EMBRYOLOGY LECTURE 8

Development of the digestive system

The digestive system consists of the; mouth pharynx, esophagus,

stomach, small and large intestines, anus. Small intestine consists of
duodenum, jejunum and ileum. Large intestine consists of; caecum,
ascending, transverse, descending, and sigmoid colon, rectum and anal
canal.
During development a primitive gut is formed. It extends from
buccopharyngeal membrane to the cloacal membrane. It consists of; the
pharyngealgut, foregut, midgut and hindgut.
The pharyngeal gut gives rise to the pharynx and related glands
The foregut gives rise to esophagus, trachea, lung buds, stomach,
proximal duodenum (1st part of duodenum). The liver, pancreas and billiary
systems develop as outgrowths of the epithelium of the proximal
duodenum.
The epithelium of digestive system and its derivative are of endodermal
origin while the muscular and peritoneal components are of mesodermal
origin.
The midgut forms the primary intestinal loop which gives rise to; the
duodenum distal to the entrance of the bile duct, jejunum, ileum, caecum,
appendix, ascending colon and two-thirds of the transverse colon.
The hindgut gives rise to; the distal one-third of transverse colon,
descending and sigmoid colon, rectum and upper part of the anal canal.
The lower part of anal canal is of ectodermal origin. Urorectal septum
separates the rectum and anal canal posteriorly and urinary bladder and
urethra/vagina anteriorly. Deviation of the urorectal septum may lead to
atresia and abnormal openings between the rectum, bladder, vagina
/urethra.

 Cephalocaudal and lateral folding of the embryo allows part of the

endoderm-lined yolk sac to be incorporated into the embryo to
form the digestive system (DS)
Mesoderm gives rise to the connective tissue, muscle and
peritoneum
Endoderm gives rise to the epithelium and parenchyma
DORSAL MESENTERY
Dorsal mesentery formed from splanchnopleuric mesoderm during
embryonic folding
Mesentery proper = dorsal mesentery of the jejunum and ileum
Initially the gut tube is in broad contact with the mesenchyme of
the posterior abdominal wall
By week five the mesenchymal bridge has narrowed and DM
formed From lower end of oesophagus to cloaca

Stomach = dorsal mesogastrium (greater omentum)

Duodenum = dorsal mesoduodenum
Colon = dorsal mesocolon

ESOPHAGUS

Arise from the foregut when the embryo is around 4 weeks. A

respiratory diverticulum develops at the ventral wall of the foregut
at the junction with the pharyngealgut.
The respiratory diverticulum is gradually separated from the dorsal
part of the foregut by a partition known as esophagotracheal
septum.

This results in the division of this part of the foregut into a ventral
portion, the respiratory primordium, and a dorsal portion, the
esophagus.
Initially the esophagus is very short but lengthens due to the
descent of the heart and lungs

Defects of the esophagus

Atresis. The proximal part of the esophagus ends as a blind sac. This
prevents the normal passage of amniotic fluid into the intestinal tract
which leads to accumulation of fluid in the amniotic sac and hence
enlarged uterus. It is noticed when attempt to feed the newborn, the
esophagus fills rapidly and the milk spill over into trachea/lungs.
Esophagotracheal fistula. The distal part of the esophagus is connected
to the trachea by a canal at a point just above tracheal bifurcation.

STOMACH

During the 4th week, the stomach appears as dilatation of the foregut. In
the subsequent weeks, differential rate of growth of the parts of the
stomach and positional changes of the surrounding organs leads to
changes in appearance and position of the stomach.
Positional changes. The stomach rotates 900 clockwise around its
longitudinal axis. This causes its left side to face anteriorly and right side
face posteriorly. The left vagus nerve which initially innervated the left
side now innervates the anterior wall, and same to the right vagus now
innervates posterior wall.
During the rotation, the original posterior wall of the stomach grows faster
than the anterior portion, hence formation of greater and lesser curvatures
Originally, the cephalic and caudal ends of the stomach are located in the
midline but following further growth, the cephalic (cardiac) portion is
moved to the left and slightly downward while the caudal (pyloric) portion
is moved to the right and slightly upward. This is the final position of the
stomach.

Defects of the stomach.

Pyloric stenosis= Due to hypertrophy of the muscles of the pylorus
region. The pyloric lumen is severely narrowed leading to obstruction in
food passage resulting in severe progressive vomiting. This is one of the
most common abnormalities of the stomach. Other rare defects includes;
atretic pylorus, duplication of stomach...

Duodenum

The 1st part is formed from caudal portion of the foregut and the
remaining parts are formed from the cephalic portion of the midgut.
Due to the rotation of the stomach, the duodenum takes the form of
a C-shaped loop, rotates to the right and comes to lie
retroperitoneally.
During the second month, the lumen of duodenum becomes
obliterated but it is re-established afterwards.

Liver and gall bladder

The liver appears in the 3rd week as an outgrowth (liver bud) of the
endodermal epithelium of the proximal duodenum. This outgrowth, liver
bud, consists of rapidly proliferating cells that penetrate the septum
transversum
While hepatic cells continue to penetrate the septum, the connection
between the hepatic diverticulum and the foregut (duodenum) narrows,
forming the bile duct. A small ventral outgrowth is formed by the
bile duct, and this outgrowth gives rise to the gallbladder and the
cystic duct
During further development, epithelial liver cords intermingle with the
vitelline and umbilical veins, which form hepatic sinusoids.
Liver cords differentiate into the parenchyma (liver cells) and form
the lining of the biliary ducts.
Hematopoietic cells, Kupffer cells, and connective tissue cells are
derived from mesoderm of the septum transversum.
When liver cells have invaded the entire septum transversum, septum
transversum lying between the liver and the foregut and the liver and
ventral abdominal wall becomes membranous, forming the lesser
omentum and falciform ligament, respectivelyTogether, having formed the
peritoneal connection between the foregut and the ventral abdominal wall,
they are known as the ventral mesogastrium
Mesoderm on the surface of the liver differentiates into visceral
peritoneum except on its cranial surface. In this region, the liver remains
in contact with the rest of the original septum transversum. This portion of
the septum, which consists of densely packed mesoderm, will form the
central tendon of the diaphragm. The surface of the liver that is in contact
with the future diaphragm is never covered by peritoneum; it is the bare
area of the liverLiver and Gallbladder Abnormalities
Malformation associated with liver/g bladder
Variations in liver lobulation are common but not clinically significant,
Accessory hepatic ducts and duplication of the gallbladder are also
In some cases the ducts, which pass through a solid phase in their
development, fail to recanalize This defect, extrahepatic biliary atresia,
occurs in 1/15,000 live births.
Another problem with duct formation lies within the liver itself; it is
intrahepatic biliary duct atresia and hypoplasia.

Pancreas

The pancreas is formed by two buds originating from the endodermal

epithelium of the duodenum. There is the dorsal bud and the ventral bud
which later fuse to form the definitive pancreas. As the duodenum rotates
to the right, the ventral bud migrates dorsally and finally lies below and
dorsal to the dorsal bud
The ventral bud gives rise to the uncinate process and the inferior part of
the head while the remaining part of the pancreas arises from the dorsal
bud.
The main pancreatic duct is formed by the entire ventral and the distal
part of dorsal pancreatic ducts. The proximal dorsal pancreatic duct forms
the accessory duct.
Islets of Langerhans form by the 3rd month and insulin production begins
by the 5th month.

Defects of pancreas

Sometimes, the two buds surround the duodenum forming annular

pancreas, which cause constriction of the duodenum or total obstruction.
Heterotopic pancreatic tissues. The heterotopic tissues may be found
anywhere from distal end of esophagus to the tip of the primary intestinal
loop.

MIDGUT

The development of the midgut is characterised by a rapid elongation of

the gut to form primary intestinal loop. The apex of the loop remains in
direct communication with the yolk sac through the vitelline duct.
The loop has two limbs; the cephalic and the caudal limbs. The cephalic
limb gives rise to; the distal part of duodenum, jejunum and upper portion
of ileum. The caudal limb gives rise to lower part of the ileum, the caecum,
appendix, ascending colon, and proximal two-thirds of the transverse
colon.
Development of the primary intestinal loop is characterised by rapid
elongation especially of the cephalic limb, and at the same time, there is
rapid expansion of the liver. As a result there is inadequate space in the
abdominal cavity to accommodate these rapid growths. Therefore, during
the 6th week, the loop herniates into the umbilical cord=physiological
herniation. The growth continues and it returns to the abdominal cavity
during the 10th week.
Coincident with growth in length, the loop rotates around an axis formed
by superior mesenteric artery. There is a 90 0 anticlockwise rotations as the
loop herniates and further 1800 anticlockwise rotation during the return of
the loop.
The first part of the loop to return is the jejunum and comes to lie on the
left side. As the rest of the lops re-enter they lie further to the right

The last part to return is the caecum which is temporarily located in the
right upper quadrant. As it descends to its definitive position, it forms the
ascending colon and the hepatic flexure. Also the appendix develops from
the distal end of the caecum.

PHYSIOLOGICAL HERNIATION

HERNIATION
As the 90 degree rotation occurs the gut tube herniates into the
umbilical cord
Allows the growth of the gut tube outwith cramped confines of
abdominal cavity
Described as physiological because is part of the intended
development sequence unlike later adult hernias

Mid and Hind gut

Defects:

Sometimes, the loop fail to return= Amphalocele. At birth, the herniated

loops cause a large swelling in the umbilical cord and are covered only by
the amnion.
Abnormal rotation of the loop. The loop may rotate 90 instead of normal
270. In this case the caecum and colon are the first to return and settles
on the left side= left-sided colon. Sometimes, there is reverse rotation
i.e. the loop rotates 90 clockwise. The clinical implication of abnormal
rotations is the danger that the loop twisting may cause a kink in the
arteries and thus a vascular obstruction of the loop.
Stenosis and atresia of the gut
Duplication of gastrointestinal tract

HINDGUT
The hindgut gives rise to; the distal one-third of the transverse colon, descending
and sigmoid colon, rectum and upper part of anal canal. The endoderm of
hindgut forms the inner lining of the bladder and urethra

The terminal portion of the hindgut enters into the cloaca, an ectoderm
lined cavity
In the 9th week, the anus canalise

Defects

Imperforate anus: The anal canal fail to open to the outside

Rectal atresia: failure of anal canal to form
Rectal fistulas: Are commonly found in association with imperforate anus.
May be found between the rectum and vagina, bladder or urethra.
Frequently, the fistulas open to the surface in the perineal region

PERITONEUM
Serous lining of the abdominal cavity
Parietal layer lines the walls
Visceral layer covers organs
Peritoneal space/cavity
Double layers = mesenteries enclose organ and connect it to the body
wall
Parietal peritoneum = sensitive to pain, touch, temperature and pressure.
Lining lateral and anterior walls supplied by lower 6 thoracic nerves;
central part diaphragm by phrenic nerves; and pelvic by obturator nerve
Visceral peritoneum = sensitive to stretch via ANS afferent fibres; overdistention will lead to pain; mesenteries of small and large intestine
sensitive to mechanical stretching
Peritoneal fluid allow smooth movement of intestines
Fluid absorbed into lymphatic system at diaphragm
Large fat store
Intra-peritoneal = have mesentery and completely covered by peritoneum
stomach, gall bladder, small intestine (only 1 st part duodenum), spleen,
liver, caecum (some appendix), transverse and sigmoid colon
Extra-peritoneal = no mesentery ever or lost in development
Retro-peritoneal = primary (kidneys, supra-renal glands); secondary (2, 3,
4th parts duodenum, pancreas, ascending and descending colon, upper
2/3rds rectum)
SEPTUM TRANSVERSUM

 Membraneous tissue separating two body orgarns/cavities

In between pericardial cavity and stalk of yolk sac
Mesodermal origin
Give rise to lesser omentum, falciform ligament, peritoneal lining of the
liver, liver hemopoietic cells, kupffer cells, connective tissue cells of the
liver