GI System Embryo (6th edition picture references)

1. Definitions
Stenosis – (intestinal) when the lumen of the intestines is narrowed,
results from minimal recanalization (programmed cell death of
endoderm in canal)
Atresia – (intestinal) when the lumen of the intestines is completely
occluded, results from no recanalization,4 different types
Canalization – endoderm (from mesoderm layer) lines the gut tub
(proliferates) nonuniformly and creates an epithelial plug
Recanalization - and following canalization there is programmed cell
death (that follows a cranial to caudal progression) which is the final
development of endoderm
No recanalizatin  no lumen  Atresia
Minimal recanlization  muscle and C.T. adapt  Stenosis
Normal recanalization  endoderm to epithelial  Lumen OK
Bile – formed by hepatic cells in 12th week, enters duodenum through
the bile duct and gives a dark green color
Meconium – intestinal contents (feces)
Polyhydramnios – accumulation of an excessive amount of amniotic
fluid, can occur from a duodenal atresia preventing normal absorption
of amniotic fluid by the intestines (double bubble sign on ultrasound),
can also be caused by esophageal atresia
Dorsal Mesentery
- Greater omentum (gastrorenal, gastrosplenic, gastrocolic,
splenorenal ligaments)
- Mesentery of small intestine
- Mesoappendix
- Transverse mesocolon
- Sigmoid mesocolon
Ventral Mesentery
- thin double layered membrane that gives rise to
o the lesser omentum (hepatoduodenal ligament &
hepatogastric ligament)
o the falciform ligament (extends from liver to the ventral
abdominal wall, umbilical vein passes through here)
o visceral peritoneum

2. 3 Major Regions of Embryonic Gut (& boundaries)

Foregut
Embryonic
Primordial pharynx (aortic arches) – Ext. Carotid a.
Lower Respiratory System – Ext. Carotid a.
Esophagus – Ext. Carotid a.
 Duodenum (proximal to opening of bile duct) – Celiac a.
Liver, biliary apparatus, pancreas – Celiac a.

Definitive
Supradiaphragmatic (larynx to diaphragm) -External Carotid a.
Pharynx
Esophagus
Respiratory System
Infradiaphragmatic – Abdominal Cavity -Celiac a.
Esophagus (portion inferior to diaphragm)
Stomach
Duodenum (1st portion including duodenal papillae)
Midgut
Embryonic
- Small Intestine (distal duodenum, jejunem, ileum)
- Cecum
- Appendix
- Ascending Colon
- Transverse Colon (1st 2/3, right half)
Definitive
Hindgut
Embryonic
- Transverse Colon( L 1/3)
Descending Colon
Sigmoid Colon
Rectum
Anal Canal (sup. Part)
Definitive (also includes)
- epithelium of urinary bladder and most of urethra

3. Structures Derived from Foregut

- Pharynx, Esophagus, Respiratory System, Esophagus, Stomach,
Duodenum
a. Blood Supply of caudal – Celiac Artery
b. Parasympathetic (pre and post ganglionic)
i. Preganglionic = Brainstem CN X Vagus
ii. Postganglionic = Terminal ganglia in wall of organ
(usually follow blood supply)
iii. Innervating smooth muscle & glands
c. Sympathetic (pre and post ganglionic)
i. Preganglionics = Lateral Horn of T1-L2
ii. Postganglionics = T1-L2 paravertebral & prevertebral
T5 – L2 (Resp Tract & Heart) & Celiac Ganglion
(Stomach, duodenum)
4. Germ layers of origin for the epithelial structures derived
from foregut:
a. Smooth muscle - endoderm
b. C.T. - endoderm
c. Vascular Supply –mesoderm (endothelium), endoderm
d. Nerve Supply – ectoderm

5. Septum Transversum & structures derived from it

a. S.T. = mass of splanchnic mesoderm b/n developing heart
and midgut
i. Forms Central Tendon of Diaphragm
ii. Ventral Mesentery (of this region)
iii. Hematopoetic tissue and Kupfer cells of liver

6. Rotation of Stomach
- slowly rotates 90 degrees clockwise
o ventral border (lesser curve)  Right
o dorsal border (Greater curve)  Left
o Original L side  Ventral Surface
o Original R side  Dorsal Surface

Before Rotation After Rotation

Cranial/ Caudal medial plane long axis transverse to body

Cranial Region  moves L and Inferior

Caudal Region  moves R and Superior

*Why L. vagus  Ant. Wall of stomach

R. vagus  Post. Wall of stomach

7. Derivatives of Hepatic Diverticulum (liver bud)

a. Liver (cranial portion = primordium liver)
b. Gallbladder
c. Biliary Duct System
- Hepatic Diverticulum extends into the septum transversum

8. Formation of Liver w/I septum transversum

- hepatic diverticulum extends into septum transversum
- enlarges rapidly & divides into 2 parts
- cranial portion  primordium liver
- Caudal portion  Gallbladder
- Stalk of diverticulum  Cystic duct
- Stalk b/n hepatic & cystic  bile duct
- endodermal cells  interlacing cords & epithelial of liver and
biliary apparatus  Hepatic sinusoids
- Mesenchyme (S.T.)  Kupfer cells and hematopoietic tissue
9. Pancreas formation (positional changes) PICTURE 12:10
- most of pancreas is forming from dorsal pancreatic bud (of
endodermal cells) in caudal part of foregut
o Dorsal Pancreatic Bud – develops 1st and b/n dorsal
mesentery layers
o Ventral Pancreatic Bud –-> Uncinate process & part of
head
 develops near entry of of bile duct into the
duodenum b/n layers of ventral mesentery, carried
dorsally when duodenum b/m C shaped
 Now lies posterior to dorsal bud and later fuses w/ it
to b/m head of pancreas
a. Definitive Duct System (positional changes)
i. Main Pancreatic Duct  from duct of ventral bud &
distal part of dorsal bud
ii. Accessory Pancreatic Duct  from proximal duct of
dorsal bud

10. Structures derived from Midgut – Superior Mesenteric

Artery
a. Small Intestine, Most of duodenum
b. Cecum
c. Appendix
d. Ascending colon
e. 2/3 of transverse colon

11. Embryonic Midgut

a. Blood Supply Pattern – Superior Mesenteric Artery
i. Variation will be found in the transverse colon
b. Autonomic Innervation Pattern
i. Paraysmpathetic
1. Preganglionic
a. Brainstem  Vagus
2. Postganglionic
a. Terminal Ganglia in Organ
ii. Sympathetic
1. Preganglionic – Lateral Horn of T1-L2
2. Postganglionic -
a. Paravertebral – T5 – T9 & T10-T12
b. Prevertebral – Celiac Ganglion & Superior
Mesenteric Ganglion
12. Amidgut Rotation (positional changes)
- while in umbilical cord midgut rotates 90degrees
counterclockwise along the axis of the superior mesenteric artery
o Cranial limb of midgut loop to the right
 o Caudal limb “ “ “ left
o Midgut elongates and forms loops of small bowel (jejunem,
ileum)
o Lg intestine returns  another 180 degree
counterclockwise rotation
-
13. History of Region and organ relationships  see p.
285

14. Congenital Basis and Define

- sometimes b/m inflamed and mimics appendicitis
- wall of diverticulum contains all layers of the ileum, gastric and
pancreatic tissues (secretions can cause ulceration)
- reminant of proximal portion of yolk stalk arising from the
antimesenteric border of the ileum
a. Meckel form of ileal diverticulum - *only in Ileum* very
common
b. Umbilico-ileal fistula- ileal diverticulum connected to the
umbilicus by a fibrous cord
15. Caudal foregut and Midgut
a. Arteries and Veins (positional changes)
- Great variation in arterial and veinous supply in Transverse
colon b/c
- During the return of midgut to the body there is great
variance in adherence of transverse colon
16. Developmental Errors
a. Pyloric Stenosis – a marked thickening of the distal
sphincter region of the stomach, hypertrophy of
longitudinal and circular muscles in this region, stomach
b/m markedly distended and projectile vomiting occurs 
surgery necessary
b. Biliary Atresia
c. Anular Pancreas – may cause duodenal obstruction,
results from growth of a bifid ventral pancreatic bud
around the duodenum, the bifid ventral bud then fuses
with the dorsal bud forming a pancreatic ring (12:11)
d. Omphalocoel - persistence of the herniation of abdominal
contents into proximal part of the umbilical cord,
abdominal cavity is proportionally small, immediate
surgical repair is necessary, epithelium of the umbilical
cord covers the herniated sac (derived from the amnion)
e. Umbilical hernia - occurs b/c not enough room in
abdomen for the rapidly growing midgut (liver and kidneys
are v. large)
i. Physiologically occurs @6th week and is the normal
migration of the midgut into the umbilical cord
 ii. Intraembryonic coelom and extraembryonic coelom
communicate at the umbilicus
f. Subhepatic cecum – adherence of the cecum to inferior
surface of liver and drawn up (as liver diminishes) and
remains in fetal position, can cause problems in diagnosing
appendicitis
g. Mobile Cecum – 10% of people have unusual amount of
freedom of cecum, result of incomplete fixation of the
ascending colon, can herniated into R. inguinal canal
h. Volvulus – “twisting of the intestines”,
i. Segmental Duplication of Intestinal Tract – tubular
duplications usually communicate w/ intestinal lumen,
usually due to failure of recanalization  2 lumen form, lies
on the mesenteric side of the intestine