FAAL SISTEM PENCERNAAN

Dr. H. SONNY P LAKSONO M.Kes

 Overview of
GI Processes

Food

Digestion

Secretion
Absorption Motility

Blood Vessels
 Mouth
•only part involved in ingestion
•Oral cavity/ buccal cavity
•Lips, cheeks, hard and soft palate and
tongue
•Most activity related to accessory organs
(teeth, salivary glands, and tongue)
•Food is chewed, mixed with saliva
containing enzymes, begins swallowing
accessory digestive organs

•Organs
–teeth, tongue, gallbladder, glands
( salivary glands, liver, pancreas)
•contribute to food breakdown
 Pharynx

•oropharynx to laryngopharynx
•(nasopharynx not involved in digestion)
•Common passageway for food, fluids and
air
•No physical or mechanical digestion
•Absorption- none
 Esophagus
•muscular tube about 25cm (10 inches) long
•Collapsed when not in use
•Routed here as epiglottis closes off larynx to
food entry
•Joins stomach at cardiac sphincter
•Secretes more mucus for lubrication
•No physical or mechanical digestion
•Pharynx and esophagus are conduits from
mouth to stomach
•Absorption- none
Digestion
 Three Phases
• Cephalic Phase

• Gastric Phase

• Intestinal Phase
 Cephalic Phase
• Anticipatory/Sensory
• Mediated via vagus/Ach
– Chief cells secrete acid
– Parietal cells secrete pepsinogen
– G cells secrete gastrin
• Vagus also mediates via pancreas
 Gastric Phase
• Begins with arrival of food in stomach
• Two stimuli:
– stretch receptors in stomach
– digested protein
• G cells in antrum stimulated by vagus and
by protein
 Digestive process involves 6 essential activities
1. ingestion- taking food in
– bolus- an amount of food passing through tract
2. propulsion- moves food through tract
– swallowing- voluntary
– peristalsis- involuntary muscular waves moves food forward
3. mechanical digestion- physical chewing, mixing, churning
– segmentation- rhythmic local constrictions of intestine for mixing
4. chemical digestion- catabolism/ breakdown of polymers into
monomers by enzymes
– begins in mouth, essentially complete in small intestine
5. absorption- passage of digested end products across wall into blood
– monomers, vitamins, minerals and water
– pass through mucosal cells lining tract
– small intestine major absorption site
6. defecation- eliminates indigestible substances and other wastes from
body via anus in form of feces
 Stomach
•“holding tank” important in protein
digestion
•Food converted into chyme
•Maximum capacity about 4L or 1 gallon
•Large longitudinal folds called rugae
•Pyloric sphincter controls emptying
 Microanatomy of the Gut
The Basic Plan

• Mucosa
• Submucosa
• Muscularis
• Serosa

• Regional variations ?
Secretion of Water and Electrolytes

Enterocyte
Na+ L
H2O
Na+ Cl- U
Cl-
K+ M
Na+
K+ K+
E
N
Enterocyte Tight Junction
•Muscularis
•additional oblique muscle layer for churning and mixing
 Small Intestine
•major digestive organ
•Longest part of alimentary canal
–(3-6 hour journey)
•3 subdivisions
–1) duodenum
•shortest but lots going on
•Hepatopancreatic ampulla- bile duct and main
pancreatic duct enter
–2) jejunum
•middle portion
–3) ileum
•last part joins large intestine at ileocecal valve
 H+ Secretion by Parietal Cells

Enterocyte

CO2
L
CO2 + H2O
U
CA
M
Cl- E
HCO3-
K+
HCO3- + H+ H+
N
Enterocyte
 HCO3- Secretion by Pancreatic Cells

Enterocyte
L
H+ + HCO3- HCO3- U
CO2
CA
Cl-
M
CO2 + H2O E
Na+ N
K+

Enterocyte
Absorption
 Primary Substances Absorbed
• Carbohydrates

• Peptides

• Fats
Motility
 Two Types of Movement

• Peristaltic
– moves food forward

• Segmental
– mixing
 Some Selected GI Disorders
• Disorders of the GI Tract
– malabsorption (lactase deficiency)
– motility (GERD)
– constipation/diarrhea
– bleeding and pain
• Disorders of Accessory Organs
– Ascites
 Lactase Deficiency
Enzymes
• Deficiency of lactase
at brush border
• Increased lactose
provides carbon for
bacteria
• Presents as bloating,
crampy pain, osmotic
diarrhea Microvillus
 GERD
• Lower esophageal sphincter relaxes
spontaneously
• Acid, bile, enzymes erode esophagus
• worsened by delayed emptying
• Presentation: post-prandial heart burn,
regurgitation at 1 hour
• Tmt: ?
 Constipation
• Many Causes
– Neurogenic
• eg: Hirschsprung’s
– Muscle weakness
• eg: post-surgery
– Low-residue diets
• Tmt?
 Diarrhea - Three Mechanisms
• Osmotic
– osmoticant in intestine H2O

• Secretory
– excessive mucosal secretion
– toxins, some tumours
• Motility
– surgical
 Laxatives We Know and Love
• A. Irritants and Stimulants
– Castor oil, aloe, phenophthalein
• B. Bulking Agents
– Psyllium, bran, magnesium
• Stool softeners
– Ducosate, mineral oil, glycerin