Digestive system

Development of digestive system

The primordial gut at the beginning of the 4th week is
closed at its cranial end by the oropharyngeal
membrane and at its caudal end by the cloacal
membrane.
The endoderm of the primordial gut gives rise to most
of its epithelium and glands.
The muscular, connective tissue, and other layers of the
wall of the digestive tract are derived from the
splanchnic mesenchyme surrounding the primordial
gut.
The primordial gut is divided into three parts: foregut,
midgut, and hindgut.
 Foregut
The derivatives of the foregut are:
• The primordial pharynx and its derivatives
• The lower respiratory system
• The esophagus and stomach
• The duodenum, distal to the opening of the
bile duct
• The liver, biliary apparatus (hepatic ducts,
gallbladder, and bile duct), and pancreas
 Midgut
The derivatives of the midgut are:
• The small intestine, including the duodenum
distal to the opening of the bile duct;
• The cecum, appendix, ascending colon, and
the right one half to two thirds of the
transverse colon.
 Hindgut
The derivatives of the hindgut are:
• The left one third to one half of the transverse
colon, the descending colon and sigmoid
colon, the rectum, and the superior part of
the anal canal;
• The epithelium of the urinary bladder and
most of the urethra.
 Mouth (oral cavity)
The mouth is divided into an
outer, smaller portion, the
vestibule, and an inner larger
part, the oral cavity proper.
Vestibule
is space between the teeth and
gums and the lips and cheeks.
Except for the teeth, the entire
vestibule is lined by mucous
membrane. The mucous
membrane forms median folds
that pass from the lips to the
gums, and are called the
frenula of the lips.
 Oral Cavity Proper
It is bounded
anterolaterally by the teeth, the
gums and the alveolar arches of
the jaws.
The roof is formed by the hard
palate and the soft palate.
The floor is occupied by the
tongue posteriorly, and presents
the sublingual region anteriorly,
below the tip of the tongue.
Posteriorly, the cavity
communicates with the pharynx
through the oropharyngeal
isthmus which is bounded:
superiorly by the soft palate,
inferiorly by the tongue,
on each side by the palatoglosgal
arches.
•
LIPS
The lips are mobile, musculofibrous folds
surrounding the mouth, extending from the
nasolabial sulci and nares laterally and
superiorly to the mentolabial sulcus
inferiorly.
• The lips are used for grasping food, sucking
liquids, keeping food out of the vestibule,
forming speech, and osculation (kissing).
• Each lip is composed of:
a. Skin.
b. Superficial fascia.
c. The orbicularis oris muscle.
d. The submucosa, containing mucous labial
glands and blood vessels.
e. Mucous membrane.
• The inner surface of each lip is supported by
a frenulum which ties it to the gum. The
outer surface of the upper lip presents a
median vertical groove, the philtrum.
 Cheeks (buccae)
• The cheeks are fleshy flaps, forming a large part of
each side of the face. They are continuous in front
with the lips, and the junction is indicated by the
nasolabial sulcus which extends from the side of
the nose to the angle of the mouth.
• Each cheek is composed of:
a. Skin.
b. Superficial fascia containing some facial muscles, the
parotid duct, mucous molar glands, vessels and nerves.
c. The buccinator covered by buccopharyrgeal fascia
and pierced by the parotid duct.
d. Submucosa, with mucous buccal glands.
e. Mucous membrane.

• Superficial to the buccinators are encapsulated

collections of fat; these buccal fat-pads are
proportionately much larger in infants, presumably
to reinforce the cheeks and keep them from
collapsing during sucking.
• Numerous small buccal glands lie between the
mucous membrane and the buccinators.
 Gums (gingivae)
The gingivae are
composed of fibrous
tissue covered with
mucous membrane.
The gingiva proper is
firmly attached to the
alveolar processes of the
mandible and maxilla and
the necks of the teeth.
The gingiva proper is
normally pink, stippled,
and keratinizing.
 Teeth
The teeth are set in the tooth
sockets and are used in
mastication and in assisting in
articulation. A tooth is identified
and described on the basis of
whether it is deciduous (primary)
or permanent (secondary).
Children have 20 deciduous teeth;
adults normally have 32
permanent teeth. Before eruption,
the developing teeth reside in the
alveolar arches as tooth buds.
Each tooth has three parts:
1. A crown, projects from the gingiva.
2. A root, is fixed in the tooth socket by the periodontium; the number of roots varies.
3. A neck, is between the crown and the root.

Structurally, each tooth is composed of:

1. The pulp in the centre (containing vessels, nerves and lymphatics, all of which enter the pulp cavity
through the apical foramen).
2. The root canal (pulp canal) transmits the nerves and vessels to and from the pulp cavity through the
apical foramen.
3. The dentine surrounding the pulp (calcified material containing spiral tubules).
4. The enamel covering the projecting part of dentine, or crown (hardest substance in the body).
5. The cementum surrounding the embedded part of the dentine (resembles bone in structure, but like
enamel and dentine it has no blood supply, nor any nerve supply).
6. The periodontal membrane (ligament) holds the root in its socket.
The types of teeth are identified by their characteristics: incisors - thin cutting
edges; canines - single prominent cones; premolars - two cusps; and molars -
three or more cusps. The vestibular surface (labial or buccal) of each tooth is
directed outwardly, and the lingual surface is directed inwardly. The mesial
surface of a tooth is directed toward the median plane of the facial part of the
cranium. The distal surface is directed away from this plane; both mesial and
distal surfaces are contact surfaces—that is, surfaces that contact adjacent
teeth. The masticatory surface is the occlusal surface.
The incisors, canines and premolars have single roots, with the exception of
the first upper premolar which has a bifid root. The upper molars have three
roots, of which two are lateral and one is medial. The lower molars have only
two roots, an anterior and a posterior.
 Development of teeth
1. By 6th week of development, the epithelium
covering the convex border of alveolar process of
upper and lower jaws become thickened to form C-
shaped dental lamina, which projects into the
underlying mesoderm.
2. Dental laminae of upper
and lower jaws develop 10
centres of proliferation
from which dental buds
grow into underlying
mesenchyme.
3. The deeper enlarged
parts of the tooth bud is
called enamel organ. The
enamel organ of dental
bud is invaginated by
mesenchyme of dental
papilla making it cap
shaped.
4. The cell of enamel
organ adjacent to dental
papilla cells get columnar
and are known as
ameloblasts. The
mesenchymal cells now
arrange themselves along
the ameloblasts and are
called odontoblasts. The
two cell layers are
separated by a basement
membrane. The rest of
the mesenchymal cells
form the "pulp of the
tooth".
5. Later ameloblasts disappear while
odontoblasts remain. The root of the
tooth is formed by laying down of
layers of dentine, narrowing the pulp
space to a canal for the passage of
nerve and blood vessels only. The
dentine in the root is covered by
mesenchymal cells which
differentiate into cementoblasts for
laying down the cementum. Outside
this is the periodontal ligament
connecting root to the socket in the
bone.
Ectoderm forms enamel of tooth.
Neural crest cells form dentine,
dental pulp, cementum and
periodontal ligament.

Formation of permanent teeth:

These develop from the dental buds
arising from the dental lamina and
lie on the medial side of each
developing milk tooth.
 Tongue
The tongue is a muscular
organ situated in the floor
of the mouth. It is
associated with the
functions of taste,
speech, chewing,
deglutition.
Tongue comprises skeletal
muscle which is voluntary.
The tongue has:
1. a root,
2. an apex (tip),
3. a body, which has:
a. A dorsum
(oral and pharyngeal parts).
b. An inferior surface - is covered with a thin,
transparent mucous membrane.

• sulcus terminalis (V-shaped),

• foramen caecum (the thyroid
diverticulum grows down in the embryo),
• frenulum linguae - allows the anterior
part of the tongue to move freely,
• plica fimbriata,
• lymphoid part of the tongue (behind the
sulcus terminalis, constitute the lingual
tonsil),
• median glossoepiglottic fold,
• lateral glossoepiglottic folds,
• the vallecula.
 Papillae of the tongue
1.Vallate papillae - they are large in size 1-2 mm in diameter and are 8-12 in
number. Lie directly anterior to the terminal sulcus and are arranged in a V-
shaped row.
2. Fungiform papillae - are numerous near the tip of the tongue.
3. Filiform papillae - cover the presulcal area of the dorsum of the tongue.
4. Foliate papillae - small lateral folds of the lingual mucosa.
 Muscles of the tongue
lntrinsic muscles:
1. The superior longitudinal
muscle lies beneath the mucous
membrane. (Shortens the tongue
makes its dorsum concave).
2. The inferior longitudinal muscle
is a narrow band lying close to the
inferior surface of the tongue.
(Shortens the tongue makes its
dorsum convex).
3. The transverse muscle extends
from the median septum to the
margins.
(Makes the tongue narrow and
elongated).
4. The vertical muscle is found at
the borders of the anterior part of
the tongue.
(Makes tongue broad and
flattened).
Extrinsic Muscles:
1. Palatoglossus
Origin - palatine aponeurosis.
Insertion - the side of tongue at the junction of
oral and pharyngeal parts.
Function – pulls up the root of tongue,
approximates the palatoglossal arches and thus
closes the oropharyngeal isthmus.
2. Hyoglossus
Origin – body and greater horn of hyoid bone.
Insertion - side of tongue.
Function – depresses tongue, makes dorsum
convex, retracts the protruded tongue.
3. Styloglossus
Origin - styloid process, stylohyoid ligament.
Insertion - side of tongue.
Function – pulls tongue upwards and back wards.
4. Genioglossus
Origin – mental spine of mandibula.
Insertion - tip of tongue, the dorsum, the hyoid
bone.
Function - retracts the tongue, depresses the
tongue, pulls the posterior part of tongue
forwards and protrude the tongue forwards.
 Development of tongue
Near the end of the fourth week
appears – median tongue bud. Soon,
two distal tongue buds develop on
each side. The three lingual swellings
result from the proliferation of
mesenchyme in ventromedial parts of
the first pharyngeal arches.
Lateral lingual swellings form the
anterior two thirds of the tongue. The
fusion site of the lateral lingual
swellings is indicated by the midline
groove of the tongue and internally by
the fibrous lingual septum.
Formation of the posterior third of the
tongue is:
The copula is gradually overgrown by
the hypopharyngeal eminence and
disappears.
From hypopharyngeal eminence
develops posterior third of the tongue.
The line of fusion of the anterior and
posterior parts is terminal sulcus.
Pharyngeal arch mesenchyme forms
the connective tissue and vasculature
of the tongue. Most of the tongue
muscles are derived from myoblasts
that migrate from the occipital
myotomes.
Lingual papillae appear toward the
end of the eighth week. Taste buds
develop during weeks 11 to 13.
 Congenital Anomalies of Tongue
• Ankyloglossia -
frenulum is short and
extends to the tip of the
tongue.

• Macroglossia –
large tongue.

• Microglossia -
small tongue.
 Hard palate
It is a partition between the nasal and oral cavities. Its
anterior two-thirds are formed by the palatine
processes of the maxillae; and its posterior one-third
by the horizontal plates of the palatine bones.
 Soft palate
The soft palate is the movable posterior third of the palate. The soft palate has no bony
skeleton; however, its anterior aponeurotic part is strengthened by the palatine
aponeurosis, which attaches to the posterior edge of the hard palate. Posteroinferiorly, the
soft palate has a curved free margin from which hangs a conical process, the uvula.
The soft palate is elevated posteriorly and superiorly against the wall of the pharynx,
thereby preventing passage of food into the nasal cavity.
Laterally, the soft palate is continuous with the wall of the pharynx and is joined to the
tongue and pharynx by the palatoglossal and palatopharyngeal arches.
The fauces is the space between the cavity of the mouth and the pharynx. The fauces is
bounded superiorly by the soft palate, inferiorly by the root of the tongue, and laterally by
the palatoglossal and palatopharyngeal arches.
The palatine tonsils are masses of lymphoid tissue. Each tonsil is in a tonsillar fossa,
bounded by the palatoglossal and palatopharyngeal arches and the tongue.
 Muscles of the Soft Palate
1. Tensor veli palatini
Origin – auditory tube, greater wing and scaphoid fossa of sphenoid bone.
Insertion - palatine aponeurosis.
Function – tenses soft palate and opens mouth of pharyngotympanic tube during swallowing and yawning.

2. Levator veli palatini

Origin – auditory tube, inferior surface of petrous temporal bone.
Insertion - palatine aponeurosis.
Function - elevates soft palate during swallowing and yawning.
3. Musculus uvulae
Origin - posterior nasal spine, palatine aponeurosis.
Insertion - mucosa of uvula.
Function - shortens uvula and pulls it superiorly.

4. Palatoglossus
Origin - palatine aponeurosis.
Insertion – tongue.
Function - elevates posterior part of tongue and draws soft palate onto
tongue.
5. Palatopharyngeus
Origin - hard palate, palatine aponeurosis.
Insertion - lateral wall of pharynx.
Function - tenses soft palate and pulls walls of pharynx
superiorly, anteriorly, and medially during swallowing.
 Development of the palate
Palatogenesis begins in the sixth week; however,
development of the palate is not completed until
the 12th week.
Primary Palate
formed by merging of the medial nasal
prominences, is a wedge-shaped mass of
mesenchyme between the internal surfaces of the
maxillary prominences of the developing maxillae.
The secondary palate begins to develop from two
mesenchymal that extend from the internal aspects
of the maxillary prominences.
Bone extends from the maxillae and palatine bones
into palatal processes to form the hard palate. The
posterior parts of these processes do not become
ossified. They extend posteriorly beyond the nasal
septum and fuse to form the soft palate, including
its soft conical projection-the uvula
Congenital disorder
 Palatine Tonsil
occupies the tonsillar
sinus or fossa between
the palatoglossal and
palatopharyngeal arches.
Medial surface has 12 to
15 crypts. The largest of
these is called the
intratonsillar cleft.
 Development of palatine tonsils
from ventral part of second pharyngeal pouch. The
lymphocytes are mesodermal in origin.
 SALIVARY GLANDS
Large salivary glands:
the parotid,
the submandibular,
the sublingual.
Small glands:
in the tongue,
the palate,
the cheeks,
the lips.
Saliva, secreted by these glands and the
mucous glands of the oral cavity:
• Keeps the mucous membrane of the
mouth moist.
• Lubricates the food during mastication.
• Begins the digestion of starches.
• Serves as an intrinsic “mouthwash.”
• Plays significant roles in the prevention of
tooth decay and in the ability to taste.
 Parotid gland
It is situated below the external acoustic meatus, between
the ramus of the mandible and the sternocleidomastoid. It is
composed mostly of serous acini. Anteriorly, the gland also
overlaps the masseter muscle.
The deep cervical fascia forms a capsule for the gland.
The facial nerve divides the gland into superficial and deep
lobes.
The parotid duct (Stensen’s) emerges from the anterior
border of the gland and passes forward over the lateral
surface of the masseter, pierces the buccinator. It enters the
vestibule of the mouth upon a small papilla opposite the
upper second molar tooth.
Development:
The parotid gland is ectodermal in origin. It develops from the
buccal epithelium just lateral to the angle of mouth.
 Submandibular Gland
consists of a mixture of
serous and mucous acini.
The submandibular glands
lie along the body of the
mandible, partly superior
and partly inferior to the
posterior half of the
mandible, and partly
superficial and partly deep
to the mylohyoid muscle.
The submandibular duct
(Wharton's duct) opens into
the mouth on a small
papilla, which is situated at
the side of the frenulum of
the tongue.
 Sublingual Gland
lies in the floor of the
mouth between the
mandible and the
genioglossus muscle.
It has both serous and
mucous acini.
Numerous small
sublingual ducts open into
the floor of the mouth
along the sublingual folds.
 DEVELOPMENT OF THE SALIVARY GLANDS
During the sixth and seventh
weeks of the embryonic period,
the salivary glands begin as
solid epithelial buds grow into
the underlying mesenchyme of
oral cavity. The connective
tissue in the glands is derived
from neural crest cells. All
secretory tissue arises by
proliferation of the oral
epithelium.
 Pharynx
The pharynx extends from the cranial
base to the inferior border of the
cricoid cartilage anteriorly and the
inferior border of the C6 vertebra
posteriorly.
Length – about 12 cm.
The pharynx is widest (5 cm) opposite
the hyoid and narrowest (1.5 cm) at
its inferior end, where it is continuous
with the esophagus.
Parts of the Pharynx:
1. Nasopharynx: posterior to the
nose and superior to the soft
palate. Transmits only air.
2. Oropharynx: posterior to the
mouth. Transmits both air and
food.
3. Laryngopharynx: posterior to the
larynx. Transmits only food.
 Nasopharynx
It is the posterior extension of the nasal cavities. The nose opens into the nasopharynx
through two choanae. The roof and posterior wall of the nasopharynx form a continuous
surface that lies inferior to the body of the sphenoid bone and the basilar part of the
occipital bone.
In the submucosa of the roof is a collection of lymphoid tissue called the pharyngeal
tonsil.
On the lateral wall is the opening of the auditory tube, the elevated ridge of which is
called the tubal elevation.
The pharyngeal recess is behind the tubal elevation.
The salpingopharyngeal fold is a vertical fold of mucous membrane covering the
salpingopharyngeus muscle.
 Auditory tube (eustachian tube)
connects the middle ear cavity with the
nasopharynx. It is about 4 cm long. The
tube is divided into bony and
cartilaginous parts.
Bony part - lies in the petrous temporal
bone. Its lateral end is wide and opens on
the anterior wall of the middle ear cavity.
The medial end is narrow (isthmus) and
is jagged for attachment of the
cartilaginous part.
Cartilaginous part - the apex of the plate
is attached to the medial end of the bony
part. The base is free and forms the tubal
elevation in the nasopharynx.
Function - the tube provides a
communication of the middle ear cavity
with the exterior, thus ensuring equal air
pressure on both sides of the tympanic
membrane. The tube is usually closed. It
opens during swallowing, yawning and
sneezing.
 Oropharynx
It is bounded by the soft palate superiorly, the base of
the tongue inferiorly, and the palatoglossal and
palatopharyngeal arches laterally. It extends from the
soft palate to the superior border of the epiglottis.
 Laryngopharynx
extending from the superior border
of the epiglottis and the pharyngo-
epiglottic folds to the inferior border
of the cricoid cartilage, where it
narrows and becomes continuous
with the esophagus. Posteriorly, is
related to the bodies of the C4–C6
vertebrae. Its lateral walls are
formed by the middle and inferior
pharyngeal constrictor muscles.
Internally, the wall is formed by the
palatopharyngeus and
stylopharyngeus muscles.
The piriform fossa is a small
depression of the laryngopharyngeal
cavity on either side of the laryngeal
inlet.
Laterally, the piriform fossa is
bounded by the medial surfaces of
the thyroid cartilage and the
thyrohyoid membrane.
 WALDEYER'S LYMPHATIC RING
There are several aggregations of lymphoid tissue.
 Pharyngeal Muscles
It is having a muscular layer composed entirely of
voluntary muscle, arranged with longitudinal muscles
internal to a circular layer of muscles. These muscles
elevate the larynx and shorten the pharynx during
swallowing and speaking.
 Constrictors of the pharynx:
1. The superior constrictor.
Origin - pterygoid hamulus, pterygomandibular raphe, mylohyoid line, side of tongue.

2. The middle constrictor.

Origin - stylohyoid ligament, lesser and greater horns of hyoid bone.

3. The inferior constrictor.

Origin - the oblique line of thyroid cartilage, side of cricoid cartilage.

Insertion - all the constrictors of the pharynx are inserted into a median raphe on the posterior wall of the
pharynx.
Functions - constrict walls of pharynx during swallowing.
The pharyngeal constrictors have a strong internal fascial lining, the,
and a thin external fascial lining, the buccopharyngeal fascia.
Inferiorly, the buccopharyngeal fascia blends with the pretracheal layer
of the deep cervical fascia. The pharyngeal constrictors contract
involuntarily so that contraction takes place sequentially from the
superior to the inferior end of the pharynx, propelling food into the
esophagus.
 Longitudinal muscles:

1. The stylopharyngeus –
Origin – styloid process.
Insertion – posterior and superior
borders of thyroid cartilage.
2. The palatopharyngeus –
Origin – hard palate and palatine
aponeurosis.
Insertion – posterior border of
thyroid cartilage and side of pharynx
and esophagus.
3. The salpingopharyngeus –
Origin - cartilaginous part of
pharyngotympanic tube.
Insertion - blends with
palatopharyngeus.
Function - elevate (shorten and
widen) pharynx and larynx during
swallowing and speaking.
 Structure of Pharynx
The wall of the pharynx
is composed:
1. Mucosa.
2. Fibrous
(submucosa).
3. Pharyngobasilar
fascia.
4. Muscular coat.
5. Buccopharyngeal
fascia.
Retropharyngeal space of Gillette is a potential
space between the buccopharyngeal fascia
and the prevertebral fascia, extending from
the base of the skull to the superior
mediastinum . It permits movement of the
pharynx, larynx, trachea, and esophagus
during swallowing. Contents loose areolar
tissue and lymph node
 Sinus of Morgagni

The large gap between the upper

concave border of the superior
constrictor and the base of the
skull is semilunar and is known as
the sinus of Morgagni. It’s closed
by the upper strong part of the
pharyngobasilar fascia.
The structures passing through
this gap are:
a. The auditory tube.
b. The levator veli palatini muscle.
c. The ascending palatine artery.’
d. Palatine branch of ascending
pharyngeal artery.
 Killian's dehiscence
In the posterior wall of the pharynx, the lower part of the
thyropharyngeus is a single sheet of muscle, not
overlapped internally by the superior and middle
constrictors. This weak part lies below the level of the
vocal folds or upper border of the cricoid lamina and is
limited inferiorly by the thick cricopharyngeal sphincter.
 Deglutition (Swallowing)
is the complex process that transfers a food bolus from the mouth through the
pharynx and esophagus into the stomach. Solid food is chewed and mixed with
saliva to form a soft bolus that is easier to swallow. Deglutition occurs in three
stages:
Stage 1:
voluntary; the bolus is compressed against the palate and pushed from the
mouth into the oropharynx, mainly by movements of the muscles of the
tongue and soft palate.
Stage 2:
involuntary and rapid; the soft palate is elevated,
sealing off the nasopharynx from the oropharynx and
laryngopharynx. The pharynx widens and
shortens to receive the bolus of food as the suprahyoid
muscles and longitudinal pharyngeal muscles contract,
elevating the larynx.
Stage 3:
involuntary; sequential contraction of all three
pharyngeal constrictor muscles forces the food
bolus inferiorly into the esophagus.
 Development of pharynx
The pharynx extends from
buccopharyngeal membrane
to the tracheobronchial
diverticulum. It is divided into
upper part, the nasopharynx;
middle part, the oropharynx;
and the lower part, the
laryngopharynx.
The musculature of the third
pharyngeal arch forms the
stylopharyngeus. The
musculature of the fourth
pharyngeal arch forms the
cricothyroid, levator veli
palatini, and constrictors of
the pharynx.
Oesophagus
 The cervical part:
Begins at the level of, the inferior
border of the cricoid cartilage or
level of the C6 vertebra.
The cervical esophagus inclines
slightly to the left as it descends
and enters the superior
mediastinum via the superior
thoracic aperture, where it
becomes the thoracic esophagus.

is related:
• Anteriorly, to the trachea and
to the right and left recurrent
laryrrgeal nerves.
• Posteriorly, to the longus colli
muscle and the vertebral
column.
• On each side, to the
corresponding lobe of the
thyroid gland; and on the left
side, to the thoracic duct.
 The thoracic part:

The esophagus enters the superior mediastinum between the trachea and vertebral column, where it
lies anterior to the bodies of the T1–T4 vertebrae and pass through the esophageal hiatus in the diaphragm at
the level of the T10 vertebra.

is related:
Anteriorly – trachea, right pulmonary artery, left bronchus, pericardium with left atrium, the diaphragm.
Posteriorly - vertebral column, right posterior intercostal arteries, thoracic duct, azygos vein with the terminal
parts of the hemiazygos veins, thoracic aorta, right pleural recess, diaphragm.
To the right - right lung and pleura, azygos vein, the right vagus.
To the left - aortic arch, left subclavian artery, thoracic duct, left lung and pleura, left recurrent laryngeal
nerve, descending thoracic aorta.
The abdominal part is only about
1.25 cm long. It enters the abdomen
through the oesophageal opening of
the diaphragm situated at the level
of vertebra T10. Terminates by
entering the stomach at the cardial
orifice of the stomach at the level of
the 7th left costal cartilage and T11
vertebra (esophagogastric junction,
on the horizontal plane that passes
through the tip of the xiphoid
process. Surgeons and endoscopists
designate the Z-line, a jagged line
where the mucosa abruptly changes
from esophageal to gastric mucosa,
as the junction).

Intraperitoneal position.
Relations:
anteriorly to the posterior surface of
the left lobe of the liver,
posteriorly to the left crus of the
diaphragm.
 Constrictions
Normally the oesophagus
shows 4 constrictions at
the following levels.
1. At its beginning, here it
is crossed by
cricopharyngeus muscle.
2. Where it is crossed by
the aortic arch.
3. Where it is crossed by
the left bronchus.
4. Where it pierces the
diaphragm.
 Layers of the oesophageal wall
Mucous membrane-epithelial
lining is stratified squamous
nonkeratinised in nature.
Submucosa contains mucus
secreting oesophageal glands.
Muscularis externa is
composed of striated muscle
in upper third, mixed type in
middle third and smooth
muscles in lower third. Its
outer layer comprises of
longitudinal coat and inner
layer comprises of circular coat
of muscle fibres.
Adventitia is the connective
tissue with capillaries.
 Development of the oesophagus
develops from the foregut
immediately caudal to the pharynx.
The partitioning of the trachea from
the esophagus by the
tracheoesophageal septum.
Its epithelium and glands are derived
from endoderm. The epithelium
proliferates and partly or completely
obliterates the lumen; however,
recanalization of the esophagus
normally occurs by the end of the
eighth week.
The striated muscle forming the
muscularis externa of the superior
third of the esophagus is derived
from mesenchyme in the caudal
pharyngeal arches.
The smooth muscle, mainly in the
inferior third of the esophagus,
develops from the surrounding
splanchnic mesenchyme.
Congenital disorder
Nine regions of abdomen
 Stomach
is the expanded part of the digestive tract between the esophagus and
small intestine. It is specialized for the accumulation of ingested food,
which it chemically and mechanically prepares for digestion and passage
into the duodenum. The stomach acts as a food blender and reservoir; its
chief function is enzymatic digestion. It is capable of considerable
expansion and can hold 2–3 L of food.
The gastric glands produce the gastric juice which contains enzymes that
play an important role in digestion of food and hydrochloric acid which
destroys many organisms present in food and drink.
The lining cells of the stomach produce abundant mucus which protects
the gastric mucosa against the corrosive action of hydrochloric acid.
Some substances like alcohol, water, salt and few drugs are absorbed in
the stomach.
Stomach produces the "intrinsic factor" of Castle which helps in the
absorption of vitamin B12.
The stomach commonly lies in
the right and left upper
quadrants, or epigastric,
umbilical, and left
hypochondrium and flank
regions.
Anteriorly, the stomach is related
to the diaphragm, the left lobe of
liver, and the anterior abdominal
wall.
Posteriorly, the stomach is
related to the omental bursa and
pancreas; the posterior surface of
the stomach forms most of the
anterior wall of the omental
bursa.
The transverse colon is related
inferiorly and laterally to the
stomach as it courses along the
greater curvature of the stomach
to the left colic flexure.
The stomach has four parts:
• Cardia: the part
surrounding the cardial
orifice, usually lies posterior
to the 6th left costal
cartilage, 2–4 cm from the
median plane at the level of
the T11 vertebra.
• Fundus: the dilated
superior part that is related
to the left dome of the
diaphragm. The cardial
notch is between the
esophagus and the fundus.
The fundus may be dilated
by gas, fluid, food, or any
combination of these,
usually lies posterior to the
left 6th rib in the plane of
the MCL.
• Body: the major part of
the stomach between the
fundus and pyloric antrum.
• Pyloric part: its wider part,
the pyloric antrum, leads
into the pyloric canal, its
narrower part. The pylorus
is the distal, sphincteric
region of the pyloric part.
It is a marked thickening of
the circular layer of
smooth muscle that
controls discharge of the
stomach contents through
the pyloric orifice into the
duodenum. When erect its
location varies from the L2
through L4 vertebra. The
pyloric orifice is
approximately 1.25 cm
right of the midline.
The stomach also features
two curvatures:
• Lesser curvature: forms
the shorter concave right
border of the stomach. The
angular incisure lies just to
the left of the midline.
• Greater curvature: forms
the longer convex left
border of the stomach. It
passes inferiorly to the left
from the junction of the 5th
intercostal space and MCL,
then curves to the right,
passing deep to the 9th or
10th left cartilage as it
continues medially to reach
the pyloric antrum.
 Stomach structure
The mucous membrane of the stomach is
thick and vascular, and is thrown into
numerous folds, or rugae. The rugae are
longitudinal along the lesser curvature and
are irregular elsewhere. The rugae are
flattened in a distended stomach. On the
mucosal surface there are numerous small
depressions that can be seen with a hand
lens. These are the gastric pits . The gastric
glands open into these pits.
The part of the lumen of the stomach that lies
along the lesser curvature, and has
longitudinal rugae, is called the gastric canal.
Cardiac end - the epithelium is simple
columnar with small tubular glands. Lower
half of the gland is secretory and upper half is
the conducting part.
Fundus and body - upper one-third is
conducting, while lower two-thirds is
secretory. The various cell types seen in the
gland are chief or zymogenic, oxyntic or
parietal and mucous neck cells.
Pyloric part - pyloric glands which consist of
basal one-third as mucus secretory
component and upper two-thirds as
conducting part.
Submucous coat is made of
connective tissue, arterioles
and nerve plexus
(Meissner's plexus).
The muscular wall of the
stomach contains
longitudinal fibers (mainly
along the curvatures),
circular fibers (form pyloric
sphincter), and oblique
fibers (spread in the fundus
and body of stomach).
Consist the Auerbach's
nervous plexus in the
cardiac end.
Serous coat (visceral
peritoneum) completely
surrounds the stomach.
 Development of the Stomach
Around the middle of the
fourth week, a slight dilation
indicates the site of the
primordium of the stomach.
It first appears as a fusiform
enlargement of the caudal
or distal part of the foregut.
The primordial stomach
soon enlarges and broadens
ventrodorsally. During the
next 2 weeks, the dorsal
border of the stomach
grows faster than its ventral
border; this demarcates the
greater curvature of the
stomach.
As the stomach enlarges and acquires its final shape, it slowly rotates 90 degrees in a
clockwise direction around its longitudinal axis. The effects of rotation on the stomach
are:
The lesser curvature moves to the right and the greater curvature moves to the left.
The original left side becomes the ventral surface and the original right side becomes the
dorsal surface.
Before rotation, the cranial and caudal ends of the stomach are in the median plane.
During rotation and growth of the stomach, its cranial region moves to the left and
slightly inferiorly, and its caudal region moves to the right and superiorly.
After rotation, the stomach assumes its final position with its long axis almost transverse
to the long axis of the body.
 Congenital disorder
The longitudinal
muscles in the
pyloric region are
hypertrophied. This
results in severe
stenosis of the
pyloric canal and
obstruction of the
passage of food.
 Small intestine
is the longest part of the
alimentary canal and
extends from the pylorus
of the stomach to the
ileocecal junction. The
greater part of digestion
and food absorption takes
place in the small
intestine. It is divided into
three parts: the
duodenum, the jejunum,
and the ileum.
 Duodenum
The duodenum, the first and shortest (25 cm) part of the small
intestine, is also the widest and most fixed part. The duodenum
pursues a C-shaped course around the head of the pancreas. It
begins at the pylorus on the right side and ends at the
duodenojejunal flexure on the left side. This junction occurs
approximately at the level of the L2 vertebra, 2–3 cm to the left of
the midline. It has retroperitoneal position.
The duodenum is situated in the epigastric and umbilical regions.
It is divided into four parts:
First Part (superior part)- begins at the pylorus to the level of the
1st lumbar vertebra.
The first 2 cm of the superior part of the duodenum - called the
ampulla.
Ascends from the pylorus and is overlapped by the liver and
gallbladder.
Second Part (descending part) - runs vertically downward in front of the hilum of the right kidney on the right
side of the 2nd and 3rd lumbar vertebrae, curving around the head of the pancreas. Initially, it lies to the right
of and parallel to the IVC.
The bile and main pancreatic ducts enter its posteromedial wall. These ducts usually unite to form the
hepatopancreatic ampulla, which opens on an eminence, called the major duodenal papilla.

The relations:
Anteriorly: The gallbladder and the right lobe of the liver, the transverse colon, and the small intestine.
Posteriorly: The hilum of the right kidney and the right ureter.
Laterally: The ascending colon, the right colic flexure, and the right lobe of the liver.
Medially: The head of the pancreas, the bile duct, and the main pancreatic duct.
Third Part (horizontal part)- runs horizontally to the left, passing over the IVC, aorta, and L3
vertebra.

The relations:
Anteriorly: The root of the mesentery of the small intestine, the superior mesenteric vessels, and jejunum.
Posteriorly: The right ureter, the right psoas muscle, the inferior vena cava, and the aorta.
Superiorly: The head of the pancreas.
Inferiorly: jejunum.
Fourth Part (ascending part) - runs
superiorly and along the left side of
the aorta to reach the inferior border
of the body of the pancreas. Here it
curves anteriorly to join the jejunum
at the duodenojejunal flexure.
The flexure is held in position by a
peritoneal fold, the ligament of
Treitz, which is attached to the right
crus of the diaphragm.
The relations:
Anteriorly: The root of the
mesentery and jejunum.
Posteriorly: The left margin of
the aorta and the medial border
of the left psoas muscle.
 Layers of the wall of duodenum
The mucous membrane of the duodenum is thick. In the first part of the
duodenum, it is smooth. In the remainder of the duodenum, it is thrown into
numerous circular folds called the plicae circulares. Shows evaginations in the
form of villi and invaginations to form crypts of Lieberkuhn. Lining of villi is of
columnar cells with microvilli.
Submucous a is full of mucus-secreting Brunner' s glands.
The muscularis externa comprises outer longitudinal and inner circular layer of
muscle fibres.
Serosa.
 Development of the duodenum
Early in the fourth week, the
duodenum begins to develop from
the caudal part of the foregut, the
cranial or proximal part of the
midgut. The developing duodenum
grows rapidly, forming a C-shaped
loop that projects ventrally. As the
stomach rotates, the duodenal loop
rotates to the right and comes to lie
retroperitoneally. During the fifth
and sixth weeks, the lumen of the
duodenum becomes progressively
smaller and is temporarily
obliterated because of the
proliferation of its epithelial cells.
Normally vacuolation occurs as the
epithelial cells degenerate; as a
result, the duodenum normally
becomes recanalized by the end of
the embryonic period.
Congenital disorder of duodenum
 Jejunum and Ileum
about 6 - 7 m long, the jejunum
constituting approximately two fifths and
the ileum approximately three fifths of
the intraperitoneal section of the small
intestine. The jejunum begins at the
duodenojejunal flexure, and the ileum
ends at the ileocecal junction. The coils
of jejunum and ileum are freely mobile
and are attached to the posterior
abdominal wall by a fan-shaped fold of
peritoneum known as the mesentery of
the small intestine. The root of the
mesentery permits the entrance and exit
of the branches of the superior
mesenteric artery and vein, lymph
vessels, and nerves into the space
between the two layers of peritoneum
forming the mesentery.
Most of the jejunum lies in the left upper
quadrant (LUQ) of the infracolic
compartment, whereas most of the
ileum lies in the right lower quadrant
(RLQ). The terminal ileum usually lies in
the pelvis from which it ascends, ending
in the medial aspect of the cecum.
 Wall of the jejunum and ileum
Jejunum
The villi here are tongue-shaped. No mucous glands or aggregated
lymphoid follicles are present in the submucosa. The muscularis
externa comprises outer longitudinal and inner circular layer of
muscle fibres. Outermost is the serous layer.
Ileum
The villi are few, thin and finger-like.
Collection of lymphocytes in the form of Peyer's
patches in lamina
propria extending into
submucosa is a
characteristic feature.
The muscularis externa
comprises outer longitudinal
and inner circular layer of
muscle fibres.
Outermost is the serous layer.
 Development of intestine
As the midgut elongates, it forms a ventral,
U-shaped loop of gut-the midgut loop of
the intestine-that projects into the remains
of the extraembryonic coelom in 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. The loop
communicates with the umbilical vesicle
through the narrow omphaloenteric duct
(yolk stalk) until the 10th week. The
physiologic umbilical herniation occurs
because there is not enough room in the
abdominal cavity for the rapidly growing
midgut.
The cranial limb grows rapidly and forms
small intestinal loops, but the caudal limb
undergoes very little change except for
development of the cecal swelling
(diverticulum), the primordium of the
cecum, and appendix.
While it is in the umbilical cord, the midgut
loop rotates 90 degrees counterclockwise
around the axis of the superior mesenteric
artery. This brings the cranial limb (small
intestine) of the midgut loop to the right
and the caudal limb (large intestine) to the
left. During rotation, the cranial limb
elongates and forms intestinal loops (e.g.,
primordia of jejunum and ileum).
During the 10th week, the intestines return to the abdomen. The small intestine returns
first, passing posterior to the superior mesenteric artery and occupies the central part of
the abdomen. As the large intestine returns, it undergoes a further 180-degree
counterclockwise rotation. Later it comes to occupy the right side of the abdomen. The
ascending colon becomes recognizable as the posterior abdominal wall progressively
elongates.
The mesentery is at first attached to the median plane of the posterior abdominal wall.
After the mesentery of the ascending colon disappears, the fan-shaped mesentery of the
small intestines acquires a new line of attachment that passes from the duodenojejunal
junction inferolaterally to the ileocecal junction.
 Congenital Omphalocele
This anomaly is a
persistence of the
herniation of abdominal
contents into the proximal
part of the umbilical cord.
The abdominal cavity is
proportionately small when
there is an omphalocele
because the impetus for it
to grow is absent.
 Gastroschisis
This anomaly is a relatively
uncommon congenital
abdominal wall defect.
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. The viscera
protrude into the amniotic
cavity and are bathed by
amniotic fluid.
Reversed Rotation
 Meckel‘s diverticulum
(Diverticulum ilei)
Meckel's diverticulum is
the persistent proximal
part of the vitellointestinal
duct which is present in
the embryo, and which
normally disappears
during the 6th week of
intrauterine life.
Stenosis and Atresia of the Intestine
 Large Intestine
The large intestine is where
water is absorbed from the
indigestible residues of the
liquid chyme, converting it
into semisolid stool or feces
that is stored temporarily
and allowed to accumulate
until defecation occurs. The
large intestine consists of
the cecum; appendix;
ascending, transverse,
descending, and sigmoid
colon; rectum; and anal
canal.
The large intestine can be
distinguished from the small
intestine by:
• Omental appendices: small, fatty,
omentum-like projections.
• Teniae coli: begin at the base of
the appendix as the thick
longitudinal layer of the appendix
separates into three bands:
❑ mesocolic tenia, to which the
transverse and sigmoid
mesocolons attach;
❑ omental tenia, to which the
omental appendices attach;
❑ free tenia, to which neither
mesocolons nor omental
appendices are attached.
• Haustra: sacculations of the wall of
the colon between the teniae
• A much greater caliber (internal
diameter).
 Cecum
It is a blind-ended pouch that is
situated in the right iliac fossa of
the right lower quadrant of the
abdomen. It is about 6 cm long and
is completely covered with
peritoneum. It does not have a
mesentery. The terminal part of
the ileum enters the large intestine
at the junction of the cecum. The
opening is provided with two folds,
which form the ileocecal valve. The
appendix communicates with the
cavity of the cecum through an
opening guarded by an indistinct
semilunar fold of the mucous
membrane, known as the valve of
Gerlach.
 Relations of the cecum
Anteriorly: Coils of small
intestine and the anterior
abdominal wall in the right
iliac region.
Posteriorly: The psoas and the
iliacus muscles, the femoral
nerve, and the lateral
cutaneous nerve of the thigh.
The appendix is commonly
found behind the cecum.
Medially: The appendix arises
from the cecum on its medial
side.
 Appendix
is a narrow, muscular tube
containing a large amount of
lymphoid tissue. The length varies
from 2 to 20 cm with an average
of 9 cm. It is longer in children
than in adults. The diameter is
about 5 mm. It has a complete
peritoneal covering, which is
attached to the mesentery of the
small intestine by a short
mesentery of its own, the
mesoappendix.
The appendix lies in the right iliac
fossa, and in relation to the
anterior abdominal wall its base
is situated one third of the way
up the line joining the right
anterior superior iliac spine to the
umbilicus (McBurney’s point).
 Wall of the appendix
There ate no villi. The
epithelium invaginates to
form crypts of Lieberkuhn.
Muscularis mucosae is ill
defined.
Submucosa reveals many
lymphoid masses. That is
why it is called the
abdominal tonsil.
Muscularis externa
comprises two layers.
Outermost is the serous
layer.
Development of cecum and appendix
The primordium of the cecum and appendix-the cecal swelling (diverticulum)-
appears in the sixth week as an elevation on the antimesenteric border of the
caudal limb of the midgut loop. The apex of the cecal swelling does not grow as
rapidly as the rest of it; thus, the appendix is initially a small diverticulum of the
cecum. The appendix increases rapidly in length so that at birth it is a relatively
long tube arising from the distal end of the cecum.
 Ascending Colon
The ascending colon is about 13 cm
long and lies in the right lower
quadrant. It extends upward from the
cecum to the inferior surface of the
right lobe of the liver, where it turns
to the left, forming the right colic
flexure, and becomes continuous
with the transverse colon. It is
covered by peritoneum on three
sides (mesoperitoneal position).
A deep vertical groove lined with
parietal peritoneum, the right
paracolic gutter, lies between the
lateral aspect of the ascending colon
and the adjacent abdominal wall.
Relations:
Anteriorly - coils of small intestine,
the greater omentum, and the
anterior abdominal wall.
Posteriorly - the iliacus, the iliac
crest, the quadratus lumborum, the
origin of the transversus abdominis
muscle, and the lower pole of the
right kidney. The iliohypogastric and
the ilioinguinal nerves cross behind
it.
 Transverse Colon
Transverse colon is about 50 cm long and
extend across the abdomen from the
right colic flexure to the left colic flexure.
It is suspended from the diaphragm by
the phrenicocolic ligament. Actually it is
not transverse, but hangs low as a loop
to a variable extent. It is suspended by
the transverse mesocolon attached to
the anterior border of pancreas and has
a wide range of mobility.
The transverse mesocolon suspends the
transverse colon from the anterior
border of the pancreas.
Relations:
Anteriorly - the greater omentum and
the anterior abdominal wall.
Posteriorly - the second part of the
duodenum, the head of the pancreas,
and the coils of the jejunum and the
ileum.
 Descending Colon
Descending colon is about 25 cm
long and extends from the left
colic flexure to the sigmoid colon.
It is covered by peritoneum on
three sides (mesoperitoneal
position). It lies in the left iliac
fossa.

Relations:
Anteriorly - coils of small
intestine, the greater omentum,
and the anterior abdominal wall.
Posteriorly - the left kidney, the
origin of the transversus
abdominis muscle, the quadratus
lumborum, the iliac crest, the
iliacus, and the left psoas.
 Sigmoid colon
Sigmoid colon is about 37.5 cm
long. The sigmoid colon extends
from the iliac fossa to the 3rd
sacral vertebra, where it joins the
rectum. It is suspended by the
sigmoid mesocolon.
(Intraperitoneal position)

Relations:
Anteriorly - in the male, the
urinary bladder; in the female,
the posterior surface of the
uterus and the upper part of the
vagina.
Posteriorly - the rectum and the
sacrum. The sigmoid colon is also
related to the lower coils of the
terminal part of the ileum.
 Wall of the colon
1.Mucous membrane
It shows only invagination to form deep crypts of
Lieberkuhn. Lining epithelium is of columnar cells with
intervening goblet cells.
2. Submucosa
Contains solitary lymphoid follicles with the Meissner's
plexus of nerves.
3 . Muscularis
Outer longitudinal coat is thickened at three places to
form taenia coli. Inner coat is of circular fibres.
4. Outermost layer is serous.
 Rectum
The rectum is about 13 cm long and begins in
front of the 3rd sacral vertebra as a
continuation of the sigmoid colon and ends in
front of the tip of the coccyx by piercing the
pelvic diaphragm and becoming continuous
with the anal canal. The lower part of the
rectum is dilated to form the rectal ampulla
(receives and holds an accumulating fecal
mass until it is expelled during defecation).
Two anteroposterior curves:
a. The sacral flexure of the rectum follows the
concavity of the sacrum and coccyx.
b. The perineal flexure of the rectum is the
backward bend at the anorectal junction.
Three lateral curves:
a. The upper lateral curve of rectum is convex
to the right.
b. The middle lateral curve is convex to the
left and is most prominent.
c. The lower lateral curve is convex to the
right.
 Wall of the rectum
Peritoneum covers the anterior
and lateral surfaces of the
superior third of the rectum, only
the anterior surface of the middle
third, and no surface of the
inferior third because it is
subperitoneal.

The muscular coat of the rectum

is arranged in the usual outer
longitudinal and inner circular
layers of smooth muscle.

The mucous membrane of the

rectum, shows two types of folds,
longitudinal and transverse
(Houston's valves).
Relations:
Posteriorly - the rectum is in contact
with the sacrum and coccyx; the
piriformis, coccygeus, and levatores ani
muscles; the sacral plexus; and the
sympathetic trunks.
Anteriorly - In the male, the upper two
thirds of the rectum, which is covered by
peritoneum, is related to the sigmoid
colon and coils of ileum that occupy the
rectovesical pouch. The lower third of
the rectum, which is devoid of
peritoneum, is related to the posterior
surface of the bladder, to the termination
of the vas deferens and the seminal
vesicles on each side, and to the
prostate.
In the female, the upper two thirds of
the rectum, which is covered by
peritoneum, is related to the sigmoid
colon and coils of ileum that occupy the
rectouterine pouch (pouch of Douglas).
The lower third of the rectum, which is
devoid of peritoneum, is related to the
posterior surface of the vagina.
 Anal canal
It extends from the superior aspect
of the pelvic diaphragm to the anus.
The canal (2.5–3.5 cm long) begins
where the rectal ampulla narrows at
the level of the U-shaped sling
formed by the puborectalis muscle.
The anal canal, surrounded by
internal and external anal sphincters.
The internal anal sphincter is an
involuntary sphincter surrounding
the superior two thirds of the anal
canal. It is a thickening of the circular
muscle layer.
The external anal sphincter is a large
voluntary sphincter that forms a
broad band on each side of the
inferior two thirds of the anal canal.
This sphincter is attached anteriorly
to the perineal body and posteriorly
to the coccyx via the anococcygeal
ligament.
 Upper mucous part of external anal sphincter
This part is about 15 mm long. It is
lined by mucous membrane, and is
of endodermal origin.
Has:
• 6to 10 the anal columns of
Morgagni.
• The inferior ends of the anal
columns are joined by anal
valves.
• Superior to the valves are small
recesses called anal sinuses.
• The inferior comb-shaped limit of
the anal valves forms an irregular
line, the pectinate line, that
indicates the junction of the
superior part of the anal canal,
and the inferior part.
• The anal sinus contains anal
glands.
 Middle Part or Transitional Zone or
Pecten
The next 15 mm or so of the
anal canal is also lined by
mucous membrane. The
mucosa has a bluish
appearance because of a
dense venous plexus that lies
between it and the muscle
coat. The mucosa is less
mobile than in the upper part
of the anal canal. The lower
limit of the pecten - white line
of Hilton (stratified squamous
epithelium which is thin, pale
and glossy and is devoid of
sweat glands).
 Lower Cutaneous Part
It is about B mm long and
is lined by true skin
containing sebaceous
glands. The epithelium of
the lowest part resembles
that of pigmented skin in
which sebaceous glands,
sweat glands and hair are
present.
 Development of the rectum and anal canal
The expanded terminal part of the hindgut, the cloaca, is an endoderm-lined chamber that is in contact with the
surface ectoderm at the cloacal membrane. This membrane is composed of endoderm of the cloaca and
ectoderm of the proctodeum or anal pit. The cloaca receives the allantois ventrally, which is a fingerlike
diverticulum.
The cloaca is divided into dorsal and ventral parts by a wedge of mesenchyme-the urorectal septum-that
develops in the angle between the allantois and hindgut. As the septum grows toward the cloacal membrane, it
develops forklike extensions that produce infoldings of the lateral walls of the cloaca. These folds grow toward
each other and fuse, forming a partition that divides the cloaca into two parts:
• The rectum and cranial part of the anal canal dorsally
• The urogenital sinus ventrally
By the seventh week, the urorectal septum has fused with the cloacal
membrane, dividing it into a dorsal anal membrane and a larger ventral
urogenital membrane. The area of fusion of the urorectal septum with the
cloacal membrane is represented in the adult by the perineal body, the
tendinous center of the perineum. The urorectal septum also divides the cloacal
sphincter into anterior and posterior parts. The posterior part becomes the
external anal sphincter, and the anterior part develops into the superficial
transverse perineal, bulbospongiosus, and ischiocavernosus muscles.
Mesenchymal proliferations produce elevations of the surface ectoderm around
the anal membrane. As a result, this membrane is soon located at the bottom of
an ectodermal depression-the proctodeum or anal pit. The anal membrane
usually ruptures at the end of the eighth week, bringing the distal part of the
digestive tract (anal canal) into communication with the amniotic cavity.
 The Anal Canal
The superior two thirds of the adult
anal canal are derived from the
hindgut; the inferior one third
develops from the proctodeum. The
junction of the epithelium derived
from the ectoderm of the
proctodeum and the endoderm of
the hindgut is roughly indicated by
the irregular pectinate line. This line
indicates the approximate former
site of the anal membrane.
Approximately 2 cm superior to the
anus is an anocutaneous line ("white
line"). This is approximately where
the composition of the anal
epithelium changes from columnar
to stratified squamous cells. At the
anus, the epithelium is keratinized
and continuous with the skin around
the anus. The other layers of the wall
of the anal canal are derived from
splanchnic mesenchyme.
Congenital disorder
 Liver
The liver is the largest gland in the body.
It weighs approximately 1500 g. In a mature
fetus—when it serves as a hematopoietic
organ—it is proportionately twice as large.
Liver is covered by Glisson's capsule.
Functions:
• Metabolism of carbohydrates, fats and
proteins;
• Synthesis of bile and prothrombin,
heparin.
• Excretion of drugs, toxins, poisons,
cholesterol, bile pigments and heavy
metals;
• Protective by conjugation, destruction,
phagocytosis, antibody formation and
excretion;
• Storage of glycogen, iron, fat, vitamin A
and D.
The liver lies mainly in the
right upper quadrant of the
abdomen. The normal liver
lies deep to ribs 7–11 on the
right side. The liver occupies
most of the right
hypochondrium and upper
epigastrium and extends
into the left
hypochondrium.
The liver has a convex
diaphragmatic surface and a
relatively flat or even
concave visceral surface,
which are separated
anteriorly by its sharp
inferior border that follows
the right costal margin.
 Relations
Anteriorly - diaphragm,
right and left costal margins,
right and left pleura and
lower margins of both lungs,
xiphoid process, and
anterior abdominal wall in
the subcostal angle.
Posteriorly: diaphragm,
right kidney, hepatic flexure
of the colon, duodenum,
gallbladder, inferior vena
cava, and esophagus and
fundus of the stomach.
Divided into:
• a large right lobe
• a quadrate lobe
• a caudate lobe
• a small left lobe
The lesser omentum
(hepatoduodenal ligament,
hepatogastric ligament),
enclosing the portal triad (bile
duct, hepatic artery, and
hepatic portal vein) passes
from the liver to the lesser
curvature of the stomach and
the first 2 cm of the superior
part of the duodenum.
 Ligaments of the Liver
The falciform ligament -
ascends from the
umbilicus to the liver.
The ligamentum teres, the
remains of the umbilical
vein.
The coronary ligament -
forms the upper layer of
the left triangular
ligament, the right
triangular ligament.
The ligamentum venosum,
a fibrous band that is the
remains of the ductus
venosus.
Subphrenic recesses—superior
extensions of the peritoneal cavity
(greater sac)—exist between
diaphragm and the anterior and
superior aspects of the diaphragmatic
surface of the liver.
The portion of the supracolic
compartment of the peritoneal cavity
immediately inferior to the liver is the
subhepatic space.
The hepatorenal recess (Morison
pouch) is the posterosuperior
extension of the subhepatic space,
lying between the right part of the
visceral surface of the liver and the
right kidney and suprarenal gland.

The diaphragmatic surface of the liver

is covered with visceral peritoneum,
except posteriorly in the bare area of
the liver, where it lies in direct contact
with the diaphragm.
 Hepatic segments
The hepatic segments are of surgical importance. The hepatic veins tend to be intersegmental in their
course.
Normal hepatic tissue, when
sectioned, is traditionally described
as demonstrating a pattern of
hexagonal-shaped liver lobules. Each
lobule has a central vein running
through its center from which
sinusoids (large capillaries) and
plates of hepatocytes (liver cells)
radiate toward an imaginary
perimeter extrapolated from
surrounding interlobular portal triads
(terminal branches of the hepatic
portal vein and hepatic artery and
initial branches of the biliary ducts).
The hepatocytes secrete bile into the
bile canaliculi formed between
them. The canaliculi drain into the
small interlobular biliary ducts and
then into large collecting bile ducts
of the intrahepatic portal triad,
which merges to form the hepatic
ducts.
 Hepatic Ducts
Bile is produced continuously by the liver and
stored and concentrated in the gallbladder,
which releases it intermittently when fat
enters the duodenum. Bile emulsifies the fat
so that it can be absorbed in the distal
intestine.

• The right and left hepatic ducts - emerge

at the porta hepatis from the right and left
lobes of the liver.
• Common hepatic duct - formed by the
union of the right and left hepatic ducts. It
is joined on its right side at an acute angle
by the cystic duct to form the bile duct.
• Cystic duct is about 3 to 4 cm long. It
begins at the neck of the gallbladder and
ends by joining the common hepatic duct.
The mucous membrane of the cystic duct
forms a series of 5 to 12 crescentic folds,
arranged spirally to form the so-called
spiral valve of Heister. This is not a true
valve.
The bile duct ends below by
piercing the medial wall of the
second part of the duodenum. It is
8 cm long and has a diametre of
about 6 mm. It is usually joined by
the main pancreatic duct, and
together they open into a small
ampulla in the duodenal wall,
called the hepatopancreatic
ampulla (ampulla of Vater). The
terminal parts of both ducts and
the ampulla are surrounded by
circular muscle, known as the
sphincter of the hepatopancreatic
ampulla (sphincter of Oddi).
When food enters the duodenum,
specially a fatty meal, the
sphincter opens and bile stored in
the gallbladder is poured into the
duodenum.
 Gallbladder
The gallbladder is 7 to 10 cm long, lies in
the fossa for the gallbladder on the
visceral surface of the liver and about 30
to 50 ml in capacity. Peritoneum
completely surrounds the fundus of the
gallbladder and binds its body and neck to
the liver.
Parts:
• The fundus - the wide blunt end that
usually projects from the inferior
border of the liver at the tip of the
right 9th costal cartilage in the MCL.
• The body - main portion that contacts
the visceral surface of the liver,
transverse colon, and superior part of
the duodenum.
• The neck - narrow, tapering end,
opposite the fundus and directed
toward the porta hepatis; it typically
makes an S-shaped bend and joins the
cystic duct.
Functions of gallbladder:
• Storage of bile, and its release into the duodenum when
required.
• Absorption of water, and concentration of bile.
• It regulates pressure in the biliary system by appropriate
dilatation or contraction.
• Excretes cholesterol.
• Secretes mucus.
• Bile is delivered to the duodenum as the result of contraction
and partial emptying of the gallbladder. This mechanism is
initiated by the entrance of fatty foods into the duodenum. The
fat causes release of the hormone cholecystokinin from the
mucous membrane of the duodenum; the hormone then
enters the blood, causing the gallbladder to contract. At the
same time, the smooth muscle around the distal end of the
bile duct and the ampulla is relaxed, thus allowing the passage
of concentrated bile into the duodenum. The bile salts in the
bile are important in emulsifying the fat in the intestine and in
assisting with its digestion and absorption.
 Wall of the gallbladder
Mucous membrane: It is
projected to form folds.
Epithelium consists of a
single layer of tall
columnar cells. Lamina
propria contains loose
connective tissue.
The fibromuscular coat: It
consists of smooth muscle
fibres and collagen fibres
which rests on an outer
fibroareolar coat.
 Development of the Liver and Biliary Apparatus
The liver, gallbladder, and biliary
duct system arise as a ventral
outgrowth-hepatic diverticulum-
from the caudal part of the
foregut early in the fourth week.
The diverticulum extends into the
septum transversum, a mass of
splanchnic mesoderm between
the developing heart and midgut.
The septum transversum forms
the ventral mesentery in this
region.
The hepatic diverticulum enlarges rapidly
and divides into two parts as it grows
between the layers of the ventral
mesogastrium. The larger cranial part of
the hepatic diverticulum is the
primordium of the liver. The proliferating
endodermal cells give rise to interlacing
cords of hepatocytes and to the epithelial
lining of the intrahepatic part of the
biliary apparatus. The fibrous and
hematopoietic tissue and Kupffer cells of
the liver are derived from mesenchyme in
the septum transversum.
The liver grows rapidly and, from the
5th to 10th weeks, fills a large part of
the upper abdominal cavity. The
quantity of oxygenated blood
flowing from the umbilical vein into
the liver determines the
development and functional
segmentation of the liver. Initially,
the right and left lobes are
approximately the same size, but the
right lobe soon becomes larger.
Hematopoiesis begins during the
sixth week, giving the liver a bright
reddish appearance. By the ninth
week, the liver accounts for
approximately 10% of the total
weight of the fetus. Bile formation
by hepatic cells begins during the
12th week.
The small caudal part of the hepatic diverticulum becomes the
gallbladder, and the stalk of the diverticulum forms the cystic duct.
Initially, the extrahepatic biliary apparatus is occluded with epithelial
cells, but it is later canalized because of vacuolation resulting from
degeneration of these cells. The stalk connecting the hepatic and cystic
ducts to the duodenum becomes the bile duct. Initially, this duct
attaches to the ventral aspect of the duodenal loop; however, as the
duodenum grows and rotates, the entrance of the bile duct is carried to
the dorsal aspect of the duodenum. The bile entering the duodenum
through the bile duct after the 13th week gives the meconium (intestinal
contents) a dark green color.
Congenital disorder
 Pancreas
Is overlying and transversely
crossing the bodies of the L1 and
L2 vertebra on the posterior
abdominal wall behind the
peritoneum (retroperitoneal
position), in the epigastrium and
the left upper quadrant. It lies
posterior to the stomach
between the duodenum on the
right and the spleen on the left.
The pancreas produces:
• an exocrine secretion
(pancreatic juice from the acinar
cells) that enters the duodenum
through the main and accessory
pancreatic ducts.
• endocrine secretions (glucagon
and insulin from the pancreatic
islets [of Langerhans]) that enter
the blood.
The pancreas is divided
into:
• head - is embraced by
the C-shaped curve of
the duodenum;
• neck;
• body - passing over the
aorta and L2 vertebra;
• tail - passes forward in
the splenicorenal
ligament and comes in
contact with the hilum
of the spleen.
 Relations
Anteriorly - from right to
left: the transverse colon
and the attachment of the
transverse mesocolon, the
lesser sac, and the stomach.
Posteriorly - from right to
left: the bile duct, the portal
and splenic veins, the
inferior vena cava, the aorta,
the origin of the superior
mesenteric artery, the left
psoas muscle, the left
suprarenal gland, the left
kidney, and the hilum of the
spleen.
 Pancreatic Ducts
The main pancreatic duct begins in the
tail of the pancreas and runs through the
parenchyma of the gland to the
pancreatic head. The main pancreatic
duct and bile duct usually unite to form,
dilated hepatopancreatic ampulla (of
Vater), which opens into the major
duodenal papilla.
The sphincter of the pancreatic duct
(around the terminal part of the
pancreatic duct), the sphincter of the
bile duct (around the termination of the
bile duct), and the hepatopancreatic
sphincter (of Oddi)—around the
hepatopancreatic ampulla—are smooth
muscle sphincters that control the flow
of bile and pancreatic juice into the
ampulla and prevent reflux of duodenal
content into the ampulla.
The accessory pancreatic duct opens into
the minor duodenal papilla. Usually, the
accessory duct communicates with the
main pancreatic duct.
 Functions of the pancreas
• Digestive - pancreatic juice contains many digestive
enzymes:
Trypsin breaks down proteins to lower peptides.
Amylase hydrolyses starch and glycogen to
disaccharides.
Lipase breaks down fat into fatty acids and glycerol.
• Endocrine - carbohydrates are the immediate source
of energy. Insulin helps in utilizations of sugar in the
cells.
• Pancreatic juice - provides appropriate alkaline
medium (pH 8) for the activity of the pancreatic
enzymes.
 Histology of pancreas
• The exocrine part is a serous
gland, made up of tubular acini
lined by pyramidal cells with
basal round nuclei, containing
zymogen granules. It secretes the
digestive pancreatic juice.
• The endocrine part of pancreas is
made up of microscopic elements
called the pancreatic islets of
Langerhans. They are most
numerous in the tail.
The islets have various types of cells:
beta cells – forming about 80% of
the cell population. They produce
insulin.
alpha cells - about 20% of the cell
population. A1 cells belong to
enterochromaffin group and secrete
pancreatic gastrin and serotonin. A2
cells secrete glucagon.
 Development of pancreas
The pancreas develops between the layers of
the mesentery from dorsal and ventral
pancreatic buds of endodermal cells, which
arise from the caudal or dorsal part of the
foregut. Most of the pancreas is derived from
the dorsal pancreatic bud. The larger dorsal
pancreatic bud appears first and develops a
slight distance cranial to the ventral bud. It
grows rapidly between the layers of the dorsal
mesentery. The ventral pancreatic bud
develops near the entry of the bile duct into
the duodenum and grows between the layers
of the ventral mesentery. As the duodenum
rotates to the right and becomes C shaped,
the ventral pancreatic bud is carried dorsally
with the bile duct. It soon lies posterior to the
dorsal pancreatic bud and later fuses with it.
The ventral pancreatic bud forms the uncinate process and part of the head of the
pancreas. As the stomach, duodenum, and ventral mesentery rotate, the pancreas
comes to lie along the dorsal abdominal wall. As the pancreatic buds fuse, their ducts
anastomose. The pancreatic duct forms from the duct of the ventral bud and the distal
part of the duct of the dorsal bud. The proximal part of the duct of the dorsal bud often
persists as an accessory pancreatic duct that opens into the minor duodenal papilla. The
two ducts often communicate with each other. The parenchyma of the pancreas is
derived from the endoderm of the pancreatic buds, which forms a network of tubules.
Early in the fetal period, pancreatic acini begin to develop from cell clusters around the
ends of these tubules. The pancreatic islets develop from groups of cells that separate
from the tubules and come to lie between the acini. Insulin secretion begins during the
early fetal period (10 weeks). The glucagon- and somatostatin-containing cells develop
before differentiation of the insulin-secreting cells. Glucagon has been detected in fetal
plasma at 15 weeks. The connective tissue sheath and interlobular septa of the pancreas
develop from the surrounding splanchnic mesenchyme.
 Spleen
is a lymphatic organ
connected to the blood
vascular system. It acts as a
filter for blood and plays an
important role in the
immune responses of the
body.
Lying mainly in the left
hypochondrium, and partly
in the epigastrium. It is
wedged in between the
fundus of the stomach and
the diaphragm, related to
9th to 11th ribs.
The spleen is surrounded by
peritoneum.
The diaphragmatic surface
of the spleen is convexly
curved to fit the concavity
of the diaphragm.
The spleen contacts the
posterior wall of the
stomach and is connected
to its greater curvature by
the gastrosplenic ligament,
and to the left kidney by
the splenorenal ligament.
These ligaments,
containing splenic vessels,
are attached to the hilum
of the spleen on its medial
aspect.
 Relations
Anteriorly - the stomach,
tail of the pancreas, and
left colic flexure. The left
kidney lies along its
medial border.
Posteriorly - the
diaphragm; left pleura;
left lung; and 9th , 10th ,
and 11th ribs.
 Functions of the Spleen
• is a hematopoietic (blood-forming) organ, but after
birth is involved primarily in identifying,
• removing, and destroying expended red blood cells
(RBCs) and broken-down platelets, and in recycling
iron and globin.
• The spleen serves as a blood reservoir, storing RBCs
and platelets, and, to a limited degree, can provide a
sort of “selftransfusion” as a response to the stress
imposed by hemorrhage.
 Histology of the spleen
1. Supporting fibroelastic tissue, forming the
capsule, coarse trabeculae and a fine
reticulum. The smooth muscle cells in the
capsule and trabeculae are few, and the
contraction and distension of spleen are
attributed to constriction or relaxation of the
blood vessels, which regulate the blood flow
in the organ.
2. White pulp consisting of lymphatic
nodules arranged around an arteriole called
Malpighian corpuscle.
3. Red pulp is formed by the collection of
cells in the interstices of reticulum, in
between the sinusoids. The cell population
includes:
a. All types of lymphocytes (small, medium
and large),
b. All three types of blood cells (RBC, WBC
and platelets),
c. The fixed and free macrophages.
Lymphocytes are freely transformed into
plasma cells which can produce large
amounts of antibodies the immunoglobulins.
4. Vascular system transverses the organ and
permeates it thoroughly.
 Development of the spleen
is derived from a mass of
mesenchymal cells located
between the layers of the
dorsal mesogastrium, begins
to develop during the fifth
week.
The spleen is lobulated in
the fetus, but the lobules
normally disappear before
birth. The mesenchymal cells
in the splenic primordium
differentiate to form the
capsule, connective tissue
framework, and parenchyma
of the spleen. The spleen
functions as a hematopoietic
center until late fetal life;
however, it retains its
potential for blood cell
formation even in adult life.
Congenital disorder
 Peritoneum
The peritoneum is a continuous, glistening, and slippery
transparent serous membrane. It lines the
abdominopelvic cavity and invests the viscera. It is
sensitive to pressure, pain, heat and cold, and
laceration.
• the parietal peritoneum, which lines the internal
surface of the abdominopelvic wall.
• the visceral peritoneum, which invests viscera.
 Functions of Peritoneum
1. Movements of viscera
2. Protection of viscera (contains various phagocytic cells
which guard against infection. The greater omentum has
the power to move towards sites of infection and to seal
them thus preventing spread of infection).
3. Absorption and dialysis (the mesothelium acts as a
semipermeable membrane across which fluids and small
molecules of various solutes can pass).
4. Healing power and adhesions (the mesothelial cells of
the peritoneum can transform into fibroblasts which
promote healing of wounds).
5. Storage of fat.
The potential space between the
parietal and visceral layers, is
called the peritoneal cavity, it
contains no organs but contains a
thin film of peritoneal fluid.
Peritoneal fluid lubricates the
peritoneal surfaces, enabling the
viscera to move over each other
without friction, and allowing the
movements of digestion, contains
leukocytes and antibodies that
resist infection.
It is divided into two parts:
• the greater sac,
• the lesser sac.

They are in free communication

with one another through an oval
window called the epiploic
foramen.
Greater sac - is the main and larger part of the peritoneal cavity.
The transverse mesocolon divides the abdominal cavity into a supracolic
compartment, containing the stomach, liver, and spleen, and an infracolic
compartment, containing the small intestine and ascending and descending
colon.
The infracolic compartment lies posterior to the greater omentum and is
divided into right and left infracolic spaces by the mesentery of the small
intestine.
 Lesser Sac (omental bursa)
The lesser sac lies behind
the stomach and the lesser
omentum. The omental
bursa has a superior recess,
limited superiorly by the
diaphragm and the posterior
layers of the coronary
ligament of the liver, and an
inferior recess between the
superior parts of the layers
of the greater omentum.
The omental bursa
communicates with the
greater sac through the
omental foramen (epiploic
foramen)
 Epiploic foramen
Anteriorly: Free border of
the lesser omentum, the
bile duct, the hepatic
artery, and the portal vein
Posteriorly: Inferior vena
cava.
Superiorly: caudate lobe
of the liver.
Inferiorly: First part of the
duodenum.
 Development of omental bursa
Isolated clefts develop in the mesenchyme
forming the thick dorsal mesogastrium. The clefts
soon coalesce to form a single cavity, the omental
bursa.
Rotation of the stomach pulls the dorsal
mesogastrium to the left, thereby enlarging the
bursa, a large recess of the peritoneal cavity. The
omental bursa expands transversely and
cranially and soon lies between the stomach and
the posterior abdominal wall.
 Omentum
is a double-layered extension or fold
of peritoneum that passes from the
stomach and proximal part of the
duodenum to adjacent organs in the
abdominal cavity.
The greater omentum is a
prominent, four-layered peritoneal
fold that hangs down like an apron
from the greater curvature of the
stomach and the proximal part of the
duodenum. After descending, it folds
back and attaches to the anterior
surface of the transverse colon and
its mesentery.
The lesser omentum is a much
smaller, double-layered peritoneal
fold that connects the lesser
curvature of the stomach and the
proximal part of the duodenum to
the liver.
• The lesser omentum, passing from the liver to
the lesser curvature of the stomach
(hepatogastric ligament) and from the liver to
the duodenum (hepatoduodenal ligament)
• The falciform ligament, extending from the
liver to the ventral abdominal wall.
The ventral mesentery, derived from the
mesogastrum, also forms the visceral
peritoneum of the liver.
 Mesenteries
is a double layer of
peritoneum that occurs as
a result of the
invagination of the
peritoneum by an organ
and constitutes a
continuity of the visceral
and parietal peritoneum.
A mesentery connects an
intraperitoneal organ to
the body wall—usually the
posterior abdominal wall.