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Anatomy 4.

November 15, 2011


Dr. Maj-maj Deriada-Melendres

Embryology - GIT
OUTLINE
Introduction to alimentary tract embryology
a. Primitive Gut
b. Mesenteries
II. Foregut
a. Esophagus
b. Stomach
c. Duodenum
d. Liver and Gallbladder
e. Pancreas
f. Abnormalities of the foregut
III. Midgut
a. Abnormalities of the midgut
IV. Hindgut
a. Abnormalities of the hindgut
I.

*In Times New Roman are information lifted from the book / some other
source
Objectives:
To understand the embryologic development of the alimentary tract and
associated organs

I. INTRODUCTION TO ALIMENTARY TRACT EMBRYOLOGY


Primitive germ layers:
o Endoderm: innermost layer (epithelium, parenchyma)
o Mesoderm: middle layer (muscle, connective tissue,
peritoneum)
o Ectoderm: outermost layer (skin)

Figure 1.1 Divisions of the gut tube at the end of the

1st month

A. PRIMITIVE GUT
Pharyngeal gut: buccopharyngeal membrane lung bud
Foregut: caudal to pharyngeal tube liver bud
Midgut: caudal to the liver bud to the junction of posterior
(right) 2/3 and distal (left) 1/3 of transverse colon
Hindgut: left 1/3 of transverse colon cloacal membrane

Figure 2. Primitive Gut

B. MESENTERIES
Suspends the primitive duct
Double layers of peritoneum
Retroperitoneal organs:
o Situated behind the peritoneum
o Covered only in its anterior surface by peritoneum
o Ex: kidneys and pancreas (originally intraperitoneal)
Peritoneal ligaments:
o Pathways for vessels, nerves and lymphatics to and from
abdominal structures
o Ex. Lesser omentum and falciform ligament
o Runs from 1 organ to another / from an organ to the body wall
Dorsal mesentery:
o Extends from lower end of esophagus to cloacal region
o Region of stomach: dorsal mesogastrium or greater omentum
o Duodenum: dorsal dorsal mesoduodenum
o Jejuno-ileal loops: mesentery proper
o Large intestines: dorsal mesocolon
o Serve as pathways
o Supplied by branches of the superior mesenteric artery and
vitiline artery
o Hindgut: inferior mesenteric artery
Ventral mesentery:
o Extends from distal part of esophagus to upper part of
duodenum (covering stomach)
o Arose from a mesodermal plate = septum transversum
(separates the pericardial cavity from the yolk stalk)
o Growth of liver into septum transversum separation into:
visceral peritoneum of liver
lesser omentum (from course of ventral mesentery to liver)
falciform ligament (from ventral body wall to liver)
II. FOREGUT
A. ESOPHAGUS
Initially, the esophagus is short but due to descent of heart and
lungs = elongation
o Upper 2/3: muscular coat, striated innervated by vagus nerve
o Lower 1/3: smooth muscle, innervated by splanchnic plexus
During development: lateral pinching of space between the future

Group - 15 | Athina, CJ, Ida, Cams, Kakay, Reena, Lester, Dave

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esophagus and respiratory tract = separation of the 2 esophageal


tubes
Dorsal and Ventral Mesogastrium
o Connect the stomach to the dorsal and ventral body wall
o Dorsal mesogastrium elongates and shifts from right to left
side = formation of omental bursa (lesser peritoneal sac)
o Ventral mesogastrium pulled towards the right
o Mesodermal proliferation between the leaves of the dorsal
mesogastrium = formation of the spleen (5th week)
Antero-Posterior rotation of the stomach:
o Dorsal mesogastrium bulges downwards lengthens
downward = Greater omentum

Figure 3. Successive stages in development of respiratory diverticulum and


esophagus through partitioning of the foregut

CLINICAL CORRELATION
Esophageal Atresia with or without tracheoesophageal fistula
Failure of the esophagus to develop completely
May be due to posterior deviation of tracheoesophageal
septum or may be due to a mechanical factor pushing
dorsal portion of the foregut forward
B. STOMACH
Change in position due to rotation of stomach along a longitudinal
axis and an antero-posterior axis due to difference in growth rates
of various parts of the wall of the stomach and in changes in
position of surrounding organs
O
90 clockwise rotation along longitudinal axis:
o Original left side of stomach becomes anterior
o Right side becomes posterior
o Left vagus nerve: anterior part of stomach
o Right vagus nerve: posterior part of the stomach
o Rapid elongation of the original posterior part of the stomach
= greater and lesser curvatures of the stomach
Initially the stomach lies along the midline but due to anteroposterior axis = caudal (pyloric) end shifts towards the right and
upward
Cephalic (cardiac) portion of stomach shifts to the left and slightly
downward

Ventral Mesogastrium
o Liver chords penetrate and increase in number in septum
transversum liver size increases transverse septum
becomes membranous ligament
o Free margin of falciform ligament umbilical vein round
ligament of the liver (ligamentum teres hepatis)
o Free margin of lesser omentum hepatoduodenal ligament
(where portal triad is located bile duct, hepatic artery and
portal vein)
Hepatoduodenal ligament: roof of epiploic foramen of
Winslow (connects greater peritoneal sac and lesser
peritoneal sac)

Figure 5. Stomach development and its mesenteries


th

Spleen Primordium (5 week)


o Part of dorsal mesogastrium comes into contact with the
peritoneum of posterior abdominal wall line of fusion
degenerates
Spleen is suspended intraperitoneally by its connection to
the posterior abdominal wall via the lienorenal ligament
and to the stomach via the gastrolienal ligament
Pancreas development
o Initially grows into dorsal mesoduodenum
o Tail eventually extends into dorsal mesogastrium
o Called a secondary retroperitoneal organ since it initially
developed intraperitoneally

Figure 4. Rotation of the stomach


Group - 15 | Athina, CJ, Ida, Cams, Kakay, Reena, Lester, Dave

C. DUODENUM
Upper part: foregut
Lower part: midgut
Initially: midline but due to rotation of stomach takes a C
shaped loop due also to rapid growth of the head of the pancreas
shifts to the right
Dorsal mesoduodenum: disappears (except duodenal cap)
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Fusion of dorsal mesoduodenum and adjacent peritoneum


nd th
2 -4 part of duodenum becomes retroperitoneally fixed
nd
2 month of development: lumen disintegrates due to an
increase in the cells produced by the walls then recanalizes soon
after in order to make the duodenum patent.

Figure 6. Dorsal Mesoduodenum

D. LIVER AND GALLBLADDER


Forms a ventral bud from the distal portion of the foregut
Penetrates septum transversum increase in cell number and

size of liver narrowing of hepatoduodenal ligament bile duct


formation
Liver cords parenchyma of the organ and lining of biliary ducts
mesoderm of septum transversum hematopoietic cells, Kupffer
cells, and connective tissue cells
Entire surface of liver is covered by peritoneum except on its
cranial surface (posterior of liver) where it is not covered by
peritoneum (bare area of the liver)
th
10 week of development: weight of liver is 10% of total body
weight due to increase in the number of sinusoid and
hematopoietic function leading to increased production of RBC
and WBC
th
12 week of development: hepatic cells start to produce bile
Last 2 months of gestation: liver becomes 5% of total body weight
Entrance of bile duct shifts from anterior to posterior due to the
rotation of the duodenum and because the bile duct passes
behind the duodenum

Figure 7. Liver Development

Group - 15 | Athina, CJ, Ida, Cams, Kakay, Reena, Lester, Dave

E. PANCREAS
Forms as 2 endodermal buds from the endodermal lining of the
duodenum
Ventral pancreatic bud: close to the bile duct
o Rotation of the duodenum = pancreatic bud together with bile
duct shifts to the right and rotates with duodenum so
ventral pancreatic bud lies immediately below and behind
dorsal pancreatic bud parenchyma and duct system of the 2
buds will fuse
o Gives rise to the head of the pancreas
Dorsal pancreatic bud: arises from dorsal aspect of duodenum
and lies within the dorsal mesoduodenum
o Gives rise to the rest of the pancreas
Dorsal pancreatic duct (distal) + entire ventral pancreatic duct =
Main pancreatic duct of Wirsung enters duodenum at major
duodenal papilla
Proximal part of pancreatic duct will either obliterate or be
retained.
o If retained, it becomes a small channel known as the accessory
pancreatic duct of Santorini which opens into the minimal
duodenal papilla
rd
3 month: Pancreatic islets of Langerhans are produced
th
5 month: insulin is produced
III. MIDGUT
Suspended in the abdominal cavity by short dorsal mesentery
Apex of primary intestinal loop will open into the yolk sac through
vitelline duct or yolk stalk
Extends from just below the liver bud in duodenum and extends
to the junction of the transverse colon (proximal 2/3 and distal
1/3)
Supplied by the superior mesenteric artery
Characterized by rapid elongation of the gut in the mesentery =
primary intestinal loop: cephalic and caudal
o Cephalic: give rise to most of the SI
Forms lower part of duodenum, jejunum and ileum
During this rotation (primary intestinal loop rotates along
an axis formed by superior mesenteric artery) rapid
increase in length leads to the formation of coils (LI will
not participate in coiling phenomenon)
o Caudal: gives rise to the rest of ileum, cecum and appendix,
ascending colon and proximal 2/3 of the transverse colon
O
o Normally should rotate at 270 counter clockwise
6th week: intestinal loops herniate into the umbilicus = primary
O
intestinal loop should rotate 90 clockwise
O
Up to 10th week, it should turn 180 more before it returns to the
abdominal cavity = thats why the transverse colon is anterior to
duodenum
CLINICAL CORRELATION
Physiological Umbilical Herniation

Occurs at 6th week gestation caused mainly by increased


growth and expansion of the liver compromising the capacity
of the abdominal cavity to accommodate the intestinal loops
primary intestinal loops goes to umbilical cord and herniates in
the extraembryonic cavity

1st segment to enter: proximal segment of the jejunum (will


settle on the left side of abdominal cavity while the other loops
will go to the right)

Last part to enter is the cecal bud which settles in the right
upper quadrant then begins forming the appendix

50% of cases have the appendices of the newborns behind the


cecum

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A. MESENTERIES OF THE INTESTINAL LOOP


Mesentery proper is the portion of the dorsal mesentery that
covers the region of the primary intestinal loop
Ascending and descending colon are not really fused to posterior
abdominal wall but eventually will come into contact with the
peritoneum fusion = ascending and descending colon become
retroperitoneal
The rest will maintain their mesenteries = still intraperitoneal
Mesentery of the transverse colon
o Transverse mesocolon fuses with part of greater omentum =
retains mobility
o Line of attachment from hepatic flexure of ascending colon to
splenic flexure of descending colon
Mesentery of the Jejunoileal loops
o Initially: mesentery proper is continuous with mesocolon of
ascending colon
o As ascending colon fuses with mesocolon of posterior
abdominal wall = mesentery proper forms a new attachment
from area of duodenal cap to area of ileocecal valve
CLINICAL CORRELATION
Abdominal Wall Problems:
Omphalocele:
Abdominal wall defect involving herniation of abdominal viscera
through enlarged umbilical ring
Intestines are covered by amnion
Origin of defect: failure of the bowel to return into abdominal
cavity after physiologic herniation
rd
Failure of infolding of the abdominal wall during 3 week of
gestation
Defect through umbilicus: 4-10cm
Gastroschisis
Protrusion or herniation of intestines directly into the amniotic
cavity through a defect in abdominal wall
Intestines are not covered with amnion, and amniotic fluid can
damage herniated viscera
Origin of defect: failure of complete closure of anterior abdominal
wall in the umbilical area
Complication: viscera may loop around itself causing death
Vitelline Disorders
Meckels Diverticulum
Vitelline duct does not obliterate, part of it forms an outpouching
of the ileum
Occurs in 2-4% of population
Located 2ft from ileocecal valve and 2 inches long
Asymptomatic
Problems only arise in certain conditions (ulceration, bleeding,
perforation)
Enterocystoma
Enlarged vitiline duct
Bowel loops may rotate upon it = compromise of vascular supply =
decrease in blood supply
Vitelline/umbilical fistula
Whole length of vitelline duct does not obliterate and remains
patent all throughout
Fecal discharge at umbilicus

Group - 15 | Athina, CJ, Ida, Cams, Kakay, Reena, Lester, Dave

CLINICAL CORRELATION contd


Gut Rotation Defects
Left Sided Colon
O
90 counter clockwise (instead of 270)
Cephalic limb gives rise to most of Small Intestine (SI)
Caudal limb gives rise to Large Intestine (LI)
O
If after herniation, the primary intestinal loop rotates 90 counter
clockwise caudal limb retracts first to settle to the left
Right Sided Colon
Duodenum ends up anterior to the transverse colon
IV. HINDGUT
Gives rise to distal 1/3 of transverse colon to anal canal
st
End of 1 month hindgut enters into a chamber known as cloaca
o Posterior portion of cloaca will give rise to primitive anorectal
canal
o Anterior portion will give rise to primitive urogenital sinus
Cloaca
o Common chamber for urogenital sinus and anorectal canal
o Endoderm-lined cavity
o Ventral boundary covered by surface ectoderm
o Cloacal membrane: endoderm + ectoderm
th
o Ruptures at the end of 7 week to give rise to development of
the perineal body
Urorectal septum
o Mesodermal tissue that separates the allantois from hindgut
o Will move downward and will lie very close to cloacal
membrane
th
o End of 7 week: rupture of cloacal membrane creates anal
opening for hindgut and ventral opening for urogenital sinus,
with a perineal body between the two
Solid Stage
o Ectoderm from distal most portion of the hind gut will
proliferate into the walls of the anal canal will undergo
recanalization to retain patency
Anal Canal: divided into upper and lower anal canal
o Upper 2/3: from endoderm
Supplied by: superior rectal artery (branch of inferior
mesenteric artery)
Lining epithelium: simple columnar (transitions into)
stratified squamous epithelium upon reaching the area of
the lower anal canal
Pectinate line: indicates the lower part of the anal
canal)
o Lower 1/3: from ectoderm
Supplied by: inferior rectal artery (from the internal
pudendal artery)
Lining epithelium: stratified squamous epithelium
o Lower 1/3: ectoderm

Inferior rectal artery from the internal


pudendal artery

Stratified squamous epith

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CLINICAL CORRELATION
Problems with the Hindgut
Imperforated Anus

Anal membrane fails to break down / recanalize

Fecal matter is unable to leave the body


Hirschsprungs Disease

Also known as: Congenital Megacolon or Aganglionic


Megacolon
th

12 week of gestation

Failure of relaxation

Due to absence of parasympathetic ganglionic fibers

Fecal odor breath

Ribbon-like stools (due to very constricted or small


passageway)
RIBBON (MNEMONICS) John Lorena, RN

Rectosigmoid (site)

Infants failure to thrive

Biopsy (most definitive diagnostic test)

Bowel impaction (constipation)

Ostomy / colostomy

Neomycin (to cleanse bowel to put in enema)

Group - 15 | Athina, CJ, Ida, Cams, Kakay, Reena, Lester, Dave

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