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Respiratory Embryology Flashcards

1
Q

What does the respiratory system start off as?

A

A median outgrowth known as the laryngotracheal groove

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2
Q

What will evagination of the laryngotracheal groove form?

A

Laryngotracheal diverticulum (lung bud)

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3
Q

Where is the laryngotracheal groove found?

A

In floor of caudal end of foregut/primordial pharynx

Inferior to 4th pAs

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4
Q

Where will the primordium of Tracheobronchioal tree develop?

A

Caudal to 4th pharyngeal pouches

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5
Q

What does the endoderm of laryngotracheal groove form?

A

Pulmonary epithelium

Glands of larynx

Trachea

Bronchi

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6
Q

In the resp. System, what does the splanchnic mesoderm from lateral plate form?

What does it surround?

A

Will form the CT, cartilage, and Smooth m. In respiratory system structures

Surrounds the foregut

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7
Q

What will happen as the laryngotracheal diverticulum (lung bud) do as it elongates?

A

Becomes invested w/ splanchnic mesoderm, forms respiratory bud

(Remember, the lung buds are what makes IE and EE coelom separate)

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8
Q

What is the origitn of the respiratory tree?

A

Respiratory bud

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9
Q

When will the tracheo-esophageal septum form?

How?

A

At end of wk 5

From the development and fusion of tracheo-esophageal folds

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10
Q

What does the tracheo-esophageal septum do?

A

Divides esophagus from laryngotrachela tube

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11
Q

What is the ventral and dorsal portion of the foregut divided into?

A

Ventral part = laryngotracheal tube

Dorsal part = primordium of oropharynx, esophagus

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12
Q

What will the laryngotracheal tube form?

A

Larynx

Trachea

Bronchi

Lungs

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13
Q

What is the embryonic origin of the

Epithelial lining of the larynx?

A

Endoderm of the laryngotracheal tube (cranial end)

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14
Q

What occluded the laryngeal lumen?

A

Proliferation of the laryngeal epithelium

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15
Q

How are laryngeal ventricles formed?

When?

A

Via recanalization of the occluded lumen

Week 10

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16
Q

How are vocal folds/cord and vestibular folds formed?

A

Formed by the bounding of the laryngeal ventricles by folds of mucous membrane

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17
Q

What is the embryonic origin of the

Cartilage of the larynx?

A

Mesenchyme of the 4th and 6th pairs of pharyngeal arches

NCC derived

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18
Q

What produced the paired arytenoid swellings of the larynx?

A

Mesenchyme

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19
Q

What is the primordial glottis converted into? F

A

T-shaped laryngeal inlet

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20
Q

What does the epiglottis develop form?

A

Hypopharyngeal eminence

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21
Q

What is the embryonic origin of the epiglottis?

A

Mesenchyme of PAs 3 and 4

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22
Q

What is the embryonic origin of the laryngeal ms?

A

Myoblasts of PAs 4 and 6

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23
Q

Wher si the larynx located in a neonate?

Epiglottis?

A

High in neck

Epiglottis in contact w/ soft palate - allowing for separate respiratory and digestive tracts

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24
Q

Why is the larynx positioned high in the neck of a neonate?

A

Helps breast feeding

Makes infants obligatory nose breathers

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25
Q

When will the larynx descend in the neck?

A

Over the first 2 years of life

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26
Q

What is laryngeal atresia?

A

Birth defects resulting form the FAILURE of recanalization of larynx

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27
Q

What are the symptoms of laryngeal atresia?

A
  • Obstruction of upper fetal airway or congenital high airway obstruction syndrome (CHAOS syndrome)
  • Airways become dilated, lungs enlarged and filled w/ fluid
  • Diaphragm flattened or inverted, & there is fetal ascites and/or hydrops
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28
Q

What is the treatment for Laryngeal atresia?

A

Endoscopic dilation of laryngeal web

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29
Q

What does the trachea form from?

A

Laryngotracheal diverticulum (lung bud)

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30
Q

What are the endodermal components of the trachea?

A

Tracheal epithelium

Glands

Pulmonary epithelium

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31
Q

Histologically, what is the pulmonary epithelium and tracheal epithelium of the trachea?

A

Pseudo-stratified columnar ciliated epithelium

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32
Q

What are the mesodermal components of the trachea?

A

Splanchnic mesenchyme makes …

Tracheal cartilages (hyaline)

CT

Muscle

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33
Q

What do the lungs develop?

A

Laryngotracheal diverticulum —> primary bronchial buds (and trachea)

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34
Q

When will the laryngotracheal diverticulum enlarge to form the respiratory bud?

A

Week 4

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35
Q

What happens to the respiratory buds formed by the laryngotracheal diverticulum?

A

Grow ventrocaudally and bifurcate

Form primary bronchial buds

36
Q

How do the Primary Bronchial Buds grow?

When do they branch?

A

Grow laterally into Pericardioperitoneal canal

Branch at beginning of 5th week into secondary bronchial buds

37
Q

What will secondary bronchial buds brnach into?

A

Tertiary bronchial buds f

38
Q

What regulates the branching pattern of lung endoderm?

A

Splanchnic mesenchyme

39
Q

What is the branching pattern of lung endoderm dependent on?

A

Induction (tissue signaling0

40
Q

When do bronchopulmonary segments form?

A

7th week

41
Q

What are bronchopulmonary segments made up of?

A

Segmental bronchi + mesenchyme

42
Q

What will lungs acquire as they develop?

A

Layer of visceral pleura

43
Q

What is visceral plerua fromed from?

A

Splanchnic portion of lateral plate mesenchyme

44
Q

What is parietal pleura formed form?

A

Somatic portion of lateral plate mesoderm

45
Q

What will the parietal plerua line?

A

Thoracic body wall

46
Q

What are the 4 stages of prenatal lung development?

A

Pseudoglandular

Canalicular

Terminal sac

Alveolar

47
Q

When is the lung in the pseudoglandular stage?

A

Weeks 5-17

48
Q

When are the lungs in the Canalicular stage?

A

Wks 16-25

49
Q

When are the lungs in the Terminal Sac stage?

A

Wks 24-birth

50
Q

When are the lungs in the alveolar stage?

A

Wks 32 - 8 years

51
Q

What characterizes the Pseudoglandular stage of Lung Maturation?

A

Lungs look like exocrine glands

All major elements of the lung have formed; except those involved w/ gas exchange

52
Q

What characterizes the Canalicular stage of Lung Maturation?

A

Overlaps the pseudoglandular stage

Vascularization of lungs
Repsiratory bronchioles (capable of gas exchange)
Primordial alveolar and sac present (primitive alveoli)

53
Q

Are fetuses able to survive in the pseudoglandular stage?

A

No

54
Q

Are fetuses able to survive in the Canalicular stage?

A

Maybe

55
Q

What characterizes the Terminal Sac stage of Lung Maturation?

A

Numerous alveoli form

Thin epithelium w/ increased vascularization

Has type 1 and 2 pneumocytes

Lymphatic capillaries

56
Q

Are fetuses able to survive in the terminal sac stage?

A

Yes

57
Q

What produces type 1 pneumocytes?

A

Type 2

58
Q

What is the role of type 2 pneumocytes?

A

Produce surfactant

59
Q

What characterizes the Alveolar stage of Lung Maturation?

A

Alveolocapillary membrane

Primitive alveoli formed and forming

Mature alveoli

60
Q

When do most mature alveoli develop?

A

~85% develop postnatally

61
Q

When is alveolar development largely completed by?

When are they added until?

A

Mostly completed by 3 years

Added until 8 years of age

62
Q

What 3 things does SPlanchnic mesoderm form that is critical for bronchi?

A
  1. Cartilaginous plates (bronchial)
  2. Bronchial SM and CT
  3. Pulmonary CT and capillaries
63
Q

What is essential for normal lung development?

A

Fetal breathing movements

64
Q

What are Fetal Breathing movements (FBM)?

A

Intermittent pattern that conditions respiratory muscles and cause aspiration of amniotic fluid helping to stimulate lung development

65
Q

How can FBMs be used?

A

Used during fetal monitoring and as predictors of fetal outcome in pre-term delivery

66
Q

How is intra-alveolar fluid of the lung replaced w/ air at birth? (3 ways)

A

Aeration of the lungs is achieved by

  1. Released via mouth/nose as pressure occurs on fetal thorax during vaginal delivery
  2. Cleared by pulmonary capillaries, arteries, and veins
  3. Cleared by lymphatics
67
Q

What is surfactant produced by?

A

Type 2 alveolar cells

68
Q

What are the consequences of surfactant not being present?

A

Under inflated lungs

Tachypnea

Nasal flaring

Suprasternal, intercostal, or subcostal retractions

Grunting/cyanosis

69
Q

What is a tracheo-esophageal fistula?

Occurrence rate?

Assoc. w/?

A

Abnormal connection b/w trachea and esophagus

1: 3000-5000 births

85% assoc. w/ esophageal atresia (blind esophagus)

70
Q

What is the cause of trachea-esophageal fistula?

A

Failure of foregut endoderm to proliferate rapidly enough in relation to the rest of the embryo

71
Q

What is the most common congenital anomaly of the lower repsiratory tract?

A

Trachea-esophageal fistula

72
Q

What are the symptoms of a tracheoesophageal fistula?

A
  • Cannot swallow, frequently drool saliva, immediate regurgitations when fed
  • Gastric and intestinal contents may also reflux thru the fistula into the trachea and lungs

• Polyhydramnios: xs amniotic fluid
◦ Cannot enter stomach/intestines for absorption
◦ Not transferred for disposal via the placenta

• excess air in GI tract

73
Q

What is polyhydramnios?

A

Excess amniotic fluid

74
Q

What is pulmonary agenesis?

Occurrence?

A

Unilateral agenesis or complete absence of a lung or a lobe and accompanying bronchi

1:15,000

75
Q

What is the cause of PUlmonary Agenesis?

A

Failure of respiratory buds to split into R/L bronchial buds

76
Q

What is oligohydramnios?

Assoc. w/?

A

Insufficient amniotic fluid production (<500 mL)

Assoc. w/ renal agenesis or failure

77
Q

What are the consequences of severe and chronic oligohydramnios?

A

Retarded lung development due to lack of counter pressure against uterine pressure

(Remember the FBMs)

78
Q

What is pulmonary hypoplasia?

Occurrence?

A

Restriction of fetal thorax due to uterine pressure and decreased hydraulic pressure on lungs affecting stretch receptors and lung growth

14:10,000 births

79
Q

What increase the risk of pulmonary hypoplasia?

A

Significant increase in risk if olgiohydramnios present at <26 Wks

80
Q

What is oligohydramnios sequence?

A 
Potter facies
Limb hypoplasia
Decreased amniotic fluid
Nasal flaring
Nasal bridge wide
Renal failure in fetus
Club feet 
Etc.
81
Q

What is Respiratory Distress syndrome?

% affects?

A

Rapid labored breathing that develops shortly after birth

2% of neonates affected
Accounts for 50-70% of deaths in premature infants

82
Q

What is a major cause of RDS?

A

Surfactant deficiency

83
Q

How will a surfactant deficiency leading to RDS presents?

A
  • Lungs are under inflated
  • Alveoli contain a fluid that resembles a glassy membrane (hyaline membrane disease)
  • Irreversible changes int he type 2 alveolar cells, making them incapable of producing surfactant
84
Q

What are the symptoms of RDS?

A

Tachypnea, nasal flaring

Suprasternal, intercostal, or subcostal retractions

Grunting and Cyanosis

85
Q

What are congenital lung cycsts

A

Cysts filled w/ fluid or air thought rob e formed by dilation of terminal bronchi

86
Q

What causes congential lung cysts?

A

Disturbances in bronchial development during late fetal life

87
Q

Sxs of congenital lung cysts?

A

Wheezing, cyanosis, difficulty breathing

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