Gastrulation, the critical process of transforming a bilaminar embryonic disc into a trilaminar disc, is highly sensitive to abnormalities, particularly teratogenic exposures, which can lead to severe developmental defects affecting midline structures, caudal development, and organ asymmetry.
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in the last lecture we were talking
about the process of gastrulation
in embryology what is meant by gastrolation
gastrolation
gastrulation is the process by which the
bi-laminar disc convert into
trilominar disc is that right that is
what we discussed in the last lecture
today we will talk about the problems or
abnormalities which may occur during
gastrulation one point I would like to
highlight sometimes in mcqs they try to
put a very funny
distraction to you they give a choice
that gastrulation mean formation of stomach
stomach
and many students take it right that is wrong
wrong
because in student mind gastro means
something related with the stomach and
when they give the process of
gastrulation during embryogenesis means
formation of stomach so don't say oh
this is the easiest answer he says it is
right this is wrong
in the embryogenesis process of
gastrulation is not the formation of
stomach or formation of gastrointestinal system
system
during embryogenesis right during the
embryological development
gastrulation means the process by which
biliminal disc convert into
trileminar disc you remember biliminal
disc is seen in which week
this is developed in which week of development
development right
right
yes biliminal disc is formed during
in the second week what do you think
second week yes
second week that's very easy biliminal
disc bimin two lamina and second wave
and triliminal disc Prime in three three
lamina in third week is that right
now we will talk about that what are the
possible or different type of
abnormalities which may occur during the
process of gastrulation one of the very
important abnormality is related with
the alcohol intake by the mother right
what are the abnormalities termed the
abnormalities which develop during the
early embryological development those
abnormalities are called
for example alcohol damages the gerund
disc or female take some drug and that
damages that embryo right so
damage to embryo during its early
development is called terrato
terrato
teratogenesis what is that called parato
parato Genesis
Genesis
right during what we are studying during
gastrulation gastro lation
lation
teratogenesis during gastrulation and
those substances which produce
teratogenesis those substances are
called teratogenic substances
you will study in Pharmacology there are
many drugs which are teratogenic there
are many toxins which are teratogenic
right now we will talk about alcohol
that alcohol intake
high dose of alcohol
big amount of alcohol
intake at the time of development of
trilaminar disc damages the developing
embryonic tissue
right and how it damages
before really I tell you you know third
I told you that gastrumulation start at
the end of the third at the beginning of
the third week right let's put the
female reproductive cycle here okay
okay
let's put a different color this is
female reproductive cycle let's suppose
this female has 28 days
cycle in 28 days cycle this is a
bleeding for first four or five days is
that right
and after that when is the time of
ovulation suppose this is the 28 day cycle
cycle
so when is the ovulation time
14 days right most probably that around
the 14th day of the cycle she ovulated
and if she was producing oven at that
time and she had intercost around that
time there are chances that her ovum
gets fertilized so it means if ovum gets
fertilized look at this over I'm very
happy because it became fertilized right now
now
already you know that from 14 days and
21 day and then
28th day when this over and will of
course go into two cell stage right then
it will go into four cell stage then it
will go into morula then it will go into
blastocyst you know what all that thing
and then it will go into bilaminar
bilaminar
what is this by laminar disc and around
this time this bilaminar disc will start
converting into yes please
try laminar
desk right it is precoordal plate and
here is primitive streak and here is
Noto chord this is what we discussed
last time so this process has started at
the beginning of the
at the beginning of the third week
this is the first week of development
this is the yes
second week of development and this is
the beginning of the
third week of the development
now listen very carefully and all your
life and you're doing Medical Practice
you have to take care of this fact
female is expecting that she will have
next menstrual bleeding around these days
is that right
She is expecting to have her periods
around these days
and actually because she is pregnant right
right
of course she will miss these periods
and around this time embryonic tissue is in
in
converting bilometer into
dry lemonade disc or we say the process
of gastrulation is going on now
around this time she may think that her
periods are somewhat delayed and very
soon shortly they will start and she may
not be aware that she is pregnant
am I clear
there's if this female is
not aware that she is pregnant and even
though her Menses are periods did not
start in time but she may think they are
little bit delayed and she may not take
those special precautions which usually
she will take if she knows she is pregnant
pregnant
is that right because she is not aware
that she is pregnant so if she is a
woman who takes alcohol she may take a
large quantity of alcohol
and that may damage
the developing trilominal disk
is that right now
now
in trilominal disc around this time
most of the cells are pre-programmed
that which tissue they will be making
when the trilominar disc is being formed
ectodermal mesodermal and endodermal
cells are already pre-programmed that
what tissues will be made out of
ectoderm what tissues will be made out of
of
mesoderm and what what which tissues
will be made out of
endoderm is that right so this is a very
very sensitive time from here onward
this is the beginning of third week from
third week of castration up to the
eighth week of gestation it's the most
this is the most dangerous time to lay
during the development of the embryo
why because during this time
three layers ectoderm mesoderm and
endoderm will form and then
they will start giving rise to the
tissues and organ system
and up to the eighth week of up to the
eighth week most of the body tissues and
organs are made
they're well established after this
further development is usually maturity
of the organ system the formation of
organ system is done again listen
carefully formation of organ system like
central nervous system or respiratory
system or cardiovascular system or
gastrointestinal system or endocrine
system so most of our body tissues
almost all of our body tissues and organ
systems have started forming from the
trilominate disc during this time and
most of the tissues are
basically formed by the
eighth week of gas station
after that organ system simply become
larger and mature
is that right now why I am stressing so
much on this because if during this
mother take some substance
right which is teratogenic substance
which is toxic to the developing
embryonal cells a little damage to
embryo May produce a very big damage to
the developing system
for example
here there's a very small area which is
going to make central nervous system
and here
and if alcohol damages that area
when baby will be bombed you will find
there's a big damage to central nervous system
system
is that right
so this is the most vulnerable
time most vulnerable window time window
through which the damage is done to the
developing embryo you may be thinking
I'm repeating I tell you it's worth
repeating again and again again and
again right with the females who are in
relationship and if they are there is a
chance that they may become pregnant
right and if they become pregnant around
this time they have to be very very
careful what type of substances they
ingest what types of drugs they are
putting in their body am I right now
let's come to exactly situation here the
female trilamina disc Plus
what is this
alcohol and what happens right
right
this is crocoder plate here is your yes
primitive streak and
here was your yes please what is it ectoderm
ectoderm
measure them very good and just last
lecture we discussed the lower most area
will be yes
and you should not forget we put a lot
of time to understand what was here notochord
notochord
right this is present between the
actor domain
Androderm and
pressed between the ectoderm and
androdum and on the sides of it it has
mesoderm now
this is a diagram you should not forget
I should make alcohol is a dangerous
thing now
this is the mother she is taking alcohol
alcohol is lipid soluble or not lipid soluble
soluble
alcohol is lipid soluble or not lipid
soluble it is a highly lipid soluble so
when she will take alcohol it will
rapidly absorb from git
go into her blood and any substance
which is a highly lipid soluble will
efficiently cross placenta any substance
any drugs or any substance which is
highly lipid soluble will dissolve into
placental barrier and go to the placenta
and baby
is highly lipid soluble so it will be
going to the product of conception here
I will not use the word placenta because
so at so early stage placenta is not
developed so I will say that alcohol
from maternal blood will
dissolve into biological barriers
and cross and reach up to the product of
conception and now look here these are
the drops of alcohol
going to destroy yes
these cells which are in the middle part right
right
these are midline cells midline
cellular structure from pre-codile plate
and anteriorly it may be destroyed
they are very very sensitive to the
higher doses of alcohol and if this area
is destroyed then all the structures
which will develop out of this area they
will be abnormal
now when the baby develop what really
happens that this area right Plus
here is also damaged by this
now what really happens all these
midline structures
which are damaged by alcohol
right will affect the baby development
and when this baby will develop look
here these structures are in abnava
because you know this was the disc you
are damaging this area of the disk when
baby developed this part of the disc
fold and this becomes the front of the
head and neck
so this frontal area is also damaged
for example the eyes of the baby
and Central structures
they are underdeveloped if Central
structures midline structures are
underdeveloped eyes will become near or
they will become far
they will become near if these Central
structures are not formed or they are
under formed then eyes will become more
near right for example normally
I should be something like this right
right this is the abnormal baby
you understand what has happened
mid lane structures are these structures
are absent so eyes become very near to
each other
for this
problem we use the term that there is hypo
hypo
telomen telescope
hyper mean if in any disease eyes go
away from each other we say hyper
terrorism in this problem I will come
very near to each other we call them
hypothelorism what is it called
hypotenourism plus do you think this
part of the central nervous system the
forebrain it will dwell up well
no so there will be under development of forebrain
forebrain
under
development of yes
yes
four brain specially
brain is basically forebrain midbrain
and hind brain and spinal cord the
forebrain is derived from these
structures and they are specially
damaged is that right and in the central
nervous system there are ventricles let
me draw
this is midbrain ponds medulla spinal
cord cerebellum this is cerebral
hemisphere right
you know this
this is cerebral hemisphere within the
cerebral hemisphere normally there are
I will not go in detail of all this
structure but
actually here
cerebrospinal fluid is produced here
also cerebrospinal CSF cerebrospinal
fluid is produced and fluid from this
ventricle this is a area called
ventricle from this ventricle and this
ventricle moves to the yes
Central Area these are called lateral
ventricle right lateral ventricle and
left lateral ventricle and fluid moves
into this space which is called third
ventricle and from the third ventricle
fluid passes through a duct and then
coming to
fourth ventricle right now if Central
structures are
damaged if Central alcohol has damaged
the development of this area of the
brain what will happen that this
underdevelopment of central area so both
ventricle both lateral ventricle right
and left they will become near or away
yeah because Central structure are
damaged by the alcohol so this part of
central part of the brain will not
forebrain will not develop properly so
both lateral structures will become more
near even both lateral ventricles May
fuse with each other so this is another
Finding in this problem that when
alcohol damages the trilominate disc
there's a hypotenourism there's
underdevelopment of the forebrain
especially lateral ventricles become
very near to each other or even lateral
ventricles May fuse with each other
right there is Fusion of lateral
ventricle Fusion of
of lateral
lateral
ventricles right so all these do you
think this is a normal baby now
and mentally very very abnormal
now hold this situation
which is produced by unfortunate intake
of alcohol at the time when female was
not sure she is pregnant or not so she
could not take proper care right all
this problem which occurred to the baby
with underdevelopment of forebrain
fusion of lateral ventricles and
hypotenourism whole this complex is
given a name
what is the name of this problem
this is called yes Hollow Frozen cephale
what we call it Hollow
Hollow Frozen
right Hollow Frozen's Valley so what is
the hollow presence Hollow closings
fellae is
it is a condition produced by
teratogenic effects of high doses of alcohol
alcohol
to the developing trileminar disc
specially its midline structures right
in which there is hypotenourism with
under development of the forebrain and
there there may be Fusion of both
lateral ventricles
no problem up to this and you understand
why this problem developed because
mother is not sure a female is not sure
that she is pregnant or not am I clear
now we come to
another problem which occurs during this time
another problem related with gastrulation
that is
that again go back to your trilaminar disc
even trilominate disc is formed the disc
is more broad
encephalic form or real more broad on
the outer land
yeah it is more broad on the
cephalic and right again so this is the
what was this membrane first of all
three quarter plate buccopharyngeal
membrane what was here primitive
primitive
straight primitive node very good and
and
what is this
notochord excellent and there was a
membrane here also what is that local
membrane that's great this will become
eventually the area where mouth will
develop and this will become area where
anus will develop
that's great you remember it so well and
what was this
measured and of course again we come
and right
right
now in pre previous problem we were
talking about alcohol damage to the
anterior midline structure
now we will talk about a different
situation and in this situation there is
problem with the posterior end of the
what is this
gastrulation in the embryonic disc the
caudal end of this is the elegant of the
embryonic disc this is the Cowardly end
of the embryonic test now the problem is
that caudal end of the embryonic disc is
not developing properly right so we say
that there is caudal disc Genesis
caudal cuddle mean the back and lower
end of the body right a truly speaking
caudible mean tail end of the body but
you know we don't have tail very sad
Genesis
caudible disc Genesis that this area
does not develop ground right especially
encodile dysgenesis the real real
problem which is very important problem
is under development of caudal mesoderm under
under
caudal measured
measured now
now
if you know that what are the structures
which are made from the Cowardly
mesoderm you can tell me what type of
problems will be there in this
fetus or when this baby is born again
again
what is the problem here maybe some drug
or some toxin has damaged the Cowardly
development of the trilamina disk but
this type of problem occurs it is
associated with the females
the females who take lot of alcohol they
cephalic part of the disc germ damage is
that right females who have another type
of problem they their babies are at
higher risk of developing abnormalities
in the caudal end of the disc right
what is the problem with the female what
kind of problem yeah
drugs can do that damage also
but I think classically you are supposed
to know females with diabetes mellitus
female female who are diabetic they also
become pregnant and if their diabetes
mellitus is not controlled right
right
maybe very high levels of glucose is
damaging these structures they are still
doing the what's the problem there but anyway
anyway
the females uh actually those babies
which are born with problems related
with caudal disc Genesis those babies
are having the mothers
which are usually diabetic is that right
now can you tell me this baby will have
what type of problem
okay let me make this structure that
you remember I told you that
and what is therein
mesoderm right okay here should be of
course development of spinal cord and
Central Nervous vertebral column but on
the side what is this measured
measured
this is
the medial part of the mesoderm then
there is
intermediate part of
mesoderm and then there's lateral plate of
of
actually this is all mesoderm is that right
right
mesoderm has medial part this was medial
then just lateral to the medial there's
intermediate and more laterally lateral
plate if you really don't understand
I'll make it more clear to you if you
look at the disc like this this is the ectoderm
ectoderm
and here is your
beautiful notochord
and here is your what is this
measure Dam right and of course here
should be yes please
androdum right then I told you that this
whole this trilemma disk fold like this
and when it folds like this it makes
this trunk of the body
is that right so of course Andrew Dome becomes
becomes
yes please Android one become the most inner
this endoderm so this was the ends of
the endoderm when it fold and fold the
meat with each other then then of course
also meets with
each other unfolding and of course what
is this ectoderm also folds like this
this is the structure ectoderm mesoderm
endoderm Amic layer now the point which
I want to tell you that later on we'll
learn that mesoderm which is
this is a medial most medium mesoderm
right later on we'll learn they make
special structures which are called
somites and then
this is intermediate mesoderm this one
this and this and this is called lateral
plate because originally this was going
laterally but eventually it folded and
came laterally and interiorly are you
understanding me
now and when you are pulling out the
limbs from here which limbs are coming
from here
of course lower lamps
right so of course this mesoderm is also
coming into that am I right
the mesoderm structure which was present
in this will also come here and make the
bones and muscles of the lower line is
that right now if
the this part of the disc is damaged it
means this part will not develop properly
properly
am I clear no problem into this so what
will be the problems with the baby first
of all lower limbs will not develop
properly because Merlin was supposed to
Bud out from this area
is that right
so lower limbs may not be formed
properly or even both lower lens may be fused
fused
you are getting it both lower lens may
be fused so in caudible disc Genesis
right in sufficient mesodermis formed
mesoderm is less than normal and when
there is insufficient mesoderm in the
caudal part of the embryonic disc that
will lead to under development of lower
limb or Fusion of lower limbs so what
are the problems yes that will
under development of lower limb is also
called hyper
plasia of lower limb or Fusion of lower
lamp both lower limbs are together
Fusion of lower lamp number one problem
number two what else will be there yes
yes
do you think vertebral column on the
back will form properly
in this baby on the back
right vertebral column will form
properly no because when this part is
developing vertebral column so vertebral
column will not be well
so abnormal vertebral
vertebral
development vertebral column will not develop
develop
normally especially in the sacral region
Lumber and sacral region which is the
lower part of the back right thirdly
thirdly
you know if you move all this mesodermis
less and not properly developed so the
structures which will develop from
intermediate major Dam those structures
will be developed well or not
if this mesoderm is not developing
can the structure derived from these
intermediate media term will develop now
what are the structures which are
you have something called kidneys
urogenital system
many parts of urogenital systems are
derived from intermediate mesodan
so you can very easily understand that
there may be renal mean
no formation of credit or
or
hypoplasia of renal tissue that renal
tissue is found less
hypoplasia of renal tissue
tissue
then of course because
because
intermediate mesoderm
forms the urogenital system so not only
renal tissue is in trouble but
development of genitalia is also
problematic so genital abnormalities
abnormalities
genital abnormalities
another unusual situation is in this baby
baby
in perforate
yes she is very right clerical membrane
does not rupture so there will be
the perforation for NS will not be there
is that right so all this is telling
that lower limbs are abnormal look
vertebral column is abnormal right
right
lower vertical column is abnormal
lower limbs are abnormal and
underdeveloped and kidneys are not
developing properly is that right and
eurogentral system is not well and NS is not
not
perforated all this is telling that
caudal part of the germ disc was damaged
this is right and whole this situation
is called caudal disc Genesis are a
slightly diff another term which is used
for this condition is called this little
cyrino
it's not a name of a girl this name of
the disease cyrino Melia
right caudal this Genesis
is that right
and again you have to remember what was
the problem with the mother
usually this type of problem is
associated with diabetes mellitus
mellitus
so you can remember now onward interior
part of the disc and midline structure
interior or you can say cephalic midline
structures are damaged in alcohol abuse
right and in diabetic mother which have
very severe episodes of hyperglycemia
uncontrolled diabetes they have higher
risk of developing caudible Genesis of
the baby
any problem up to now or clearly
understood okay then we go to one more problem
problem
which occur
due to abnormality during gastrulation
let me tell you something more about gastrulation
gastrulation
during the gastrulation
when this trilaminar disc is formed I
told you this is which which part of the
desk hurry up
what is this part of the ectoderm this
is neither damn and what is here
endoderm actually the endodermal cells here
here
this is the ventral part of the baby and
this is a dorsal part of the baby so on
the disc on the ventral part there are
cells with cilia what are these the
cells with
Celia so in the trilominate disc again
listen carefully let us suppose this is
ectoderm right this is a spelican this
is the cowderland this is the ectoderm
here in between is mesoderm and here it
is my lower hand is endoderm this is
endoderm now endoderm this side is the
ventral side of the embryonic structure
and this is the dorsal side because
eventually this will become the back and
this will become
ventral side now listen actually
on the endoderm on the ventral surface
there are cilia what are there cilia
and the Cilia and movement of Celia
control the concentration of certain molecules
molecules
which determine which side of the
fetus will become right side and which
side will become the left side it means
the Cilia here right on the ventral
aspect of the endoderm which
alter the concentration of certain
substances we'll discuss them in detail
later and those substances some of those
substances are called Left Lefty one and
Lefty two
those substances are more on the left
side of the disc and they help in the
development of left-sided structure is
that right anyway we will talk about
them later so this cilia actually play a role
role
play a role in pattern pattern
development of the right side of the
body and the left side of the body is
that right actually this endoderm is on
the visceral side so viscera will form
here the visceral the thorax will form
and more quarterly Visa of the abdomen
will form right like quarterly issue
there will be development of the heart
and respiratory system and sorry
cephalically sorry spherically there
will be development of the respiratory
system and the heart and cloudly there
will be development of you know
gastrointestinal system along with the
liver and pancreas and other structures
in abdomen many other vifra author
I'm telling you all this because I have
to link this basic information with the
clinical problem
clinical problem is this that now their
thing actually doctors came across you
will come across sometimes in your life
in your professional career with the
people who do not have a heart on this side
side
you know normally you're supposed to
have heart on the left side
you put your stethoscope here and you
don't hear the person is smiling at you
not dead
where is the heart has gone
use them in a chest of a man or spirited
there's no heart here where it has gone
other side where
okay you are having a very least
romantic answer you could say it has
gone to his beloved but anyway so heart
may be on the
other side
rarely you come across a patient who a
person who has a heart on the right side
of the chest we call it dextrocardia
dextromine right right sided heart
dextrocardia and sometimes you come
across a patient
where every visra in the thorax and
abdomen has a wrong orientation
you are supposed to have hard on the
left so please on the left stomach on
the left
but you find the patient all these
things are on the right and liver is
supposed to be on the left and you find
the funny situation liver is on the
liver is supposed to be on the right and
you know like me embryo also got
confused and do the wrong things right
so liver
injure patient rarely may be on the left
so some very rarely you may come across
a patient that not only your heart is
on the
reverse side of the body either all the
vifra in the wrong side of the body
we call this situation cytus and verses
what we call this situation this is now
third situation I'm talking situs
inverses
that sight of the visra is inversed in
the body is that right
they're flipped in the body so a
condition called cytus inverses is a
condition in which there is
transposition of
thorax and abdominal viscera
transposition means are supposed to be
on the left side or on the right side
and this one which are supposed to be on
the right side are actually on the left side
side
but otherwise patient may not have any
other serious problem right
right
so these people who have cytus inverses
now they believe probably the real
trouble occurred when these patients
were in the stage of their development
of gastrola gastrulation you know when
you are developing into gastrulation
process the product of conception is
called gastrola you don't remember there
was two cell stage four cell stage there
were morola blast processed remember
right then the biliminal disc and when
this trilominar disc the product of
conception is called
gastrula is that right and later on
nervous system will develop we call it neurola
neurola
right anyway right now we are
concentrating about gastrola so when
gastro is forming an endoderm
is having special cilia and producing
from certain factors are being produced
by The Germ desk we determine the right
and left orientation but during
gastrulation if right and left
orientation is not done properly there
may be visra goes in the they rotate in
the wrong direction and you end up with
a patient who is having a problem called
cytosineverses now I will tell you
another interesting situation let us
suppose you are doing specialization and
patient with cytosis inverses and all
over the world all patients of
cytosineverses are referred to you
your Center has every patient coming
with cytus inverses right from
everywhere every American state is
referring such people to you out of them
out of them 20 percent patient may have
some additional problems
and those 20 patient you have 100
patients with cytosine versus eighty
percent have only one problem
eighty percent patient have only one
problem they're very happy patient
because they don't have any additional
problem just viscera rotated but twenty
percent of the patient may have some
you know what are the additional problem
that most of the structures in the body
adult body where Celia or celia-like
structures are working
they are cilia are dysfunctional
you know the structure of cilia
right for example here's a cell
and from the cell I make a Celia Celia
has a lot of protein then it has some
Central proteins I will not go into
detail right now but later on you will
understand Celiac make a movement with
molecular Motors and there are special
proteins here and these proteins are
called dinin what are these called
Dinan these Dinan proteins are abnormal
probably the genes the genes which
control the formation of this dinine
proteins those genes are mutated in this
patient so when dynin when genetic
defect is there in the gene
of course the normal DNA will make up
normal RNA and abnormal protein and if
dinine proteins are molecularly of
normal cilia cannot work well
and when cilia do not work well
problems start from the gastrulation you
remember in the gastrulation endoderm
has some cilia which direct which side
should become the right side we should
become left side so cilia don't work
well and number one structures May
rotate wrongly and you may end up with a
patient with
cytose inversus and when this patient
is born
right and if he is born he may have more
problems due to
abnormal function of Celia
for example the lot of celias which are
present in respiratory epithelium you
know respiratory mucosa lines the
paranasal sinuses you know paranasal
sinuses is maxillary sinus and there are
other frontal sinus and there are
ethnoidal sinuses they are still there
right so all these sinuses they are
having cilia which beat them
be towards our nose so that from these
sinuses mucus should go to the
nose should I make a diagram or you are
understanding me
right that from for example this is
exactly sinus this is maxillary sinus
okay there should be
either konka here is the opening of
maxillary sinus and here is also opening
of maxillary sinus
and actually in the measly sinus is a
respiratory mucosa that respiratory
mucosa is cilia and these cilia are
beating the mucosa towards these
openings so that mucus should go to the
nose and mucus should not collect into
paranasal sinuses right
now what really happens if Celia are not
working well in this patient mucus will
be efficiently moving toward the mother
it will start collecting here
when it will collect into these Pockets
very happily bacteriable
settle on them and proliferate there and
produce chronic
sinusitis chronic mean their sinusytosis
for long duration so these patient this
this is only one problem then they have
other problem also
you know in the lungs okay
and the respiratory
passages there are also cells which are
having cilia and again these cilias are
beating towards okay
okay
you know in the respiratory lining
respiratory mucosa
there are selfish produced mucus and
this mucus which is produced suppose
this is a passage these are the cells
they are having cilia and some cells
produce mucus here this mucus which is
present over here
you know why this mucus is here so if
some dust particles of bacteria come
they should stick on the mucus and then
this mucous carpet is pushed towards a where
from the respiratory system towards the
larynx and from the larynx where this
will go from the bronchial tree mucus is
going towards the trachea then upward to
the larynx then where this mucus goes
mucus along with all bacteria and dust
particle will be thrown into esophagus
through the esophagus it will fall into
stomach in the acid pool everything is
destroyed you know
if you throw this mucus out you call it sputum
sputum
so this is if you throw out it is putum
but usually you don't throw out your
very good people you just swallow it
how much mucus you produce daily
at least equal to one cup of tea
everyone produces it is
mucous ciliary clearance mechanism of
the respiratory system and if in these
patients if these cilia are also not
working well they think mucus will get clear
clear
so mucus will accumulate there bacteria
will settle on them lot of infections
will settle and bronchial tree will be
damaged and bronchial walls will become
strong or weak
we can they will balloon out
so there will be abnormal dilatation of
bronchial passages and full of lot of
infection this situation is called bronchiectasis
bronchiectasis bronchiat
bronchiat ases
ases
so these patients who have cyterson
versus they may develop yes these words
are present in embryology book I'm not
teaching from my own private knowledge
right so there is chronic sinusitis and
this person may develop bronchiatases
and you may also develop
especially males develop a problem
there's male type of infertility you
know why
you know it's the duty of the male to
travel after the female
and it holds true even up to sperm and
o1 relationship over strain fallopian
tube and weight path
it's firm to come all the way so much
long travel
and for that sponge should have power to travel
travel
and the legs of the Sperma the Celia on
the back of the sperm you know tail of
the sperm
and when this person is having problem
with the diamonds do you think sperm
tail can be moving so what happened
these males have sperm which are immortal
immortal
even in epididymis also Celia don't work
well so they don't produce motile sperms
right do you think these males will be
fertile then so they are infertile so
they have problem with the infertility
with the male male infertility
is that right
so these people who have cytus inverses
along with the chronic sinusitis
bronchiatases and male infertility hold
this situation and of course if there's
female then don't say there's male
infertility you simply say there's no
problem because
Uber does not need to have cilia to
travel around the female has a problem
she will have chronic sinusitis or
bronchial cases or cytosineverses but
such female will not have the
infertility problem but if this patient
happened to be male then he'll have
fertility problems issues as well so
this whole complex
cytosine versus all this disease complex
it is called Carta
Carta
Cartagena syndrome generous
generous syndrome
syndrome
I don't know why this is very high yield
in USMLE they like to make mcqs about
Cartagena syndrome and Celia function
and how because this is an example how
the defect in DNA in the gene can
produce defect in the RNA and how
defective RNA make defective dinens and
how defective dine in and defective
cilia problem and how cilia problem
at as early as gastrulation can produce
cytosis inverses and how Celia problem
can eventually lead to chronic sinusitis
bronchectasis or male infertility so you
can go down from DNA problem to RNA
problem to protein molecular problem to
structure of the cell severe problem and
tissue abnormality and whole system
abnormality right so let's have a break now
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