Embryology solid organs

abdomen
 Liver
• Arise as ventral outgrowth endoderm (Hepatic
diverticulum)
• Diverticulum extends into the septum transversum
• Diverticulum enlarges rapidly and divides into two
parts as it grows between the layer of the ventral
mesogastrium.
• Larger cranial -> hepatic diverticulum
• Small caudal -> primordium of gallblader
• Stalk of the diverticulum -> cystic duct
• Liver growth rapidly from 5th-10th weeks
• The proliferation endoderm cells form the
epithelial lining of intrahepatic part of the biliary
apparatus.
• The fibrous and hematopoetic tissue and
kuppffer cells of the liver are derivide from
mesenchyme in septum transversum.
• Hematopoesis begins in the liver during sixth
weeks -> redish appearance.
• Bile formation begins during 12th weeks. After
13th weeks gives meconium a dark green color.
 Ventral mesentery
• Gives rise to
– The lesser omentum (hepatogastric ligament and
hepatoduodenal ligament)
– The falciform ligament
– Also peritoneum that cover liver
 Accessory
hepatic ducts
Extrahepatic biliary atresia
 Kasai hepatoportoenterostomy
• the extrahepatic bile ducts are removed and
replaced with a portion of the affected infant’s
small intestine thereby forming a conduit for
improved bile flow
Biliary cyst
• The surgical management for each choledochal cyst type is
described as follows:
• Type I: Treatment of choice is complete excision of the
involved portion of the extrahepatic bile duct; a Roux-en-Y
hepaticojejunostomy is performed to restore biliary-enteric
continuity [7]
• Type II: Complete excision of the dilated diverticulum
comprising a type II choledochal cyst; the resultant defect in
the common bile duct is closed over a T-tube
• Type III (choledochocele): Therapeutic choice depends on the
size of the cyst; choledochoceles measuring 3 cm or less can
be treated effectively with endoscopic sphincterotomy,
whereas lesions larger than 3 cm (which typically produce
some degree of duodenal obstruction) are excised surgically
via a transduodenal approach—if the pancreatic duct enters
the choledochocele, reimplantation into the duodenum may
be required following excision of the cyst
• Type IV: Complete excision of the dilated extrahepatic duct,
followed by a Roux-en-Y hepaticojejunostomy to restore continuity;
intrahepatic ductal disease does not require dedicated therapy
unless hepatolithiasis, intrahepatic ductal strictures, and hepatic
abscesses are present (in such instances, resection of the affected
hepatic segment or lobe is performed)
• Type V (Caroli disease): Hepatic lobectomy for disease limited to
one hepatic lobe (left lobe usually affected); however, one should
carefully examine the hepatic functional reserve before committing
to such therapy; patients with bilobar disease manifesting signs of
liver failure, biliary cirrhosis, or portal hypertension may require
liver transplantation
• Lilly technique: When the cyst adheres densely to the portal vein
secondary to long-standing inflammatory reaction, it may not be
possible to perform a complete, full-thickness excision of the cyst;
the Lilly technique allows the serosal surface of the duct to be left
adhering to the portal vein, while the mucosa of the cyst wall is
obliterated by curettage or cautery—theoretically, this removes the
risk of malignant transformation in that segment of the duct
 Alagille syndrome
• is an autosomal dominant genetic disorder
that affects the liver, heart, kidney, and other
systems of the body
 Pancreas
• The pancreas develops between the layers of the
mesentery from dorsal and ventral pancreatic
buds of endodermal cells, which arise from the
caudal part of the foregut.
• The ventral pancreatic bud forms the uncinate
process and part of the head
• As duodenum rotates ventral bud is carried
dorsally with the bile duct and soon lies posterior
to the dorsal pancreatic bud and later fuses with
it.
• Insulin secretion begins during the early fetal
period (10th weeks)
• Glucagon can be detected in fetal plasma at
15 weeks
• The connective tissue sheath and interlobular
septa of the pancreas develop from the
surrounding splanchnic mesenchyme
Ectopic pancreas
 Annular pancreas
• Annular pancreas can be either complete or
incomplete 1:
• complete annular pancreas: pancreatic
parenchyma or annular duct is seen to
completely surround the 2nd part of
duodenum
• incomplete annular pancreas: annulus does
not surround the duodenum completely,
giving a 'crocodile jaw' appearance
Pancreas divisum
Puestow procedure or sphincterotomy
 Spleen
• 5weeks, Derived from mass of mesenchymal cells
located between the layer of the dorsal
mesogastrium.
• The notches in the superior border of the adult
spleen are remnants of the grooves that
separated the fetal lobules.
• Left surface of mesogastrium fuses with
peritoneum over the left kidney -> splenorenal
ligament
• Hematopoietic center