Week 4 Embryology

Development of Gastrointestinal
Dr Marselina Tan

Learning objectives
Topic : development of gastrointestinal and pelvic organ
Students should be able to:
know the embryonic development of digestive organ
describe the congenital abnormality and the aging of
digestive organ

Derivatives of the endodermal germ layer:

the gastrointestinal tract
The gastrointestinal tract formation depends on cephalocaudal & lateral
folding of the embryo
As a result from folding movements initial wide communication
between embryo & yolk sac narrow the vitelline duct remains

In the anterior, endoderm forms : foregut

In the tail region, endoderm forms: hindgut. Between: midgut
The endoderm forms the lining of the GIT, and cells of glands.
The splanchnic mesoderm forms stroma (connective tissue) of the gland,
muscle, and connective tissue of the gut wall.
Midgut yolk sac by broad stalk: vitelline duct the vitellin duct
At cephalic end, foregut bounded temporarily by ectodermal-endodermal
membrane: buccopharyngeal membrane 4th week ruptures: open
connection amniotic cav. & primitive gut. Hindgut 7th week breaks down :
create openings: cloacal membrane
Important result of cephalocaudal & lateral folding: partial incorporation of
allantois into the body of embryo forms cloaca
In human, yolk sac vestigial : has nutritive role in early stages

 Gastrointestinal tube is
derivatives from
primitive gut.
When endoderm folds
foregut (anterior)
and hindgut
(posterior). In the
middle midgut

 At day 28th ,
gastrointestinal tube
buds form
digestive glands:
- liver
pancreas
bile

Gastrointestinal tube
differentiates further

Gastrointestinal tube and its derivatives

Posterior: pharynx,
gastrointestinal tube,
oesofagus, gut, small intestine
& large intestine.
Endoderm cells become
epithelial lining digestive tube
and glands.
Mesenchyme mesodermal cells
will surround the tube and
become peristaltic muscles.

Mesenteries

Initially, the gut is in contact with the posterior body wall.

By 5th week, the connecting tissue (mesenchyme) between the gut and body wall
narrows.
Thus, caudal part of the foregut, midgut and major part of the hindgut are suspended
by the dorsal mesentery.
Dorsal mesentery forms- greater omentum, mesoduodenum, mesocolon and
mesentery.

Figure is from Langmans Embryology

Mesenteries

Ventral mesentery exists only at the lower end of esophagus, stomach and upper part
of the duodenum.
Ventral mesentery is derived from the septum transversum.
The growth of the liver into the septum transversum results in division of the ventral
mesentery.
The part of the ventral mesentery between the liver and stomach forms the lesser
omentum.
The part between the liver and anterior abdominal wall forms the falciform ligament.

Figure is from Langmans Embryology

Foregut

The part of the foregut extending from the buccopharyngeal membrane to the respiratory
diverticulum is called pharyngeal gut (considered with pharyngeal arches).
Remaining part extends from the respiratory diverticulum to the liver bud.
Esophagus:- develops from the foregut between the respiratory diverticulum and
stomach.
-The muscle wall develops from the splanchnic mesoderm (upper 1/3-skeletal, middle
1/3-mixed and lower 1/3-smooth).
-It elongates due to the descent of heart and lungs.

Figure is from Langmans Embryology

Esophageal abnormalities

Esophageal atresia/ tracheo-esophageal fistula:- due to abnormal tracheo-esophageal septum

formation or some mechanical factors.
-In common form, the proximal part of the esophagus ends blindly, and the distal part is
connected to the trachea.
Atresia of the esophagus prevents the passage of amniotic fluid into the gut thus accumulating
the fluid in the amniotic sac-polyhydramnios.
Esophageal stenosis:- narrow lumen.

Figure is from Langmans Embryology

Stomach

Appears as a fusiform dilation of the foregut (4 week).

Later, the appearance and position change due to differential growth and change in surrounding
organs.
It rotates 90 degrees clockwise around a longitudinal axis.
-So that left side becomes the anterior surface and the right side becomes the posterior surface.
-The left margin grows faster than the right resulting in the formation of the greater and lesser
curvatures.
The pyloric end moves to the right and the cardiac end moves to the left.

Figure is from Langmans Embryology

Stomach

Stomach is attached to the dorsal body wall by dorsal mesogastrium and to the
ventral by ventral mesogastrium.
Rotation of the stomach results in creation of a space behind it called omental bursa
(lesser sac).
In the dorsal mesogastrium, spleen develops from the mesenchyme (5th week).
-from dorsal mesogastrium-greater omentum, lienorenal and gastrosplenic ligaments
develop.

Figure is from Langmans Embryology

Duodenum

Formed from the terminal part of the foregut and cranial part of the midgut.
Origin of the liver bud marks the junction of 2 parts of the gut.
Initially, the duodenum is a straight tube, but due to the rotation of stomach, duodenum assumes
a C-shaped structure and lies to the right.
The head of the pancreas grows into the concavity of the duodenum.
Both of them become retroperitoneal.
During 2nd month, the lumen becomes obliterated by cells, but later re-canalization takes place.
In summary- First part and upper part of second part up to the bile duct develops from the
foregut.
-Remaining of the duodenum develops from the midgut.

Figure is from Langmans Embryology

A. Anterior view of the intestinal loops after 270 counterclockwise

rotation. Note the coiling of the small intestinal loops and the position
of the cecal bud in the right upper quadrant of the abdomen. B.
Similar view as in A, with the intestinal loops in their final position.
Displacement of the cecum and appendix caudally places them in the
right lower quadrant of the abdomen.

Liver and gall bladder

The liver bud (endodermal) grows from the terminal part of the foregut during middle of the third
week.
This bud with proliferating cells grows into the septum transversum (mesodermal).
The connection between the cellular proliferation and foregut narrows and becomes the bile duct.
A cystic bud grows from the bile duct to form the gall bladder and cystic duct.
The hepatocytes develop from endoderm.
The blood cells, Kupffer cells and connective tissue and its cells develop from the mesoderm of
the septum transversum.
During 10 week, liver forms 10% of body weight, whereas at birth it is only 5%.

Figure is from Langmans Embryology

Liver and gall bladder abnormalities

Accessory hepatic ducts-common-without any problem.

Duplication of gall bladder- common-without any problem.
However, during surgery that is important to avoid any injury.
Extrahepatic biliary atresia: 1/15,000 live births.
-due to failure in re-canalization of duct during development.
Intrahepatic biliary duct atresia: biliary duct inside liver is not canalized.

Figure is from Langmans Embryology

Development of pancreas

Develops from 2 dorsal and ventral endodermal buds from duodenum.

The ventral bud rotates to the left and lies below the dorsal bud.
Both buds fuse and form the pancreas.
Ventral bud forms the uncinate process and inferior part of the head.
The dorsal bud forms the rest of the pancreas.

Figure is from Langmans Embryology

Pancreas

The main pancreatic duct is formed by the union of distal part of the duct of the dorsal
bud with the duct of the ventral bud.
The accessory pancreatic duct is formed from the proximal part of the duct of the
dorsal bud.
Third month-islets of Langerhans develop from pancreatic tissue-endodermal.
The connective tissue of the gland-develops from the splanchnic mesoderm.
5th month, insulin secretion begins.
Figure is from Langmans Embryology

Pancreatic abnormalities

Annular pancreas:
-The part of the ventral pancreatic bud rotates towards the left in front of the
duodenum.
-Hence, the pancreatic tissue surrounds the duodenum.
-Obstructs the duodenum.
Accessory pancreatic tissue:
-Lies frequently in the mucosa of the stomach and Meckels diverticulum.

Figure is from Langmans Embryology

Congenital malformations of the digestive tract

atresia or stenosis of digestive tract: caused
by failure of recanalization or improper
recanalization, mostly in esophagus and
duodenum

stenosis

A, the most common, occurs in 50% of cases; B and C occur in

20% each of cases, and D occurs in 5% of cases. Most are
caused by vascular accidents; those in the upper duodenum may
be caused by a lack of recanalization. Atresias (A-C) occur in 95%
of cases, and stenoses (D) in only 5%.

 congenital umbilical hernia: caused by

incomplete closure of the central part of the
abdominal wall, the viscera return to the abdomen
but herniated again during the fetal period
A. Omphalocele showing
failure of the intestinal
loops to return to the body
cavity after physiological
herniation. The herniated
loops are covered by
amnion. B. Omphalocele in
a newborn. C. Newborn
with gastroschisis. Loops of
bowel extend through a
closure defect in the ventral
body wall and are not
covered by amnion

Omphalocele
Occurs in 1 in 6,000 births
GI structures protrude through an
unclosed umbilical ring, covered in
membranes
Herniated organs may not have fully
retracted in the 10th wk (likely if amnion
covered only)
Or, if there is peritoneum in the sac, the
organs retracted but herniated again
secondarily when the ventral abdominal
wall failed to close

Omphalocele
to 1/3 have other anomalies or chromosomal
defects
Pentology of Cantrell (failure of migration and fusion of the
lateral and cephalic folds): omphalocele, diaphragmatic
hernia, sternal cleft, ectopia cordis (evagination of the heart),
& intracardiac anomaly
Beckwith-Wiedeman Syndrome: omphalocele, macroglossia,
macrosomia, hemihypertrophy, hypoglycemia related to
pancreatic hyperplasia
Associated with Trisomy 13, 18, &21

Gastroschisis
Occurs in 1 in 10,000 births
Defect of the ventral abdominal wall between the
rectus muscles lateral to the umbilicus
Occurs on the right side
Arises through an abnormality in the involution of the
right umbilical vein during the 5th & 6th wks causing a
maldevelopment of associated mesodermal elements in
that region of the body wall

Gastroschisis
Not covered by a membrane
Herniated intestine is often edematous,
and can be ischemic- especially if the
defect is small
Increased risk of sepsis
Increased fluid and heat losses

Not associated with other abnormalities

 congenital aganglionic megacolon:

results from the absence of ganglion
cell of the parasympathetic ganglia,
which cause failure of the distal
segment to move the intestinal contents
onward HIRSCHPRUNG

imperforate anus, rectal atresia and rectal fistula:

---imperforate anus: results from failure rupture of
anal membrane

imperforate anus

Urorectal (A) and rectovaginal (B) fistulas that result from

incomplete separation of the hindgut from the urogenital
sinus by the urorectal septum. These defects may also
arise if the cloaca is too small, which causes the opening of
the hindgut to shift anteriorly. C. Rectoperineal (rectoanal
atresia). These defects probably result from vascular
accidents involving the caudal region of the hindgut,
resulting in atresias and fistulas. D. Imperforate anus
resulting from failure of the anal membrane to break down.

 abnormal rotation of the intestinal loop:

nonrotation or reversed rotation of the midgut

A. Abnormal rotation of the primary intestinal loop. The colon is on the left side of the
abdomen, and the small intestinal loops are on the right. The ileum enters the cecum
from the right. B. The primary intestinal loop is rotated 90 clockwise (reversed rotation).
The transverse colon passes behind the duodenum.

atresia of the gall bladder and bile ducts:

results from failure of vacuolization of the
epithelial cords or reopen