal artery development

A

Sciatic artery gives deep popliteal artery (anterior to popliteus muscle)

Iliofemoral artery gives superficial popliteal artery (posterior to popliteus mucle)

Distal section of deep popliteal regress
Proximal section of deep popliteal join with superficial popliteal artery

26
Q

Two variations of upper limb vascular anomalies

A

High origin of radial artery proximal to level of elbow at cubital fossa = 14.2%

Persistence of the median artery to palm = 12%

27
Q

Embryologic development of the venous system

A

Higher variations

4 weeks: 3 paired venous system
Vitelline vein drain yolk sac and GI tract
umbilical vein bring blood from placenta
cardinal vein drains embryo

28
Q

What is the first step in the development of the vascular system

A

Modification of splanchnic mesodermal cells into angioblasts –> form vesicular aggregates in the splanchnic mesoderm of the embryo and extraembryonic regions (yolk sac, connecting stalk, chorion)

29
Q

How do angioblasts become vessels

A

They develop into flattened endothelial cells that form small vessel cords that eventually coalesce This is vasculogenesis

30
Q

Fate of primitive aortic arches

A

1st: regress quickly
2nd: regress quickly
3rd: CCA and proximal ICA

4th: L = aortic arch between L CCA and L subclavian
R = proximal segment of R subclavian

5th: never develops in humans

6th: pulmonary arteries
R distal portion disappear
L distal portion = ductus arteriosus

distal ICA from dorsal aorta between 1st and 3rd arches

dorsal aorta between 3rd and 4th arches disappear

distal segment of R subclavian from right dorsal aorta and R 7th intersegmental artery

R horn of aortic sac elongate to become innominate

L horn of aortic sac = proximal aortic arch

31
Q

Percentage of people with single artery to each kidney

A

71%

Variations due to embryologic failure of segmental arteries to fuse

higher incidence in ectopic kidneys or horshoe kidneys

32
Q

Retroesophageal right subclavian artery: etiology and symptoms

A

R 4th aortic arch and the connected R dorsal aorta involuted

Right dorsal aorta distal to R intersegmental artery persist and forms R subclavian

R subclavian pushed posterior by developing aortic sac (proximal arch)

95% asymptomatic; 5% esophageal compression

33
Q

Persistent sciatic artery:

incidence

course

findings

complication

A

0.05%

Follows sciatic nerve: pass into thigh through sciatic notch; posterior to adductor magnus; join popliteal artery

Absent femoral pulse, normal popliteal pulse; can be traumatized by sitting

Early atherosclerotic changes, aneurysm formation, sciatic nerve compression

34
Q

Anomalies of IVC (2 types)

A

Duplication of IVC

L sided IVC

35
Q
A
36
Q

Function of the gene prospero-related homeobox-1 (Prox-1)

A

Budding of the lymphatic system from veins

37
Q

What are the components of the hemangioblastic aggregates

A

Inner core of hematopoietic stem cells Outer rim of endothelial cells Hematopoietic stem cells serves as source of blood cells in first 60 days

38
Q

Embryologic variations in aortic arch

A

65% normal

22% with “bovine arch: brachiocephalic gives off R subclavian, R CCA and L CCA

  • short brachiocephalic trunk that bifurcate immediate; L CCA arise from arch at base of brachiocephalic
  • L vertebral from arch between L CCA and L subclavian
  • L brachiocephalic trunk
39
Q

When does vasculogenesis begin

A

Day 17 in yolk sac

40
Q

Normal vascular development of the upper extremity

A
  • 7th cervical intersegmental artery join axial artery in limb bud
  • axial artery becomes axillary, brachial, anterior interosseus
  • deep brachial is a bud from brachial; supply posterior arm
  • brachial artery gives rise to radial and ulnar
  • common interosseos bifurcate to anterio and posterior and median
  • radial and ulnar replace anterior interosseos artery as dominant artery of hand; median regresses
41
Q

Embryological lymph sacs (6)

origin of each

timing of development

A

Jugular lymph sacs (2): bud off anterior cardinal vein (junction of subclavian and IJ); 5th week

Posterior lymph sacs (2): bud from caudal segment of posterior cardinal veins (junction of IIV and EIV); late 6th week

Retroperitoneal lymph sac: mesonephric venous system near suprarenal gland; end of 5th week

Cisterna chyli: veins at L3-L4; end of 5th week

42
Q

Key constituents of the basement membrane

A

Type IV collagen Laminins

43
Q

Figure: primitive aortic arches and their evolvement

A

R9 (200 decks)

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