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FISIOLOGI

GASTROINTESTINAL
IRAWAN YUSUF
M.E.RACHMAN

BLOK X
SISTEM GASTROINTESTINAL

Motto : The Anatomi-Physiology Of To-day Is


The Medicine OfTo-morrow
Tujuan Instruksional Khusus
Setelah kuliah ini mahasiswa akan dapat :

 Mengetahui tujuan pencernaan


 Mengetahui proses-proses sistem gastrointestinal
 Mengetahui fungsi traktus gastrointestinal
 Mengetahui fungsi accesory Organs
 Mengetahui mekanisme sekresi sistem gastrointestinal
 Mengetahui regulasi sistem gastrointestinal .
 Mengetahui mekanisme gangguan pada sistem
gastrointestinal
LEARNING CONCEPT
ORAL CAVITY
PHARYNX
ESOPHAGUS
GI TRACT STOMACH
SMALL INTESTINE
LARGE INTESTINE
RECTUM
STRUCTURE ANAL CANAL

TONGUE
TEETH
ACCESSORY SALIVARY GLANDS
ORGANS PANCREAS
LIVER
GALL BLADDER

INGESTION
SECRETION
FUNCTION DIGESTION
MOVEMENT
ABSORPTION
FUNCTION
 Breaking down food and supplying the
body with the water, electrolytes, and
nutrients to sustain life.
 Before can be used, food must be:
 ingested
 digested
 absorbed
 All of these processes involve
coordinated movemen of muscle and
secretion of various substances
INGESTION

 Placing food into the mouth


 Chewing the food into smaller pieces
(mastication)
 Moistening the food with salivary
secretions
 Swallowing the food (deglutition)
DEGLUTITION
(SWALLOWING)
 Deglutition or swallowing consists of three
phase:
 Oral (voluntary) phase. During this phase, the
tongue forms a bolus of food and forces it into
the oropharynx by pushing up and back against
the hard palate
 Pharyngeal phase. This phase coordinated by a
swallowing center in the medulla and lower pons
 Esophageal phase. After reaching the esophagus,
food is propelled into stomach by peristaltis
Pharyngeal Phase
 This phase begins when the food reaches the
oropharynx and progresses as follows:
 The nasopharynx is closed by the soft palate,
preventing regurgitation of food in to nasal
cavities
 The palatopharyngeal folds are pulled medially,
forming a passageway for the food to move into
the pharynx
 The glottis and vocal cords are closed and the
epiglottis swing down over the larynx, guiding
the food toward the esophagus
 Respiration is inhibited for the duration of
the pharyngeal phase (1-2 seconds)
DIGESTION
 Food is broken down into small particle by
grinding action
 Food is degraded by digestive enzymes
into usable nutrient
 Starches are degraded by amylase into
monosaccharides
 Proteins are degraded by variety of enzymes
(pepsin, trypsin) into dipeptides and amino
acids
 Fats are degraded by lipases and esterases into
monoglyserides and free fatty acids
MOTILITY OF GI TRACT

 The basic mechanisms of GI movement is peristaltis.


Peristaltis is a coordinated pattern of smooth muscle
contraction and relaxation
 Peristaltis helps move food through the paharynx and
esophagus and within the stomach. Peristaltis plays a
minor role in propelling food through the intestine
 During peristaltis, contraction of small section of
proximal muscle is followed immediately by relaxation of
the muscle just distal to it. The resulting wavelike motion.
MOTILITY OF STOMACH
Innervation
 Intrinsic innervation directly responsible for
peristaltis
 The myenteric plexus (Auerbach’s) is located between the
layers of the circular and longitudinal muscles of the
stomach
 The submucosal plexus (Meissner’s) is located between the
layers of the circular muscle and mucosa on the luminal
surface of the stomach
 Extrinsic through autonomic nervous system:
 Sympathetic, via the celiac plexus (inhibits motility)
 Parasympathetic, via the vagus nerve (stimulates motility)
Electrical Activity and Regulation
of Motility

 The smooth muscle of GI tract has spontaneous rhytmic


fluctuations (basic electrical rhytm; BER) which is
initiated by the interstitial cells of Cajal
 The rate of BER is 4/min in the stomach, 12/min in
duodenum and fall to about 8/min in distal ileum
 Spike potensials playing important role in BER
 Ionic basis of spike potentials is due to Ca2+ influx, and K+
efflux
 Many neurotransmitter and hormone affect the BER.
Acetylcholine increases BER and Epinephrine decrease
BER
Basic Electrical Activity (BER) of
Gastrointestinal Sooth Muscle
Migrating Motor Complex

 Modification of motor activity during fasting


between periods of digestion
 Each cycle of this activity starts with quiescent
period (phase I), continues with period of
irregular activity (phase II), and ends with a burst
of regular activity (phase III)
 MMCs migrate at a rate of about 5 cm/min, with
interval of 90 minutes
 The function of MMC is to clear the stomach and
small intestine luminal contents in preparation of
the next meal
 MMC immediately stopped by ingestion
Migrating Motor Complexes
III
Stomach Meal
II
I
Propagatian
rate 5cm/min

Distal
Ileum
90 minute
MASTICATION
Function of Mastication

 Breaks food into smaller pieces, which:


 Makes it easier for the food to be swallowed
 Breaks off the undigestible cellulose
coatings of fruits and vegetables
 Making easier for food to be digested by
digestive enzymes
MASTICATION
Function of Mastication

 Mixes the food with salivary gland


secretions, which:
 Initiates the process of starch digestion by
salivary amylase
 Initiates the process of lipid digestion by
lingual lipase
 Lubricates and softens the bolus of food,
making it easier to swallow
MASTICATION
Function of Mastication

 Brings food into contact with taste


receptors and release odors that stimulate
the olfactory receptors
 The sensations generated by these receptors
increase the pleasure of eating and initiate
gastric secretions
MASTICATION
Mastication Reflex
 Although mastication is a voluntary act, it is
coordinated by reflex centers in he brain stem that
facilitate the opening and closing of the jaw
 When the mouth opens, stretch receptors in the
jaw muscle initiate a refkex contraction of the
masseter, medial pterygoid, and temporal
muscle, causing mouth to close
 When the mouth closes, food comes into contact
with buccal receptors eliciting a reflex
contraction of digastric and lateral pterygoid
muscles, causing the mouth to open
 When the jaw drops, the stretch reflex causes the
entire cycle to be repeated
Esophageal Phase
 Sphincters involved in esophageal :
 The upper esophageal sphincter (striated muscle)
 The lower esophageal sphincter (smooth muscle)
 Types of esophageal peristaltis:
 Primary esophageal peristaltis is initiated by
swallowing
 Secondary peristaltis is initiated by the presence
of food within the esophagus
 Coordination of esophageal peristaltis:
 Primary esophageal peristaltis is coordinated by
vagal fibers
 Secondary esophageal peristaltis is coordinated
by the intrinsic nervous system
Swallowing Mechanism and Regulation
Disorders of Swallowing
 Esophageal reflux, may occur if the
intragastric pressure rise high enough to force
the lower esophageal sphincter open
 During pregnancy
 Reflux of stomach acid causes esophageal pain
 Belching (eructation), following a heavy meal
or ingestion of large amount of gas (e.g., from
carbonated beverages)
 Achalasia, is a neuromuscular disorder of the
lower two-thirds of the esophageal that leads
to absence of peristaltis and failure of the
lower esophageal sphincter to relax
MOTILITY OF STOMACH

Functional components
 The three functional parts of the stomach are the
fundus, corpus, and antrum
 Gastric contents are isolated from other parts of
the GI tract by the lower esophageal sphincter
proximally and by the pylorus distally
 The antrum and pylorus are anatomically
continous and respond to nervous control as a unit
MOTILITY OF STOMACH
Musculature
 Each muscle layer forms a functional syncytium
and therefore acts as a unit
 In the fundus, where the layers are relatively thin,
strength of contraction is weak; in the antrum,
where the muscle layers are thick, strength of
contraction is strong
 The stomach and duodenum are divided by a
thickened muscle layer called the pyloric
sphincter
MOTILITY OF STOMACH
Innervation
 Intrinsic innervation directly responsible for
peristaltis
 The myenteric plexus (Auerbach’s) is located between the
layers of the circular and longitudinal muscles of the
stomach
 The submucosal plexus (Meissner’s) is located between the
layers of the circular muscle and mucosa on the luminal
surface of the stomach
 Extrinsic through autonomic nervous system:
 Sympathetic, via the celiac plexus (inhibits motility)
 Parasympathetic, via the vagus nerve (stimulates motility)
Function of Motility
Gastric motility serves three basic function
 Storage. When food enters the stomach, the upper
region - primarily fundus - enlarges to accommodate
the food by receptive relaxation
 Mixing. Combination of peristaltis and retropulsion
mixes the food with acid and enzymes. When the
food is mixed into pasty consistency, it is called
chyme
 Emptying. When the chyme is broken down into
small enough particles, it is propelled through the
pyloric sphincter into intestine
Function of Motility
Receptive relaxation
 Initiated as apart of the peristaltic process
causing swallowing and esophageal motility
or in response to food entering the stomach
 Strecth receptors in the upper portion of
stomach detect the presence of food and
initiate a vago-vagal reflex producing
relaxation
 This process regulate by postganglionic fibers
within the enteric nervous system release a
noncholinergic nonadrenergic transmitter,
may be ATP or VIP
Function of Motility
Peristaltis
 Produced by periodic change in BER originate in a
pace maker within longitudinal muscle
 BER or slow wave occur at a rate of approximately
3-4/min and velocity is 1 cm/sec at the corpus and
increase to 3-4 cm/sec in the antrum
 Ca2+ play an important role in BER, and the force of
peristaltis contractions is regulated by gastrin and
acetylcholine
Function of Motility

Retropulsion
 Is the back and forth movement of the chyme
caused by the forceful propulsion of food
against the closed pyloric sphincter
 The forward and backward movement of the
chyme (caused by peristaltis and retropulsion)
breaks the chyme into smaller and smaller
pieces and mixes it with the gastric secretions
present within stomach
Function of Motility
Gastric emptying
 Each time the chime pushed against the
pyloric sphincter, a small amount (2-7 ml)
may escape into duodenum
 The amount of chyme passing the pylorus
depends on the size of the particles
 Liquids empty much faster than solids. The
rate of liquids emptying is proportional to
pressure within the upper portion of stomach,
which increase slowly during the digestive
period
Function Disorder of Motility
Vomiting or emesis
 Initiation
 The vomiting center. Directly activated by afferent fibers
or by irritation due to injury or increases in intracranial
pressure
 Chemoreceptor trigger zone. Activated by afferent nerves
originating within the GI tract or by circulating emetic
agents
 Mechanical sequence of vomiting
 Begins with deep inspirasion followed by the closing of
the glottis
 Intestine propels chyme into upper region of stomach
 Increase in abdominal pressure forces the chyme into
esophagus and out of the mouth
Vomiting Reflex
INTESTINAL MOTILITY

Contractile activity
 Contractile activity of the smooth muscle lining the
small intestine serve two functions:
 Mixing the chyme with digestive enzymes and bile to
facilitate digestion and absorption
 Propelling the chyme from the duodenum to the colon
 It usually takes about 2-4 hours for the chyme to
move from one end of the small intestine to the
other
INTESTINAL MOTILITY

Types of movements

 Segmentation is the most common type of


intestinal contraction
 Peristaltic contractions is not considered to be an
important component of intestinal transit
 MMC spreads over the intestine during
interdigestive period
INTESTINAL MOTILITY
Segmentation contractions
 During segmentation, about 2 cm of the intestinal wall
contracts, forcing the chyme throughout the digestive
period
 When the muscle relaxes, the chyme returns to the area
from which it was displaced
 This back-and-forth movement enables the chyme to
become mixes with digestive enzymes and to make
contact with the absorptive surface of the intestinal
mucosa
 Segmentation occur about 12 times/min in the duodenum
and 8 times/min in the ileum. The contraction last for 5-6
seconds
INTESTINAL MOTILITY
Regulation of intestinal motility
 Segmentation occur only if the slow waves produce spikes
potentials which is controlled by pacemaker cells within
the wall of the intestine and is not infuenced by neural
activity or circulating hormones
 The frequency of segmentation is directly related to the
frequency of the slow wave
 The strength of segmentation is proportional to the
frequency of the spike potentials generated by slow wave
 Slow wave amplitude is increased by gastrin, CCK,
motilin, and insulin; and decreased by secretin and
glucagon
FUNGSI SEKRESI SALURAN
CERNA
IRAWAN YUSUF
M.E.RACHMAN

BLOK X
SISTEM GASTROINTESTINAL

Motto : The Anatomi-Physiology Of To-day Is


The Medicine OfTo-morrow
INTRODUCTION
 Throughout the gastrointestinal tract
secretory glands serve two primary
function;
 To produce digestive enzymes;
 To provide mucus for lubrication and
protection
 Most digestive secretions are formed
only in response to the presence of
food in the gastrointestinal tract
 The types of enzyme and its
component are varied according to
the types of food present.
 Functions of gastrointestinal secretions
GENERAL PRINCIPLES
 Transport
 Digestion
 Protection
 Absorption
 The type of secretory glands
 Mucus gland or mucus cells (Goblet cells)
 Pits; invagination of surface lining epithelial
 Tubular glands (stomach and upper duodenum)
 Complex glands (Salivary glands, pancreas and
liver)
 Basic mechanism of secretion by glandular cells
 Secretion of organic substances
 Water and electrolyte secretion
 Basic regulatory mechanism of glandular cells
Daily Secretion of Gastrointestinal Fluid

Fluid Daily volume (ml) pH

Saliva 1000 6.0 – 7.0


Gastric secretion 1500 1.0 – 3.5
Pancreatic secretion 1000 8.0 – 8.3
Bile 1000 7.8
Small intestinal secretion 1800 7.5 – 8.0
Brunner’s gland secretion 200 8.0 – 8.9
Large intestinal secretion 200 7.5 – 8.0

Total 6700
Guyton, AC; 2000
PENGATURAN FUNGSI SEKRESI

 Kontak dengan makanan dan saraf


enterik
 Pengaruh susunan saraf otonom
 Pengaruh hormonal
SALIVA
 Ludah 95% terutama terdiri atas air,
elektrolit, dan sedikit protein
 Osmolalitasnya rendah
 Konsentrasi ion K tinggi
 Mengandung bahan organik -
amilase, lipase, dan faktor
pertumbuhan
Saliva Function
 Protection the mouth by:
 Cooling hot food
 Diluting gastric acid or bile regurgitated
into the mouth
 Washing food away from the teeth
 Antibacterial and antiviral effects (IgA
and peroxidase)
 Aids speech by facilitating movement of
the lips and tongue
 Digestion of glucose by amylase (ptyalin)
and fat by lingual lipase
 Lubrication; for easier swallowing,
moisten the mouth
Karakteristik ludah yang dihasilkan oleh perangsangan
kolinergik dan adrenergik

Parameter Kolinergik -adrenegik -adrenergik

Volume banyak sedikit sedikit


Viskositas rendah rendah tinggi
Protein rendah tinggi tinggi
Musin rendah rendah sangat tinggi
Control of Salivary Secretion
 Autonomic Nervous System
 Parasympathetic cause secretion of
watery fluid, high electrolyte but low in
protein
 Increases secretion of amylase with
large volumes of fluid
 Sympathetic cause secretion of small
volume of fluid containing high mucin
 Stimulates small volume of saliva rich in
amylase, bicarbonate and K+
 Salivary reflexes. Thought, aroma, or taste
cause salivary reflexes
MUKUS

 Melekat kuat pada makanan/partikel


lainnya, menutupi permukaan dinding
sal cerna
 resistensi rendah ----> pergerakan
makanan menjadi mudah terjadi
 Resisten thd enzim pencernaan
 Buffer asam atau alkali
 Mengandung ion bikarbonat untuk
netralisir asam
ESOFAGUS

 Sepanjang esofagus umumnya


kelenjarnya bersifat mukoid untuk
fungsi lubrikasi (agar mudah
menelan) dan proteksi (mencegah
ekskoriasi mukosa akibat makanan
atau asam lambung
Gastric Secretory Cells
 Gastric secretory cells are located on the
surface of the stomach and in glands that are
buried within the mucosa consits of:
 Oxyntic glands are located in the fundus and
corpus. They contain three types of secretory
cells:
 The parietal (oxyntic) cells, secrete HCl and
intrinsic factor
 Peptic (chief) cells secrete pepsinogen, the
precursor of pepsin
 Mucous cell secrete mucus

 Pyloric glands are located in antrum and


pyloric. They contain G cells and some
mucous cell. G cells produce gastrin hormone
Secretion of the Stomach

 Hydrochloric Acid (HCl)


 Pepsinogen
 Intrinsic Factor
 Mucus
 Glycoprotein products which primary
function as lubricant, but can also
have many other regionally specialized
function
FASE SEKRESI ASAM
 Chepalic phase : penglihatan, penciuman,
menelan makanan, terapi ADO atau
pemberian insulin ---> 1/3-1/2 sekret HCL
 Gastric phase : saat makanan masuk ke
lambung -----> distensi lambung, sekresi
gastrin -----> 2/3 sekret HCL
 Intestinal phase : adanya makanan dalam
duodenum disebabkan duodenum
menghasilkan gastrin
HCl Secretion
Mechanism HCl secretion
 HCl is secreted into the parietal cells canaliculi
by three step process:
 The active transport process is begun by the
transport of K+ and Cl- into the canaliculi
 H+ is then exchanged for K+ by a H+-K+ ATPase
 Water enters the canaliculi down the osmotic
gradient created by movement of HCl-
 The H+ entering the canaliculi is supplied by the
dissociation of H2CO3 into H+ and HCO3-
 The active transport process involved in the
generation of HCl- secretion require a large
amount of ATP
 The pH of acid secretion as low as 0.8
Control of HCl Secretion

 Stimulation of HCl secretion


 Acetylcholine (Ach)
 Histamine; histamine can stimulate
HCl secretion directly or can
potentiate the secretion produced
by ACh or gastrin
 Gastrin
 Inhibition of HCl secretion
 Somatostatin
PEPSINOGEN SECRETION
 Function of pepsinogen. Pepsin the
active form of pepsinogen is
proteolytic enzyme that begins the
process of protein digestion
 Regulation of pepsinogen secretion.
 Cephalic state, vagal nerve stimulate
secretion of pepsinogen
 Gastric phase, low pH stimulate secretion
 Intestinal phase, secretin stimulate
pepsinogen release
MUCOSAL BARRIER
 The gastric mucosal barrier protects
the gastric lining cells from damage
 The main component of mucus is a
thick viscous alkaline mucous layer
secreted by the mucous cells
 Mildly injury results in increased
mucus secretion and surface
desquamation
 More serious injury denudes the
mucosal surface, forming an ulcer,
and produce bleeding
PANKREAS
 Enzim pankreas sangat penting untuk proses
digesti, dan sekresi enzim ini diatur oleh kontrol
hormon sekretin dan CCK
 Secretin merangsang duktus pakreas
menghasilkan juice yang alkalis (HCO3 banyak,
enzim )
 CCK merangsang sel acinus produksi juice
pankreas yg volumenya sedikit tapi enzimnya
 Stimulasi vagus merangsang sekresi pankreas
Anatomy and Histology of Pancreas
Pancreatic Secretory Cells
 Pancreatic exocrine cells are
arranged in grape-like clusters
called acini.
 The exocrine cells themselves
are packed with membrane-
bound secretory granules which
contain digestive enzymes that
are exocytosed into the lumen
of the acinus.
 From there these secretions
flow into larger and larger,
intralobular ducts, which
eventually coalesce into the
main pancreatic duct which
drains directly into the
duodenum.
Composition of Pancreatic Secretion
 Pancreatic juice is composed of two
secretory products critical to proper
digestion:
 Digestive enzymes, secreted by acinar cells
 Bicarbonate (HCO3-), secreted from epithelial
cells
 Digestive enzymes digesting all three
major types of nutrients
 HCO3- play important role in
neutralizing the acid chyme from the
stomach
Enzim Pankreas dan fungsinya
ENZIM FUNGSI

Enzim proteolitik (protease)


Tripsinogen Memecah ikatan peptida
antara arginin dan lisin
Khimotripsin Memecah ikatan peptida
asam amino aromatik

Elastase Memecah ikatan peptida


asam amino alifatik
Karboksipeptidase A Memecah ikatan karboksil
asam amino aromatik dan
alifatik

Enzim amilolitik (amilase)

Alfa-amilase Hidrolisa glikogen, gula

Enzim lipolitik (lipase)

Lipase Hidrolisa monogliserida,


asam lemak

Fosfolipase Memecah asam lemak dan


fosfolipid

Kholesterol esterase Hidrolisis kolesterol


Phase of Pancreatic Secretion
Cephalic phase
 Vagal stimulation
 Stimulates enzyme secretion
 Non-cholinergic
 HCO3- secretion
Gastric phase
 Distension of the antrum and corpus
 Secretion of low volume of enzymes and HCO3-
 Food breakdown (primarily amino acids)
 Secretion of pancreatic secretion
Intestinal phase
 Cholecystokinin
 Secretin
Control of Pancreatic Secretion
Hormonal Control
 Secretin (from increased HCl in
duodenum)
 stimulates fluid and electrolyte secretion
 CCK (from increased fatty acids,
peptides, amino acids)
 stimulates release of enzymes
Nervous System
 Parasympathetic input
 initiates secretion during cephalic and
gastric phases
HATI & BILIARY SYSTEM
 Empedu dibuat di hati dan disekresi lewat
duktus biliaris menuju duodenum saat
makan.
 Saat tdk makan, empedu dibawa ke
kandung empedu, dan akan disekresi saat
makan oleh pengaruh CCK (kontraksi kdg
empedu)
 Sekresi empedu meningkat oleh pengaruh
vagus, secretin
 Empedu sangat penting pada proses
emulsifikasi lemak
Usus halus

 Sel goblet, kelenjar Brunner


(duodenum), kel. Lieberkun
menghasilkan mucin yang alkalis
pada mukosa usus halus,
 Mucin ini gel-hydrat untuk melapisi
usus, lubrikasi, mengandung
bakteria dan Ig,
 Hormon TGI (VIP) dan stimulasi
vagus menstimulasi sekresi mucin
Sekian

Mohon Maaf dan Terimah


Kasih
Wassalamu Alaikum WrWb

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