Digestive System

Primitive gut (PG) develops I0 from endoderm

PG digestive system
Dorsal part of the yolk sac is incorporated into embryo as the PG due to formation of head, tail & lateral folds during 4th week

Endoderm gives rise to most of epithelium of the digestive tract & parenchyma of its associated glands
Liver & pancreas

Ectoderm of stomodeum (primitive mouth) epithelium at the superior end of digestive tract Ectoderm of proctodeum (anal pit) epithelium at the inferior end of the digestive tract

Digestive tract
Connective tissue & muscles in the wall of the digestive tract are derived from splanchnic mesenchyme that surrounds the endodermal primitive gut (PG) PG is divided into four parts
Pharynx Foregut Midgut hindgut

Pharynx
Supported by pharyngeal/branchial arches
Series of paired sacculations in lateral walls Pharyngeal pouches
By the end of the 4th week five pairs have formed

Pharyngeal Pouches
First pharyngeal pouch
Enlarges & develops into a tubotympanic recess
This will become the auditory tube & tympanic cavity (middle ear)

Second pharyngeal pouch

Remains small & is largely obliterated as palatine tonsil develops
Endodermal cells form surface epithelium of tonsil & lining of its crypts Mesenchyme around this pouch differentiates into lymphoid tissue

Pharyngeal Pouches (cont.)

Third pharyngeal pouch
Dorsal endoderm inferior parathyroid glands Ventral endoderm unite to form thymus Both glands lose connection with pharynx & migrate in a caudal & medial direction

Fourth pharyngeal pouch

Dorsal endoderm superior parathyroid glands

Fifth pharyngeal pouch (part of fouth)

Ultimobranchial body which incorporates into thyroid gland
These cells give rise to parafollicular/C cells & secrete calcitonin

Foregut
Lies caudal to pharyx & extends as far back as the liver outgrowth At about 4 weeks a small diverticulum appears in ventral wall at caudal border
Tracheobonchiole/respiratory diverticulum
Gradually separates from foregut dividing foregut
Dorsal esophagus Ventral respiratory primordium

Foregut
Esophagus
Tube extending from pharynx to stomach
Initially short but elongates rapidly keeping pace with differentiating neck & descending heart & lungs

Foregut
Stomach
Fusiform dilatation in 4th week of development During the following weeks appearance & position changes (descends)
Increases in length Dorsal border grows faster than ventral wall + 90o CW rotation along its long axis
Posterior faces left, Anterior faces right Convex greater curvature (GC) lies on left Concave lesser curvature (LC) lies on right

Epithelium differentiates into gastric glands & surrounding mesenchyme

Three incomplete layers of the muscular coat

Foregut
Duodenum
Develops early in 4th week from caudal part of foregut & cephalic part of midgut
Junction of two parts directly distal to origin of liver bud

Takes form of C shape loop & rotates to right as stomach rotates

Duodenal rotation along with rapid growth of head of the pancreas causes swing to left side of abdomen

During 2nd month the lumen is obliterated by cell proliferation but recanalized shortly after

Foregut
Liver & gallbladder
Liver primordium appears in middle of 3rd week as hepatic diverticulum (HD) or liver bud at distal end of foregut
Hepatic diverticulum rapidly enlarges due to cell proliferation dividing into a large & small part
Large cranial part liver primordium Small caudal part gallbladder primordium

Hepatic cells continue to divide, the connection between the HD & duodenum narrows bile duct

Liver (cont.)
Epithelial hepatic cell cords intermingle with vitelline & umbilical veins Hepatic sinusoids Liver grows rapidly & fills most of abdominal cavity
Initially right & left lobe are = size
Right lobe becomes larger & subdivides into caudate & quadrant lobes
At 9th week 10% of fetal body weight At full term 5% of fetal body weight

Gallbladder & Pancreas

Gallbladder primordium
Distal end expands gallbladder Proximal part stays narrow cystic duct

Pancreas formed by two buds originating from endodermal lining of duodenum

Buds arise on opposite sides at end of 4th week
Dorsal pancreas forms most of the gland
Pushes out from dorsal wall slightly above hepatic diverticulum

Ventral pancreas head & uncinate process

Develops near entry of bile duct

Main pancreatic duct

Formed by distal part of dorsal duct + entire ventral duct

Midgut
In a 4-5 week old embryo midgut is suspended from dorsal abdominal wall by a short mesentery & communicates with the yolk sac via vitelline duct Will give rise to:
Part of duodenum & rest of the small intestine
Distal to where the bile duct enters

Ceacum Appendix Ascending colon Proximal 2/3 of transverse colon

Midgut (cont.)
All structures of midgut supplied by superior mesenteric artery Development is characterized by a rapid growth in the length of the gut formation of primary intestinal loop
Cranial limb
Part of duodenum, jejunum, part of ileum

Caudal limb
Balance of ileum to proximal 2/3 of transverse colon

Vitelline duct
At junction of cranial & caudal limb If it persists in adult Meckels diverticulum

Midgut (cont.)
As the intestinal loop elongates rapidly & liver enlarges, the abdominal cavity is temporally too small causing intestinal loop to project into the umbilical cord physiological umbilical hernia (starting around the 6th week)
By about the end of the 3rd month the herniated loops begin to return to the abdominal cavity

Hindgut
Gives rise to:
distal 1/3 of transverse colon the descending colon the sigmoid colon the rectum upper part of anal canal

All hindgut derivatives are supplied by the inferior mesenteric artery The terminal portion = cloaca
Cloacal membrane
lined with endodermal cells internally Lined with ectodermal cells externally

Congenital Malformations
Branchial Anomalies Esophageal Atresia Esophageal stenosis Short esophagus Intestinal stenosis & atresia Omphalocoele Umbilical hernia Meckels Diverticulum

Branchial Anomalies
Most of the abnormalities of the branchial region are represented by remnants of the branchial structures that normally disappear
Branchial fistula
An abnormal opening on the side of the neck
Usually the result of persistance of parts of 2nd branchial groove & 2nd branchial pouch

Agenesis of thyroid & parathyroid

DiGeorge Syndrome Failure of 3rd & 4th pharyngeal pouches to differentiate May be due to teratogen action No known genetic cause

Esophageal Atresia
Usually occurs with tracheo-esophageal fistula (TEF) Several types
Lower esophagus communicates with back of trachea & upper esophagus ends in a blind pouch ( most common) Discontinuous esophagus with no tracheoesophageal fistula (rare)

Possibly genetic Possible maternal vitamin A deficiency

Congenital Esophageal Stenosis

Rarer than esophageal atresia with TEF Little known etiology Symptoms
Regurgitation of food Failure to gain weight Dilation of esophagus above level of obstruction may press against the trachea & bronchi produce wheezing sounds

Congenital Malformations (cont.)

Short esophagus
Causes partial thoracic stomach
Small portion of stomach above diaphragm Gastroesophageal incompetence is a common cause of vomiting (often projectile) during infancy

Intestinal stenosis & atresia

Occurs commonly in duodenum & ileum May be due to interruption of blood supply to a loop of fetal intestine
Results in necrosis, which later becomes fibrous cord connecting proximal & distal ends

Congenital Malformations (cont.)

Omphalocoele
Results from failure of intestine to return to abdomen during 10th week Hernia may contain a single loop of intestine or most of the intestine
Herniated mass is covered by a thin transparent membrane composed of peritoneum & amnion

Associated with chromosome abnormalities & other severe defects

Umbilical hernia
Differs from omphalocoele
herniated mass is covered by skin & subcutaneous tissue

Congenital Malformations (cont.)

Gastroschisis
Herniation of abdominal contents through the body wall directly into the amniotic cavity
Defect occurs lateral to umbilicus, usually on the right, through a region weakened by regression of the right umbilical vein which normally disappears

Viscera are not covered by peritoneum or amnion

Bowel may be damaged by exposure to amniotic fluid

1 in 10,000 births (frequency is )

May be related to cocaine use

Congenital Malformations (cont.)

Meckels Diverticulum
Ileal diverticulum is common Higher frequency among males Represents remnant of the vitelline duct Appears as finger-like pouch arising from ileum 3-6 cm long & may remain connected to umbilicus by a fibrous cord or fistula Wall of diverticulum contains all tissue layers of the ileum
May include gastric & pancreatic tissue Gastric secretion often produces ulceration