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3002 > 12 Peritoneal and GI development 2 > Flashcards

12 Peritoneal and GI development 2 Flashcards

1
Q

What does the ventral mesentery end and what does it form?

A
  1. Ends 1/2 way along duodenum
  2. Therefore:
    Falciform ligament and lesser omentum have free edges
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2
Q

What arteries are in dorsal mesentery?

A

Celiac, superior mesenteric and inferior mesenteric arteries

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3
Q

Where does the foregut extend to and from?

A

Mouth –> distal to developing liver

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4
Q

What supplies the foregut?

A

Celiac trunk

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5
Q

Where is the referred pain of foregut?

A

To epigastrium

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6
Q

What does the foregut give rise to?

A
  1. Oesophagus (that gives the respiratory diverticulum that forms the trachea & lungs)
  2. Stomach
  3. Proximal duodenum
  4. Liver & biliary system
  5. Pancreas
  6. Spleen
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7
Q

What does abnormal trachea-oesophageal development in foregut give rise to?

A

Trachea-Oesophageal fistula

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8
Q

What occurs to the oesophagus length in the foregut during development?

A

Initially short but lengthens with descent of heart

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9
Q

When does the development of stomach appear in the foregut?

A
  • Week 4

* Dilation of foregut

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10
Q

Describe the rotation of stomach during development

A

It rotates around both at a longitudinal & an anterior-posterior axis:

• 90° clockwise around the longitudinal axis so the left side faces anteriorly & the lesser curvature faces to the right while the greater curvature faces to the left

• Anterior-posterior axis so the pyloric part comes to lie on the right & the oesophago-
gastric junction slightly left so that the greater curvature faces left & inferiorly

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11
Q

Describe the sequence of events during the formation of the duodenum from the foregut

A
  • Formed from foregut and beginning of midgut
  • Initially found in midline but rotations of stomach cause duodenum to rate and swing to the right
  • “Falls” onto posterior abdominal wall and becomes retroperitoneal (except for proximal 1st part - remains intraperitoneal)
  • During development, the lumen of duodenum becomes obliterated by a proliferation of cells and then it’s re-canalised
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12
Q

Describe the sequence of events during the formation of the liver and gallbladder from the foregut

A
  • Liver develops from an endodermal bud during week 3
  • Penetrates the ventral mesentery & septum transversum
  • Gives rise to the hepatic ducts & gallbladder
  • The ventral mesentery directly in contact with the liver becomes its visceral peritoneum
  • Bare area of the liver is where it contacts the diaphragm with no intervening peritoneum
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13
Q

Describe the sequence of events during the formation of the pancreas from the foregut

A
  • Pancreas forms from dorsal and ventral endodermal buds from the duodenum
  • The rotation of the latter causes the ventral bud to migrate around to lie behind and fuse with the dorsal bud so that the adult pancreas lies in the curve of the duodenum
  • The ducts of the dorsal and ventral buds unite to form the main pancreatic duct
  • The accessory duct is the remnant of the duct of the dorsal bud
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14
Q

Name the congenital abnormalities in foregut?

A
  1. Duplication of parts of biliary system - e.g. gallbladder

2. Annular pancreas

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15
Q

How does an obstructive annular pancreas form?

A

• The ventral pancreatic buds may consist of 2 lobes that do not fuse & migrate in opposite directions encircling the duodenum

=> Forming an obstructive annular pancreas

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16
Q

What does the rotation of the stomach around its longitudinal axis do to the ventral mesentery?

A

Throws ventral mesentery (divided into lesser omentum and falciform ligaments by developing liver) to the right

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17
Q

What vein is in the free edge of the falciform ligament?

A

Umbilical vein

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18
Q

What lies in the free edge of the lesser omentum?

A
  1. Common bile duct
  2. Hepatic artery proper
  3. Portal vein
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19
Q

What happens when the stomach is rotated around an anterior-posterior axis?

A
  • The fundus goes slightly left, the greater curvature inferiorly & the pylorus to the right & upwards
  • The liver is also thrown upwards under the diaphragm
  • The free edge of the lesser omentum lies almost vertically between the liver & duodenum
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20
Q

What happens when the stomach is rotated around its longitudinal axis?

A
  • Its posterior aspect (that will become the greater curvature) rotates to the left so that the dorsal mesentery i.e. dorsal mesogastrium (that will become the greater omentum) is thrown to the left as well
  • A potential space (lesser sac/omental bursa) is left posterior to the stomach & lesser omentum
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21
Q

Where does the lesser sac (omental bursa) lie? How does it communicate with the greater sac?

A
  • Behind stomach and lesser omentum

* Must communicate with grater sac around the free edge of the lesser omentum (epiploic foramen)

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22
Q

What are the boundaries of the epiploic foramen?

A
  • Anteriorly: free border of the lesser omentum, with the bile duct, the hepatic artery proper, and the portal vein
  • Posteriorly: inferior vena cava
  • Superiorly: caudate process of the caudate lobe of the liver
  • Inferiorly: first part of the duodenum
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23
Q

What is Pringle’s manoeuvre?

A
  • During surgery, when the hepatic artery proper and portal vein are compressed with fingers/ haemostat to control bleeding
  • Lesser sac approached via epiploic foramen
24
Q

How is the greater omentum formed?

A
  • As the dorsal mesentery is thrown left, the stomach rotates on its AP axis and the greater curvature faces inferiorly
  • The dorsal mesentery is then dragged with it so that a big, double-layered fold of mesentery, the greater omentum, hangs off the greater curvature
25
Q

What does the greater omentum hang off of?

A
  • Hangs off the greater curvature

* Lies like an apron in the abdomen in front of transverse colon

26
Q

Relationship between lesser sac and greater omentum?

A
  • The greater omentum, initially with the lesser sac (omental bursa) extending into it
  • The omental layers fuse to obliterate that part of the lesser sac & the greater omentum overlies the transverse colon & small intestine
27
Q

Boundaries and relations of the lesser sac (omental bursa)

A
  1. Anteriorly:
    • caudate lobe
    of liver
    • lesser omentum; stomach
  2. Posteriorly: pancreas
  3. Laterally:
    • left kidney and adrenal gland
    • on the right the epiploic
    foramen
  4. Superiorly:
    • extends as far as the diaphragm
  5. Inferiorly:
    • extends a little way between the layers of the greater omentum
28
Q

How is the spleen formed in the foregut

A

Forms with the dorsal mesentery of the stomach

29
Q

What is the lienorenal/ splenorenal ligament?

A

Dorsal mesentery (double layers of peritoneum) between the spleen and posterior abdominal wall (close to kidney)

30
Q

What is the gastrolienal/ gastrosplenic ligament?

A

Dorsal mesentery (double layer) between the spleen and the stomach

31
Q

What the tail of the pancreas extend into? With which nerves?

A

Lienorenal/ splenorenal ligament along with splenic nerves

32
Q

Greater omentum overlies which structures?

A

Transverse colon and small intestine

33
Q

Where does the midgut commence and end?

A
  • Immediately distal to entrance of common bile duct into the duodenum
  • Ends 2/3 along transverse colon
34
Q

What is the midgut supplied by?

A

Superior mesenteric artery

35
Q

Where is pain from midgut referred to?

A

Periumbilical region (T10)

36
Q

What happens at week 5 to the midgut?

A
  • Suspended from the posterior abdominal wall as the primary intestinal loop by a dorsal mesentery
  • Connected to yolk sac by vitelline duct
37
Q

What does the vitelline duct connect?

A

Connects the primary intestinal loop by a dorsal mesentery (midgut) to the yolk sac

38
Q

What does rapid growth of intestinal loop in midgut result in?

A

Physiological herniation through the umbilicus and into the umbilical cord

39
Q

What does the cranial limb of the loop (midgut) grow to become?

A

Much of the jejunum and ileum

40
Q

How does the cranial limb of loop (midgut) rotate?

A

• The loop rotates in a counter clockwise direction
90° in the physiological hernia

  • And then another 180° as the loop drops back into the abdomen at about 70 days (10 weeks)
  • Overall this is a total of 270° of rotation around the axis of the SMA
41
Q

Describe the migration of the caecum during midgut development?

A
  • Initially as the intestine drops back into the abdomen, the jejunum lies to the left & the caecum is up in the right hypochondrium adjacent to the liver
  • The caecum with the vermiform appendix then migrate inferiorly to the right iliac fossa
42
Q

What are the congenital abnormalities that can occur in the midgut?

A

Vitelline duct:

  1. Meckel’s diverticulum
  2. Vitelline cyst
  3. Vitelline fistula or patent duct
  4. Gatroschisis
  5. Exomphalos
  6. Umbilical hernia
43
Q

What does failure of recanalisation in midgut development lead to?

A

Narrowing or even complete obstruction of the gastrointestinal tract at any point

44
Q

When does cephalic-caudal and lateral folding of trilaminar disc start?

A

Towards end of week 3 (~ 18 days)

45
Q

What occur in trilaminar disc folding? What does it create?

A

• Head and tail folds meet 2 lateral folds at umbilicus

Creates:
• Endodermal tube of pharynx and oesophagus
• Stomach and intestinal tract
• Glands associated with the gastrointestinal tract

46
Q

What is the hindgut supplied by?

A

Inferior mesenteric artery

47
Q

Where is hindgut pain referred to?

A

Suprapubic region (T12)

48
Q

What does the hindgut give rise to?

A
  • Distal end of transverse colon (1/3)
  • Descending colon
  • Sigmoid colon
  • Rectum
  • Upper 2/3/ anal canal
49
Q

What does the most inferior part of the hindgut develop into?

A

Cloaca

50
Q

What is the cloaca divided by?

A

Mesodermal urorectal septum

51
Q

Anterior, what does the cloaca develop into?

A

Urogenital system

52
Q

Posteriorly, what does the cloaca develop into?

A

Anorectal canal

53
Q

Describe the embryological development of the anal canal?

A
  • The distal aspect of the cloaca is closed by a membrane
  • As the surrounding mesoderm & ectoderm proliferate, the anal part of the membrane sinks into the anal pit
  • The membrane breaks down at 8 weeks, so that the proximal 2/3 of the anal canal is derived from the hindgut endoderm
  • Distal 1/3 is derived from ectoderm
  • The pectinate line marks the change in embryological derivation, blood & nerve supply
54
Q

What are the congenital abnormalities in hindgut?

A
  1. Fistuale between anal canal and urogenital organs

2. Imperforate anus

55
Q

What causes an imperforate anus?

A

Anal membrane does not break down

56
Q

What is Hirschsprung disease?

A
  • Lack of normal development of the colonic innervation leads to a constricted aganglionic segment of bowel
  • With a distended segment proximally, the innervation of which is normal

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