Development of the Digestive System
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Primitive Gut
The Primitive Gut is Formed from the Yolk Sac
during the 4th week
Epithelial lining of the digestive tract & the
Parenchyma of glands (liver and pancreas) Is
derived from the Endoderm except stomodeum
and proctodeum (ectoderm)
Muscles, peritoneum and connective tissues
from splanchnic mesoderm
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The Primitive Gut Tube is closed at its two ends: Cephalic end: Buccopharyngeal membrane
Caudal end: Cloacal membrane
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Gut Tube Recanalization
6th wk: endodermal epithelium of the gut tube
proliferates until it completely occludes the lumen
Vacuoles develop and coalesce until the tube is
recanalized
Stenosis or duplication of the digestive tract may
result from incomplete recanalization
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Derivatives of the Primitive Gut
The Foregut The Midgut
The Hindgut
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FOREGUT
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FOREGUT
1.Pharynx 2.Lower respiratory system 3.Esophagus 4.Stomach 5.Duodenum (proximal part) 6.Liver and biliary tree 7.Pancreas
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ESOPHAGUS
During the 4th weeks the tracheoesophageal septum gradually partitions the proximal part of the foregut into:
1. Ventral portion, the respiratory primordium 2. Dorsal portion, the esophagus
The muscular coat is striated in its upper two-thirds and smooth in the lower third of the esophagus
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Congenital Anomalies of the Esophagus
Esophageal Atresia Tracheo-esophageal Fistula
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STOMACH
The stomach appears as a fusiform dilation of the foregut in the fourth week Its appearance and position change due to the different rates of growth in various regions. Positional changes of the stomach take place due to the rotation of the stomach around a longitudinal and an anteroposterior axis
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Congenital Hypertrophic Pyeloric Stenosis
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The spleen The spleen primordium appears as a mesodermal proliferation between the two leaves of the dorsal mesogastrium
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The duodenum is formed from 1. The distal part of the foregut 2. The proximal part of the midgut During the second month, the lumen of the duodenum is obliterated by proliferation of cells in its walls. However, the lumen is recanalized shortly thereafter
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Duodenal Atresia
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LIVER AND GALLBLADDER
The liver primordium appears in the middle of the third week as an outgrowth of the endodermal epithelium at the distal end of the foregut
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1. Ventral pancreatic bud 2. Dorsal pancreatic bud
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Annular Pancreas
Portions of the gut tube and its derivatives are suspended from the dorsal and ventral body wall by mesenteries
Mesenteries and ligaments provide pathways for vessels, nerves, and lymphatics to and from abdominal viscera
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Dorsal mesentery forms
Greater Omentum mesentery of the small intestine
Ventral mesentery forms
Lesser omentum Falciform ligament
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Development of the Midgut
The derivatives of the midgut
Duodenum (distal to ampula) Jejunum Ileum Cecum Appendix Ascending colon Transverse colon ( right or )
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The midgut derivatives are supplied by the Superior Mesenteric Artery As the midgut elongates, it forms a Ushaped midgut loop of the intestine-that projects into the remains of the proximal part of the umbilical cord This midgut loop of the intestine is a physiologic umbilical herniation, which occurs at the beginning of the sixth week
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The physiologic umbilical herniation occurs because there is NO enough room in the abdominal cavity for the rapidly growing midgut. The shortage of space is caused mainly by the relatively massive liver and the kidneys that exist during this period of development.
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The midgut loop
Cranial (proximal) limb Caudal (distal) limb
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The cranial limb grows rapidly and forms small intestinal loops The caudal limb undergoes very little change except for development of the cecal swelling (diverticulum), the primordium of the cecum, and appendix
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Rotation of the Midgut Loop
While it is in the umbilical cord, the midgut loop rotates 90 degrees counterclockwise around the axis of the superior mesenteric artery
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Return of the Midgut to the Abdomen
During the 10th week, the intestines return to the abdomen (reduction of the midgut hernia)
The return is due to enlargement of the abdominal cavity, and the relative decrease in the size of the liver and kidneys
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The small intestine (formed from the cranial limb) returns first (occupies the central part of the abdomen)
As the large intestine returns, it undergoes a further 180-degree counterclockwise rotation (occupy the right side of the abdomen
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The Cecum and Appendix
The primordium of the cecum and appendixthe cecal swelling appears in the sixth week as an elevation on the caudal limb of the midgut loop The appendix increases rapidly in length so that at birth it is a relatively long tube arising from the distal end of the cecum
The appendix is subject to considerable variation in position.
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Congenital Omphalocele
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Congenital Omphalocele
persistence of the herniation of abdominal contents into the proximal part of the umbilical cord The covering of the hernial sac is the epithelium of the umbilical cord, a derivative of the amnion.
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Umbilical Hernia
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Umbilical Hernia
A congenital umbilical hernia occurs through a weak umbilical scar Males are affected twice as frequently as females Many close spontaneously during the first year of life.
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Gastroschisis
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Gastroschisis
Gastroschisis results from a defect lateral to the median plane of the anterior abdominal wall. The linear defect permits extrusion of the abdominal viscera without involving the umbilical cord.
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Nonrotation or malrotation of the gut
Result from incomplete rotation and/or fixation of the intestines
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Reversed Rotation
Rotation occurs on the opposite side
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Meckel's (ileal) diverticulum An outpouching of the ileum The wall of the diverticulum contains all layers of the ileum and may contain small patches of gastric and pancreatic tissues This ectopic gastric mucosa often secretes acid, producing ulceration and bleeding Rule Of 2?
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Most anomalies of the hindgut are located in the anorectal region
Result from abnormal development of
the urorectal septum Clinically, they are divided into high
and low anomalies (puborectal sling)
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1. Persistent cloaca
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2. Imperforate anus
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3. Ectopic anus
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4. Congenital Megacolon (Hirschsprungs Disease) (Aganglionosis)
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