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Updated: Nov 11 2020

GI Embryology

  • 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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