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Neuroembryology Final
Neuroembryology Final
Neuroembryology Final
Neuroembryology:
Introduction:
Normally as a child develops in the womb nerve cells develop from the
top of the intestines to the anus
With hirschprung’s disease the nerve cells stop developing before they
reach the end:
The migration of neural crest cells is directed by the RET gene. As the
multipotent crest cells migrate they differentiate into neuroblasts and
form the nerve fibers of the peripheral nervous system, including the
autonomic nervous system.
In Hirschprung’s disease neural crest cells fail to migrate and develop into
parasympathetic ganglia innervating part or all of the colon and rectum.
As a result there are no parasympathetic ganglia/postganglionic
parasympathetic fibers innervating these areas and they remain dilated.
In 80% of Hirschprung’s patients there is no innervation to the colon and
rectum, whilst in 10-20% of patients there is only no innervation to the
transverse and ascending colon.
References:
Crossman, A.R., Neary D., 2009. Neuroanatomy: An Illustrated Colour Text. 4th Ed.
Churchill Livingstone Elsevier.
Sadler, T.W. 2010. Langman’s Medical Embryology. 11th Ed. Wolters Kluwer
Health.
Image source:
Martini, Frederich H. et al, 2009. Atlas of the Human Body. 8th Ed. Wolters Kluwer
Health. [scanned image page 130: Embryology summary 10: An introduction to
the development of the nervous system]
Psychosocial functioning:
Psychosocial problems can be a consequence of Hirschprung’s disease in
adolescence. This is a result of faecal incontinence, soiling and fear of
flatus which causes embarrassment to adolescents amongst their peers.
Furthermore, incontinence has some negative effects of families of
sufferers, especially if parents are not educated in it’s management.
This ‘second handicap’ poses significant mental health problems. The
mental problems identified included low self esteem, poor body concept,
withdrawal, anxiety, and depression.
However, with proper management by the medical team and child’s
parents, it has been proven that psychosocial complications can be
avoided.