Foregut

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Foregut
Gray27.png
Diagram showing the expansion of amnion and delimitation of the umbilicus.
Digestive system showing bile duct.svg
Termination of the foregut.
Details
Carnegie stage 9
Precursor Endoderm
Identifiers
Latin praeenteron, proenteron
TE E5.4.4.0.0.0.2
FMA 45616
Anatomical terminology

The foregut in humans is the anterior part of the alimentary canal, from the distal esophagus to the first half of the duodenum, at the entrance of the bile duct. Beyond the stomach, the foregut is attached to the abdominal walls by mesentery. The foregut arises from the endoderm, developing from the folding primitive gut, and is developmentally distinct from the midgut and hindgut. Although the term “foregut” is typically used in reference to the anterior section of the primitive gut, components of the adult gut can also be described with this designation. Pain in the epigastric region, just below the intersection of the ribs, typically refers to structures in the adult foregut.

Contents

Adult foregut

Components

Nerve supply

The enteric nervous system is one of the major divisions of the nervous system derived from neural crest cells. In mammals, it is composed of large number of interconnected ganglia that are arranged into two concentric rings embedded throughout the gut wall, beginning in the esophagus and ending in the anus. The main function of the ENS is to control the secretory activity of the gastrointestinal glands and peristalsis of the gastrointestinal wall. [1] A large number of organs derived from the developing foregut also receive input from the vagus nerve, which also works in tandem with the ENS to control gastrointestinal function.

Development

The foregut develops from a cranial region of endoderm created after the initial cephalocaudal folding of the embryo. Starting at the stomodeum, a rapid expansion of the primitive gut forms the esophagus, from which the respiratory bud branches off. [2] During early foregut development, the esophagus lengthens considerably, reaching its proportional postnatal size. Simultaneously, the stomach begins to expand in width dorsally and ventrally in an asymmetric manner. This asymmetric expansion creates two curvatures, with the ventral side creating the lesser curvature and the dorsal side creating the greater curvature. [2] The expanding dorsal stomach wall then rotates the on its transverse plane, pulling its caudal portion upward and forcing the upper duodenum into a C shape. This rotation positions the left vagus nerve anteriorly and right vagus nerve posteriorly. [2]

While the hindgut and midgut are only attached dorsally to the body wall by a fold of peritoneum, the foregut also has a ventral attachment. Its two attachments are commonly referred to as the dorsal mesogastrium and the ventral mesogastrium.

As the stomach rotates during early development, the dorsal and ventral mesentery rotate with it; this rotation produces a space anterior to the expanding stomach called the greater sac, and a space posterior to the stomach called the lesser sac. After this rotation the dorsal mesentery thins and forms the greater omentum, which is attached to the greater curvature of the stomach. The ventral mesentery forms the lesser omentum, and is attached to the developing liver. In the adult, these connective structures of omentum and mesentery form the peritoneum, and act as an insulating and protective layer while also supplying organs with blood and lymph vessels as well as nerves. [2] Arterial supply to all these structures is from the celiac trunk, and venous drainage is by the portal venous system. Lymph from these organs is drained to the prevertebral celiac nodes at the origin of the celiac artery from the aorta.

Signalling pathways

In vertebrates, functional differentiation continues even after birth, with the transformation into the adult phenotype occurring through epithelial–mesenchymal transition. [1] Patterning events that determine tissue differentiation in vertebrates rely on several hox genes, the morphogen sonic hedgehog, and transcription factors such as sox2 and sox9. [3] Recent research has suggested that most foregut malformations are due to defects in these signalling pathways, with sonic hedgehog gene knockout mice showing phenotypes similar to those seen in patients with esophageal atresia/stenosis, tracheo-esophageal fistula, and respiratory tract anomalies. [4]

Clinical significance

Related Research Articles

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<span class="mw-page-title-main">Stomach</span> Digestive organ

The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach is involved in the gastric phase of digestion, following chewing. It performs a chemical breakdown by means of enzymes and hydrochloric acid.

<span class="mw-page-title-main">Gastrointestinal tract</span> Organ system within humans and other animals

The gastrointestinal tract is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and other animals, including the esophagus, stomach, and intestines. Food taken in through the mouth is digested to extract nutrients and absorb energy, and the waste expelled at the anus as faeces. Gastrointestinal is an adjective meaning of or pertaining to the stomach and intestines.

<span class="mw-page-title-main">Duodenum</span> First section of the small intestine

The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In mammals it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest part of the small intestine.

<span class="mw-page-title-main">Body cavity</span> Internal space within a multicellular organism

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<span class="mw-page-title-main">Esophagus</span> Vertebrate organ through which food passes to the stomach

The esophagus or oesophagus, colloquially known also as the food pipe, food tube, or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach. The esophagus is a fibromuscular tube, about 25 cm (10 in) long in adults, that travels behind the trachea and heart, passes through the diaphragm, and empties into the uppermost region of the stomach. During swallowing, the epiglottis tilts backwards to prevent food from going down the larynx and lungs. The word oesophagus is from Ancient Greek οἰσοφάγος (oisophágos), from οἴσω (oísō), future form of φέρω + ἔφαγον.

<span class="mw-page-title-main">Mesentery</span> Contiguous fold of tissues that supports the intestines

The mesentery is an organ that attaches the intestines to the posterior abdominal wall and is formed by the double fold of peritoneum. It helps in storing fat and allowing blood vessels, lymphatics, and nerves to supply the intestines, among other functions.

<span class="mw-page-title-main">Esophagogastroduodenoscopy</span> Diagnostic endoscopic procedure

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<span class="mw-page-title-main">Diverticulum</span> Medical or biological term for an outpouching of a hollow (or a fluid-filled) structure in the body

In medicine or biology, a diverticulum is an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, diverticula are described as being either true or false.

<span class="mw-page-title-main">Suspensory muscle of duodenum</span> Muscle between the duodenum and jejunum

The suspensory muscle of duodenum is a thin muscle connecting the junction between the duodenum and jejunum, as well as the duodenojejunal flexure to connective tissue surrounding the superior mesenteric and coeliac arteries. The suspensory muscle most often connects to both the third and fourth parts of the duodenum, as well as the duodenojejunal flexure, although the attachment is quite variable.

<span class="mw-page-title-main">Endoscopic ultrasound</span> Medical imaging procedure

Endoscopic ultrasound (EUS) or echo-endoscopy is a medical procedure in which endoscopy is combined with ultrasound to obtain images of the internal organs in the chest, abdomen and colon. It can be used to visualize the walls of these organs, or to look at adjacent structures. Combined with Doppler imaging, nearby blood vessels can also be evaluated.

<span class="mw-page-title-main">Greater omentum</span> Fat sheath under abdominal wall

The greater omentum is a large apron-like fold of visceral peritoneum that hangs down from the stomach. It extends from the greater curvature of the stomach, passing in front of the small intestines and doubles back to ascend to the transverse colon before reaching to the posterior abdominal wall. The greater omentum is larger than the lesser omentum, which hangs down from the liver to the lesser curvature. The common anatomical term "epiploic" derives from "epiploon", from the Greek epipleein, meaning to float or sail on, since the greater omentum appears to float on the surface of the intestines. It is the first structure observed when the abdominal cavity is opened anteriorly.

<span class="mw-page-title-main">Intestinal atresia</span> Medical condition

Intestinal atresia is any congenital malformation of the structure of the intestine that causes bowel obstruction. The malformation can be a narrowing (stenosis), absence or malrotation of a portion of the intestine. These defects can either occur in the small or large intestine.

<span class="mw-page-title-main">Uncinate process of pancreas</span>

The uncinate process is a small part of the pancreas. The uncinate process is the formed prolongation of the angle of junction of the lower and left lateral borders in the head of the pancreas. The word "uncinate" comes from the Latin "uncinatus", meaning "hooked".

<span class="mw-page-title-main">Anterior vagal trunk</span>

The anterior vagal trunk is one of the two divisions into which the vagus nerve splits as it passes through the esophageal hiatus to enter the abdominal cavity. The anterior and posterior vagal trunks represent the inferior continuation of the esophageal nervous plexus inferior to the diaphragm. The majority of nerve fibres in the anterior vagal trunk are derived from the left vagus nerve.

<span class="mw-page-title-main">Laryngotracheal groove</span>

The laryngotracheal groove is a precursor for the larynx and trachea.

The tracheoesophageal septum is an embryological structure. It is formed from the tracheoesophageal folds or ridges which fuse in the midline. It divides the oesophagus from the trachea during prenatal development. Developmental abnormalities can lead to a tracheoesophageal fistula.

The development of the digestive system in the human embryo concerns the epithelium of the digestive system and the parenchyma of its derivatives, which originate from the endoderm. Connective tissue, muscular components, and peritoneal components originate in the mesoderm. Different regions of the gut tube such as the esophagus, stomach, duodenum, etc. are specified by a retinoic acid gradient that causes transcription factors unique to each region to be expressed. Differentiation of the gut and its derivatives depends upon reciprocal interactions between the gut endoderm and its surrounding mesoderm. Hox genes in the mesoderm are induced by a Hedgehog signaling pathway secreted by gut endoderm and regulate the craniocaudal organization of the gut and its derivatives. The gut system extends from the oropharyngeal membrane to the cloacal membrane and is divided into the foregut, midgut, and hindgut.

<span class="mw-page-title-main">Human digestive system</span> Digestive system in humans

The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion. Digestion involves the breakdown of food into smaller and smaller components, until they can be absorbed and assimilated into the body. The process of digestion has three stages: the cephalic phase, the gastric phase, and the intestinal phase.

References

  1. 1 2 Sanderson, I. Walker, W.A., (1998) Development of the Gastrointestinal Tract. B.C. Decker Inc, Lewiston, NY
  2. 1 2 3 4 Sadler, T.W, (2011) Langman’s Medical Embryology (12th edition), LWW, Baltimore, MD
  3. Faure, S. De Santa Barbara, P. (2011) Molecular Embryology of the Foregut, Faure S, De Santa Barbara P. Molecular embryology of the foregut. Journal of Pediatric Gastroenterology and Nutrition. 52.Suppl 1: S2–3. PMC. Web. 3 Mar. 2015.
  4. Litingtung, Y. Lei, L. Westphal, H. Chiang, C. (1998) Sonic Hedgehog is Essential to Foregut Development. Nature Genetics 20, 58–61 doi:10.1038/1717
  5. 1 2 3 4 5 Pansky, B. (1982). Chapter 87: Congenital Malformations of the Digestive System: Foregut Malformations. In Review of medical embryology. New York: Macmillan.