Embryology of digestive system:

The alimentary (digestive) system is the digestive tract from mouth to anus

Primordial gut starts at 4th week as head, tail and lateral folds incorporating dorsal part of
umbilical cord (yolk sac) and divided to foregut, midgut and hindgut.

- Cranial end closed by oropharyngeal membrane

- Caudal by cloacal membrane

Endoderm forms most of gut, epithelium and glands while ectoderm of the stomodeum
and anal pit (proctodeum) form epithelium of cranial and caudal ends. Splanchnic
mesoderm forms muscular, connective tissue and layers of wall of GIT tract.

Foregut: supplied by celiac trunk

- Primordial pharynx
- Lower respiratory system
- Esophagus and stomach: greater and lesser omentum
- Duodenum upper: hepatoduodenal lig
- Liver, biliary apparatus (hepatic ducts, gallbladder and bile duct) (lesser omentum
and falciform lig), pancreas (splenorenal lig)

Development of esophagus:

Develops from foregut caudal to pharynx and divides from trachea by tracheoesophageal
septum. First its short and elongates due to growth of heart and lungs by 7th week.

Epithelium and glands derived from endoderm. And recanalization occurs end of 8th week.

- Superior third formed by striated muscle (external muscle) by mesenchyme in 4th

and 6th pharyngeal arches (myogenic reg. factors)
- Inferior third is smooth muscle from splanchnic mesenchyme

Innervated by vagus nerve (cranial X) branches.

Esophageal atresia: blockage of esophageal lumen. 90% associated by tracheoesophageal

fistula where septum deviates in post direc. Isolated one due to failure of recanalization in
8th week. Fetus cant swallow amniotic fluid result is polyhdramnios. Appear good at birth
but need surgery soon after if baby healthy above 2 kilo 100% treated if not reduced.

Esophageal stenosis: narrowing of lumen mainly distal third from incomplete

recanalization in 8th week or failure of blood vessels to develop.

Development of stomach:
During 4th week the distal foregut tubular structure dilates indicating primordial stomach
seen as fusiform enlargement and oriented in median plane. Then enlarges ventrodorsally.
Next 2 weeks (5 & 6) dorsal (post) border grows faster than ventral (ant) indicating greater
curvature of stomach.

Rotation of stomach:

Stomach rotates 90 degrees in clockwise direction and causes:

- Ant or ventral (lesser curvature) moves to right and dorsal (greater curvature) to left
- Original left side becomes ventral surface and right becomes dorsal one
- Cranial moves to left and inferior, caudal to right and superior (median originally)
- Long axis of stomach becomes transverse to long axis of body. left vagus nerve to
ant. Wall of stomach and right vagus nerve to post wall

Mesenteries of stomach:

- Primordium dorsal mesogastrium connects the stomach and dorsal wall of

abdominal cavity
o Mesentery in median plane moves to left in rotation and formation of
omental bursa (lesser sac)
o Contain spleen and celiac artery
- Primordial ventral mesogastrium attaches to stomach, and duodenum to liver and
ventral abdominal wall

Omental bursa:

Mesenchyme forms dorsal mesogastrium that will form omental bursa (lesser peritoneal
sac) and is pulled to left by rotation of stomach and lies between stomach and posterior
abdominal wall.

- Superior part cut o^ when diaphragm develops forming closed space, infra-cardiac
bursa
- Inferior region persists as superior recess of omental bursa
- As stomach enlarges acquires inferior recess of omental bursa between greater
omentum which hangs intestines and then disappears as omentum fuse

Omental bursa communicates with peritoneal cavity through omental foramen

Hypertrophic pyloric stenosis: muscular thickening of pylorus due to hypertrophy result to

obstruction of food passage and stomach becomes distended and infant has projectile
vomiting. Pyloromyotomy is done. In monozygotic twins suggests genetic factors.

Development of duodenum:
 - In 4th week develops from caudal foregut, cranial midgut and splanchnic
mesenchyme.
- Forms c-shaped loop projecting ventrally and rotates to right as stomach develops
to be pressed in post abdominal wall in retroperitoneal position.
- Supplied by celiac trunk and superior mesenteric arteries

Duodenal atresia: blockage of duodenal lumen due to incomplete recanalization mainly at

hepatopancreatic ampulla (bile and panc ducts). In familial, recessive autosomal. Vomits
begins after hours of birth contain bile (bilious emesis) with distended epigastrium. May be
besides other defects like annular panc, cardiovascular defects..and causes
polyhydramnios. Diagnosis (double-bubble) sign of US due to distended gas filled stomach
and prox duodenum.

Duodenal stenosis: partial occlusion from incomp. Recanal. Due to defective

vacuolization. Bile is with vomit and occur in 3rd and 4th parts.

Development of liver and biliary apparatus:

- Liver, gallbladder and biliary duct arise as hepatic diverticulum

- Extends to septum transversum (separates pericardial and peritoneal cavities)
which forms ventral mesogastrium and divide to 2 parts
o Cranial larger one form liver
o Smaller caudal form gallbladder
o Stalk of diverticulum becomes cystic duct
- Mesenchyme of septum transversum form fibrous and hematopoietic tissue and
Kup^er cells of liver
- Liver grows from 5th to 10th weeks and soon right lobe larger than left
- 6th week: hematopoiesis begins in liver (bright red)
- 9th week: 10% of weight of fetus is liver
- 12th week: bile formation
- Stalk connecting cystic and hepatic ducts to duodenum becomes bile duct
o Bile entering duodenum in 13th week gives meconium a green color
(intestinal discharge)

Ventral mesentery:

Thin double-layered mem gives:

- Lesser omentum: lesser curv of stomach to liver (hepatogastric lig) and liver to
duodenum (hepatoduodenal lig)
- Falciform lig (liver to ventral abdominal wall
o Umbilical vein pass in free border of falciform lig from umbilical cord to liver
 - Also forms visceral peritoneum of liver
o Has a bare area contact with diaphragm

Anomalies of liver: accessory hepatic ducts in 5% are narrow channels from right lobe to
gallbladder and in some the cystic duct opens to it instead of common hepatic duct.

Extrahepatic biliary atresia: most serious, obliteration of bile ducts at or above porta
hepatis (transv. Fissure on central liver) due to failure of remodeling process at hilum or
infections or immune rxns. Signs: jaundice and clay colored acholic stools and dark urine.
Surgery is done but in 70% it progresses

Development of pancreas:

Develops from dorsal and ventral pancreatic buds of endoderm

- Dorsal mostly and appears first

- Ventral smaller an near entry of bile duct to duodenum
o Forms uncinate process and part of head of pancreas
- Pancreatic duct form from ventral and distal part of dorsal bud and open to minor
duodenal papilla

Histogenesis of pancreas:

- Endoderm of pancreatic buds form parenchyma of pancreas

- Acini from cells around primordial pancreatic ducts (tubules)
- Islets from cells separating from tubules and lie btw acini
- 10th week: insulin secretion
- Cells containing glucagon and somatostatin develop before di^ of beta cells
secreting insulin
o Glucagon detected in plasma at 15 week
o In maternal diabetes mellitus beta cells exposed to high glucose levels and
undergo hypertrophy to increase insulin secretion

Ectopic pancreas: pancr. Tissue located away from panc. (stomach mucosa. Prox
duodenum) asymptomatic but may be present with GIT symp, obstruction, bleeding. And
cancer.

Annular pancreas: can obstruct duodenum if it is inflamed and ass with down syndrome
and other defects. Females more. Due to growth of bifid ventral pancreatic bud around
duodenum. Surgery.

Development of spleen:
 - From Mesenchymal cells btw dorsal mesogastrium in 5th week and gain shape in
early fetal period and lobules disappear before birth
- Left mesogastrium at stomach rotation fuses with peritoneum over left kidney
o Splenorenal ligament has dorsal att.
o Splenic artery ant to left kidney (largest celiac branch)
- Hematopioetic center

Accessory spleens: polysplenia multiple acc spleens without main body of spleen result in
suscep. To infections

Midgut: superior mesenteric artery

- Small intestine (duodenum distal to bile duct) no mesentery ileum and jejunum by
small bowel mesentery
- Cecum : varies
- appendix : mesoappendix
- ascending colon
- right ½ to 2/3 of transverse colon: transverse mesocolon

herniation occurs since no room for dev organs and midgut is suspended by dorsal
mesogastrium and have 2 limbs joined at omphaloenteric duct

- cranial limb forms small intestine loops

- caudal cecal swelling (primordium of cecum and appendix)

rotation of midgut loop:

rotates 90 degrees counterclockwise around superior mesenteric artery

- cranial limb to right (small int)

- caudal to left (large int)

retraction of intestinal loops:

in 10th week the intestines return to abdomen and intestines post to SMA occupy central
part

large intestines 180 counterclock rotate and desc colon and sigmoid move to right side

fixation of intestines:

duodenum has no mesentery in midgut and head of pancreas and asc colon also

jejunum and ileum have small bowel mesentery

cecum and appendix:

primordium: cecal swelling appears in 6th week and appendix may be retrocecal or
retrocolic or pelvic

congenital omphalocele: hernation of abdominal contents from umbilical cord persists

and ass with chrom ab. Surgery is done to close minor ones. Big ones su^er from pulmo
and thoracic hyperplasia. The hernia is covered with peritoneum and amnion. Results from
impaired mesodermal muscle and ectodermal skin of abd. Wall. Gastrulation.

Umbilical hernia: intestines return at 10th but herniate again in unclosed umbilicus and
hernia covered by subcutaneous tissue and skin is in linea alba and protrudes while crying,
coughing and corrected by fibrous ring.

Gastroschisis: ant. abdominal wall defect laterally and viscera protrudes without involving
umbilical cord and are bathed in amniotic fluid (split or open stomach means) hardest

Anomalies of midgut: malrotation of intestines, and nonrotation (sm intes. On right and
large on left)

Reversed rotation: clockwise one transverse colon may be obstructed and failure of int fix.

Subhepatic cecum and appendix: cecum adhere to liver

Mobile cecum: mobile and may herniate to right inguinal canal due to incomp. Fixation of
asc colon. And volvulus of cecum can occur

Internal hernia: asymptomatic intestinal internal hernia

Stenosis and atresia of intestine: failure of vacuolization or interruption of blood supply

leading to necrosis

Ileal diverticulum and omphaloenteric remnants: outpouching of ileum part (congenital:

Meckel diverticulum) when inflamed it mimics appendicitis. The diverticulum wall may
have ectopic gastric tissues secreting acids and causing ulcers. It is the remnant of
omphaloenteric duct. It may be connected by fibrous cord which causes intest. Obstr. Or
form omphaloenteric fistula.

Duplication of intestine: cystic more common than tubular. Due to failure of recanal. And
often have ectopic gastric mucosa causes ulcers.

hindgut: inferior mesenteric artery

- 1/3 transverse colon:

- Descending colon retroperitoneal
- Sigmoid: sigmoid mesocolon
- Rectum
 - Superior anal canal
- Epithelium of urinary bladder and urethra

Cloaca:

Terminal part of hindgut endoderm lined and contact cloacal membrane

Partitioning of cloaca:

Have dorsal and ventral parts divided by urorectal septum and form

- Rectum
- Cranial anal canal
- Urogenital sinus

Then ruptures by apoptosis and recanalization form anal pit

Anal canal:

2/3 superior formed by hindgut (superior rectal artery and vein, inferior mesenteric lymph,
autonomic nerves) and inferior 1/3 form anal pit (inferior rectal artery, vein, superficial
inguinal lymph and inferior rectal nerve sensitive to pain touch and temp) separated by
pectinate line

Splanchnic mesenchyme