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Embryology
Embryonic Period: Weeks 3-8, organ system development simultaneous
I.
The Heart
A. Development (MESODERM)
1. Primitive heart tube
- pair of endocardial heart tubes (mesoderm) form within cardiogenic region
-EHT fuse during lateral folding to form primitive heart tube = endocardium
-surrounding mesoderm develops into myocardium and epicardium
-PHT forms five dilations (First Aid p. 94)
2. AP septum (aorticopulmonary)
-divides truncus arteriosus into aorta and pulmonary trunk
-neural crest cells migrate into truncal and bulbar ridges
-grow and twist in spiral, fuse to form AP septum
3. AV septum (atrioventricular)
-partitions AV canal into right and left AV canals
-dorsal and ventral AV cushions fuse to form AV septum
4. Atrial septum
-septum primum grows toward AV septum
-foramen primum between edges of septum primum and AV septum; obliterated when SP fuses
with AV cushions
-septum segundum (crescent-shaped) forms to right of SP and fuses after birth with SP to form
atrial septum
-foramen ovale is opening between upper and lower parts of SS; shunts blood from right atrium
to left atrium
-functional closure soon after birth due to pressure changes; anatomical fusion incomplete in 25%
of population; incidental (Image, see High-Yield Embryo)
5.
IV septum (interventricular)
-muscular IV septum develops into floor of ventricle and grows toward AV septum; stops short to
create IV foramen
-membranous IV septum forms following fusion of right and left bulbar ridges and AV septum;
closes IV foramen
II.
2.
3.
III.
IV.
V.
VI.
-sx: gagging and cyanosis after feeding, abd. distention after crying, reflux of gastric contents into
lungs
Respiratory distress syndrome
-deficiency of surfactant
-common in premature infants, infants with diabetic mothers, fetuses with prolonged IU asphyxia
-tx: thyroxine and cortisol to mother
Pulmonary hypoplasia
-secondary to congenital diaphragmatic hernia (into pleural cavity) and bilateral renal agenesis
Liver
A. Development
-hepatic diverticulum (endoderm of foregut) forms in septum transversum (surrounding mesoderm,
also plays part in development of diaphragm)
-HD sends hepatic cell cords into ST
-Cell cords surround vitelline veins, which form hepatic sinusoids
Kidney
A. Development
-Intermediate mesoderm forms elevation along dorsal body wall = urogenital ridge
-portion of UG ridge, called nephrogenic cord, forms 3 sets of kidneys
1. Pronephros completely regresses
2. Mesonephros forms mesonephric (wolffian) duct
3. Metanephros develops from metanephric mesoderm and ureteric bud (outgrowth of
mesonephric duct); becomes definitive adult kidney
-ascends during development from sacral region to adult location at T12-L3
B. Congenital anomalies
1. Renal agenesis - failure of ureteric bud to develop
2. Horseshoe kidney inferior poles fuse, kidney trapped behind inf. mesenteric artery
3. Wilms tumor malignant tumor in children, probably of embryonic origin, good prog
4. Urachal cyst remnant of allantois, urine drainage from umbilicus
5. Pheochromocytoma chromaffin cell tumor, generally along migratory path of neural crest cells
CNS
A. Development
1. Notochord induces overlying ectoderm to differentiate into neuroectoderm to form neural plate;
notochord becomes nucleus pulposus
2. Neural plate folds to form neural tube
-some cells diff. into neural crest cells
-craniocaudal folding
3. Vesicles
B. Congenital anomalies
1. Spina bifida (high AFP levels)
2. Anencephaly (high AFP levels)
-1/1000 births
-most common serious birth defect in stillborns
3. Arnold-Chiari herniation of cerebellum into foramen magnum
4. Dandy-Walker hydrocephalus from atresia of foramena of Luschka and Magendie
5. Hydrocephalus most commonly from stenosis of cerebral aqueduct
6. Fetal alcohol syndrome most common cause of MR; microcephaly, heart disease
7. Craniopharyngioma congenital cystic tumor, remnants of Rathkes pouch
Gut (ENDODERM & MESODERM)
A. Development
1. Foregut: celiac artery
-esophagus, stomach, liver, gallbladder, pancreas, upper duodenum
2. Midgut: superior mesenteric artery
-lower duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 transverse
colon
3. Hindgut: inferior mesenteric artery
-distal 1/3 of transverse colon, descending colon, sigmoid colon, upper anal canal
VII.
VIII.
IX.
X.
B. Week Three
1. Gastrulation
-establishes three germ layers: ectoderm, mesoderm, endoderm (trilaminar disk by day 21); give
rise to all tissues and organs
-primitive streak first indication
-all derived from epiblast
Gross Anatomy
1.
Duodenum T12-L1
Kidneys T12-L3
Conus medularis L1-L2 adult, L3 newborn
Umbilicus L4
Knee: 1. Patellar ligament- damage to femoral nerve or spinal cord L2-L4. Loss of patellar reflex 2. MCL- tear also
tears medial meniscus. Passive abduction of extended leg at knee joint. 3. LCL- passive adduction of extended leg
at knee joint. 4. ACL- anterior drawer sign. 5. PCL- posterior drawer sign. 6. Terrible triad- MCL, medial
meniscus and ACL tears.
Hip: 1. Posterior dislocation- head of femur moves posterior to the iliofemoral ligament. Presents with lower limb
that is flexed at hip joint, adducted, medial rotated and shorter than opposite limb. 2. Fracture of neck of femur
presents laterally rotated and shortened.
Shoulder: 1. Dislocation- may be anterior or posterior. If anterior then axillary nerve may be damaged. 2.
Separation- results in a downward displacement of clavicle.
Clavicle: 1. Fracture- most common at medial 1/3. Results in upward displacement of proximal fraagment and
downward displacement of distal fragment
4.
Brachial Plexus: 1. Axillary n- dislocation of shoulder, abduction (deltoid) and lateral rotation (teres
minor) are compromised. 2. Long thoracic n- winging of scapula (serratus anterior). 3. Radial n- wrist drop
(extensors of forearm). 4. Median n- ape hand (thumb muscles) and flexors of forearm if damage is at elbow or
above. 5. Ulnar n- claw hand and radial deviation of hand, loss of some flexors if at elbow or above.
5.
Peripheral nerves: 1. Common peroneal n- foot drop (tibialis anterior m) and inversion (peroneus
muscles). 2. Deep peroneal n. entrapment- Compression of anterior compartment muscles of the lower leg by ski
boot or athletic shoes that are too tight. Causes pain in the dorsum of the foot that radiates to the space between the
first two toes.
6.
Hands: 1. Carpel Tunnel Syndrome- compression of median nerve by inflammation, weakend flexion and
abduciton and opposition of thumb, loss of extension of index and middle fingers, sensory loss of index, middle and
half of ring fingers and palmar part of thumb. 2. Cubital tunnel syndrome- sorry I was not able to find this one. 3.
Dupuytrens contracture- progressive fibrosis of palmar aponeurosis, pulls digits into marked flexion at MCP joints.
7.
Blood-testes barrier: There is a barrier that exists between the blood vessels that supply the testes (branches
of the testicular artery and vein) and the duct system in which spermatozoa are produced and transported. The testis
is derived partly from celomic mesoderm and partly from intermediate mesoderm with the blood vessels migrating
in around the duct system.
8.
Abdominal arteries: 1. Celiac trunk(CT)-FOREGUT-left gastric a., splenic a., hepatic a. 2. Superior
messenteric a.(SMA)- MIDGUT- part of duodenum through proximal 2/3 of transverse colon. 3. Inferior mesenteric
a.(IMA)-HINDGUT- distal 1/3 of transverse colon to upper rectum
Collaterals: 1. Internal thoracic a. to superior epigastric a. to inferior epigastric a. 2. Superior
pancreaticoduodenal a.(from CT) to inferior pancreaticoduodenal a. (from SMA) 3. Middle colic a. (from SMA) to
left colic artery (from IMA) 4. Marginal a. (from SMA and IMA) 5. Superior rectal a. (from IMA) to middle rectal
a. (from internal iliac a.)
9.
Bone: 1. Metaphysis: between epiphysis and diaphysis. 2. Epiphysis: growth plate responsible for linear
bone growth. 3. Diaphysis: long part of bone responsible for annular bone growth.
(Add histology and neuroanatomy 1-2)
Neuroanatomy
3. Hearing
-Unlike other sensory systems, the central auditory pathways have bilateral representation of
sounds (sound from 1 ear reaches auditory cortex in both hemispheres).
-Pathway
-first neruons in spiral ganglion synapse in cochlear nucleus
-second neurons synapse bilaterally in superior olivary nuclei
-third neurons travel in the lateral lemniscus to synapse in the inferior colliculus
-fourth neurons then synapse in the medial geniculate nucleus
-the fibers then go to the transverse temporal gyrus of the cortex
-Conduction and nerve deafness
-Weber test (forehead)
-lateralizes to the affected ear with conduction deafness and to the unaffected
ear with nerve deafness
-Rinne test (mastoid process)