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GENERAL EMBRYOLOGY
NOTES

Prepared BY : 2022-2023-WAVES
STEP 1
LECTURES LINKs

LECTURE 1

LECTURE 2

LECTURE 3
 GENERAL EMBRYOLOGY
Early embryonic development
- Ovulation: Release of ovum from the ovary to the fallopian tube (details later)
- Fertilization: Occur in the ampulla of the fallopian tube (Day 0)
- Zygote formation: Sperm (1N) + ovum (1N) = zygote (2N) (Day 1)
- Morula formation: due to mitotic division of the zygote (Day 4)
- Blastocyst formation: cells starts to differentiate into epiblast and hypoblast (Day 5)
- Week 1: hCG secretion begins around the time of blastocyst implantation
- Week 2: Formation of bilaminar embryonic disc; two layers = epiblast, hypoblast.
- Week 3:
* Formation of trilaminar embryonic disc via gastrulation (epiblast cell invagination through primitive
streak)
* Notochord arises from midline mesoderm and induces overlying ectoderm (via SHH) to become
neural plate, which gives rise to neural tube via neurulation (See neuroscience)
- Week 4:
* Heart begins to beat (four chambers). Cardiac activity visible by transvaginal ultrasound
* Upper and lower limb buds begin to form (four limbs)
- Week 8: Genitalia have male/female characteristics (pronounce “geneightalia”)
 Embryological derivatives

Types of dysmorphogenesis
- Agenesis: Absent organ due to absent primordial tissue
- Aplasia: Absent organ despite presence of primordial tissue
- Hypoplasia: Incomplete organ development; primordial tissue present
- Disruption: 2° breakdown of tissue with normal developmental potential (e.g., amniotic band
syndrome)
- Deformation: Extrinsic mechanical distortion (e.g., congenital torticollis); occurs during fetal period
- Malformation: Intrinsic developmental defect (e.g., cleft lip/palate); occurs during embryonic period
- Sequence: Abnormalities result from a single 1° embryologic event (e.g., oligohydramnios  Potter
sequence)
- Field defect: Disturbance of tissues that develop in a contiguous physical space (e.g.,
holoprosencephaly)
 IMPORTANT TERATOGENIC SYNDROMES
Fetal alcohol syndrome
- Incidence: One of the leading preventable causes of intellectual disability in the US
- Cause: maternal alcohol use during pregnancy
- Manifestations: Developmental delay, microcephaly, facial abnormalities (e.g., smooth philtrum, thin
vermillion border, small palpebral fissures, flat nasal bridge), limb dislocation, heart defects
- Severe cases: Holoprosencephaly due to impaired migration of neuronal and glial cells

Neonatal abstinence syndrome

- Def: Complex disorder involving CNS, ANS, and GI systems
- Cause: maternal substance use (most commonly opioids) during pregnancy
- Manifestations: uncoordinated sucking reflexes, irritability, high-pitched crying, tremors, tachypnea,
sneezing, diarrhea, and possibly seizures
- Prevention: Universal screening for substance use is recommended in all pregnant patients
- Treatment: treat opioid abuse (see neuroscience)

Other teratogenic syndromes

 Placenta
- Def: 1º site of nutrient and gas exchange between mother and fetus
- Fetal component:
* Cytotrophoblast = Inner layer of chorionic villi
* Syncytiotrophoblast = Outer layer of chorionic villi; synthesizes and secretes hormones, e.g., hCG
- Maternal component:
* Decidua basalis = Derived from endometrium. Maternal blood in lacunae
 Amniotic fluid

Twins
- Types: Monozygotic or dizygotic twins (See table below)
- Monozygotic twin type depends on time of splitting:
* Splitting 0–4 days: separate chorion and amnion (di-di)
* Splitting 4–8 days: shared Chorion (mo-di)
* Splitting 8–12 days: shared chorion and Amnion (mo-mo)
* Splitting 13+ days: shared chorion, amnion, and Body (mo-mo; conjoined)
- Complications: usually with monozygotic twins
* Conjoined twins  failure of separation
* Monochorionic twins  Twin-twin transfusion
# Unbalanced arteriovenous anastomoses between twins in shared placenta
# Net blood flow from one twin to the other
# Donor twin  hypovolemia and oligohydramnios
# Recipient twin  hypervolemia and polyhydramnios
 Umbilical cord
- Derived from: Allantois (hollow sac-like structure filled with clear fluid that forms part of a developing
amniote's conceptus) and yolk sac
- Histology:
* Two umbilical arteries: return deoxygenated blood from fetal internal iliac arteries to placenta
* One umbilical vein: supplies oxygenated blood from placenta to fetus; drains into IVC (see fetal circ.)

- Clinical correlates:
* Single umbilical artery (2-vessel cord) is associated with congenital and chromosomal anomalies.
* Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in
the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood
and associated with high perinatal mortality. In normal pregnancies.

Urachus
- Derived from: Remnants of the allantois after umbilical cord vessel formation
- Structure: duct between fetal bladder and umbilicus
- Fate: Involute forming median umbilical ligament covered by median umbilical fold of the peritoneum
- Clinical correlates: Abnormal obliteration lead to:
* Patent urachus: Total failure of urachus to obliterate  urine discharge from umbilicus
* Urachal cyst:
# Partial failure of urachus to obliterate  fluid-filled cavity lined with uroepithelium,
between umbilicus and bladder.
# Cyst can become infected and present as painful mass below umbilicus.
* Vesicourachal diverticulum: Slight failure of urachus to obliterate  outpouching of bladder
 Vitelline duct (omphalomesenteric duct)
- Connects: yolk sac (which give umbilical cord/umbilicus) to the gut tube (which gives intestine)
- Fate: Obliterate at week 7 (either disappear or form vitello-intestinal ligament)
- Clinical correlates:
* Patent vitelline duct: Total failure of vitelline duct to obliterate ➔ meconium discharge from
umbilicus
* Vitelline duct cyst: Partial failure of vitelline duct to obliterate ➔ risk for volvulus (See GIT)
* Meckel diverticulum: Slight failure of vitelline duct to obliterate ➔ outpouching of ileum (See GIT)

Fetal membranes
- Amnion (Towards the baby):
* Avascular ➔ obtain necessary nutrients and oxygen from nearby chorionic and amniotic fluid
* Cuboidal (away from placenta) and columnar (near placenta) epithelial layers
- Chorion (Towards the mother):
* Fibrous tissue layer containing the fetal blood vessels
* Chorionic villi form on its outer surface ➔ maximize surface area for contact with maternal blood
- Yolk sac and Allantois (discussed above)

- Functions of fetal membranes: surrounds the fetus during the gestational period and ensures
maintenance of pregnancy to delivery, protection of the fetus as well as being critical in maintaining
the conditions necessary for fetal health
 Pharyngeal apparatus
- Structure:
* Pharyngeal clefts: derived from ectoderm. Also called pharyngeal grooves.
* Pharyngeal arches: derived from mesoderm (muscles, arteries) and neural crest (bones, cartilage).
* Pharyngeal pouches: derived from endoderm.

- Pharyngeal cleft derivatives:

* Second, third and fourth clefts are obliterated by elongation of the second arch & its fusion with the
sixth arch forming temporary cervical sinuses which completely obliterate
* 1st cleft develops into external auditory meatus

- Pharyngeal pouch derivatives:

‫ ودن لوز‬thyroid thymus

 - Pharyngeal arch derivatives:

‫ بلعت باالتيكيت والستايل‬... ‫ عشان طرت وعمل سسس‬... ‫ رشبت سيفن ابتسمت‬... ‫ قلت مممم‬... ‫ مضغت األكل‬٥ ‫ دخلت مطعم الساعه‬...
‫أو بلعت عادي واتكلمت وتفتفت وانت بتاكل‬

- Clinical correlates:
* Pharyngeal cleft cyst: persistent cervical sinus; presents as lateral neck mass anterior to
sternocleidomastoid muscle that does not move with swallowing (vs thyroglossal duct cyst).
* Pierre Robin sequence & Treacher Collins syndrome: See above
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