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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