ANATOMI – FISIOLOGI

GASTROINTESTINAL
IRAWAN YUSUF
M.E.RACHMAN

BLOK II
STRUKTUR DAN FUNGSI DASAR
TUBUH MANUSIA

Motto : The Anatomi-Physiology Of To-day Is

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

 Menyebutkan struktur anatomi sistem gastrointestinal

 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 .
 STRUCTURE

Structure of gastrointestinal system

 Gastrointestinal tract; oral cavity, pharynx,

esophagus, stomach, small intestine, large
intestine, rectum, and anal canal
 Accessory organs; tounge, teeth, salivary
glands, liver, and gall bladder
Esophageal Muscle
 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
 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
 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.
 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
 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)
 SEKIAN

KE KULIAH

SELANJUTNYA
 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 peristaltis:
 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
 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
BLOK II

STRUKTUR DAN FUNGSI DASAR

TUBUH MANUSIA

Motto : The Anatomi-Physiology Of To-day Is

The Medicine OfTo-morrow
FUNGSI SEKRESI

 Diperankan oleh kelenjar ludah,

lambung, duodenum, dan pankreas
 Berfungsi untuk menghasilkan
enzim pencernaan dan
menghasilkan mukus untuk proses
lubrikasi dan proteksi
PENGATURAN FUNGSI SEKRESI

 Kontak dengan makanan dan saraf

enterik
 Pengaruh susunan saraf otonom
 Pengaruh hormonal