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Break
Mechanical
Absorb
nutrients
Movement
Release
of waste
Elimination
The GI tract
(gastrointestinal tract)
The accessory
digestive organs
Supply secretions
contributing to the
breakdown of food
Teeth & tongue
Salivary glands
3Gallbladder
Ingestion
Defecation
Absorption
Chewing
Churning in stomach
Mixing by segmentation
Chemical digestion
Swallowing
Peristalsis propulsion by alternate
contraction &relaxation
Mechanical digestion
Chemical digestion
Ways to divide.
The more common
Plus:
epigastric
periumbilical
suprapubic
flank
1.
2.
3.
4.
Mucosa
Submucosa
Muscularis
externa
Serosa
Three sub-layers
*
1.
2.
3.
Lining epithelium
Lamina propria
Muscularis
mucosae
Lamina propria
Muscularis mucosae
10
Connective tissue
containing major
blood and lymphatic
vessels and nerves
Many elastic fibers
so gut can regain
shape after food
passes
11
Squeezes
In some places
forms sphincters
(act as valves)
Outer longitudinal
Simple squamous
epithelium
(mesothelium)
Exceptions:
12
Smooth muscle
Smooth muscle
14
The Mouth
15
Vermillion border or
red border
Between highly
keratinized skin of face
and mucosa of mouth
Needs moisture
16
Uvula
Tongue
Mostly muscles
17
Teeth
Teeth live in sockets (alveoli) in the gumcovered margins of the mandible and maxilla
18
Teeth
Two sets
Primary or deciduous
Baby teeth
Start at 6 months
20 are out by about 2 years
Fall out between 2-6 years
Permanent: 32 total
Variable
19
incisor
canine
premolar
molar
20
Tooth structure
Enamel
.
.
Crown (exposed)
Root (in socket)
Meet at neck
Tooth structure
Cementum bone
layer of tooth root
Periodontal
ligament
Attaches tooth to
periodontal ligament
Anchors tooth in
boney socket of the
jaw
Continuous with
gingiva (gums)
Salivary glands
(tuboalveolar glands)
Intrinsic salivary
glands within
mucosa
Extrinsic salivary
glands
moistens food
23
antibacterial and antiviral
Paired (2 each)
Parotid
Submandibular
Sublingual
External to mouth
Ducts to mouth
Secrete saliva only right
before or during eating
+
24
Pharynx
___oropharynx
Oropharynx and
laryngopharynx
___laryngopharynx
Three constrictor
muscles*
*
*
Stratified squamous
epithelium
Sequentially squeeze
bolus of food into
esophagus
Are skeletal muscles
*
25
Voluntary action
Vagus nerve (X)
Esophagus
Continuation of pharynx
in mid neck
Muscular tube collapsed
when lumen empty
Esophagus___________
Descends through
thorax
On anterior surface of
vertebral column
Behind (posterior to)
trachea
26
Esophagus continued
___________________esophageal hiatus
(hiatus means opening)
27
Contains all 4
layers (see
right)
28
When
empty, mucosa and submucosa lie in longitudinal folds
Esophagus histology
29
Stomach
J-shaped; widest part of alimentary canal
Temporary storage and mixing 4 hours
Into chyme
30
Stomach
epigastrium
dome
32
Stomach Regions
Cardiac region
Fundus (dome shaped)
Body
Pyloric region
33
Greater curvature
Lesser curvature
Antrum
Canal
Sphincter
dome
junction
with
esophag
contains
us
pyloric
sphincter
funnel shaped
Rugae: longitudinal
folds on internal
surface (helps
distensibility)
Muscularis: additional
innermost oblique layer
(along with circular and
longitudinal layers)
34
Histology of
stomach
Simple columnar
epithelium: secrete
bicarbonatebuffered mucus
Gastric pits opening
into gastric glands
HCL
Intrinsic factor (for
B12 absorption)
Chief cells
Pepsinogen
(activated to pepsin
with HCL)
Stimulated by
gastrin: a stomach
hormone
35
Small intestine
Duodenum 5% of length
Jejunum almost 40%
Ileum almost 60%
mesenteric artery;
Veins drain into hepatic
portal vein
37
*
Lacteal*: network of
blood and lymph
capillaries
-Carbs and proteins into blood
to liver via hepatic portal vein
-Fat into lymph: fat-soluble
toxins
38e.g. pesticides circulate
systemically before going to
Absorptivie
cell with
microvilli to
increase
surface
area &
many
mitochondr
ia: nutrient
uptake is
energydemanding
Intestinal crypts
Cells here divide every 3-6 days to renew epithelium (most rapidly dividing
cells of the body)
Secrete watery intestinal juice which mixes with chyme (the paste that food
becomes after stomach churns it)
Duodenal glands
Mucus to counteract
acidity from stomach
Hormones:
Cholecystokinin (stimulates
GB to release stored bile, also
pancreas)
39
Secretin (stimulates
*
*
-have
many
mitochon
dria:
nutrient
-produce
uptake
is
mucus
energydemandin
40
41
42
Large intestine
Digested residue reaches it
Main function: to absorb water
and electrolytes
Subdivisions
Cecum
Appendix
Colon
Rectum
Anal canal
43
Three special
features
1.
2.
3.
3.
2.
1.
44
Colon has segments: ascending, transverse and descending colon; then sigmoid colon
Right angle turns: hepatic flexure* in RUQ and splenic flexure* in LUQ
*
*
Between
ileum and
cecum
1st part
S-shaped
Blind tube
45
Rectum
In pelvis
No teniae
Strong longitudinal
muscle layer
Has valves
Anal canal
Pectinate line*
Hemorrhoids (enlarged
veins)
Sphincters (close
opening)
Internal*
smooth muscle
involuntary
External*
46 skeletal muscle
voluntary
*
*
Defecation
1.
2.
3.
47
Triggered by stretching
of wall, mediated by
spinal cord
parasympathetic reflex
Stimulates contraction of
smooth muscle in wall
and relaxation of
internal anal sphincter
If convenient to defecate
voluntary motor neurons
stimulate relaxation of
external anal sphincter
(aided by diaphragm
and abdominal wall
muscles -called Valsalva
maneuver)
No villi
Columnar cells in
pic = absorptive
cells
48
Fewer nutrients
absorbed
Lubricates stool
More lymphoid
tissue
A lot of bacteria in
The Liver
Falciform ligament
2 surfaces
Diaphragmatic
Visceral
Covered by
50
peritoneum
posterior
anterior
Fetal
circulation
___________
Umbilical vein
Ligamentum
teres__________
Navel_______
52
53
Produces bile
Picks up glucose from blood
Stores glucose as glycogen
Processes fats and amino acids
Stores some vitamins
Detoxifies poisons and drugs
Makes the blood proteins
54
Liver histology
55
Portal triad
Portal arteriole
Portal venule
Bile duct
Liver sinusoids
Branch of hepatic
portal vein
Delivers substances
from intestines for
processing by
hepatocytes
Large capillaries
between plates of
hepatocytes
Contribute to central
vein and ultimately to
hepatic veins and IVC
Kupffer cells
Liver macrophages
Old blood cells and
microorganisms
removed
56
57
Fig. 21.18
Fig. 21.19
Blood and Bile
Flow Through the
Liver
Many organelles
63
Bile Transport
Bile
Emulsify fat
Facilitate fat and cholesterol absorption
Helps make cholesterol soluble
Fig. 21.20
Cholecystokinin causes:
Gallbladder*
69
70
71
Fig. 21.22
Pancreatic Secretions
Fig. 21.23
one acinus
Pancreatic
exocrine function
Compound acinar
(sac-like) glands
opening into large
ducts (therefore
exocrine)
Acinar cells make 22
kinds of enzymes
76
Stored in zymogen
granules
Grape-like arrangement
Enzymes to
duodenum, where
(more later)
77
Endocrine cells:
78
Thank you
Fungsi Hati
Protrombin
Heparin
Fibrinogen
Albumin
Globulin
SISTEM BILIER
KERUSAKAN SEL
Transminase petunjuk
yang peka kerusakan / nekrosis sel hati
persistensi
nekrosis oleh karena toksin transaminase
dasar :
sgpt kerusakan membran.
sgot kerusakan organel.
25
GLUTAMATE DEHYDROGENASE
( GLDH )
26
LACTATE DEHYDROGENASE
( LD / LDH )
juga pada :
27
ALKALI PHOSPHATASE
( ALP )
HALUS,
HATI, PLACENTA.
( TLG 40 70% DALAM SERUM )
PADA ANAK 2 3 X DEWASA.
KOLESTASIS
INTRA HEP.
EXTRA HEP.
28
29
5 NUCLEOTIDASE
( 5 NT )
TERDAPAT DALAM :
SALURAN EMPEDU
GINJAL
ORGAN LAIN ( SEDIKIT )
KEPEKAANNYA = ALP
( Pada Penyakit Tulang Normal ).
31
FETOPROTEIN
(AFP)
32
Albumin
Faktor Koagulasi :
HBsAg
HBeAg
Anti-HBc
Anti-HBc
Anti-HBs
IgG
IgM
IgG
Acute HBV
Chronic HBV,
Resolved HBV
Postvaccine
Active replication
Chronic HBV,
quiescent
Immune HBV
Quiescent = inactive = quiet
103
Hepatitis C
Perjalanan infeksi Hepatitis C akut dan
kronik lihat gambar 15-3
Virus RNA ini mempunyai 6 genotipe utama.
Penularan utama melalui transfusi (90%
kasus, sekarang hanya 4% kasus )
Sekarang lebih dari 50% penularan melalui
pengguna suntikan obat/ narkoba
104
Diagnosis Hepatitis C:
adanya anti-HCV (metode EIA )
Anti-HCV tidak mempunyai daya proteksi,
malah pada hepatitis akut maupun kronis
sebagai penanda adanya HCV
sebagai penyebab
106
108
Hepatitis E :
Kasus dengan infeksi virus E ini adalah
self-limited ( tidak menjadi carrier ), tetapi
pada wanita hamilmempunyai angka
kematian tinggi (10-20 % )
dan mempunyai risiko yang meningkat
untuk terjadinya dekompensasi hati
pada kasus yang pada dasarnya
mempunyai penyakit hati kronis.
109
Prognosis
Hepatitis A :
tidak menyebabkan penyakit hati kronik
Hepatitis kronik :
aminotransferase > 6 bulan
Hepatitis C akut 80% menjadi kronik
( B: 1-2% ) Cirrhosis (C:30%,B:40%, C&B
%>, atau dgn HIV %>)
Px Cirrhosis: 3-5%/ tahun HCC
Tanpa cirrhosis, virus B dgn replikasi virus aktif
HCC
112
Thank You
113