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FETUS
Formation of Cecum and Appendix

The cecum and appendix develops from cecal diverticulum which appears a swelling
on the antimesenteric border of the caudal limb of the intestinal loop.
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EMBRYOLOGY
Rotation of Midgut

During 6th week of intrauterine life, the greater part of midgut is extruded from
the celom and within the umbilical cord. This temporary affairs as rotation of gut
soon occurs to reduce this so called physiological hernia However, rotation of the
midgut continues even after reduction inside the coelomic cavity In fact, rotation
is completed in three stages, namely 1st., 2nd and.3rd

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FETUS

1 The first stage of rotation occurs when the midgut loop is occupying the
umbilical cord. It comprises of elongation and rotation anticlockwise (180 0) of
the gut on the axis of mesenteric vessels.
2 In the Second stage of rotation, midgut returns to the coelomic cavity with
further rotation of 900 anti clock wise (Total 2700 anticlock wise)
3 In the third stage, further rotation fixes organs like duodenum, mesentery and
descending colon to the posterior abdominal wall. The caecum also comes to
rest in the right iliac fossa during this stage with the completion of 3rd stage
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EMBRYOLOGY
of rotation; the gut revolves by 2700 in the anticlockwise direction. [Ref. Aids
to emb by Samit]

SAQ: What is physiological umbilical hernia?

Development of primary intestinal loop is characterized by rapid elongation,
particularly the cephalic limb.
As a result of rapid growth & expansion of liver, the abdominal cavity
temporally become too small to contain all the inter final loop & so enter the
extra embryonic cavity in the umbilical cord during six week of development.
This is called physiological umbilical hernia.

Development of Midgut Derivatives

Liver
Endodermal hepatic bud arises from the junction of foregut and midgut and
penetrates the mesoderm (septum transversum) to form liver.
(1) Parenchyma and bile capillaries- Endodermal. Develop from hepatic bud.
(2)Sinusoids- Mesodermal. Formed by breaking down of umbilical and vitelline veins
(3)Hemopoietic cells, Kupffer cells, Capsule and Stroma -
Mesodermal. Derived from mesoderm of septum
transversum [Ref. Langman]

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FETUS

Fig Development of liver & biliary apparatus

.
Q-: Explain on developmental background that liver is primarily an exocrine gland.
Ans.
 At fist the liver cells are arranged as portal lobules around the interlobular bile ductules,
the radicles of portal vein and the branches of the hepatic artery.
 Then the liver cells are organised along the intralobular sinusoids and around the central
veins (tributaries of the hepatic veins) showing the formation of the classical liver lobules.
These alterations of the arrangement of the liver cells suggest that primarily the liver is
exocrine in function but in the later part of development it shows greater importance as an
endocrine organ. The bile secretion usually starts from the 5th month

Gall bladder and Biliary Apparatus

1. Pars cystica arises from the hepatic bud forms gall bladder & cystic duct.
2. Hepatic bud proximal to pars cystica gives rise to the bile duct [Inderbir Singh]

Q. Where bile duct opens and what does it indicate?

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EMBRYOLOGY
Ans. Bile duct opens into posteromedical aspect of 2 nd part of doudenum, 8-10 cm distal to
pylorus. It indicates the embryological junction between foregut and midgut.

Q. When bile secretion starts?

Ans. At 12th week of development.

Pancreas

The pancreas develops from two buds - Dorsal and ventral pancreatic buds.
Dorsal and ventral pancreatic buds arise from the endoderm of duodenum. They
later fuse to form pancreas. Head and uncinate process are formed by ventral
pancreatic bud. The dorsal bud forms the remaining part.

Duct system: Dorsal and ventral pancreatic duct fuse. The main duct is formed by
the ventral duct and part of the dorsal duct distal to the fusion

Secretory elements: Formed by proliferation of primitive duct.

Islets of langerhans: They are derived from parenchymatous pancreatic tissue
[Langman]

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FETUS

Q-: How pancreases become retroperitoneal organ?

Ans. As long as the pancreas grows dorsally in the meso-duodenum it is invested by
the peritoneurn on both right and left surfaces. With the rotation of the
duodenum the pancreas rotates to the right so that the original right surface
(covered with peritoneum) now becomes posterior. Later the peritoneum
disappears from the posterior surface except the tail of the pancreas hence the
pancreas become a retroperitoneal organ.

Q. When pancreas starts secretion of insulin

Ans. At 5th month
Q. Why branches from coeliac trunk and superior mesenteric artery both supply the
pancreas?
Ans. As it develops from junction of foregut and midgut. (But it is considered as a
derivatives of foregut).

Spleen
(Though it is not a derivative
of gut, it is being described in
this chapter because of its
relation with this system]
Spleen is developed in the
dorsal mesogastrium from its
mesodermal cells it is
vascularised by splenic artery.
Some of the capillaries are
transformed into splenic pulp.

C. Hindgut

Rectum
It is derived from dorsal subdivision of cloaca. Surrounding mesenchyme gives rise
to musculature and connective tissue component of it
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EMBRYOLOGY

Anal Canal
(1) Above pectinate line-
Endodermal. Develops from lower part of dorsal subdivision of cloaca.

(2) Below pectinate line

Ectodermal. Develops from anal pit. [ Sinqhl

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FETUS
Developmental Anomalies of the Digestive system

Esophagus
(1) Atresia-.

Esophageal Atresia

 When a segment of the esophagus fails to recanalize, the atresia results.

 It is more frequent below the bifurcation of trachea (Datta)
(2)Tracheo-esophageal fistula-
 the distal part of oesophagus is connected to the trachea by a narrow canal
at a point just above the bifurcation.
 This is thought to result either from a spontaneous deviation of the
esophageotracheal septum in a posterior direction, or from some mechanical
factors pushing the dorsal wall at the foregut anteriorly [Ret. Aids to emb,
by Samit Pub.)

Tracheoesophageal fistula

(3)Bronchoesophagal fistula
Q. Oesophagial atresia causes poly hydroamnios. Explain.
Ans:
 Polyhydroamnios means excessive amount of amniotic fluid (about 1.2-2 Ltr.)
 Amniotic cavity filled with amniotic fluid, which is formed by secretion from
amnotic membrane passively from maternal blood.
 At the beginning of 5th month the volume of fluid replaced every three
hours.
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EMBRYOLOGY
 Fetus drink about 400ml/ day and also contribute 1/3 rd of amniotic fluid
(mainly water) through urination.
If there is Oesophegial atresia- fetus cann’t swallow amniotic fluid so no
decreases of fluid volume but continuously increased by secretion and urination
lead to polyhydroamnios.

Stomach
Pyloric stenosis- Characterized by a hypertrophy of the
circular and to a lesser extent, the longitudinal muscle
layer of the stomach in the pyloric region [Ref Aid to
emb, by Samit Pub]

Small intestine
1. Diverticulum in duodenum
2. Duodenal stenosis.

 Narrowing of the duodenal lumen

 Usually results from incomplete recanalization of
the duodenum. it may also be caused by pressure
from an annular pancreas or Peritoneal bands.
 Most stenoses involve the horizontal (third)
and /or ascending (fourth) parts of the
duodenum. Hence the vomitus usually contains bile
3. Vitelline duct abnormalities
a. Diverticulum ilei.
It is also called Meckel’s diverticulum it is the
persistent proximal part of vitello intestinal duct which normally disappears during

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FETUS
6th week of 1U life
1 It occurs in 3% subjects.
2 Length is 5 cm,
3. Situated about 60.cm. proximal to ileocecal valve.
4. Calibre is equal to ileum. [Ref Gray, B-D]

b. ,Vitelline cyst- Both ends of vitelline duct transform into fibrous cord and
middle portion forms a large cyst, vitelline cyst.
c. vitelline fistula- vitelline duct remain patent

.Biliary Tract

1. Gall bladder absent, bilobed or buried in liver or floating under mesentery.

2. Absent or very long cystic duct
3. Presence of accessory (hepatic0cholecystic) duct
4. Extrahepatic biliary atresia (EHBA]
5. Intrahepatic biliary duct atresia and hypoplasia (Langman)
6. Septate gall bladder
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EMBRYOLOGY

Malformations of the Hindgut

1. Congenital Aganglionic Megacolon or Hirschsprung's Disease.
Rarely a portion of the colon is dilated because of the absence of ganglion cell
of the myenteric plexus distal to the dilated segment.

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FETUS
2. Imperforate Anus and Related Malformations abnormal
development of the urogenital septum, resulting in
incomplete separation of the cloaca into urogenital and
anorectic portions.
(i) The following are low Malformations of the anorectal
region
a. Anal Agenesis With or Without Fistula – The anal
canal may end blindly and there may be a ectopic
opening (ectopic anus) or fistula. Results from
incomplete separation of cloaca by urorectal septum.

Figure: Anal agenesis with fistula

b. Anal Stenosis – narrowing of anal canal. The anal membrane (and later the
anus) is small sometimes only a small probe can be inserted (the so-called
microscopic anus). Probably caused by a slight dorsal deviation of the
urorectal septum as it grows caudally to fuse with the cloacal membrane.

Figure: Anal Stenosis

c. Membranous Atresia (Covered Anus) - The anus is in the normal position but a
thin layer of tissue separates the anal canal from the exterior. Results from
failure of the anal membrane to perforate at the end of eight week.
7. The following’ are high Malformations of the anorectal region. The anal
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EMBRYOLOGY
a. Anorectal Agenesis - With or Without Fistula- the rectum ends well above
the anal canal. This is the most common type of anorectal malformation.
Results from incomplete separation of cloaca by urorectal septum.

b. Rectal Atresia –

Figure: Rectal Atresia (male)

The anal canal and the rectum are present but they are separated by an atretic
segment of rectum. The cause of rectal atresia may be abnormal recanalization
or defective blood supply as discussed with atresia of the small intestine.
[Source Keith L Moore]

c. Rectum in communication with bladder. urethra and vagina,

Anomalies of Midgut Rotation:

1. Nonrotation (abnormal rotation) of the midgut - occurs when the intestinal loop
does not rotate as it reenters the abdomen.
2. Reversed rotation - occurs when the intestinal loop rotates 900 clockwise. In
this abnormality the transverse colon passes behind the duodenum.

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FETUS
3. mixed rotation and volvulus - occurs when the intestinal loop fails to
complete the final 900 rotation.

Figure: Non Rotation

Figure: Reversed Rotation

Pancreas
1. Agenesis of the Islers of Langerthans - Results in juvenile diabetes
2. Annular pancreas –
 Such a pancreas completely surrounds the duodenum and
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EMBRYOLOGY
 may results when right portion of the ventral pancreatic bud migrate normal
route but the left part of the ventral bud migrates in an opposite route.

3. Pancreatic bladder-
 Denotes pancreatic nodule close the gall bladder.
 The anomaly results when a major part of the ventral pancreatic bund grows
out with the liver bud.
4. Heterotrophic pancreatic tissue

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FETUS

16. Respiratory System

First professional examination SAQ
1. Give the development of lung Larynx (00J) Trachea.
2. Give the maturation process of lung.
3. When respiration is posble & why.?
4. Fetus reaches viable ages at alveolar stages & of lung development.
5. Respiration is possible at alveolar stage of lung dev elopment.

Introduction for grasping the chapter

An endodermal out growth
(respiratory diverticulum or
lung bud) from the ventral wall
of the foregut (caudal to
hypobranchial eminence -
examiner's like to hear it)
develops. It is later invested
by mesodermal tissue. Thus,
whole respiratory system
develops

Germ Layers of Development

1. Lining or alveoli of the
system develop from
endoderm (of respiratory
diverticulum)
2. Rest structures (cartilage,
muscle etc.) develop from splanchnopleuric mesoderm.

Larynx
It develops as follows
1. Lining epithelium— Endodermal. Comes from cranial most part of the
respiratory diverticuluir
2. Cartilage- Mesodermal. Comes from 4th & 6th arches
3. Musculature— Mesodermal Mesenchymes of 4th & 6th pharyngeal arches give
origin to musculatures.
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EMBRYOLOGY

Q.: Why superior laryngeal & recurrent laryngeal nerves supply the larynx?
Answer- Musculature of larynx is derived from 4th and 6th pharyngeal arches &
nerves of these arches are sup. laryngeal & recurrent laryngeal, So these nerves
supply larynx.

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FETUS
Trachea

It develops as follows —
1. Lining epithelium- Endoderml. From the intermediate portion of respiratory
diverticulum.
2. Cartilages & muscle- Mesodermal. Mesoderm of 6th pharyngeal arch.
[Ref. Datta].

Lungs

Fig.: Successive stages In the development of the trachea and lungs.

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EMBRYOLOGY
1. Alveoli, lining epithelium of bronchi & glands :Endodermal. They come from
caudal end of respiratory diverticulum. This part of the diverticulum forms two
lung buds which become the two principal bronchi. The right principal bronchus
des into 3 lobar & that of the left nb 2 lobar bronchi These Iobai bronchi now
divide again & again to form the bronchial tree & alveoli of the lungs. Glands
also develop from the. lung buds
2. Muscles & connective tissue (cartilage, blood capilaries & other connective
tissues) - Mesodermal. Come from the splanchnopleuric mesoderm in which the
lung buds grow.
[Langman]
[Development of lung passes through following stages –

Table: Maturation of the lungs

1. psudogiandular period 5-16 weeks Branching has continued to form terminal
bronchioles. No respiratory bronchioles or
alveoli are present

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FETUS
2. Canalicular period 16-26 weeks Each terminal bronchiole divides into 2 or
more respiratory bronchioles, which in
turn, divide into 3-6 alveolar ducts

3. terminal sac period 26 weeks to terminal sacs (primitive alveoli form arid
(saccular stage) birth capillaries establish close contact

4. Alveolar period 8 months to Mature alveoli with well developed

Childhood epithelial endothelial (capillary) contacts.

[Langman]

Q. When respiration Is possible? Why?

Answer- Respiration is possible at alveloar stage of lung development, I, e at 7th month
of intrauterine life. Because, at this time epithelial cells of lung become squamous, blood
capillaries come in relation to them & gas exchange ts thus possible.

Causes of growth of lung after birth

1. Increase number of respiratory bronchioli
2. Increase number of alveoli (about 5/6th of adult number of alveoli are formed during
1sf 10 years of poscnatal of postnatal life)
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EMBRYOLOGY
Q. Explain developmentally – lung alveoli is lined by simple squamous epithelium.
Ans. - The part of the human body in which there is exchange of nutrients , gases or
other substances , it is lined with simple squamous epithelium developmentally. The lung
alveoli are involved with gaseous exchange, so they are lined by simple squamous
epithelium.

Q. What type of cell are abundant in alveoli?

Ans. Type I pneumocyte.

Q What is the function of type II pneumocyte?

Ans. It secrets surfactant.

Q. What is surfactant?
Ans. It is a surface tension reducing agent, which prevent collapse of lung.

Anomalies in Development of Respiratcoy System

(1) Larynx - Congenital webs of larynx
(2) Trachea- Tracheo esophageal fistula
(3) Lung-

i. Aberrant lobe Arises from the trachea or esophagus. Formed from

additional respiratory buds of the foregut]
ii. Supernumerary lobuLes: Result from abnormal divisions of the bronchial
tree.
iii. Congenital cyst . Formed by dilation of the terminal or larger bronchi. When
multiple give the lung a honeycomb appearance in X-ray. These frequently
cause chronic inftctions
iv. Pulmunary hypoplasia, aplasia or agenesis
v. Hyaline membrane disease (Respiratory distress syndrome)- alveoli collpse
due Insufficient surfctant secreted by type II alveoler cells.

Q. What is respiratory distress syndrome? Give its treatment

Ans: It is a clinical condition which develops in a premature baby (below 7 month)
due to absence of surfactant in the alveoli.
After formation of lungs, type II cell secret surfactant which is a surface tension
reducing agent. It prevents collapse of lung after 1st breathing. When
insufficient surfactant is present, the air-blood surface membrane tension become
high and cause collapse of alveoli during expiration, leading to respiratory distress

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FETUS
syndrome.
• it is a common cause of death in premature infant.
• In this case alveoli contain a fluid with high protein count.
• Hyaline membrane and lamellar body derived from surfactant layer therefore it
is also called Hyaline membrane disease.

Explanatory SAQ : How tracheo-esophageal fistula develop?

Ans.:
A Fistula is an abnormal communication between 2 epithelial surfaces. At 4th week
of development respiratory diverticulum grows from ventral wall of pharynx.
1. Tracheo-esophageal fold divides the primitive pharynx into
a. Ventraly—Laryngo-tracheal diverticulum.
b. Dorsaly—esophagus.
2. Later tracheo-esophageal fold fuses to form tracheo-oesophageal septum and
complete partition is formed between trachea and esophagus.

In abnormal condition, incomplete fusion of tracheo-oesophageal fold results in

defective tracheo-oesophageal septum.Thus a communication develops between
trachea and esophagus (tracheo-esophageal fistula).

Pleura
1. Visceral pleura - It develops from the splanchnopleuric mesoderm covering the
outside of the lung.
2. Parietal pleura - Develops from somatopleuric mesoderm covering the body wall
from inside.

17. Diaphragm and Septum Transversum

First professional examination SAQ
1. Give the development & derivatives of septum transversum.
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EMBRYOLOGY
2. Give the nerve supply of diapragm on developmental back ground.
3. Mention the developmental source of diaphragm.
4. Why the central tendon of diaphram is closely attached with the periocardium?

Introduction for Grasping the Chapter

Diaphragm separates the pericardio-pleural cavity and peritoneal cavity. For this
separation (i e. formation of diaphragm), several components come to lie in relation
to septum transversum which lies between the thoracic cavity and stalk of the
yolk sac.

Septum Transversum

Definition

Septum transversum is thick plate of mesodermal tissue lying between thoracic

cavity and stalk of the yolk sac.

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FETUS

Structures develop from it

1. Diaphragm (central tendon) - from cranial part of the septum.
2. Liver (stroma) - from the caudal part of it.
3. Pericardium (fibrous layer).

Cause of close relation of the above three structures In adult

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EMBRYOLOGY
As the three structures develop from same embryonic component, the septum
transversum, they are intimately related with each other.

Diaphragm

Development
1. The most important structure forming the diaphragm is septum transversum.
This septum alone does not form the diaphragm to separate the thoracic &
abdominal cavities entirely.
2. During further development, the caudal borders of the pleural cavities are
delineated by a crescent shaped fold, the pleuroperitoneal membrane. The
fold later extends in medial and ventral directions and by the 7th week fuses
with the mesentery of the esophagus and with the septum transversum,
3. [Further] expansion of the pleural cavities relative to the mesenchyme of
the body wall results in addition of a peripheral rim to the pleuroperitoneal
membranes. Once this rim is established myoblasts originating in the body wall
C3, C4 & C5 myotomes penetrate the membranes to form the muscular part of
the diaphragm.

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FETUS

The diaphragm is thus derived from following structures –

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EMBRYOLOGY
1. Septum transversum - forms the central tendon.
2. Pleuroperitoneal membrane
3. Mesoderm from lateral and dorsal body wall forms muscular component
4. C4 myotome partly, C3 & C5 myotomes;
5. Mesentery of esophagus - forms the crura [Ref. Datta & Langman]
[3, 4, 5 form muscular component]

Congenital Anomalies of Diaphragm

1. Congenital diaphragmatic hernia
 a triangular gap between costal & vertebral origins of diaphragm,
 due to failure of pleuro-peritoneal membrane to close the pleaura-peritoneal
opening,
2. Parasternal hernia
 The opening between sternal and costal origines of diaphragm is known as
foramen of Morgoni.
 Small peritoneal sac containing the coils of intestine may enter the
parasternal part of thorax through this opening.
3. Esophageal hernia
it is due to congenital shortness of esophagus. A part of stomach is retained in
thorax. [Datta, ]

Nerve supply on Developmental Background

 In earlier age, septum transversum lies opposite the cervical somites and nerve
components of C3 (phrenic N) grow into it. Later the septum comes in thoracic
level in course of its formation of diaphragm. Central tendon develops from this
septum, thus its nerve supply is phrenic N.

 As the peripheral part (muscular) of diaphragm develops from body wall its
sensory innervation is intercostal Nerve. [Ref Langman]

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