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GIGU Midterm > Development of the GI system > Flashcards

Development of the GI system Flashcards

1
Q

What embryonic germ layer do the foregut, midgut, and hindgut form from?

A

endoderm

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2
Q

what is the narrow opening to the yolk sac referred to as?

A

vitelline duct

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3
Q

what does the endoderm contribute to the GI tract?

A

mucosal epithelium and GI glands (except the lower 1/3 of the anus)

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4
Q

what does the splanchnic mesoderm contribute to the GI tract?

A

connective tissue, vasculature, and smooth muscle wall

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5
Q

what does the ectoderm contribute to the GI tract?

A

enteric ganglia, nerves, and glia (via neural crest) and the epithelium of the lower 1/3 of the anus

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6
Q

what is the arterial supply of the foregut?

A

the celiac trunk

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7
Q

what is the arterial supply of the midgut?

A

superior mesenteric artery

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8
Q

what is the arterial supply of the hindgut?

A

inferior mesenteric artery

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9
Q

what arises from the foregut?

A

esophagus, stomach, liver, gallbladder, pancreas, upper duodenum

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10
Q

what arises from the midgut?

A

lower duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of the transverse colon

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11
Q

what arises from the hindgut?

A

distal 1/3 of the transverse colon, descending colon, sigmoid colon, rectum, and upper anal canal

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12
Q

what is the abdominopelvic cavity lined with?

A

peritoneum

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13
Q

what does the dorsal mesentery give rise to?

A

the greater omentum, small intestine mesentery, mesoappendix, transverse mesocolon, and the sigmoid mesocolon

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14
Q

what does the ventral mesentery give rise to?

A

lesser omentum, falciform ligament of liver, coronary ligament of liver, triagnular ligaments of liver

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15
Q

what is the general description of intraperitoneal organs?

A

they are suspended by mesentery

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16
Q

what is the general description of retroperitoneal organ?

A

they are excluded from the peritoneal cavity

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17
Q

what are secondary retroperitoneal organs?

A

they were initially suspended within mesentery that later fused with a body wall

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18
Q

what are some examples of secondary retroperitoneal organs?

A

ascending/descending colon, duodenum, and bulk of pancreas

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19
Q

what are the retroperitoneal organs?

A

suprarenal glands, aorta/IVC, duodenum (2nd and 3rd parts), pancreas, ureters, colon (ascending and descending), kidneys, Esophagus, rectum

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20
Q

When the stomach rotates 90 degrees, how will the left side be positioned?

A

it will be ventral

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21
Q

when the stomach rotates 90 degrees, how will the right side be positioned?

A

it will be dorsal

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22
Q

the rotation of the stomach also causes the vagus nerve to rotated. The left vagus nerve will be positioned how after 90 degrees of rotation?

A

anteriorly

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23
Q

the rotation of the stomach also causes the vagus nerve to rotate. The right vagus nerve will be positioned how after 90 degrees of rotation?

A

posteriorly

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24
Q

where does the lesser sac sit?

A

behind the stomach

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25
Q

what ligaments make up the lesser omentum?

A

the hepatoduodenal ligament and the hepatogastric ligament

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26
Q

what causes hypertrophic pyloric stenosis?

A

faulty migration of neural crest cells–> ganglion cells of enteric nervous system not properly populated

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27
Q

what is hypertrophic pyloric stenosis?

A

inability of the pyloric sphincter to relax- narrowing of the pyloric lumen between the stomach and the duodenum

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28
Q

how does hypertrophic pyloric stenosis present?

A

palpable mass (OLIVE) at the right costal margin, projectile non-bilious vomiting after feeding, within a few months after birth

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29
Q

When does the stomach/liver form?

A

week 4 of development

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30
Q

what does the formation of the liver begin as?

A

hepatic diverticulum from the gut endoderm

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31
Q

what is the connection of the diverticulum to the foregut?

A

the common bile duct

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32
Q

what does the endoderm of the liver give rise to?

A

hepatocytes, bile ducts, and hepatic ducts

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33
Q

what does the splanchnic mesoderm in the liver give rise to?

A

stromal cells, Kupffer, and stellate cells

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34
Q

when does hematopoiesis in utero begin? and where does it occur?

A

by week 10 and in the liver

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35
Q

what does the gallbladder begin as?

A

cystic diverticulum

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36
Q

what does the cystic diverticulum come off of?

A

the common bile duct

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37
Q

what is the connection between the cystic diverticulum and the common bile duct called?

A

the cystic duct

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38
Q

when is bile formed by the hepatic cells?

A

beginning of week 12

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39
Q

what is biliary atresia?

A

obliteration of the bile duct/ inflammation replaces the duct with fibrotic tissue

40
Q

what is the presentation of biliary atresia?

A

immediate onset of progressive jaundice in infants, white colored stool, dark urine

41
Q

how does pancreas formation begin?

A

as two endodermal buds sprouting from the foregut inferior to the cystic diverticulum- the ventral and dorsal pancreatic bud

42
Q

what does the ventral pancreatic bud give rise to?

A

the uncinate process of the pancreas

43
Q

what does the dorsal pancreatic bud give rise to?

A

the pancreatic head, body, and tail

44
Q

when does the ventral pancreatic bud migrate posteriorly to fuse with the dorsal pancreatic bud?

A

week 5

45
Q

after rotation and fusion, what does the ventral pancreatic duct become?

A

the main pancreatic duct

46
Q

what happens to the dorsal pancreatic duct after rotation and fusion?

A

it will disintegrate or if it remains it is known as an accessory pancreatic duct

47
Q

what is pancreas divisum?

A

it is when the ventral and dorsal parts fail to fuse by week 8

48
Q

what are patients with pancreas divisum prone to?

A

it is mostly asymptomatic, but they are prone to abdominal pain and pancreatitis

49
Q

what is annular pancreas?

A

poor migration of the pancreas–> there is a pancreatic ring around the 2nd part of the duodenum

50
Q

how does annular pancreas present?

A

duodenal obstruction/stenosis, bilious vomit, low birth weight

51
Q

when does the spleen begin formation?

A

week 4

52
Q

where does the spleen begin formation and as what?

A

as a mesenchymal condensation that forms in the dorsal mesentery

53
Q

when is the spleen fully formed?

A

week 5

54
Q

what is the spleen derived from?

A

from mesoderm NOT endoderm

55
Q

when does the midgut herniate out from the umbilicus?

A

week 6

56
Q

when does the midgut return to the abdomen?

A

by week 10

57
Q

what does the proximal portion of the midgut loop do after it makes a 90 degree counterclockwise rotation outside of the abdomen?

A

it is now on the right and it becomes convoluted

58
Q

what happens to the distal portion of the midgut loop after it makes a 90 degree counterclockwise rotation outside of the abdomen?

A

it is on the left and it develops the cecum

59
Q

What ligaments make up the great omentum?

A

the gastrosplenic, gastrocolic, and splenorenal ligaments

60
Q

what day does the gallbladder begin developing?

A

day 26

61
Q

where does the gallbladder grow into?

A

the ventral mesentery

62
Q

What happens with the midgut at week 6 of development?

A

it herniates out of the umbilicus and makes a 90 degree counterclockwise rotation

63
Q

what happens to the midgut during the 10th week of development?

A

the proximal portion of the loop returns, passing under the distal portion- makes a second 90 degree counterclockwise turn

64
Q

what is the positioning of the midgut during the 10th week of development?

A

the cecum is in the upper right quadrant and the ascending colon is anterior to the duodenum

65
Q

what happens to the midgut during the 11th week of development?

A

the distal portion of the loop returns, making a 3rd 90 degree counterclockwise turn

66
Q

what is the positioning of the midgut after the 11th week of development?

A

the cecum descends to the right lower quadrant, carrying the ascending colon to end up on the right side of the abdomen

67
Q

what is an omphalocele?

A

a herniated bowel through the umbilicus that does not fully retract

68
Q

what is an omphalocele covered with?

A

parietal peritoneum

69
Q

who is at risk for having an omphalocele?

A

there is an increased risk with trisomy 13 or 18

70
Q

what is gastroschiscis?

A

when there is an abnormal lateral body folding and fusion- so it creates wall weakness that allows the bowel to herniate

71
Q

what does not form normally in a patient with gastroschiscis?

A

the connective tissue of skin and hypaxial musculature of body wall

72
Q

what is the main difference between omphalocele and gastroschiscis?

A

with omphalocele, the herniated bowel is covered with parietal peritoneum; with gastroschiscis, the herniation is not covered by parietal peritoneum

73
Q

what is meckel’s diverticulum?

A

failure of the yolk stalk (vitelline duct) connect to the midgut to regress- the midgut remains connected to the umbilicus

74
Q

what is the presentation of Meckel’s diverticulum?

A

usually asymptomatic; rule of 2s: 2x more likely in males, presents in first 2 years of life

75
Q

what is malrotation/non-rotation of the midgut loop?

A

the midgut loop completes the first 90 degree CCW turn, but does not do the remaining 180 degree CCW turn

76
Q

what is the presentation of a malrotation/non-rotation midgut loop?

A

there is a left-sided colon and right sided small intestines; formation of fibrous Ladd bands

77
Q

what can fibrous ladd bands lead to?

A

volvulus or duodenal obstruction

78
Q

what is reverse gut rotation?

A

the midgut loop complete the first 90 degree CCW turn, but then does a 180 clockwise turn resulting in a 90 degree clockwise turn of the midgut loop

79
Q

what is the presentation of a reverse gut rotation?

A

the duodenum ends up anterior to the transverse colon

80
Q

what is a volvulus?

A

twisting of bowel around its mesentery

81
Q

who is at an increased risk for developing a volvulus?

A

people with gut rotation anomalies

82
Q

what is the presentation of a volvulus?

A

acute abdominal pain, vomiting, GI bleeding; coffee bean sign

83
Q

what could a volvulus lead to?

A

bowel obstruction or infarction

84
Q

what is the cloaca?

A

its a portion of the hindgut in the early embryo that separates into the rectum and the urogenital sinus

85
Q

how is the cloaca divided?

A

by the urorectal septum

86
Q

what is the cloaca divided into?

A

the ventral urogenital sinus and the dorsal anorectal canal

87
Q

what is the anal rectal lumen temporarily closed by?

A

an endodermal epithelial anal plug- it eventually opens up via apoptosis

88
Q

what germ layer makes up the rectum?

A

endoderm

89
Q

what is the vasculature of the rectum?

A

the superior rectal (from the IMA) and the middle rectal (from the internal iliac artery) arteries; veins of hindgut

90
Q

what germ layer makes up the anus?

A

ectoderm

91
Q

what is the vasculature of the anus?

A

inferior rectal arteries (from the pudendal artery) and veins

92
Q

what is the pectineal line?

A

it divides the origin of hindgut and anal pit within the anal canal

93
Q

what is an imperforate anus?

A

when the opening of the anus is missing/blocked due to persistent anal membrane

94
Q

what is hirschsprung’s disease?

A

failure of neural crest cell migration–> there is an absence of ganglionic plexus; lack of peristalsis (the colon fails to relax)

95
Q

what is the presentation of hirschsprung’s disease?

A

intestinal wall hypertrophy proximal to the aganglionic segment; abnormal colonic dilation or distention (megacolon); failure to pass meconium

GIGU Midterm (19 decks)

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