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Doctor • Hisham AI Mohtasill (Embryology) Date • 8\12\2011 Done lip • Slides

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DOCTOR 2011 I

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42

Chapter 2 i 'l

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future external ear

5 weeks

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6.5 weeks buccopharyngeal membrane forming floor of stomodeum

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medial nasal process

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mandibular maxilla 5.5 weeks

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mandible

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weeks Figure 2-5 Different stages in development of the face.

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communication between nasal palatal process

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Figure 12.1. A. Embryo of approximately

_35 days gestation showing the relation of

the respiratory diverticulum to the heart, stomach, and liver. B. Sagittal section through the cephalic end of a 5-week embryo showing the openings ofthe pharyngeal pouches and the laryngotracheal orifice.

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Figure 12.2. A, B, and C. Successive stages in development of the respiratory divertic- ~

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ulum showing the ~haotracheal ridses.and formation af the sepl!Jm, splitting the foregut into esophagus and trachea with lung bu.,g~.

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pharynx seen from above showing the laryngeal orifice and surrounding swel!jgs.

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?OS Part Two I Systems-based Embryology Bifurcation

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Figure 14. J Variations of esophageal atresia and/or tracheoesophageal f.; .ula in order of their frequency of appearance: A, 90%; B. 4%; : , 4%; D, I%; and E, I%.

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rotation axis ! esser

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curvature

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curvature curvature Figure 14.8 A-C. Rotation of the stomach along u.s longitudinal axis as seen anteriorly. D,E. Rotation of the stomach around the anteroposterior axis. Note the change in pos1tion of the pylorus and cardia.

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SLIDE 7

Epiglottis Laryngeal

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Figure 12.4. Laryngeal orifice and surrounding swellings at successive stag3s of

• development. A. 6 weeks. B. 12 weeks.
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SLIDE 8

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coelomic cavity p?rietal pleura visceral pleura pleural cavity costodiaphragmatic recess Figure 3-19 Formation of the lungs. Note that each lung bud invaginates the wall of the coelomic cavity and then grows to fill a greater part of the cavity. Note also that the lung is covered with visceral pleura and the thoracic wall is lined wit!'-

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Parietal pleura Viscer pleura Lung bud Pericardioperitoneal canal Visceral peritoneum

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Heart Phrenic nerve cardinal vein Figure 12.6. Expansion of the lung buds into the ~ricardioperitoneal

• canals. At this

stage the canals are in communication with the peritoneal and pericardia! cavities. A. Ventral view of lung buds. B. Transverse section through the lung buds showing the pleuropericardial folds_Jhat will divide the thoracic portion of the body cavity into the pleural and pericardiill._ cavities.

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Figure 12.7. Once the pericardioperitoneal canals separate from the pericardia! and peritoneal cavities, respectively, the Lungs expand in the pleural cavities. Note the visceral and parietal pleura and definitive pleural cavity. The visceral pleura extends

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SLIDE 10

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Maturation of the lungs

Pseudoglandular 5-16 weeks period Canalicular 16-26 weeks period Terminal sac period Alveolar period

A

26 weeks to birth 8 months to childhood Terminal bronchiolus Branching has continued to form terminal bron-

• chioles. No respiratory bronchioles_ or alycoll,

rirc prescr-1~. Each terminal bronchiole divides into 2 or more respiratory bronchiolesJ which in turn divide into 3-6 alveolar ducts. ·" Terminal sacs (p__r:imitive alveo~i) forn:, and ~1-

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Figure 12.8. Histological and functional development of the lung. A. The ~-19£

Qi!ri.QQ lasts from the 1£tb tQ_tb_e 26th we~. Note the cuboidal cells lining the respiratory

• bronchioli. B. The !!llminal sac perio_c!,begins at the end of the sixth ant! beg!g!JjiJg 9,f

tj)e S!(Venth.prenat.aLmont~. Cuboidal cells become very thin and intimately associated with the endothelium of blood and lymph capillaries or form terminal sacs (primi- : tive alveoli~)

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in a newborfl. Note the thin squan-:ous epithelial cells (also known as alveolar epithelial cells, type I) and surrounrling capillaries protruding into mature alveoli.

SLIDE 11

~-

pulmonary veins cuff of pleura cantiCO.i pleu;.: (parietal p!euraj

The Chest Wall, Chest Cavity, Lungs, and Pleural Cavities

99

r,ostal pleura ;;Jarietal pleura) diaphragmatic pleura

(pari~t~'

;::!eura) left lung Figure 3-20 Different areas of the parietal pleura. Note the cuff of pleura (dotted lines) that surrounds structures entering and leaving the hilum of the left lung. It is here that the parietal and visceral layers of pleura becorr•' continuous. Arrows indicate the position of the costodiaphragmatic recess.

Intercostal nerves (T1-T11) "",-:_--

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Diagram showing the innervation of the parietal and visceral layers of pleura.

SLIDE 12

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· CLINICAL CORRELATES

.

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surfactant is insufficient, the air-water (blood) surface membrane tension be- comes high, bringing great risk that alveoli will collapse during expiration. As a result, ~espiratory distrQSS syodromQ. (RDS) develops. This is a common cause

• f death

Tn the premature infant. In these cases the partially collapsed alveoli

contain a fluid with a high protein content, many hyaline membranes, and lamel- lar bodies, probably derived from the surfactant layer. RDS, which is therefore also known as ~!aline membrane djse"ase, accounts for aeeroximately 20%

• f deaths among newborns. Recent development of artificial surfactant and

treatment of premature babies with ~<?COrticoids,_to stimulate surfactant pro- duction has reduced the mortality associated with RDS and allowed survival of some ba!:>ies as young as 5.5 months of gestation. Although many abnormalities of the lung and bronchial tree have been de-

• .·scribed (e.g., bjind-ending trachea wjth absence of lunru; and agenesis of one

lung), fl'IQSt .of these gross abnormalities are rare. Abnormal divisions of the

.. broncnJal.tre'earemore common; some result in ~ernumerarv

• lobules. These

vari~iOf\S

• f the bronchial tree have little functional significance, but they may

.. caus:~·

~n~p£lcte9

difficulties during bronchoscopies.

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a,re ~C!Eic lung lobes arising from the trachea or esophagus.

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tha.t t~se)obes are formed from additional respiratory buds of

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· the foregutJhafgevelop independently of the main respiratory system.

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Me>sf!~R'?rt~ ~lini~aly

are ~n~enital cysts of the lung, which are formed ,

'": by'dilatici'n:o:f termin~l

• r larger bronchi. These cysts may be small and multiple,

'"giving· thf3 '·lu.ng ·a honeycomb appearance on radiograph, or they may be re-

• ·~strictecl'to.
• ne pr more larger ones. Cystic structures of the lung usually drain

' poorly ~·Md

frequ~ntly

cause <i.hronic iofectjnp§.