Last edited: 9/11/2021 Medical Editor: Jan ile |) HEAD AND NECK | ll) INFERIOR HYOID, TRUNK, AND GIRDLES | ‘tunes | IV) MUSCLE FORMATION | REVIEW QUESTIONS | vy REFRENCE eee ote: itis recommended thal you waich the video on the “Development of the Skeletal System" before this, ‘* Visualize a sagital section through the primitive pharynx «© Along the cranial end of the embryo is the bbuceopharyngeal membrane © Fusing of the ectoderm and endoderm layers, '¢ The pharynx forms vesiculations, forming the pharyngeal ‘apparatus, wihict has three layers © Outer layer: Ectoderm © Core: Mesoderm o Inner layer: Endoderm 1 The mesoderm within the 1"'~ 4" and 6" arches undergo ‘a diferentition process to form the muscles ofthe head ‘and suprahyoid muscles ‘¢ The muscles each have their own innervation SAGITTAL seeron exami soa “n= rrrve pay v Jae errate me eu re raet myo) > sen ranck p06 (pret rranet me 0 Figure 1. Development ofthe Pharyngeal Arches Table 1. Muscles derived from the Phanyngeal arches Pharyraeal | wusceD Nerve Supply ‘ Muscles of mastication NV © Temporalis (geminal © Masseter nee) Ast « Prerygoids * Myonyod 1 Digastic anterior bey) ‘Tensor vel alain ‘Muscles of facial expression | CNV ana__| @Stlohyoid (adil neve) Digastic (posterior bely) 2 Stapedius ox ard | stylophanngeus (Gessopnanmaes rere © Levator val palati ‘ONx aranage | * Prange constctr (Vagus nerve) 1 Laryngeal muscles ‘* Recall: The paraxial mesoderm undergoes segmentation {0 form somites flanking the neural tube ‘© Three somites are formed each day untl there are 44- 45 somites by the 5” week of development «© A.caviy within the somites (somitocele) forms ‘# The somitocele continues to expand, dividing into a dorsal and ventral portion ‘© Dorsal: dermatomyotome ‘= Dormatome - forms the dermis, ‘= Myotome — forms muscle «© Ventral: sclerotome — forms bones and cartilage © Syndetome - a layer between the myotome and sclerotome which develops into tendons ‘¢ The sclerotome wraps around the neural tube to form the bony casing ofthe spinal cord and thoracic cage: © Verlebrae «Intervertebral discs © Ribs ‘¢ The myotome is further spit into: © Dorsal/Medial ‘Forms the muscles of the back + Epiaxial muscles Ventral/Lateral “Forms the muscles of the trunk and imbs ‘+ Hypaxial muscles ast Figure 2, Development ofthe Somites @ [omar aoa EMBRYOLOGY. Noe #7‘¢ These muscles are derived from the dorsalimedial portion of the myotome ‘¢ The epiaxial muscles surround the base of the skull and the vertebrae, all the way down to the pelvic girdle ‘The back muscles include: © Erector spinae © Mutfidi muscles © Semispinalis capitis © Suboctipital muscles ‘¢ These muscles are derived from the ventralfateral portion cof the myotome ‘© The hypaxial muscles form the: Trunk muscles * Diaphragm tercostal muscles + Serratus anterior and posterior * Abdominal muscles o Limbs * Upper limb muscles * Lower limb muscles © Infranyoid muscles! “strap” muscles ‘© Recall: The ibs are initaly star as ectodermal ‘outpouchings called limb buds © The following genes induce limb bud formation and dictate their position: Hox = Tex4 = TExs “FGF 10 ‘¢ The somatic mesoderm rom lateral plate mesoderm) migrate to the im buds to form the limb skeleton ‘© The apical ectodermal ridge (AER) drives the proximal to distal formation ofthe limb skeleton ‘¢ The syndetome migrates to the limb buds to form the tendons ‘¢ The myotome migrates tothe mb buds to form the muscles. © Initialy, the myotome forms nonspecific chunks of muscle Eventually, the chunks diferentiate based on their ‘anatomical position (anterior, posterior) «© The embryological structures lead to functional differences (See Table 2) * Sealene o * For example, the anterior condensation forms the wz fevor end pronetor muscles of he upper lms ‘eee «©The dermatome migrate tthe limb buds to form the dermis anc subcutaneous tissue ePayaL sees Table 2 Muscies ofthe Limos Condensation | Upper Limbs Lower Limbs HyPRMIAL ee pero Anterior 9 Flexors ‘© Dorsiflexors SS # Pronators @ Adductors oo mo Flexor Posterior Extensors ¢ Plantar flexors: ssupinators | 3 een A comin ypu Figure 3, Development ofthe Epiaxial and Hypaxial Muscles Dore EMBRYOLOGY. Now #1 Figure 4. Development of the Limb Muscles‘¢ Muscies generally come from the mesoderm ‘©The epithelial mesoderm cells transition into ‘mesenchymal cells «The mesenchymal cells transform to myoblasts —+ Myoblass fuse to form muscle fibers. Fibers fuse to form a big chunk of muscle 1 These muscle cells need genes to differentiate: The first gene to be activated isthe Pax gene © Pax gene is activated —+MyoD and Myi4 genes are activated + Myogeninis activated 1 These genes are necessary for the production of proteins which make muscle cells phenotypically different (MUSCLE FORMATION BQ > GS > EER ou mom “ smyod sunt @ » sown Figure §. Muscle Formation *@ [bearer atone Sen EMBRYOLOGY. Noe #7 1) The muscles of facial expression develop from which pharyngeal arch? a) tst bj 2nd ©) 3rd aatn 2) The following structures are derived from the 4" pharyngeal arch EXCEPT: 2) Stylopharyngeus 'b) Pharyngeal constrictor muscles ©) Laryngeal muscles 8) Levator vel palatiri 3) Which of the following muscles Is dorived from the dorsal/medial portion of the myotome? 2) Semispinalis capitis ») Serratus anterior ) Sealene 8) Transversus abdominus 4) Which of the following statomonts is FALSE? 2) The anterior condensation gives rise to the flexor ‘muscles of the upper limbs ) The anterior condensation gives rise to the dorsilexors of the lower limbs ) The posterior condensation gives rise to the adductor muscles ofthe lower limbs ) The posterior condensation gives rise to the supinator muscles of the upper limbs '5) Which gene is crucial for the production of muscle- specific proteins? a) Hox b) Soxa ) TBxa 0) PaxLast edited: 8/24/2021 Embryology: Development of Phi Medical Editor: Dr. Sofia Suhada M. Uzi (Ww) Pharyngeal pouches r «© Made out of endoderm | INTRODUCTION il) PHARYNGEAL CLEFTS/GROOVE | «Thera ae 4 pharyngeal pouches Il) PHARYNGEAL ARCHES The 9 and 4 wl spit ito | lv) PHARYNGEAL POUCHES. ‘Dorsal pouch | VJ REVIEW QUESTIONS * Ventral pouch 9.16 4 | vl) REFERENCES. ‘0 Will develop into | * Epithelium [ie “Lining cavities + olands (reopen) * Paratyod Thymus (1) Location ‘¢ Located atthe cranial end of a sagittal section of an embryo Gill ike structure fi rama BUCCOPHARYNGEAL MEMBRANE Caneenn PHARYNGEAL ARCH Uinesosenm Rawal Pragynceat chs Neeronens Figure 1. Parts of pharyngeal apparatus (2) Parts in pharyngeal apparatus Figure 1 ‘¢ Pharyngeal apparatus consists of (i) Buccopharyngeal membrane ‘© Connects endoderm and ectoderm layer © Becomes the mouth (li) Pharvngeal clefts/aroove © Al the outer parts and covered with ectoderm © Will become the epithelium *= The first cleft develops into tissue lining the ‘external ear canal (ii) Pharyngeal arches There are 6 arches The 5" usually doesn't formidigress © Mesoderm core (mesenchymal tissue) © Will develop into * Muscle * Connective tissue * Cartlage + Laryngeal = Bone + Nerves OTT OTC TTS ‘© At the outer parts and covered with ectoderm ‘¢ Will become the epithelium © The 1 cleft develops into tissue lining the extemal ear canal ‘# Mesoderm core (mesenchymal tissue) (1) arch ‘¢ Muscle of mastication supplied by trigeminal nerve ‘© Medial and lateral pterygoids © Masseter © Temporalis ‘¢ Mylohyoid/ anterior belly of digastric ‘© Suprahyoid muscles ‘¢ Tensor vel palatini ‘© Movement of soft palate during swallowing 2) 2 arch ‘¢ Muscles of facial expression ‘ Styiohyoid / posterior belly of digastric muscle © Supratyoid muscles 1 Stapedius| « Inthe middle ear ‘© Helps in control in sensitivity of hearing (3) arch ‘ Stylopharyngeus supplied by glossopharyngeal nerve © For degltition (4) 4 and 6" arches ‘* Pharyngeal constrictor muscles ‘© Superior, middle and inferior constrictors © Helps in degiution ‘Laryngeal muscles © Cricothyroid © Arytenoid ‘¢ Levator vel paatiai ‘© Helps in degiuttion EMBRYOLOGY. Noe #7ea L Figure 2. Bones and ligaments developed (1) arch ‘@ Almost the entire skull ure 2 © Maxila © Zygomatic bones © Mandible ‘© Squamous part of temporal bone with its processes. + Siyloid process: + Mastoid process + Zygomatic process ‘© Maleus and incus * Bones in the idole ear @ ‘¢Hyoid bone ‘© Some of t comes from the 3" arch « Stylonyoid tigament ‘© Connecting hyoid bone to styloid process. © Stapes © Bones in the middle ear © Taps on the oval window (3) 4° and 6° arch, ‘© Laryngeal cartilages: fo Thyroid cartilage © Arytenoid cartiage © Cuneifornvcorniculate Dore EMBRYOLOGY. Now #1 Isr 3a, eure Figure 3. Nerves of pharyngeal arches (1) arch ‘* Trigeminal nerve Cranial nerve 5 (2) 24 arch ‘¢ Facial nerve Cranial nerve 7 (3) arch '* Glossopharyngeal nerve Cranial nerve 9 (4) 4" and 6 arch ‘* Vagus nerve © Cranial nerve 10 + Superior laryngeal nerve (4* arch) + Recurrent laryngeal nerve (5" arch) (1) tarch ‘¢ Maxilay artery (2) 2+ arch ‘¢ Hyoid artery — stapedial artery ‘© Only 1036 remains in adulthood (3) 3arch "¢ Common carotid artery ‘© Proximal portion of intemal carotid artery (4) 4 arch ‘© Right ‘© Subclavian artery Let ‘Aortic arch (5) 6%arch ‘© Right ‘© Right pulmonary artery eet © Left pulmonary artery © Ductus arteriosus * Connects pulmonary trunk to aorta DEVELOPMENT OF PHARYNGEAL APPARATUS 1S‘© Made out of endoderm \@="= a7 venrat vernal, ar 7 ~ Figure 4. Pharyngeal pouches (1) 4% pouch '¢ Endoderm moves into the midle ear cavity © Tympanic cavity © Eustachian tube * Drains Into nasal cavity 2) 2°4 pouch, ‘© Lymphatic tissue/tonsis © Specificaly pharyngeal tonsil * At the back of nasopharynx © Others: + Palatine, tubal, lingual tonsiis ‘Lines the naso-oral cavity (3) 3 pouch Dorsal © Inferior parathyroid glands * Located at the back and bottom part of thyroid © During development, the 4 dorsal pouch moves Upwards hence gives the superior parathyroid gland # Ventral o Thymus Lymphatic tissue © Slaris in the neck then moves down tothe chest where T-cells mature (4) 4 pouch ‘Dorsal © Superior parathyroid glands Ventral © Utimopharyngeal body —- parafolicula ces (C-cels) * Secrete calcitonin which helps regulate calcium ‘© DiGeorge syndrome © 3 and 4" pouches malformation © Absent or poorly developed thymus and parathyroid ‘lands * Immurity issues due to impaired T-cell ‘development «© Parafolicular cells which secrete caleitonin * Caleium metabolism wil be affected © aeRO RATE EMBRYOLOGY. Noe #7 1) Parafollicular cells of thyroid gland are derived from which endodermal pouch? a. Mand 2" b. 2 and 3 ©. and 4m d. 4 and 5° 2) Which of the muscles attaching to the styloid ‘process Is NOT derived from a pharyngeal arch? a. Styloglossus. b. Stylopharyngeus «. Styiohyoia 4. Levator vel palatine e. Tensorteli palatini concerning 3) The nerve delivering sensory innervation to the posterior side of the external ear canal is a protromatic nerve supplying dorivatives branch of the cranial of the fourth pharyngeal arch. It is the: 2. Greater petrosal nerve Nerve of the pterygoid canal «. Aurieular nerve (of Arnold) d. Tympanic nerve (of Jacobson) ©. Deep petrosal nerve 44) The muscular derivatives of the 2° pharyngeal arch are all except? 2. platysma b. stylohyoid mylohyoid d. posterior belly of digastric fe. muscles of facial expression 5) the bone derivatives of the 1* arch include all of the following except? a. Maxilla b. Zygomatic bones ©. Mandible d. Stapes 6) The epithelium derivative of the 1" pouch lines the: ‘a. Tympanic cavity b. Inferior parathyroid glands . naso-oral cavity d. Superior parathyroid glands 7) The epithelium derivative of the 2% pouch lines the: fa, Eustachian tube b. Naso-oral cavity Tympani cavity 4. Superior parathyroid glands 8) The muscle dorivatives of the 2% arch Include: a. Stylopharyngeus b. Stapecius ©. Cricothyroid J. Arylenoid 9) the bone derivatives of the 3 arch include: ‘a. Hyoid bone b. Thyroid cartiage ©. Zygomatic bones 4, Mandible 10) In DiGeorge syndrome Immunity is normal '. Calcium metabolism increases «. There is malformation of 3rd and 4th pharyngeal pouches 4d, The thymus is unaffected * Sader TW. Langman’ Medial Embryclogy Phiadelphie ters Klaver 2040. "Le Tt Aid for the USHLE Stop #2020, $0h anniversary eden: WSraw rt 2020, "Marie EN. Heh Anatomy & Physiciogy. Hoboken, Ni Pearacn 2020 ‘doron WF, Boulpsep EL. Media! Prysilegy 2017 ERT 3 ofS> \ EMBRYOLOGY Embryology | Development of the Respiratory System | FUNDAMENTALS. ll) DEVELOPMENT OF THE RESPIRATORY SYSTEM ihapsenon | IV) REVIEW QUESTIONS: | Y) REFERENCES ‘ We develop the respiratory system from two germ layers: © Endoderm © Mesaderm + Gastuation i process where bilaminar dic —> trlaminar dse 6 There's quick foling process in both lateral folding process and craniocaudal folding process * Some of fe structures thal are developing from these layers + Larynx Trachea Lungs ( @ silamnar Disc=week2 eas EPIBLAST o HYPOBLAST Figure 1. Gastrlation of embryo ¢ We made up of our epiblast layer on the top: © Above epblast is amniotic cavity © Bolow epibiast is hypablast layer * Below hypobiast layers yolk sac layer + We develop nice primitive streak inthe epiblast layer «6 Some epiblasteolls move fvough the peimitive stroak * Conver the hypoblast layer —+ new endoderm layer © More epiblast cells move through primitive streak * Itforms a new layer between these rew endoderm — mesoderm ‘¢ Notochord —- epiblast cells moving through the primitive node © And then go through the process called neurulation and make a structure called neural tube « Epiblast coll start difforontiating themselves and ‘umning into ectoderm « This is called gastrulation © Take bilaminar disc and turn into a tlaminar dise ‘¢ Notogenesis is also occurring SQ RATT OTERO EMBRYOLOGY. Note FIA Last edited: 9/24/2021, Medical Editor: Aldrich Christiandy ‘© Trlaminar disc looks lke a pancake and we want to fold © Fold this pancake into two directions (view from cross section) Lateral folding ‘+ Fold in a lateral type of way and bring them together += Craniocaudal folding ‘Pullout from the top ofthe embryo or cranial partion and going back to the caudal portion LATERAL FOLDING (CRANIO-CAUDAL FOLDING, PARAXIAL MESODERM INTERMEDIATE MESO ENDODERM * \eur Tuse ‘SOMATIC LAYER OF LPM 'SPLANCHNIC LAYER oF LPM Fue 2 Fong ot ania de «+ Endoderm an mesoderm make your respirator sytem @ Endoderm is going to give way to gut tube (the epithelial lining and the gland of GI tract) «© Epithelial lining ofthe respiratory tract (larynx, trachea, lung) ‘* Mesoderm closest to the neural tube is called paraxial mesoderm ‘* Abil more lateral is your intermediate mesoderm ‘# The one closest to the ectoderm called somatic layer of the lateral plate mesoderm ‘Closest tothe endaderm or the gut tube is going to be splanchnic layer of lateral plate mesoderm © Gives rise to cartllage, muscle, connective tissue around the larynx, trachea, lungs Table 1. Dervatves ofthe layer of embi Layers Derivative Structures: ‘Mesoderm ‘Around the larynx, trachea, and lungs ‘Cartilage e Muscle Connective tissue Epithelial lining of the respiratory tract ‘Splanchnic layer of the lateral plate mesoderm Endodormaa Evie 4 LARYNX < deere {ENDODERM —= PHARYNGEAL Pouches -MESODERM Yr ntscteR ENDODERM ~ roxecuT OTRACHEACEMOPERM ron enonenm = ronecur OUINGS << esopeRe ir Figure 3. Derivatives of endoderm and splanchnic layers of Tater plate mesoderm «© Sagittal view after craniocaudal folding © Three portions from endaderm and splanchnic layors of tho latoral plate * Foregut + Midgut * Hindgut « Little pouches that are part of the pharyngeal apparatus * Pharyngeal apparatus comes from primitive pharynx «© Endoderm and splanchnic layers ofthe lateral plate Larynx ‘© Endoderm * Coming from a structure called 4% and 6% haryngeal pouc! += Gives rise tothe gpithetia ining ofthe larynx © Mesodorm * Coming from a structure called 4 and mesoderm part of pharyngeal arches Trachea © Endoderm * Coming from the foregut (buds off the foregut) © Mesoderm * Lateral plate mesoderm splanchnic layer of the lateral plate mesoderm Lungs © Endoderm + Foregut © Mesoderm * Lateral plate mesoderm (splanchnic layer ofthe lateral plate mesoderm) ‘© We have to make the larynx fist + then trachea —> and then the lungs Table 2, Respatoy system and the origin Respiratory -_ ‘System La 4” and 6 pharyngeal Endoderm | pouches ey vated 4 and 6” mesoderm Mesoderm | part of pharyngeal arches Endoderm | Foregut Trachea ‘Splanchnic layer ofthe Mesoderm | jateral plate mesoderm Endoderm | Foregut Lungs [ wesoderm | Splanchnic layer ofthe lateral plate mesoderm Zar EMBRYOLOGY. Note FIa ENDODERM PHARYNGEAL POUCHES: MESODERM ‘MUSCLE, CT, CARTILAGE ECTODERM PHARYNGEAL CLEFTS weer 5 ‘UuaRynaeat oririce ‘Svoca corns: Figure 4.Pharyngeal apparatus ‘¢ We have foregut, midgut hindgut, pharyngeal apparatus ‘¢Le’s take alitle section, take a look at the layer of pharyngeal apparatus © Buccopharyngeal membrane — become mouth « Inner portion -» endoderm (pert of pharyngeal pouches) * Makes the epithelium and the glands of the larynx «© Next layer is mesoderm (part of pharyngeal arch) + Makes muscle, connective tissue, cartilage + We have 1% 2" "and 6” pharyngeal arches, ‘Sometimes 5” pharyngeal arch elther ‘develops or digresses or doesn't develop at all © Eetoderm (part of pharyngeal clefts) ‘* Portion ofthe pharyngeal apparatus that is actualy ‘making the larynx —- 4 and 6% pharyngeal arch (1) Wook 5 '* Develop a tie cavity — laryngeal orifice ‘* Within the orifice, some of the endodermal tissue within pharyngeal pouches start invading ito the laryngeal orifice © It makes vocal cord (2) Week 6 ‘¢ Mesoderm starts forming cartilage, muscles that are surrounding the portion of the larynx ‘Sart developing swollings around the orifice ‘© One of the swellings develop on the top of the laryngeal orifice -> epiglottic swelling Below develops another swelling —-arytonold swelling ‘* Overtime the mesoderm continues to make more cartilage ‘© Endoderm continues invade to laryngeal orice © Help pharyngeal pouches to make a nice litle epithelia lining of larynx DEVELOPMENT OF THE RESPIRATORY SYSTEM 1G)(3) Wook werk 6 CSweLunes ARouNo once Bh Kenstorric swetun ‘reo swell lo ermoveem EPITHELUM OF LARYNOC Crcce vocal coeds MESOERM. TARY NGEAL CARTILAGE. ve Ye vyous tangent msetes weeei2 (Comaune Lanynx Counce —+ LaRyNgeaL wi Figure 5. Week 6 12 develooments of mature larynx ‘© We want to make mature larynx ‘© Along the way, we develop some things © Endoderm give way tothe epithelium lining ofthe tary F ified ciliated columnar epithelia ‘issue + Vocal cords + Laryngeal orifice becomes laryngeal inlet © Masodecm * Laryngeal cartilage > thyroid, cricoid, arytenoid cartilage, cu cartilage * Laryngeal muscles —+ crlcoarytonoids, ericothyroid muscles + Nerve that supplies down the larynx muscles (vagus nerve) em cartilage, corniculate ‘Also derived from the 4" and 6 pharyngeal ‘arches, supplying the laryngeal muscles Table 3. Week 5 derived structures of lary Layers Derivative Structures: ‘Laryngeal cartilage — thyroid ‘rigold, arytenoid cartiage uneiform cartilage, ‘somiculate carfiage Mesoderm — | « Laryngeal muscles — cticoarytenoids, cricothyrold muscies ‘¢ Nerve that supplies down the larynx muscles (vagus nerve) Epithelial lining ofthe larynx +» Pseudostraified ciated columnar epithelial tissue Endoderm | « Vocal cords ‘Laryngeal orice becomes laryngeal in (4) Week 12. ‘© Now we have mature larynx © Laryngeal orifice ~- laryngeal inlot © Epigiottic folds © Cartiage made from the mesoderm ‘© Muscle from the cricoarylenoid,cricothyroid © Vagus nerve supplying muscles —» penetrate through here and give sensory information to the actual laryngeal epithelium © [RRR OPTERON OTE Se aie, = f ‘own sun smescnca ef pei oe UT sce ie yn. NG Figure 6. Formation of lung bud trom foregut '* We have @ nice good old sagittal section ‘© We have foregut, midgut, hindgut. pharyngeal apparatus ‘¢ Take a portion of the foregut ‘Side and front view ‘© What is happening? + Foregutis helping us to develop our trachea and tung (1) Weok 5 wes OANT Chune, ‘uD oposT ESOPHAGUS (© evonene — eprrieulum LANs ° moun ac aneln CARTILAGE Figure 7. Lung development during week § ‘# Some of the endodermal cells start coming out ang budding off of the foregut — lung bud (From the side view) ‘Frontal view or anterior view + Some of the endodermal cells come out into the ‘bud and create a long bud + Itcreates a litle groove that goes into the anterior lung bud -~- tracheoesophageal groovelridge ‘© Which structure that is wrapping around the gut tube? Mesoderm ‘© Which part of mesoderm? * Splanchnic layer of the lateral plate mesoderm —» ceartlage, connective issue and muscle ‘¢ Endoderm become epithelial lining ofthe tracheal lung ‘* Lung bud creates bifurcation — bronchial bud EMBRYOLOGY. Note FIA+ Tracheoesophageal groovesiridges come together and ‘meet inthe migcle ©. They form rge title septum between the anterior lung bud and posterior foregut (which becomes esophagus) ~ tracheoesophageal septum + theps us to separate the foregut right fom the {erminal bronchioles ToT EMBRYOLOGY. Note FIa (3) Canalicular stage o euMuEYAR STAGE (unas) namonaty caraises a Figure 9. Canaiicular stage ‘# Continues at week 16 to about week 26 ‘# We take our terminal bronchial ‘© Terminal bronchial will make neck structures called respiratory bronchial ‘¢ Respiratory bronchial breaks off into smaller things called alveolar ducts (3-6 alveolar ducts each respiratory bronchial) ‘© They feed into primitive alveoti © They're made up of cuboidal colls * Not good for gas exchange because too thick ‘0 They're not very good at their job yet ‘+ Some pulmonary capillaries start kind of growing here around the primitive alveoli '# Zoom into the primitive alveott © I's very immature, i's only cuboidal cells — immature primitive alveoli that are formed at the end of canalicular stage ‘© Cuboidal cells are not goad at gas exchange * | activity for gas exchange process «© Next stage is to make some of them smaller * So that they'll be easier for that gas exchange process to occur nerve wy cat SS ont ee 26TH of ormvenu [oFaeconenaee Figure 10. Saccular stage ‘¢ Happens around week 26 — birth ‘#1 the number of alveol, t numbers of respiratory bronchioles. ‘* Basement membrane forms around the primitive lveot (© Consists of four structures onset 2017 * Alveolar wall ‘Type | and typeI! alveolar cells «Associated alveolar macrophages (dust calls) + Epithelial basement membrane * Capillary basement membrane * Capillary endothelium ‘¢ | pumber of pulmonary capillaries ‘© Alveol is starting to be more mature © All cuboidal — 2 diferent types of cells + Flat cells — Type | pneumocytes ‘= Gas exchange occurs 1+ 0; moves occurs across the cell, COs move ‘across the call DEVELOPMENT OF THE RESPIRATORY SYSTEM 1G)* Cuboidal cells Type Il pneumocytes (more specialized) ‘Make a kind of protein and lipid complex that coals the inner surface of the alveolar membrane —> surfactant + Surfactant prevents alveoli from collapsing. keeps them open, reducing surface tension + Alveoti naturally wants to collapse «I's realy hard for the baby to bringin air because it has to pop open, already collapsed avo 5) Alveolar stage t arta Sys 100, 300 mason ition test sera | fo hveoun sage Ce 36-8 YES OF AGE orypel+ tyre 2 of# or aveou ofeernary [SURFACE AREA MATURATION CO BASEMENT MENERANE CO PUMONARY CAPILLARIES Figure 11. Alveolar stage «¢ Generally this starts around week 36 (occurs around the ‘same time as saccular stage) °c But extend very far past birth —» 8 years of age ‘© Type | + Type I! alveolar celts © | number of alveoli © Form a Septum (or partion) within the alveoli —+ to Incroaso the surfaco aroa ‘Contributes to maturation process ‘Thickening of basement membrane ‘¢ | number of pulmonary capilaries ‘© Around birth start off with approximately close to 100 rion of alveoli — Increase the numberof alveoli to ‘about 300 milion at year of ‘OAMMOTIC FLUID ‘ABSORBED suse crane LayeR nan PM guerncranr inns. o terone ear OBREATHES AMMoTI ay Lungs + muscues Wonk Teaetie Figure 12. Baby breathing process SQ RATT OTERO “0 irth pros «© Birth does have a lite bit of fetal breathing movement ‘+ Purpose to allow forthe lung and the musole of the respiratory system fo kind of work one another + Baby breathes in amniotic fuid ‘Amniotic fuidffom the amnion will actually come Into baby's alveoli and cover al ofthe area of alveoli ‘Allow the lung and muscle to work together —» strengthen baby's lung “= Bringing in ar from the first ery (i) Atthe time of birth, ‘¢ amniotic fui gets sucked up into the pulmonary capillary © Surfactant helps fo reduce surface tension and keep those alveoli open o ifthe baby is born premature (e.g., week 26, 27). baby doesn't have time to really produce surfactant * Surfactant decrease, surface tension incro ‘collapsing pressure increase (ii) When the baby is born, ‘ take in its fist breath —> push the amniotic fui to pulmonary capillary — leave a layer of suractant, layer of surfactant is thin «© Because of that, alveolar collapse ‘© Whenever it tries to breath, it has to take in so much mote air to open the closed alveol © This is called infant respiratory distross syndrome * {J surfactant production © Baby takes airin -» amniotic Mud gets absorbed surfactant layer remains “This helps to reduce surface tension to allow the baby to breathe and take in air without a lt of Figure 13. Infant respiratory des syPEM ewe 4 | # Prematurely bom babies (< 34" week fg, 31° week) aren abe fo produce enough surfactant infant rospiratory distress syndrome (RDS) / neonatal respiratory distress syndrome ‘> Hard for baby to expand the alveoli due tot surface tension * Collapsing of the alveol creates unequal alveoli + Have o put the baby on a mechanical ventilator 0 push airinto the baby ‘© When the baby is form and the umbilical cords cut > | O2 level inside baby 6 This triggers hypoxia + activats respiratory centers inside baby ~ Activates some of the muscle — contraction to bring ‘ait in baby's first ery * But, when the baby has IRDS, they cant bring the air in due to alveol don't want to open + Takes so much energy and work to open the alveoli ~» hard time for breathing © Baby go into disttess and need tobe put on f EMBRYOLOGY. Note FIATable 4. Summary of un development stages — i oreeenarenaaaT aa i eniral ameanng eae jana oe fe cea game ‘Week 5 tracheoesophageal groovelridge (© ENDODERM — EPITHELIUM: ‘septum aiee spree uses Diack eee omen eae owR S lobar bronchi ee ru oe etasegiagt ove | «Second bone ea cae omen | ran (Week 5) ,R: 3 LOBAR (2°) BRONCH © 20 tertiary bronchi on the right edtegaijeony |< Zaimioy oreo ca E 0 #:20(sr)eronen «Tertiary bronchi feed into even smaller CRG mens bronchi — terminal bronchioles Fale ae i ied ed tease) fn J octiegaesryce 2 They eed into primitive seo! an eeaa © They're mace up of eubotdal cells = + Not good for gas exchange - testers Canaticulsr stage Es (0 eure aves ‘¢ Some pulmonary capillaries growin aan a 7 core elrnan pie rong | cotties | seespeeecess Bo ee — ‘peruse eve crecemeat,, | RRC et cute a a — rea | Hsia needa cae ves Inorease the number of alveoli to about (OeAsE ENT MEMORANE 300 milion at year of ‘Orumonany caPLaties 8) Which stage that involves the development two types of pneumocytes? ‘a, Pseudo-clandular stage ». Canalicular stage ©. Saccular stage 1) Where does epiblast colls move through in order to form mesaderm and endoderm layers? Siena 4. Aveolr stage @ Yolesoc 9) What's the function of soptum within the alveott that's formed during alveolar stage? ‘a, Decrease surface area ofthe alveoli Increase surface area of he alveoli 2) Which parts doos the splanchnic layor of latoral : . Decrease volume ofthe alveoli 4 plate mesoderm give rise to? tee Becese he net ote sent mentrane © Cues ae 6 tape 10) wen conten at eer in roma baby warty ean produce enough surat? 2) Wher dons the andodom ot ann ome tam? *"preumon a" repre pues ony ob bs ars Sepagen poites ©. herepiy dass saree osname pate aye aces &: antennae: ree ‘ eae (cE YOUR ANSWERS) 4 Which structure tht buccopharyngeal membrane —Ea ae] ‘ves rise to? > Sader TW. Langman Weseal Emeryclogy. Pade a. Mouth \oters Kluwer 2099. b. Larynx is LeT et Aid forthe USHLE Step $2020, 30% arvereary a ceehe cedon: MeGraw tt 2020, * Mare EN, Hoenn K Anatomy & Physiology Hoboken, Ni . Trachea Pearson 2020, ‘aaron WF, oulpaep EL, Medial Phyilegy: 2017 1 oor, K. Persaud. Torena, (2016). The Deveoring '5) Which structure that laryngeal orifice gives rise to? Haman: Cinealy Onertd Embryology. Phinda: Ele @. Lungs ‘Tonera G1, Demcison Behn Viley& Sens (207). b. Trashet Prnoles of anaiomy & pyeisgy. ae Case coutesy of DF lefeny Jones, <2 ©. Vocal cord eres asked erg">Radepacda og From the case 4. Nose 6) Vagus nerve that supplies the larynx muscle derived from which structure? {2 and 5" phanmgeal arches 4 and 6" phanngeal arches, 5° pharyngeal ach only 4 pharyngeal arch ony 7) Which stage that involves the development of primary bronchi to lobar bronchi? ‘a. Pseudo-glandular stage . Canalicular stage c. Saccular stage 4. Alveolar stage © [RRR OPTERON OTE THERTOLOGT NOT> \ EMBRYOLOGY Last edited: 8/5/2021 Medical Editor: Jan ile |) TRILAMINAR DISC Il) EMBRYONIC FOLDING “thpevew cuesroNs | IV) REFRENCES ‘Ai the 3° week of development, the embryo is @ ‘vlaminar dise ‘Made up ectoderm, mesoderm, and endoderm + Underneath the surface ectoderm fs the neural ube and «Flanking the notochord is the inaembryonic mesoderm, which can be divides into °c Paraxil mesoderm 6 Intermediate mesoderm 6 Lateral plate mesoderm * Somatic layer + Spanchnie layer + Underneath the mesoderm isthe endoderm, which forms the epihefal ring ofthe gastrointestinal organs, ccessary organs. and glands + Above the ectoderm i the amniotic sac «Below the endoderm is the yolk se, which helps inthe sythesis of ed blood cels © The yolk sac also secretes the extraembryonic mesoderm, which surtourds the yok sac and amniotic cavity ‘©The somatic and splanchnic mesoderm develop a cavity called the intraembryonic coetom, which allows the two ‘mesoderm layers to become continuous with the ‘extraembryonic mesoderm ‘© Eventually, the embryo wil fold along the transverse and sagittal plane Figure 1. Tilaminar Disc @ lamers SAGITTAL PLANE CLOACAL ‘OROPHARYNGEAL MEMBRANE MEMBRANE UMBILICAL CORD Figure 2, Sagital Plane of Embryo ‘¢ The sagittal view shows the cranial and caudal ends of the gut tube ‘¢ During the 4" week of development, folding along the sagittal plane wil form the cranial and caudal folds © The endoderm lining will expand outwards and fold ‘# The gut tube can be divided into three parts: ‘© Cranial ~ foregut © Middle — midgut ‘© Caudal -hindgut ‘# Mesoderm surrounds the gut tube ‘© Mesoderm cells atthe eranial end will help form the Pericardiac cavity and the heart ‘¢ Neural crest cells from the ectoderm layer wil develop into important ganglia for the GIT (e.g, myenteric plexus) ‘¢ The yok sac is connected to the midgut ia the viteline/omphalomesenteric duct ‘¢ The two openings ofthe digestive tract are derived from areas of fusion between the ectoderm and endoderm (of ‘the gut tube) © The oropharyngeal membrane (foregut) will perforate to form the mouth © The cloacal membrane (hindgut) will perforate to form the urogenital tract and anus ‘# By the 6” week of development, the vieline duct will, obliterate, leaving the umbilical cord ‘© Meckel's Diverticulum ‘An outpouching ofthe smal intestine ‘+ Results from the fallue ofthe vitelline duct to ‘obliterate, leaving behind a connection between the midgut and the anterior abdominal wall ‘# Aiso during the 6 week, the small intestines will form a loop and herniate through the umbilical cord © The developing organs within the abdominal cavity push out the small intestines ‘¢ During the 11 week, the abdominal cavity has increased in size, so the intestinal lop is pulled back in ‘© Omphalocele ‘= Results from the failure ofthe intestinal loop to return inside the atdominal cavity ‘Can be detected through fetal ultrasound or serum alpha fetoprotein levels of the mother, EMBRYOLOGY. Noe #7TRANSVERSE PLANE NE Figure 8. Transverse Plane of Embryo ‘+ The transverse plane shows a cross-section of the embryo ‘+ The endoderm will fold outwards and downwards. wll {get sucked in and pushed out, forming the vieline duct, ‘+ The amniotic cavity starts folding down ‘+ The splanchnic mesoderm will surround the viteline duct and yolk sac ‘+ The somatic mesoderm wil ine the inner walls of the ‘armiatic cavity ‘+ Once the vteline duct obliterates, the two endoderm folds can merge, forming a closed gut tube © Gastroschisis * The lateral folds fail to fuse, resulting in the herniation of abdominal contents * The herniated intestines are not covered in peritoneum, which could irate the abdominal cavity 1) Intraperitoneal Organs ‘©The splanchnic mesoderm will surround the gut tube forming 2 part of the Gi tract (submucosa up to visceral peritoneum) ‘© The somatic mesoderm wil ine the inner walls of the abdominal cavity (parietal peritoneum) «The visceral and parietal peritoneum connectimeet at the ‘mesenteries, aligament which connects ‘organs/structures to the abdominal wall and provides mobilty ‘© Ary organ with a mesentery is considered intraperitoneal ‘© Examples: ‘© Stomach Liver © Spleen Transverse colon 8 MESENTERY rea PERITONEAL ORGAN pawera nos viscene Siero cavrry Fe 4. hritperionea Org Ta EMBRYOLOGY. Note FIZ. (2) Rotroporitonoal Organs ‘# Retroperitoneal organs have no mesentery and are located outside the peritoneum ‘ Instead of visceraliparietal serosa, they have adventitia Dense, ireguiar fibrous connective tissue that anchors retroperitoneal organs to the abdominal wall «© Does not provide mobility © Examples: Kidneys, © Adrenal glands © Parts of the duodenum (i) Primary Retroperitoneal Organs + Organs which never had a mesentery ‘Located posterior tothe peritoneum + Examples: Abdominal aorta © Inferior vena cava Adrenal glands © Kidneys © Ureter o Bladder Lower rectum © Esophagus (i) Secondary Retroperitoneal Organs ‘Organs with mesenteries that were obliterated + Examples: © 2%, 3°, and 4 parts ofthe duodenum ® Ascending colon © Descending colon © Head and body ofthe pancreas —RETRO-PERITAL __ ‘ORGANS G 1 lig 2") ABDOMAL AORTA 23,4 tron veincava | PARFSOF movenuee soeena cuains scaietacoton yale vey bescenoacotow 2 en .800y oF pvcneas ance L tower secru Figure 6. Retroperitoneal Organs Development of the GIT1) Meckel’s diverticulum results from _ 2) Failure of the endodermal folds to use ») Failure ofthe viteline duct to form ©) Failure ofthe viteline duct to regress 4) Failure ofthe intestinal loop to return inside the ‘abdominal cavity 2) Which structure secrotes the extraembryonic ‘mesoderm? 2) Yolk sac ) Amniotic sac {) Notochors 4) Intraembryonic coelom 3) All ofthe following structures aro intraperitoneal, EXCEPT 2) Stomach ») Jejunum ©) Transverse Colon ) Ascending Colon 4) Which of the following statements is TRUE? ‘2) Omphalocele results from the failure ofthe lateral endodermal folds to fuse ') The livers a retroperitoneal organ ©) The yolk sac is connected tothe hindgut via the vitelline duct. 4) Retroperitoneal organs are covered with adventitia '5) Which of the following is NOT a primary retroperitoneal organ? a) Adrenal gland b) Pancreas ©) Bladder ) Lower Rectum cystic artery © Gastroduodenal artery > superior pancreatic ‘duodenal artery Table 1. Vascular Supply and Mesentery of Foregut Derivatives Fe rT fovea vascular Supey or a Left geste Greater omentum en Lesser omentum Speen | Lak gst ‘Gastospleni igament ‘Common hepai ‘© Lesser omentum Liver © Hepatogastic © Hepatoduodenal 0 Faleiform Galbiadder | Cystiea ‘Same as above Gastroduodenal a. | Tail spienorenal ligament Pancreas ¢ Head & Body — retroperitoneal; no mesentery Proximal half | Gastroduodenal a. | Hepatoduodenal ff duodenum ligament Dore EMBRYOLOGY. Note FIs ‘This section vill enumerate the midgut derivatives and their corresponding vascular supply and mesentery. ‘¢ The main vascular supply of the midgut derivatives is the Superior mesenteric artery , which further branches into: «Intestinal arteries 6 lleo-colie artery © Right colic artery © Middle colic artery Table 2 Vascular Supply and Mesentery of Midgut Derivatives Midgut_ | Vascular Derivative | Supply barat Distal halfof | intestinal a. | Retropertoneal: no Duodenum mesentery intestinal | 6 sau bowel mesentery ieee «Ligament of Treite — suspends the fourth partof the suodenum = intestinal | sma povel mesentery Distal leum | leo-cole a {atthe eo cecal junction Tleo-coic 8 | Sma bowel mn mesentery: can be (ore revvopertoneal in Aopendx | lleo-colca | wesoappendix Ascending | Rightcolica. | Retroperitoneal; no colon mesentery Proximal 2/3 | Middle calle ofthe Transverse Transverse mesocolon colon ‘* This section ill enumerate the hindgut derivatives and their coresponding vascular supply and mesentery. ‘¢ The main vascular supply ofthe hindgut derivatives is the Inferior mesenteric artery, which further branches into: Left colic artery © Sigmoidal arteries 1 Superior rectal arteries Table 3. Vascular Supply and Mesentery of Hindgut Derivatives Hindgut Vascular a Derivative ‘Supply ad Distal 173 of | Left colic a 1 Srrenevereal ranaverse Colon ‘mesocolon Descending | Left colic a Retroperitoneal; no colon mesentery ‘Sigmoid | Sigmoidal eae Sana ‘Sigmoid mesocolon Upper ‘Superior rectal rectum artery (above the No mesentery pectinate line) Developmen & Embryarogy ofthe GI Tract a 1S“SUPERIOR mesenTenic ‘aereRy, inresion cere Figure 4. Summary of Vascular Supply and Mesentenes °& [osama eer TRS OTTNGTE EMBRYOLOGY. Noe #7 1) The following is derived from the ventral ‘mesogastrium, EXCEPT? a) Liver ) Hepatogastric ligament ) Hepatoduodenal ligament 8) Spleen 2) What is the mesenterylligament supporting the Jejunum? ') Hepatoduodenal igament Small bowel mesentery ©) Transverse mesocolon 4) It isnot supported by a mesentery 3) What vessol supplies the proximal transverse colon? 2) lleo-colic artery ) Right colic artery ©) Middle colic artery @) Left colic arteryEMBRYOLOGY Da eS Last edited: 9/18/2021 Embryology | Development of Fetal Circulation ee) | ) OVERVIEW i) BEFORE BIRTH | Ill) AFTER BIRTH | {V) PECULIARITIES OF FETAL CIRCULATION | | V) CHANGES FROM FETUS TO ADULT | Vi) ANOMALIES | | viy suMMaRy | | vu APPENDIX | | [%) REVIEW QUESTIONS: LX) REFERENCES ‘The circulation in fetuses is slightly diferent compared to that seen in adults = This is because lungs are non-functional and hence ‘blood needs to be directed to other parts ‘Placenta isthe organ responsible for gas exchange « Various remnants are present in adults, which represent {otal structures of he fetal circulation ‘ In utero, that is before birth, the lungs are stil developing —+Hence, they are non-functional As a result, there is |O2 concentration within alveoli —+Called Hypoxia (1) Consequence of Hypoxi ‘© Due to hypoxia inthe lungs, the pulmonary vasculature ‘undergoes vasoconstriction ee! REMEMBER Effect of Hypoxia on. (i) Systemic Vessels- Vasodilation (ii) Pulmonary Vessels- Vasoconstriction 2) Reason for Vasoconstriction in Hypoxia ‘© The pulmonary capillaries near hypoxic alveol undergo ‘vasoconstriction — This pushes blood AWAY from the hypoxic alveoli = It helps in shunting blood TOWARDS other well ventilated alveoli ‘© By this, alveoli wth more O: concentration will receive better blood supply fr effective ventitation 3) Hypoxic Vasoconstriction in Fetus (i) Condition in Fetus + Pulmonary circult vasoconstriction normally occurs ‘around hypoxic alveoi! + In Fetus- all alveoli have 10, concentration * This results in intense vasoconstriction throughout the pulmonary circulation © RRO OH ORTATN Medical Editor: Sohani Kashi Puranic ) Consequence “As the whole pulmonary crcut undergoes vasoconstriction, Pulmonary Artery pressure = Pressure in pulmonary circulation + © Because ofthis, Right side of heart (right Atrium & ventricle) needs to generate high ‘pressure to pump blood into the high- pressure pulmonary circuit —+ This causes a difference in pressures across the two sides of the heart: Pressures in heart Right side > Left side Ime aA (CN) wom r eo *tHvasotonerneriott Treearany eset TTRIGHT sive pressure] rm \ oon ree Figure 7 Fypoxe Vasoconstriction > ae (1) Pla '* Plays a role in exchange of ga ‘¢ The placenta is connected withthe fetus through Umbilical cord Exchange of gases, + Occurs by simple difusion + Ox delivery to fetus is by placental blood flow Exchange of nutrients & electrolytes * Occurs rapidly + Increases as pregnancy advances ) Transmission of maternal antibodies *lgG + Provides PASSIVE IMMUNITY to fetus Hormone production + Progesterone + Estriol "hCG (human Chorionic Gonadotropin) + Somatomammatropin/ hPL (human Placental Lactogen) \v) Protection + Protects fetus from damaging agents + However, many drugs & viruses pass through placenta easily =» CMV, Rubella, Variola, Measles, Polio et. EMBRYOLOGY. Noe #7(3) Umbilie toe (i) Ductus Venosus PLACENTA + itis a structure that shunts blood from (Let) \ Umbilcal Vein DIRECTLY into IVC ‘Removes CO2 -PRovine 02 ‘Sot Mecano Buaius Venass 1 Regulates biood fow om Umbilical Vein * During uterine contraction: = The sphincer closes | This preven 1 of Venous Return | | eee | ! heart (i) Components ) Hepatic Sinusoids (2) Blood Vessels “ Umbilical vein also drains into the sinusoids of the aoe liver () 2Umbilical Arteries “These drain into the Hepatic portion of IVC 1 Umbilical Vein (left) — Hepatic portion of IVC is derived from Right “= Carries Oxygenated biood Meta ven + 85% Oz SATURATION. (4) Right Atrium of Hoart (b) Wharton's Jelly ‘© Mucopolysaccharide ‘Rich in proteoglycans. + Provides insulation + Protects the blood vessels, Figure 3. Structure of Umbical Cord Figure 5. Openings in Right Atrium (c) Remnant of vitelline duct Gi (2) IVC (inferior Vena Cava) + Receives blood from (i) Ductus Venosus (ii) Liver sinusoids + Drain into Right Aum (b) SVC (Superior Vena Cava) ‘+ Receives blood from head, neck & upper extremities (0 Te Drama ne Right Aum oe *Detwed tom igh Common Cra! Vln airmataly pours ie (ii) Pathways from Right Atrium sovvplaanda Io + Blood from the right aium can got the folowing IVC (Inferior Vena structures: os (Left rium pathways for the (b) Right Ventricle Be toca nwne Figure 4. Umbical Vein & Duetus Venosus Ta SETS TAT DETERRENT OF ETAT GROTTO GY*© ‘¢ 70% of the biood from Right Atrium goes to Left Atrium. f¢ The connection between the Right & Left atria is Foramen Ovale Atrium of Heart (i) Eoramen Ovale + After the formation of Septum secundum, it doesn't completely join the Septum intermecium — There isa gap atthe distal end of the Septum ‘secundum + The gap communicates withthe remaining lap of Septum primum + This communication is called Foramen Ovalo RA LA Figure 6. Foramen Ovale (6) Right Vontricio of He The remaining 30% of blood from Right Atrium flows into Right Ventricle Wii many of Bide ows nto Left A Blood flows from igh Pressure to Low Pressure (i) Right side of heart: HIGH pressure * Due to hypoxic vasoconstriction (li) Leftside of heart: LOW pressure + Relatively lower than right side HENCE, MAJORITY OF BLOOD FROM Richt ATRIUM (HIGH PRESSURE) FLOWS INTO LEFT ATRIUM (Low PREssuRe), & NOT RIGHT VENTRICLE. (7) Pathway from Left Atrium ‘Blood from right atrium passes through Foramen Ovale to ‘each the left atrium, From there, it goes to different structures, inthe following order: (i) Left Ventricle (il) Ascending Aorta, Arch of Aorta (ii) Descending Aorta (iv) Common tliac Artery (v) Internal iliac Arter (vi) Umbilical Artery * Carries Oxygenated blood mixed with Deoxygenated blood * 58% Oz SATURATION “QQ [DR LORTENTOF FETA OROULATION Figure 7. Formation of Umbilical Arteries vil) Placenta ‘Blood from Umbilical arteries drain into placenta, where COsis given out + O;is taken up in the placenta, and oxygenated blood is delivered to fetus via Umbilical vein (8) Pathway from Right Ventricio ‘Blood to right ventricle |. Majority of O20xy genated blood from SVC li, 30% of Oxygenated blood from IVC ‘© Biood from right ventricle is pumped into Pulmonary Trunk ‘¢ From pulmonary trunk, it follows 2 pathways: ) Ductus Arteriosus “It isa structure that connects Pulmonary Artery to Aorta + More specifically, it connects Left Pulmonary ‘tery (near its origin) to the Descending Aorta anna ie asst) ‘It shunts the deoxygenated blood + AWAY from pulmonary circulation = TOWARDS Aorta "Figure 8. Ductus arteriosus i) Pulmonary Arteries + {41 blood flows through Right & Left Pulmonary arteries + This blood reaches the developing lung Blood flows from High Pressure to Low Pressure Pulmonary Artery: HIGH pressure * Due to hypoxic vasoconstriction Aorta: LOW pressure + Relatively lower pressure inlet side of heart & aorta HENCE, MAJORITY OF BLOOD FROM PULMONARY ARTERY (HIGH PRESSURE) FLOWS INTO AORTA (Low PRESSURE), EMBRYOLOGY. Nowe #7Structures that shunt blood AWAY from Pulmonary Circulation: Foramen Ovale Ductus Arteriosus (1) Umbilical Gord is cut ‘¢ Connection between Placenta & Fetus is broken = Blood supply to fetus via Umbilical vein terminated = Drainage from fetus via Umbilical arteries terminated Figure 8. Umbieal Cordis cut ater bith 2) Lungs (i) Baby cries right after birth + Allows for air to flush into lung * Os foods into alveoli “+ 02 concentration in alveolt -+NO hypoxic vasoconstriction (ii) Consequence of no vasoconstriction —+Pulmonary Artery pressure | —+Pressure in pulmonary circulation | © Because of this, pressure on Right side of heart (right Atrium & ventricle) | OPPOSITE pressure gradient to that seen before bith —+ This causes a difference in pressures across the two sides of the heart re Pressures in heart Left side > Right side esas reer EET Fore EMBRYOLOGY: Note #17, = Ullvasocoustmcrio4 LL LUpuotasy reste ene omen, < pattie Figure 10. No hypaxie vasoconstriction (1) Closure of Foramen Ovale boi reese “¢ Pressure in left side of heart 7 = Pressure in Left Atrium 1 This causes the flap of Septum primum to ‘approximate with Septum secundum ‘¢ This is called the FUNCTIONAL closure of Foramen Ovale —+ This occurs immediately after bith ‘© Anatomical closure occurs by fusion of Septum ‘secundum & Septum primum + Remnant of (septum primum) is called Fossa Ovalis: FORAMEN OVALE ite u ( as tose | Oost, Figure 11. Fossa Ovals es REMEMBER Closure of Foramen Ovale: Functional: Immediately after birth (ii) Anatomical. 1 year after birth Figure 12. Pulmonary Circulation DETERRENT OF ETAT GROTTO GY*‘There is now f blood flow through the pulmonary circuit, (i) Pulmonary Arteries * Carry deoxygenated blood from right ventricle to lungs: (ii) Pulmonary Capillaries + Supply alveoli which are now wellventiated + Exchange of gases occurs at alveoli (ii) Pulmonary Veins * Carry oxygenated blood from lungs to left atrium (2) Closure of Ductus Artoriosus Figure 13, Closure of Ductus Ateriosus ‘© Ductus Arteriosus closes dve to: (i) Qa (i) PGE One Tce ‘¢ Hypoxia and PGEzkeep Ductus Arteriosus patent & ‘open before birth Bradykinin ‘After bith, the DA remains open for 2 very shor period of time before it closes tone ie RK. ont PROSTAGLANDIN ‘Beanynnst Figure 14. Factors affecting patency of DA (1) Pulmonary Circulation ‘© With air entering alveoli, and production of surfactant, the lungs are now functional ‘© Gas exchange occurs at alveoli where: = C02is expelled out ~+O2is taken up * This means blood is oxygenated ‘* Pathway for oxygenated blood ) Pulmonary Veins (i) Left Ateium (2) Loft Side of Heart ) Left Atrium ) Left Ventricle (ii) Aorta (3) Systemic Circulation ‘* Oxygenated blood is supplied to diferent organs via the ‘Aarla and its branches ‘eAtthe tissues, + 02s taken up by cells for metabolic activities + COzis released into blood as a by-product of metabolism ‘= This means blood is deoxygenated ‘© Pathway for deoxy genated blood: ) Blood from lower extremities: lilac Veins -> IVC ) Blood from head, neck, upper extremities: SVC (4) Right Sido of Heart ) IVC, SVC > Right Atrium i) Right Ventricle (ii) Pulmonary Trunk Ductus Arteriosus is closed. Before Closure, fora very short period, ‘blood is shunted to Aorta, (8) Pulmonary Circulation ) Pulmonary Trunk i) Pulmonary Arteries (ii) Pulmonary Capillaries = Gas exchange occurs al alveoli, where the ‘dooxygonatod blood is oxygenated Blo. shuntod along its course at 3 points: ) Ductus Venosus += To direct blood to IVC by bypassing liver, without losing O; content ) Foramen Ovale + To equalize distribution to each half of heart, and ‘more oxygenated blood to upper half vital organs ) Ductus Arteriosus + To direct blood to placenta for oxygenation by bypassing lungs 6501 “@ [oRELORVENT OF FETAL GRCULATION T ENBRTOLOGY Noe wt tamaaanDT S018During its course from placenta to the organs ofthe fetus, blood in the Umbilical vain gradually oses its high oxygen ‘content as it mixes with deoxygenated blOOd. jane Places where mixing occurs: Table 1. Stes of mung of Oxygenated & Deon raed oad oxygenated cae Blood Blood oa ee wi we Umbiical Lower we vin extomitos wo) sient) Umbiteat = Aion | veimblood +], Ueper ‘rom ive From Right (ete ‘trim com | trough || From Lungs Foramen vale (0) Ductus : Pulmonary Ateriosus | 4% “Trunk ‘© IVC cartes the most oxygenated blood in fetus ‘¢ More oxygonatod blood is delivered to Upper Limbs —+ Hence in fetus, longth of Upper limbs > Lower Limbs Table 2. Postnatal occlusion of vessels/ structures & their remmants ‘Structure Remnant Left Umbilical Vein___[ Ligamentum Teres Hepatis Umbilical Arteries 1. Proximal part |. Superior Vesical Artery 4, Distal part li, Medial Umbilical Ligament Ductus Venosus Ligamentum Venosum Ductus Artenosus Ligamentum Arteriosum Foramen Ovale Fossa Ovalis a REMEMBER Remnant of: (i) Umbilicat Arteries- Media Umbilical Ligaments (ii) Allantois (Urachus)- Median Umbilical Ligament Da Sore EMBRYOLOGY: Note #17, '¢ Foramen Ovale doesn't close Figure 15, Patent Foramen Ovale Irayoancora ‘# Ductus Arteriosus doesn't close Figure 16, Patent Ducts Arterosus neers ‘* Ligamentum teres hepatis recanalizes DETERRENT OF ETAT GROTTO GY*FETAL CIRCULTION BEFORE: {FETAL CIRCULATION AFTER BRTH wR ori Ok’ WNIJANIERD Figure 17. Development of Fetal Culation Figure 18. Fetal Circulation & Transition o Post-natal Cculation Inet i “QQ [DR LORTENTOF FETA OROULATION ERERYOLOGY Nate1) Which is NOT essential for maintenance of fetal circulation? 2) Foramen ovale ») Ductus arteriosus ©) Renal veins 4) Inferior Venta Cava 2) Which structure carries the most oxygenated blood In fetus? 8) Umbilical vein ») Renal vein ©) Inferior vena cava ) Umbilical artery 3) What is the romnant of umbilical arteries? 2) Ligamentum arteriosum ») Superior vesical artery ©) Ligamentum teres hepatis 4) Ligamentum venosum 4) What is tho concentration of oxygon in Umbilical ‘Artery? a) 15% b) 28% ©) 58% 0) 85% 5) Ductus arteriosus connects pulmonary artery to ‘which of the following? 2) Pulmonary vein ») Foramen ovale ©) Subetavian artery ) Aorta 6) Before birth, blood is shunted: 2) Away from pulmonary circulation ») Towards pulmonary circulation (o}No shunts present 4) Both a & b, according to respiration 7) What Is tho remnant of urachus? ‘2) Medial umbilical ligament ») Lateral umbilical igament ©) Median umbilical ligament 4) Ligamentum teres, £8) Ductus arteriosus is sonsitive to all EXCEPT: 2) Prostaglandins ») Leukotrienes .) Oxygen 4) Bradykinin Bore EMBRYOLOGY. Note FIT © Gochard LR, Netter. FH. (2002) Nets ats of human embiyeegy Telerare, Noon Leaming Systems. "inde Sigh Pal GP. Homan Embryo.gy. Bh ed Ind: Mac ‘than PubihersUioa 2007 "Sader TW. Langman Medical Embryclogy. Phadlphia: Woes Kuve 2048, '*LeT rst Aid forthe USMLE Step #2020, 30h aniversary codon Meraw ta 2020 eens EN Hoenn Anatomy &Prystony.Hetoken Mi ‘Boron WF, Boulpsep EL, Media Physiology: 2017 DEVELOPMENT OF FETAL CIRCULATION 1(@S~(EMBRYOLOGY Embryology | Development of the Heart |) RECAP GASTRULATION 1) HEART TUBE |My esine cooPNs | IV) SEPTA AND A-V VALVES. | Y) HEART CHAMBERS Vi) INFLOW AND OUTFLOW TRACKS. | Vi) SEMILUNAR VALVES | vu APPENDIX | D0) REVIEW QUESTIONS: ‘© Transform blaminar eis into trlaminar aise « Blaminar disc layers: © Epiblast © Hypoblast « Calls of epiblast move down through primitive streak © Epiblast layer now called ectoderm © Convert hypoblast into endoderm © Migrate to cranial area and form mesoderm = Accumulation of mesoderm in cranial, infront of ‘prechordal plate + Hear actually develops in the cranial area! Later ‘moves down to thorax ‘© Triaminar disc layers: © Endoderm fo Mesoderm Eetoderm cals SAGITTAL at Figure 1: Supenor view of embryo ‘© 3 types of mesoderm © Paraxial mesoderm (next to notochord) © Intermediate mesoderm «© Lateral mesoderm * Somatic layer * Splanchnic layer ‘¢ Heart tube develops from splanchnic layer of latoral mesoderm ECTO ‘MESO LATERAL ENDO MESO SOMATIC INTERMABIATE ‘SPLANCHME oon Figure 2: Mesaderm is divided into 3 types “@ [oasomren tere EMBRYOLOGY. Noe #7 Last edited: 9/14/2021 Medical Editor: Uta Haining ae en ance aia Sina cee a ectecae mutes ppl temeliceert ogee E eaves to ae sl Ga ea ee veges — Dresovern ANGIOBLAST eMocyTOBLAST CAVITIES. HEART TUBES. Figure 3: VEGF stimulates formation of heart tubes and pericarlal cavities 2) Lateral fold ‘ Lateral folding of layers forms a tube © Ectoderm layers fuse ‘© Mesoderm layers fuse °c Heart tubes fuse —> make 1 heart tubo © Pericardial cavities fuse + make 4 pericardial cavity * Heart tube connected to pericardial cavity by dorsal mesocardium DORSAL MESOCARDIUM T PERICARDIAL CAVITY THEART TUBE Figure 4: Lateral foing forms the heat tube, pericardial cavity (red) and Gl trac (green) ‘¢ Heart tube layers © inner layer: endocardium (from mesoderm) ‘© Outer layer: myocardium (from carciomyocytes) + Secrete jlly.ike connective tissue between ‘endocardium and myocarcium = Cardiac jelly ENDOCARDIUM CARDIAC JELLY MYOCARDIUM‘© Accumulation of mesoderm in cranial part = Will become heart tube ‘© Cardiogenic mesoderm connected to ectoderm and endoderm by: © Buccopharyngeal membrane + Will become opening —+ mouth eCTO ENDO. { \veGr (MESODERM Figure 5: Mesoderm connected to ectoderm and endoderm, ‘Simulated by VEGF (1) VeGr '¢ Endoderm releases VEGF + Mesaderm differentiates © Forms heart tubes and pericardial cavities, ECTO ENDO HEART TUBE PERICARDIAL CAVITY Figure 6: Heart tube and pericardial cavity formed 2) Cranio-caudal folding '* Ectoderm and endoderm start folding © Pull mesoderm toward neck area © Pushes heart into chest cavity ‘© Heart tube moves into pericardial cavity oe Figure 7: Cranio-caudal folding pushes heart into chest cavity Figure 8: Heart tube moves into pencardal cavity TOP DORSAL AORTAE \ (\n mr ndy BOTTOM Figure 9: Heart tube NERD EMBRYOLOGY. Now #1 Dorit ‘© Blood enters from bottom ‘* Leaves on top through outfiow tracts (dorsal aorta, from ‘aortic sack on truncus arteriosus) (1) Divisions ‘© Divisions —» structure which they form later ‘o Truncus arteriosus (T.A) — Pulmonary trunk + aortic arch (ascending aorta) © Bulbus cordis (B.C) — Right ventricle + outflow tracks Primitive ventricle (P.V.) Left ventricle © Primitive atria (P.A) — left right atrium © Sinus venosus (S.V,): right and left horn with right ‘and left inflow tracks: Common cardinal veins (outside) = Umbilical veins (mile) + Viteline veins (inside) = Inflow tracks L. HORN Figure 10: Heart tube divisions ‘* Heart tube changes into shape of the heart ‘¢ Happens inside pericardial cavity ‘© Depends on dynein proteins © If absent: Kartagener syndrome with dextrocardia or situs inversus * Dextrocardia: heart towards right side of body (instead lef) + Situs inversus: all intemal organs on opposite side ‘of body (i) Leste ‘# Truncus arteriosus + Bulbus cordis move down and to the right CARDIAC LOOPING J DyNens TATBC. ie ‘MOVE DOWN te + ( TO THE RIGHT “Hl W Figure 11: Heart tube starts o fold(i) 2.step: ‘¢Truncus arteriosus + Bulbus cords further move down ‘and tothe right Primitive ventricle (P.V.) moves up and to the left «Primitive atria (P A.) move back and up Figure 12: Frontal and side view of cardi folaing (ii) step: ‘© Primitive atria (P A.) move on top of primitive ventricle (PV) and bulbus cords (@.C.) Figure 13: PA. move on top of primitive heart during cardiac fotaing ‘Cells move from sinus venosus (S.V.) © Into pericardial cavity and form a layer around heart Visceral pericardium «Into heart — Primitive conduction system (in week 4-6) Allows heart to beat (detect on transvaginal ultrasound ~week 6) PERICARDIUM WV. VIS al PERICARDIUM rm ER SYSTEM Figure 14: Formation of pericardium and primitive canduction system = pe (1) Development '* Separate atria and ventricles from one another ‘© Goal: form atrioventricular (A-V) canal on both sides (canal connecting atia and ventricies) ‘¢ Between P.V. and P.A.is sulcus: atrioventricular sulcus fost ee: OO NEURAL ee eetts ANT. Figure 15: Cross section through A-V-sucus ‘# Neural crest ces move into heart tube —- form posterior and anterior endocardial cushion ‘# Endocarcial cushions grow towards each other and fuse + Septum intermedium ‘¢ Septum intermedium: separates right from let A-V-canal SEPTUM teneotuM RAV. J Lay. CANAL CANAL Figure 16: Septum intermedium separates right frm lft A-V- (1) Development ‘¢ Endocardial cells form valves ‘* Connect valves: by annulus ring ‘* Chordae tendineae develop from valve flaps ‘¢ Valve between PA, and P.V.— mitral valve ‘* Valve between PA. and B.C. — tricuspid valve MITRAL VALVE TRICUSPID VALVE gure 17: Ariovertrcularvaves fom (coronal section '* Provide one-way flow ‘* Prevent back low through chambers EHBRYOLOGY Nee Fr Tp Sor(1) Development ‘© Septum primum forms from top down towards septum intermecium ‘© But doesn't reach septum intermedium —+ gap hole ostium primo iM inh ‘OSTIUM PRIMUM Figure 18: Ostium primum remains ater between septum ‘primum and septum intermedium ‘¢ Septum primum grows unt it reaches septum intermedium ‘¢ Hole in septum primum develops towards top + Ostium secundum ostium ‘SECUNDUM. SP. Figure 19: Ostium secundum develops in septum primum ‘¢ Septum secundum forms next to septum primum to block the ostium secundum —+ remaining passage =+Foramen ovale PA. divided into right and left atrium! La. RA. SEPTUM revate” SECUNDUM ene rage seam etn 2) Foramen ovale ‘¢ Normal path of blood flow: © RA RV — pulmonary circulation — LA LV —+ systemic circulation ‘© Embryortetus path of blood flow © RA + bypasses RV. directly oes to LA + LV + systemic circulation ewny? © Inuterus no need for pulmonary circulation, baby ‘doesn't breathe air by lungs —- lungs can be skipped in circulation ‘¢ Eventually foramen ovale will close Patent foramen ovale |» Open foramen. aso in aduithood | © Blood clots formed in systemic circulation fe. due | tev are transported to RA | « Pass through foramen ovale LA | | =: LV enter systemic circulation as “paradoxical embolism” “can cause stroke EMBRYOLOGY. Now #1 (1) Development ‘© Coming from apex, a tissue grows upwards + Muscular portion of intraventricular septum ‘© Coming from septum intermedium, a tissue grows down + Membranous portion of intraventricular septum — Fuse and form intraventricular septum ‘¢ Primitive ventricle (P.V.] forms left ventricle ‘© Bulbus cordis (B.C. right ventricle = Left and right ventricles formed! ok septum ‘SECUNDUM roguven -MEMGRANGUS BA one ea 4 ‘MUSCULAR PORTION Ry USCULAR PORTION Figure 21: Ventricles are formed by development of lnterventrcularseptim (2) Detects ‘ ITtissues don't meet + hole in septum + Ventvicular septal defect ‘Sinus venosus (S.V}) has 2 hors: right and let horn ‘© Each hom has 3 veins: ‘© Common cardiac v ‘© Umbiicalv. Viteline v (1) Development ‘Left hom: ‘veins break down —+ no voins loft «© Right horn: ‘© umbilical vein degenerates + common cardinal and vitelne vein remain ‘Left hom shifts to the right -> fuses to right horn =+S.V. is absorbed into P.A. ‘© Right common cardinal vein shifts upwards “+ Superior vena cava ‘© Right vieline vein shift downwards = Inferior vena cava ‘¢ Lett horn becomes —- coronary sinus «Inflow tracks to RA formed! S Hf ay, HO R. COMMON CARDINAL Wye NN CORONARY SINUS Figure 22: Veins of ight hor of S.V. form inflow tracks to RA Developme ote hear |)eo Aortic-pulmonary soptum ¢ In truncus arteriosus and part of bulbus cordis f¢ Neural cest cells migrate to this area einTA © On right + left wall form truncal ridges einBc, © On right + left wal form bulbar ridges ‘© Om top part of BC. towards T.A. (in conus cordis) © On anterior + posterior wal form ridgos NEURAL Figure 23: Ridges fuse in TA and B.C. ‘© Paired ridges approach each other and fuse o Truncal ridges —- truncal septum © Bulbar ridges + bulbar septum © Conus ridges + conus septum 1 Septa connect —+Aortic-pulmonary septum ‘* Aortc-pulmonary septum has a spiral shape around ‘central axis (corkscrew) due to position of truncal ridges a ne "mt T.A. J win BULBAR —> ences Ba srtergay ot Figure 24: Aortc-pulmonary septum with spiral shape «# Blood flow © To aortic arch * Blood flow from LV moves posteriorly of bulbar septum * Spiral upwards * Leaves the trunk anteriorly of truncal septum © To pulmonary trunk * Blood from RC moves anteriorly of bulbar septum + Spiral upwards + Leaves the trunk posteriorly of truncal septum Development of the heart 2) Rotation '* Aortic-pulmonary-trunk rotates ‘© Rotation spit structures into separate aortic arch + pulmonary trunk ‘© Blood flow: folow same path as their blood flow along ‘aorti-pulmonary septum © Aortic arch: + Starts underneath pulmonary trunk + Leaves above © Pulmonary trunk: + Slarts above aortic arch + Continues undemeath Figure 26: Aortic arch and pulmonary trunk formed [Wr Sewicunarvatves ‘¢ Neural crest cells form 4 cushions: © Right, lef, anterior, posterior ‘¢ During rotation of aortic pulmonary-trunk happens + Invaginations a right and let cushion, starts spliting — Invaginations fuse with each other = 2 openings formed, cushions spit totally —+Posterior opening moves right, anterior left ‘© Left ventricular outflow tract, for aorta + Aortic valve ‘¢ Right ventricular outfow tract, for pulmonary trunk =» Pulmonary valve est rest rest (wor . ae ona a ©) vor a Se OTA Figure 26: Cross section at junction of 8 C. and conus cords (rigtr) AoRTIC aN (tert) oe O punanaey + nvor Figure 27: Posterior opening moved righ, anterior opening left EWBRYOLOGY Note #1 TATED] 5 oF6 cro ‘ENDO N al esoueem i, ta —— Dwesoverm ecTo ‘HEART TUBE one el PERICARDIAL CAVITY = : CAVITIES ag as DoRSAL MESOCARDIUM X\ —rencasaan J aan THEART ‘TUBE ioe J ENDOCARDIUM DAL ce => MYOCARDIUM Figure 28: Formation ofthe heart tube — overview ‘OFT TomngATERD EMBRYOLOGY. Now FT Developmentot the heart io© AORTIC SAC — DORSAL AORTAE © TRUNCUS ARTERIOSUS P. TRUNK + AORTIC ARCH © BULBUS CoRDIS G RY. + OUTFLOW TRACTS L. HORN O PRIMITIVE VENTRICLE Guy. O PRIMITIVE ATRIA GLA FRA. CARDIAC Ah Oa el Loop| ‘SINUS VENOSUS uoorms 0 COMMON CARDINAL VEINS © UMBILICAL VEINS +DYNEINS TAF BC. © VITELLINE VEINS MOVE DOWN TO THE RIGHT PERICARDIUM penne ee Figure 29: Cardiac looping — overview “@ Pacopmentartne rear ENERYOLOGY. Nowe #7 MATER 7 ot3 SEPTUM. SECUNDUM C. SEPT| @D Inteemeum FORAMEN OVALE RAV. GK PMim ry, MUSCULAR PORTION Oris Lav. CANAL J OSTIUM SECUNDUM SP. MITRAL TRICUSPID VALVE Figure 20: Formation of heart chambers, oventrculer valves and septe - overview O11 TaaATERD EMBRYOLOGY. Now FT Developmentot the heart ioie OC) wor r 4 & AORTA RVOT uy ar, HORTA Post. CROSS-SECTION @ suveus cons + conus cons SwnerioN J ROTATION NEURAL (eigeT) Roi okie SLY. O (ter) TA. + PULMONARY “r SLY. Ov" RVOT Bc. J a Bt AORTIC ARCH a Ae: ou septum BUaR inges Be SEPTUM porTi¢g-pULMONARY Serum ai g Lv. Figure 31: Formation of aortic arch, pulmonary trunk and semilunar valves - overview °@ [oectapmertore neat Teac note a Tre heat EMBRYOLOGY Nowe #7 TATE) oorDEVELOPMENT OF THE HEART fok Figure 32: Development ofthe heart - overview 1) Which cells form the cardiac tissue? ‘8) Endoderm 'b) Mesoderm ©) Ectoderm 4) Neural crest cells 2) Which part of the heart tube moves back and on top of the B.C. and P.V.? 2) Truncus arteriosus, ») Primitive ventricle ©) Primitive atrium 4) Sinus venosus 3) Which septum is formed first? 2) Septum primum ») Septum secundum ©) Septum intermedium 4) Aortic-pulmonary septum 4) Which action leads to the final positioning of the ‘aortic arch and pulmonary trunk? 2) Rotation ») Stretching ©) Flexion 4) Division 5) The suporior vena cava develops from: 2) The right hn ) The left homn ) The tuncus arteriosus 6) The buibus corcis, {6) When isthe primitive conduction system developed? '8) As soon as the hear tube is formed ) After the heart vaves are formed «) After the cardiac looping 4) Atthe end ofthe heart development Tort EMBRYOLOGY. Now #1 SST TTT SS> EMBRYOLOGY Last edited: $/5/2021 Sofia Suhada M. Uzi ee) [paconyessns oe |p oss Se oe | V VENOUS CIRCULATION |W nerentnces Figure 1. The structures oftrlaminar asc ‘Cross section through the embryo around the third week Which shows the trilaminar dise composing of (1) Ectoderm ‘© Dorsal part| ‘© Amniotic cavity above it (2) Mesodorm ‘Parts of the mesoderm () Paraxial mesoderm ‘© Which separates into blocks of cells called somites (i) Intermediate mesoderm ‘Develops into the gonads & urinary system (ii) Lateral plate mesoderm ‘© Structures ofthe lateral plate mesoderm include © Intraembryonic cootom in between the two plates © Somatic layer of lateral plate * Moves with tne ectoderm and around the ‘amniotic cavity © Splanchnic layer of lateral plate * Involves in development of cardiovascular system + Moves with the endoderm and around the yolk ‘sac (3) Endoderm ‘© Gives way tothe gut tube © Foregut © Midgut © Hindgut © Pharyngeal apparatus ‘Ventral part Yolk sac below it (4) Noural tubo ‘inbetween the mesoderm (5) Notochord ‘© Below the neural tube ‘@ mn ‘* Development of blood vessels from mesoderm of ‘rilaminar disc within the embryo ‘* Developmental process: (1) VEGF release ‘* Endodermal tissue releases vascular endothelial growth factor (VEGF) > influence splanchnic layer of lateral plate to protierate and differentiate into specific types of tissue (2) Proliferation and differentiation phase () Endothelial cells ‘¢ Mesoderm (mesenchymal cells) (© VEGF causes the cells o proliferate and differentiate — some areas start specializing and forming tubes lined by angioblast ‘* Angioblast will give rise to endothelial cells: ‘© Endothelium += Lining the blood vessels © Endocardium * Line heart cavity (i) Formed elements ‘# Some mesoderm form hemocytoblast calls inside the ‘ube which move through the tube = this will develop into RBC, WBC and platelets. ents) —- move through blood vessels and (3) Canalization ‘¢ Tubes formed will connect (eanalize between one another) —- make one long tube -- blood vessel with formed elements moving inside of it ‘© Blood vessels made sprout more blood vessels. Remember: ‘* Vasculogenesis ‘© Mesoderm developed into blood vessels += Angiogenesis “Blood vessels mace from blood vessels vst, scmssrs—ongin Se SE semceyromae FESS) egnaute acs EMBRYOLOGY. Noe #7‘© Endoderm release VEGF — lateral mesoderm proliferates and differentiates forming © Zheart tubes/blood vessels at the front * undergo folding process — fusion of the 2 tubes © 2 dorsal aortae bohind the heart tubo * Undergo folding — fusion ‘¢ Folding causes all the layers to come together and make cylindrical shape © Heart tubes become 1 which also gives the blood vessels «© Dorsal aorta comes off the heart tube and move backwards into 2 dorsal aortae — fuse together as it moves down the embryo —— Figure 3 Lateral plate flcing ‘© From the below upwards © Sinus venasus withthe inflow tracts, drain the * Cardinal veins * Umbilical veins * Viteline veins © Primitive atria © Primitive ventricle © Bulbus cords fo Truncus arteriosus © Aorlc sac which moves backwards into the dorsal ortae Figure 4. The heart tube andits structures Zar EMBRYOLOGY. Now #1 '* Atthe level of aortic sac ‘© Will show structures including the © Developing arterial system © Aortic sac ‘Dorsal aortae © Ectoderm ‘© Endderm which will develop into gut tube ' Foregut “= Miggut += Hindgut “ Primitive pharynx withthe pharyngeal apparatus ‘+ The highest part ofthe gut tube © Neural tube «© Notochord Figure 5. Embryonic cut section ‘ Structures ofthe upper part of pharyngeal arch include: ‘© Pharyngeal pouches = The inner part © The arches ‘= Mesoderm around the pharyngeal pouches © Clettsigrooves “ Ectoderm forming the outer part ofthe pharyngeal A Figure 6. Structures of pharyngeal arch DEVELOPVENT OF VASCULAR SYSTEM | GS(i) Angiogenesis «© Blood vessels bridging to the dorsal aorta © Aortic sac makes blood vessels which reach the pharyngeal arches. © Pharyngeal arches which are mesoderm make blood vessels reaching to the dorsal aorta (© This is formed at multiple levels —+ making a total of 6 aortic arches ‘¢ The 8” doesn't form or fit does, it regresses quickly (ll) Arteries developed from the arches: © omic arch fo Maxillary artery 2 aortic arch © Hyold artery — will developed into staped (very rare to exist in humans, only 10%) © 3" aortic arch ‘© Common carotid arteries, and proximal part of Internal carotid arteries, 24” aotic arch ‘© The right arch wil form the right subclavian artery and parts of brachiocephalic artery © The left arch wil form the aortic arch after the brachiocephalic artery * Which is from the left common carotid unt the left subclavian * Subclavian arteries supply the arms, + Aartic arch continues downwards into descending aorta —. abdomen reaching the ‘common liac arteries — external lac arteries supplying the lower limbs 6M aortic arch The right arch wl form the right pulmonary artery © Left arch wil form the left pulmonary artery and ductus arteriosus tory Figure 7. The aortic arch ‘@anr ore EMBRYOLOGY. Noe #7 Figure 8, The major blood vessels (i) Pulmonary trunk ‘¢ From truncus arteriosus — spits into pulmonary ah puna sty © Left pulmonary artery ‘= Between pulmonary trunk and aorta is the ductus arteriosus ofthe embryo (i) Ascending aorta ‘* From truncus arteriosus (ii) Aortic arch ‘¢ From the left fourth arch © Give branch to left and right subclavian and common carotid arteries © Goes down to descending aorta — abdomen — lower lime'¢ The dorsal aortae fuse downwards and supply lower pats of the embryo DORSAL LATERAL BRANCHES. Figure 9. Descending eorta ofa fetus (1) Beginning of fetal circulation ‘© Descending aorta goes down the length of embryo and ives of 4 general branches © Dorsolateral branches * From the back Lateral branches * From the sides © Viteline artery + From the center + Runs into the yolk sac through the vitellin duct * The viteline duct connects the embryo tothe yolk © Right and lef umblical arteries * At the beginning point of branching ofthe dorsal aorta ToT EMBRYOLOGY. Now #1 (2) Progression to an adult ion ‘¢ The general branches wil develop to form the adult circulation (i) Dorsolateral branches ‘#Intercostal and lumbar arteries. (i) Lateral branches ‘* Adrenal/suprarenal arteries supplying the adrenal glands ‘© Adrenal sits on the kidneys ‘# Ronal arteries -- supplying the kidneys. ‘* Gonadal arteries supplying the gonads ‘0 Developing embryo have gonads -» these later become ovaries or testicles (i) Viteline artery '*Viteline artery which goes to the yolk sac breaks into 3 parts to supply the gut tube «© Collac artery — supplying the foregut © Superior mesenteric artery —- supplying the midgut 6 Inferior mesenteric artery > supplying the hindgut (iv) Common iliac arteries ‘© Split into internal and extemal iliac arteries © In the internal —- have interal iliac arteries + Umbilical arteries descend and come off the intemal lia arteries "9." 10) —+ Becomes the ‘adult remnant of umbilical artery which isthe ‘medial umbilical ligament ‘© Umbilical part that persists —- forms the superior vosical artery —- supplies the bladdor © External iliac arteries —- supply lower limbs ou iat, a ee unsuien A IEE a oe Figure 10. Descending aorta of a fecal development ‘approaching adult creulation. Note the development of lac DEVELOPWENT OF VASCULAR SYSTEM 1SRemember ‘Parts ofthe heart tube from the below upwards: © Sinus venosus with the inflow tracts, drain the * Cardinal veins * Umbilical veins * Viteline veins Primitive atria © Primitive ventricle © Bulbus cordis, © Truncus arteriosus © Aortic sac which moves backwards into the dorsal aortae Figure 11. Cut section of sinus vensus ‘© Cut section ofthe sinus venosus and the inflow tracts (iguie 1) will showe (1) The right sik ‘© Right horn gives rise to © Right posterior cardinal vein * Drain blood from the bottom «© Right anterior cardinal vein * Drain blood from the top © Right common cardinal vein * Connecting the two cardinal veins =; blood will empty into the right hom —» which ‘empties into the sinus venosus (2) Tho loft sido « Left hom gives rise to: © Left post cardinal vein * from the bottom « Left anterior carcinal vein * from the top ¢ Left common cardinal vein * Connecting the two cardinal veins —+ blood will ‘emply into the left horn -» which empties into the sinus venosus (3) The middle ‘© Umbilical veine ‘© Medial tothe right and left homs respectively « Viteline system (right and left vtelline veins) ‘© The most medial portion The right side ‘dominant in the venous system ‘© The lef sided veins wil either shift their supply to the Tight side or degenerate SS ROT ORT (1) Embryonic life ‘ Viteline system consists ofthe right and feft veins ‘¢ These form plexus around the Gl trac (he right and lef, respectively) =: move tothe liver to give of capillaries called sinusoids (very permeable) ‘¢ The biood from the sinusoids drains into hepatic veins + moves pass the septum transversum (future iaphragm) = to reach sinus venosus © This is the right and left hepatocardiac channel ‘* Remember: 6 Viteline system connects the yolk sac to the heart (2) Development to adult (i) Left vitelline vein digression ‘The left viteline system wl start to digress. ‘© The right viteline system will dominate ‘© More blood goes tothe right vein, which then enlarges in size — capillaries network formed, taking blood from the spleen and gastrointestinal tract = draining it into the iver feeding both sinusoids + Splenic veins “= From the spleen + Superior mesenteric vein '* Upper part of the gut + Inferior mesenteric vein ‘Lower part of gut tube ‘¢ The hepatic portal vein, which combines all the three veins above — drains the blood into the sinusoids of the liver (i) Hepatic veins formation ‘¢ When the left vitelline vein digresses, the right hhepatocardiac channel receives blood from the left and right sinusoids © This forms the right and left hepatic veins (li) Inferior vena cava formatios ‘# When the two hepatic veins combine together —»it will become the inferior vena cava — this empty into the right hom — sinus venosus —> primitive atria which becomes the right atrium. EMBRYOLOGY. Noe #7