Difference between revisions of "SH Lecture - Respiratory System Development"

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* [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Respiratory/respir.htm Blue Histology - Respiratory]
 
* [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Respiratory/respir.htm Blue Histology - Respiratory]
  
==Developmental Overview==
 
'''Week 4''' - laryngotracheal groove forms on floor foregut.
 
  
'''Week 5''' - left and right lung buds push into the pericardioperitoneal canals (primordia of pleural cavity)
 
 
'''Week 6''' - descent of heart and lungs into thorax. Pleuroperitoneal foramen closes.
 
 
'''Week 7''' - enlargement of liver stops descent of heart and lungs.
 
 
'''Month 3-6''' - lungs appear glandular, end month 6 alveolar cells type 2 appear and begin to secrete surfactant.
 
 
'''Month 7''' - respiratory bronchioles proliferate and end in alveolar ducts and sacs.
 
 
===Lung Development===
 
 
* week 4 - 5 embryonic
 
* week 5 - 17 pseudoglandular
 
* week 16 - 25 canalicular
 
* week 24 - 40 terminal sac
 
* late fetal - 8 years alveolar
 
 
===Germ Layers===
 
* Endoderm form epithelium of conducting and alveoli.
 
* Ectoderm will contribute the neural innervation.
 
* Mesoderm contributes connective tissues, blood vessels, smooth muscle, also contributes the supporting musculoskeletal components.
 
 
==Foregut development==
 
From the oral cavity the next portion of the foregut is initially a single gastrointestinal (oesophagus) and respiratory (trachea) common tube, the pharynx which lies behind the heart. Note that the respiratory tract will form from a ventral bud arising at this level.
 
 
* Oral cavity
 
* Pharynx (esophagus, trachea)
 
* Respiratory tract
 
* Stomach
 
 
==Upper respiratory tract==
 
<gallery>
 
File:Gray0961.jpg|Adult upper respiratory tract conducting system
 
File:Gitbpm.jpg|stage 11 foregut
 
File:Gray0982a.jpg|week 4 early respiratory endodermal bud
 
File:Head_arches_cartoon.jpg|Head arches cartoon
 
File:Pharynx_cartoon.jpg|Pharynx
 
File:Nasal cavities.jpg|Nasal cavities
 
File:Pharynx.jpg|Pharynx
 
File:Larynx.jpg|Larynx
 
</gallery>
 
* part of foregut development
 
* anatomically the nose, nasal cavity and the pharynx
 
* the pharynx forms a major arched cavity within the pharyngeal arches (pharyngeal arches will be described in head development lecture)
 
 
{|
 
| <wikiflv width="280" height="322" autostart="true" position="left">Endoderm 002.flv|File:Endoderm 002 icon.jpg</wikiflv>
 
| [[File:Endoderm_cartoon.jpg]]
 
 
[[Quicktime Development_Animation_-_Endoderm|Quicktime]] | [[Development_Animation_-_Endoderm|Flash]]
 
|}
 
 
==Lower respiratory tract==
 
<gallery>
 
File:Gray0982a.jpg|week 4 early respiratory endodermal bud
 
File:Gray0982b.jpg|week 4 later ventral endoderm growth
 
File:Stage14 respiratory tract.jpg|Developing lung buds
 
File:Bronchi lungs.jpg|lower respiratory tract
 
</gallery>
 
[[File:Stage14-22 lungs.jpg]] [[File:Stage_22_image_171.jpg|300px]]
 
 
* The lungs go through an embryonic and 4 distinct histological phases of development
 
 
Growth initially of branched "conducting" system of bronchial tree, followed by later development of the "functional units" of the alveoli.
 
 
* '''embryonic''' -  week 4 - 5 (stage 14 above)
 
* '''pseudoglandular''' - week 5 - 17  (stage 22 above)
 
*  '''canalicular''' - week 16 - 25
 
*  '''terminal sac''' - week 24 - 40
 
*  '''alveolar''' - late fetal - 8 years (Latin, ''alveus'' = cavity or hollow)
 
 
===Lung morphogenesis===
 
====Embryonic stage====
 
[[File:Stage_13_image_070.jpg|600px]]
 
 
[[Movie_-_Gastrointestinal_Tract_3D_stage_13|Stage 13 movie]]
 
 
* Lung buds ( endoderm epithelial tubes) grow/push into splanchnic mesenchyme covered with pleural cells (lung border)
 
** '''embryonic tissue''' (adult tissue) organised inside to out
 
** '''endoderm''' (future respiratory epithelia) - '''splanchnic mesoderm''' (connective tissue, blood vessels, smooth muscle) - '''splanchnic mesothelium''' (visceral pleura) - pericardioperiotoneal canals (pleural cavity) - '''somatic mesothelium''' (parietal pleura) - '''somatic mesoderm''' (body wall CT, skeleton)
 
* generates a tree-like network by repeated:
 
 
# elongation
 
# terminal bifurcation
 
# lateral budding
 
 
===Pseudoglandular stage===
 
[[File:Fetal lung histology.jpg|thumb|Fetal lung histology ([[:File:Fetal_lung_histology_01.jpg|large image]])]]
 
* week 5 - 17 (late embryonic, fetal)
 
* tubular branching of the human lung airways continues (16-25 generations of branching)
 
* by 2 months all segmental bronchi are present.
 
* lungs have appearance of a glandlike structure.
 
* stage is critical for the formation of all conducting airways.
 
* lined with tall columnar epithelium, the more distal structures are lined with cuboidal epithelium.
 
 
===Canalicular stage===
 
 
* week 16 - 24 (fetal to end of second trimester)
 
* Lung morphology changes dramatically
 
* differentiation of the pulmonary epithelium results in the formation of the future air-blood tissue barrier.
 
* Surfactant synthesis and the canalization of the lung parenchyma by capillaries begin (week 17).
 
* future gas exchange regions can be distinguished from the future conducting airways of the lungs.
 
* 1 respiratory bronchiole gives rise to 3-6 alveolar ducts.
 
 
===Saccular stage===
 
[[File:Lung alveoli development cartoon.jpg|thumb|Lung alveoli development cartoon]]
 
* week 24 to near term (fetal third trimester)
 
* most peripheral airways form widened airspaces, termed saccules.
 
* saccules widen and lengthen the airspace (by the addition of new generations).
 
* future gas exchange region expands significantly.
 
* Fibroblastic cells also undergo differentiation, they produce extracellular matrix, collagen, and elastin.
 
** May have a role in epithelial differentiation and control of surfactant secretion
 
* The vascular tree also grows in length and diameter during this time.
 
 
===Alveolar stage===
 
[[File:Pig lung alveolarization.jpg|thumb|Fetal lung alveolarization]]
 
[[File:Alveolar-sac-01.jpg|Alveolar sac structure|600px]]
 
 
* Thyroid hormone required for differentiation and stimulate surfactant production.
 
====Alveolar type I cells====
 
* small alveolar cells, type I pneumocytes
 
* very flat cells (thin as 0.05 µm)
 
* form most of the surface of the alveolar walls
 
* may contribute epithelium on both faces of the alveolar wall
 
 
====Alveolar type II cells====
 
* large alveolar cells, type II pneumocytes
 
* irregular to cuboidal shaped cells
 
* contain large number of granules called lamellar bodies, these are the precursors to pulmonary surfactant (phospholipid mixture).
 
 
* end month 6 alveolar cells type 2 appear and begin to secrete surfactant - premature babies have difficulties associated with insufficient surfactant.
 
 
====Alveolar macrophages====
 
* remove particulate matter that enters the alveoli with inspired air
 
* migrate over alveolar epithelium and phagocytose particulate matter
 
 
===Fetal lung volume===
 
Each lung volume as determined by ultrasound and matched to gestational age (PMID: 16388511)
 
* 12-13 weeks 0.05 mL
 
* 19-22 weeks 0.5 mL
 
* 29-32 weeks 1.9 mL
 
 
== Pleural Cavity ==
 
[[File:Gray0965.jpg|thumb|pleura]]
 
[[File:Gray0968.jpg|thumb|pleura]]
 
* The anatomical body cavity in which the lungs develop and lie.
 
* The pleural cavity forms in the lateral plate mesoderm as part of the early single intraembryonic coelom.
 
* This cavity is initially continuous with pericardial and peritoneal cavities and form initially as two narrow canals
 
** later becomes separated by folding (pleuropericardial fold, pleuroperitoneal membrane) and the later formation of the diaphragm
 
 
pleuropericardial fold - (pleuropericardial membrane) An early embryonic fold which restricts the communication between pleural cavity and pericardiac cavity, contains both the cardinal vein and phrenic nerve.
 
 
pleuroperitoneal membrane - An early embryonic membrane that forms inferiorly at the septum transversum to separate peritoneal cavity from pleural cavity.
 
 
 
===Pleura===
 
* serous membrane covers the surface of the lung and the spaces between the lobes
 
* arranged as a closed invaginated sac
 
* two layers (pulmonary, parietal) continuous with each other, the potential space between them is the '''pleural cavity'''
 
 
==Diaphragm==
 
Not respiratory tract but musculoskeletal development, there are  5 elements that contribute to the diaphragm.
 
{|
 
| [[File:Diaphragm components.jpg|300px|Components of the diaphragm]]
 
|
 
# septum transversum- central tendon
 
# 3rd to 5th somite- musculature of diaphragm
 
# ventral pleural sac- connective tissue
 
# mesentry of oesophagus- connective tissue around oesophasus and IVC
 
# pleuroperitoneal membranes- connective tissue around central tendon
 
|}
 
[[File:Gray804.gif|thumb|Adult Cervical Plexus (phrenic nerve shown lower right)]]
 
[[File:Adult diaphragm.jpg|300px|adult diaphragm]]
 
 
Innervation of the human diaphragm is by the phrenic nerves, arising from the same segmental levels from which the diaphragm skeletal muscles arise, segmental levels C3 to C5.
 
 
The paired phrenic nerves are mixed containing motor neurons for the diaphragm and sensory nerves for other abdominal structures (mediastinum, pleura, liver, gall bladder).
 
 
==Pulmonary Circulation==
 
[[File:Pulmonary circulation cartoon.jpg|thumb|300px|Pulmonary circulation]]
 
[[File:Gray0975.jpg|thumb|alveoli and blood vessels]]
 
* the pulmonary system not "functional" until after birth
 
* pulmonary arteries - (deoxygenated blood to lung) 6th aortic arch arteries
 
* pulmonary veins - (oxygenated blood from lung) are incorporated into the left atrium wall
 
* bronchial arteries - branches from dorsal aorta
 
 
==Fetal Respiratory Movements==
 
* Fetal respiratory movements (FRM) or Fetal breathing movements (FBM) are regular muscular contrations occurring in the third trimester.
 
*  thought to be preparing the respiratory muscular system for neonatal function (and amniotic fluid are thought to have a role in lung maturation)
 
*  thought to also have a role in late lung development.
 
 
==The First Breath==
 
[[File:Alveolar-sac-01.jpg|thumb|Alveolar sac structure]]
 
* The respiratory system does not carry out its physiological function (gas exchange) prenatally and remain entirely fluid-filled until birth.
 
* At birth, fluid in the upper respiratory tract is expired and fluid in the lung aveoli is rapidly absorbed this event has also been called "dewatering of the lung".
 
** The lung epithelia has to now rapidly change from its prenatal secretory function to that of fluid absorbtion.
 
 
===Exchange of Fluid for Air===
 
* fall in pulmonary vascular resistance
 
* increase in pulmonary blood flow
 
* thinning of pulmonary arteries (stretching as lungs increase in size)
 
* blood fills the alveolar capillaries
 
 
In the heart, pressure in the right side of the heart decreases and pressure in the left side of the heart increases (more blood returning from pulmonary).
 
[[File:Neonatal rib orientation.jpg|thumb|Neonatal rib orientation]]
 
* Respiratory Rate is higher than adult (30 breaths/minute).
 
===Rib Orientation===
 
* Infant rib is virtually horizontal, allowing only diaphragmatic breathing
 
* Adult rib orientation is oblique (both anterior and lateral views), allows for pump-handle and bucket handle types of inspiration.
 
 
== Respiratory Tract Histology==
 
<gallery>
 
File:Respiratory_histology_05.jpg|Trachea
 
File:Respiratory_histology_06.jpg|Trachea
 
File:Respiratory_histology_01.jpg|Bronchiole
 
File:Respiratory histology 09.jpg|Bronchiole ciliated simple columnar epithelium
 
File:Respiratory histology 07.jpg|Lung structure
 
File:Respiratory_histology_02.jpg|Alveoli and Duct
 
File:Respiratory_histology_03.jpg|Alveoli
 
File:Respiratory_histology_04.jpg|Alveoli elastin
 
</gallery>
 
 
 
 
:'''Histology Links:''' [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Respiratory/respir.htm Blue Histology] | [http://vslides.unsw.edu.au/VirtualSlideV2.nsf/id/F51ED7 UNSW Virtual Slides] | [http://www.path.uiowa.edu/cgi-bin-pub/vs/fpx_browse.cgi?cat=o_lung&div=nlm UIOWA Virtual Slidebox]
 
 
== Respiratory Tract Abnormalities ==
 
[[File:Respiratory tract.jpg|thumb|conducting system bronchi to lungs]]
 
[[Respiratory System - Abnormalities]]
 
===Tracheoesophageal Fistula ===
 
* Tracheo-Oesophageal Fistula, Oesophageal Atresia - Oesophageal Atresia with or without tracheo-oesophageal [[F#fistula|fistula]]
 
** '''Fistula''' - an abnormal communication between 2 structures (organs, vessels, cavities) that do not normally connect.
 
 
===Lobar Emphysema (Overinflated Lung)===
 
# There is an overinflated left upper lobe
 
# There is a collapsed lower lobe
 
# The left lung is herniating across the mediastinum
 
 
===Congenital Diaphragmatic Hernia===
 
* Failure of the pleuroperitoneal foramen (foramen of Bochdalek) to close (left side)
 
* allows viscera into thorax -iIntestine, stomach or spleen can enter the pleural cavity, compressing the lung.
 
 
* rare (Morgagni hernia) -an opening in the front of the diaphragm.
 
 
:'''Links:''' [http://www.ncbi.nlm.nih.gov/books/NBK1359 GeneReviews]
 
 
===Azygos Lobe===
 
[[File:Lung_Azygos_Lobe_02.jpg|thumb|Lung Azygos Lobe]]
 
* Common condition (0.5% of population).
 
* The right lung upper lobe expands either side of the posterior cardinal.
 
* There is also some course variability of the phrenic nerve in the presence of an azygos lobe.
 
 
===Congenital Laryngeal Webs===
 
* Laryngeal abnormality due to embryonic (week 10) incomplete recanalization of the laryngotracheal tube during the fetal period.
 
* Rare abnormality occuring mainly at the level of the vocal folds (glottis).
 
 
===Meconium Aspiration Syndrome===
 
 
(MAS) Meconium is the gastrointestinal contents that accumulate in the intestines during the fetal period. Fetal stress in the third trimester, prior to/at/ or during parturition can lead to premature meconium discharge into the amniotic fluid and sunsequent ingestion by the fetus and damage to respiratory function. Damage to placental vessels meconium myonecrosis may also occur.
 
 
===Newborn Respiratory Distress Syndrome===
 
* Hyaline Membrane Disease (membrane-like substance from damaged pulmonary cells)
 
* absence of surfactant, if prolonged can be irreversible
 
* intrauterine asphyxia, prematurity and maternal diabetes
 
 
:'''Links:''' [http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/001563.htm medline plus] | [http://www.medscape.com/article/976034-overview eMedicine]
 
 
===Bronchopulmonary Dysplasia===
 
* A chronic lung disease which can occur following premature birth.
 
* The definition of bronchopulmonary dysplasia (BPD) has in recent years changed from a severe lung injury and associated repair, to more of a disruption of lung development.
 
 
==Terms==
 
* '''antenatal''' before birth.
 
* '''alveoli number at birth''' -  from 20 - 50 million and eventually in the adult 300 million.
 
* '''Bronchopulmonary dysplasia''' - (BPD) the most common serious sequela of premature birth.
 
* '''Bronchiolitis''' - is a viral infection of the lower respiratory tract and most common lower respiratory tract infection in infants. Respiratory syncytial virus (RSV) is responsible for 70 percent of all cases overall and Parainfluenza, adenovirus and influenza account for most of the remaining cases. (HSTAT Management of Bronchiolitis in Infants and Children)
 
* '''Chronic obstructive pulmonary disease''' (COPD) causes include smoking (85–90 percent of all cases), genetic factors (alpha-1 antitrypsin deficiency), passive smoking (children), occupational exposures, air pollution, and hyperresponsive airways. (HSTAT Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease)
 
* '''Clara cells''' non-ciliated cell found in the small airways (bronchioles) consisting of ciliated simple epithelium, these cells secrete glycosaminoglycans (Clara cell secretory protein, CCSP) to protect the bronchiole lining.
 
* '''Congenital Diaphragmatic Hernia''' (CDH) disorder with an incidence of 1 in 2500 live births.
 
* '''fetal breathing-like movements''' (FBMs) or Fetal respiratory movements are thought to be regular muscular contrations occurring in the third trimester, preparing the respiratory muscular system for neonatal function and to have a role in late lung development.
 
* '''glucocorticoid treatment''' - antenatal therapy to promote the maturation of the human fetal lung. Given as a synthetic glucocorticoid between 24 and 32 weeks of pregnancy to promote lung maturation in fetuses at risk of preterm delivery.
 
* '''lamellar bodies''' the storage form of surfactant in type II alveolar cells, seen as centrically layered "packages" of phospholipid. A count of lamellar bodies can be used as an assay for measuring fetal lung maturity.
 
* '''maternal diabetes''' if not controlled in pregnancy may delay fetal pulmonary maturation.
 
* '''Persistent Pulmonary Hypertension of the Newborn''' (PPHN) serious newborn condition due to due to the failure of closure one of the prenatal circulatory shunts, the ductus arteriosus. Occurs in about 1-2 newborns per 1000 live births and results in hypoxemia. (More? Respiratory Development - Birth)
 
* '''Pharyngitis''' inflammation of the pharynx involving lymphoid tissues of the posterior pharynx and lateral pharyngeal bands.
 
* '''pneumocyte''' or alveolar type I and type II cells.
 
* '''pulmonary hypoplasia''' can be due to anencephaly, renal hypoplasia or abnormalities of the thoracic cage
 
* '''pulmonary neuroendocrine cells''' (PNEC) single or innervated clusters of cells (neuroepithelial bodies) that line the airway epithelium, thought to have a role in regulating fetal lung growth and differentiation. At birth may also act as airway oxygen sensors involved in newborn adaptation. These cells synthesis and release amine (serotonin, 5-HT) and a several neuropeptides (bombesin).
 
* '''Respiratory distress syndrome''' (RDS) due to a surfactant deficiency at birth, particulary in preterm birth.
 
* '''secondary alveolar septa''' formed during the alveolar stage and are formed by projections of connective tissue and a double capillary loop.
 
*''' surfactant''' produced by alveolar type II cells is a mixture of lipids and proteins that both maintains alveolar integrity and plays a role in the control of host defense and inflammation in the lung.
 
* '''Surfactant therapy''' ([http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/2/419 American Academy of Pediatrics Policy] | [http://www.cps.ca/english/statements/fn/fn05-01.htm Canadian Paediatric Society Recommendations])
 
*''' thyroid hormone''' involved in the regulation of fetal lung development.
 
* '''vascular endothelial growth factor''' (VEGF) a secreted growth factor acting through receptors on endothelial cells to regulate vasculogenesis through their development, growth and function.
 
 
{{Glossary}}
 
{{Glossary}}
  

Revision as of 08:07, 28 February 2012

SHsmall.jpg

Introduction

Mark Hill.jpg
Respiratory tract

The lecture will introduce the development of the respiratory system and associated structures. The lecture will not cover adult anatomy, physiology of gas exchange and red blood cell function and cardiovascular development.

SH Links: Lymphatic Lecture | Lymphatics Practical Support | Respiratory Lecture | Respiratory Practical Support | Medicine

Start Time/End Time: 10am to 11am Thursday 1 March 2012 Clancy Auditorium eMed Link to Learning Activity - Respiratory System Development


The respiratory system does not carry out its physiological function (of gas exchange) until after birth, though the respiratory tract, diaphragm and lungs do begin to form early in embryonic development and continue through fetal development, only functionally maturing just before birth.

The respiratory tract is divided anatomically into 2 main parts:

  1. upper respiratory tract - consisting of the nose, nasal cavity and the pharynx.
  2. lower respiratory tract - consisting of the larynx, trachea, bronchi and the lungs.

The respiratory "system" usually includes descriptions of not only the functional development of the lungs, but also related musculoskeletal (diaphragm) and vascular (pulmonary) development.

Aims

adult lungs

To understand the prenatal and postnatal developmental anatomy of human respiratory organs.

Key Concepts

  1. Embryonic origin of respiratory components (tract, lungs, diaphragm, muscles)
  2. Key stages in respiratory development.
  3. Time course of respiratory development.
  4. Respiration at birth.
  5. Postnatal development of respiration.
  6. Developmental abnormalities.


lung structure
alveoli and blood vessels

Textbooks

The Developing Human, 8th edn.jpg Moore, K.L. & Persuad, T.V.N. (2008). The Developing Human: clinically oriented embryology (8th ed.). Philadelphia: Saunders.
Larsen's human embryology 4th edn.jpg Schoenwolf, G.C., Bleyl, S.B., Brauer, P.R. and Francis-West, P.H. (2009). Larsen’s Human Embryology (4th ed.). New York; Edinburgh: Churchill Livingstone.
Logo.png Hill, M.A. (2011) UNSW Embryology (11th ed.). Sydney:UNSW.
Respiratory Links: respiratory | Science Lecture | Lecture Movie | Med Lecture | Stage 13 | Stage 22 | upper respiratory tract | diaphragm | Histology | Postnatal | respiratory abnormalities | Respiratory Quiz | Respiratory terms | Category:Respiratory
Historic Embryology  
1902 The Nasal Cavities and Olfactory Structures | 1906 Lung | 1912 Upper Respiratory Tract | 1912 Respiratory | 1914 Phrenic Nerve | 1918 Respiratory images | 1921 Respiratory | 1922 Chick Pulmonary Vessels | 1934 Right Fetal Lung | 1936 Early Human Lung | 1937 Terminal Air Passages | 1938 Human Histology

Additional Textbooks


Glossary Links

Glossary: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Symbols | Term Link

Cite this page: Hill, M.A. (2019, December 15) Embryology SH Lecture - Respiratory System Development. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/SH_Lecture_-_Respiratory_System_Development

What Links Here?
© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G