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Overview
  • Developmental derivatives
    • foregut (supplied by celiac trunk) → pharynx to duodenum
    • midgut (supplied by the superior mesentric artery) → duodenum to transverse colon
    • hindgut (supplied by the inferior mesentric artery)→ distal transverse colon to rectum
  • GI embryologic timeline
    • week 6
      • midgut herniates through umbilical ring
    • week 10-11
      • rotates 270 degrees counterclockwise around SMA as it returns to the abdominal cavity 
        • abnormal rotation and fixation of the midgut during early fetal life may result in obstruction and volvulus (which may lead to intestinal ischemia) 
Pathology
  • Anterior abdominal wall defects due to failure of
    • rostral fold 
      • sternal defects result 
    • lateral fold 
      • omphalocele 
        • abdominal contents (stomach, liver, intestines, etc.) protrude through umbilical cord and persist outside of the body but covered by peritoneum
        • associated with trisomy 13 and 18
      • gastoschisis 
        • failure of lateral body folds to fuse, resulting in extrusion of intestines through umbilical ring but not covered by peritoneum
    • caudal fold 
      • bladder extrophy is the protrusion of the anterior bladder through the lower abdominal wall
  • Duodenal atresia
    • due to failure to recanalize lumen of intestines 
    • associated with trisomy 21
    • "double bubble" sign
    • NOTE: atresia is occlusion of the lumen of the intestines and stenosis is narrowing of the lumen
  • Jejunal, ileal, and colonic atresia
    • due to vascular accident ("apple peel/corkscrew" atresia 
    • segment of bowel wrapped around a remnant of mesentary
  • Congenital pyloric stenosis  
    • hypertrophy of muscalaris externa causing the pylorus lumen to narrow 
      • palpable "olive" mass in epigastric region
      • food obstructs in pyloric region
      • nonbilious and projectile vomiting at about 2 weeks of age
    • treatment: surgery
    • incidence: 1/600; mainly first born males
  • Pancreas divisum- failed fusion of the ventral and dorsal pancreatic buds

 

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