TRACTUS DIGESTIVUS

dr Aris Prasetyo,MKes
Proses dalam Sistem pencernaan :
Makanan + air

sekresi Pencernaan

motilitas absorbsi V. porta

hepar

V.hepatika
Feses
V. Cava Inferior
 SIFAT UMUM
Dinding Usus
Lapisan: dari luar ke dalam
1. Serosa
2. Otot longitudinal
3. Otot sirkuler
4. Sub mukosa
5. Mukosa
 PENGONTROLAN SARAF
1. Sistem persarafan Enterik
a. Pleksus Myenterik Auerbach
Letak : ant lap.otot longitudinal - sirkuler
Sifat : motorik - mengontrol gerak usus

b. Pleksus submukus Meissner

Letak : di lapisan submukosa
Sifat : sensorik - mengontrol sekresi
2. Otonomik
a. Parasimpatik : N. Vagus
- meningkatkan gerak/sekresi usus
b. Simpatik :
- menurunkan gerak / sekresi usus
 Refleks Gastrointestinal
1. Refleks : Pleksus Auerbach &
Meissner
2. Dari usus  prevertebral gl simpatik usus
– Refleks Gastrokolik
– Refleks Enterogastrik
– Refleks Kolonoileal
3. Dari usus  medulla spinalis  usus
– Refleks defekasi (bisa disadari)
 Refleks Gastrokolik

Signal dari Lambung

(mis. Lambung yg terisi makanan / irritasi )

menimbulkan refleks di kolon
(meningkatkan gerakan kolon: gerak mass)
 Refleks Enterogastrik
Signal dari usus, mis:
- usus penuh / infeksi / irritasi
- mengandung banyak protein, lemak
- osmol, pH belum netral

menimbulkan refleks hambatan
pengosongan lambung
Refleks Kolonoileal .
- Signal dari kolon ( mis. Kolon yg penuh /
infeksi / irritasi)  menimbulkan refleks
hambatan pengosongan ileum
Refleks defekasi
Timbul bila: Rektum terisi feses
THE ORAL CAVITY
Salivary Glands
• Composition of saliva:
– 97-99.5% H2O
– Electrolytes:
– pH 6.75-7.0
– Amylase: (digestive enzyme)
– Proteins: mucin, lysozyme, & IgA
• Protection from microbes by saliva:
– IgA: immunglobulins in secretions
– Lysozyme: bacteriostatic (inhibits bacterial growth)
– Cyanide
– Defensins: local antibiotic activity & when activated promote
chemotaxis by WBCs
– Normal flora: convert salivary components to nitrates then to NO.
NO is toxic & bacteriocidal
Proses Deglutition / Swallowing
- Palatum molle menutup nasofaring
- Epiglottis menutup laring
- Napas berhenti sejenak
* Proses berlangsung selama 5-10 detik
Swallowing, or deglutition
 Gastric glands didominasi oleh 2
tipe sel sekretorik:
• (1) parietal cells
• (2) chief cells.
 Sel Parietal mensekresi:
• intrinsic factor, penting untuk absorbsi
vitamin B12
• hydrochloric acid (HCl)
 pH 1.5-2.0 gastric juice, penting
untuk :
• membunuh microorganisme yg masuk
bersama makanan
• mendenaturasi protein dan
menginactivasi enzym dalam makanan.
• Memisahkan dinding sel makanan yang
berasal dari tumbuhan dan jaringan ikat
daging
• Mengaktifkan pepsin, enzim protease
yang disecresi oleh chief cells.
 Chief Cell
• mensecresi pepsinogen
• Mensekresi Rennin atau chymosin, dan
gastric lipase, enzym yang penting untuk
mencerna susu pada bayi baru lahir
 produksi asam dan enzim oleh
mucosa lambung
• (1) dicontrol CNS
• (2) diregulasi reflex dinding lambung
• (3) diregulasi hormon traktus digestivus.
Distribution of gastrointestinal peptides along the
gastrointestinal tract.
 Usus halus
• (1) duodenum
• (2) jejunum
• (3) ileum.
 Diagrammatic representation of the layers of the wall of the stomach, small
intestine, and colon. The structure of the esophagus and the distal rectum is
similar, except that they have no serosa or mesentery. In addition, the muscle
in the upper quarter of the esophagus is striated, and there is a transitional
zone of mixed smooth and striated muscle before the muscle becomes solely
smooth in the distal esophagus
The Movement of Digestive
Materials
 Diagram of segmentation contractions of the intestine.
Arrows indicate how areas of relaxation become areas of
constriction and vice versa.
 The Control of Digestive
• Neural
• Hormonal
• local mechanisms
 duodenum
• 25 cm
• Berhubungan langsung dengan lambung
• disebut"mixing bowl“ karena menerima
chyme dari lambung dan sekresi dari
pancreas dan liver.
 jejunum
• 2.5 meters
• Pencernaan kimia terbesar dan absorpsi
nutrien terjadi di jejunum
 ileum
• 3.5 meter
• Berakhir pada sphincter, ileocecal valve,
yang mengontrol kecepatan makanan dari
ileum ke cecum
 Integrated action of gastrointestinal hormones in regulating digestion
and utilization of absorbed nutrients. The dashed arrows indicate
inhibition. The exact identity of the hormonal factor or factors from the
intestine that inhibit(s) gastric acid secretion and motility is unsettled,
but it may be peptide YY
 Fungsi liver
• (1) mengatur metabolisme
• (2) hematological regulation
• (3) memproduksi empedu
 Metabolik regulation
• Metabolisme Carbohydrate.
• Metabolisme Lipid
• Metabolisme Asam Amino
• Membuang sampah tubuh
• Vitamin storage.
• Mineral storage.
• Drug inactivation
 hematological regulation
• Phagocytosis antigen
• Synthesis plasma protein.
• Mengubah/ membuang hormones di
sirkulasi.
• Mengubah/ membuang antibodies.
• Menetralisir/ membuang toxin
 Sirkulasi Enterohepatic
hepar
Duodenum 18x Duodenum Feses
Hepar

Empedu mengandung
a. Air : 97%
b. Garam Empedu
c. Billirubin
d. Cholesterol
e. Lesithine (bahan protector hepar)
f. Asam Lemak
g. Elektrolit : Na+,K+,Cl+,HCO3+
 Garam Empedu
Bahan dasar: Cholesterol
Konjugasi Glycin / Taurin
Garam Empedu
- Asam Glycocholat
- Asam Taurocholat
Fungsi garam empedu :
 Deterjen : lemak berbentuk emulsi
 mudah larut  mudah diserap
 membantu absorbsi lemak
 Mengaktifkan enzim lipase
Batu empedu :
- kebanyakan : batu cholesterol

Kausa:
a. Absorbsi air/elektrolit berlebihan
b. Produksi cholesterol berlebihan
c. Infeksi kandung empedu
 Pengosongan empedu
Rangsangan :
1. Hormon cholecystokinin (perangsang terkuat)
2.Parasimpatis / Acethylcholine / N.Vagus
3.Bahan Cholagoga (misalnya.temulawak)
Bilirubin
Penyebab warna kuning pada urine dan feses
Berasal dari pemecahan Hb - eritrosit(umur 120 hari)
Icterus = Jaundice
• Warna kuning pada jaringan tubuh
• kadar total bilirubin darah : 2 mg% (normal
:0,5 mg%)
• Jelas terlihat pada bola mata

• Macam Ikterus :
- Ikterus Haemolitik
- Ikterus obstruktif
Hemolitik Ikterus
- Hemolisa darah ↑↑
- Hepar : normal

Obstruktif icterus
- Hemolisa darah : Normal
- Hepar : treganggu
Enterohepatic circulation of bile salts. The solid lines entering the portal
system represent bile salts of hepatic origin, whereas the dashed lines
represent bile salts resulting from bacterial action.
• Large numbers of Acinar
cells in clusters around
ducts; exocrine (Acini)
– Acinar cells: Secrete
pancreatic digestive
enzymes
• Endocrine cell clusters form
the pancreatic islets that
produce insulin & glucagon
• Proteolytic enzymes are released as inactive
forms then are activated in the duodenum
– Trypsinogen g Trypsin by the brush border
enzyme enterokinase
– Trypsin activates precursors to form
carboxypeptidase & chymotrypsin
• Amylase, lipase, & nuclease are released in their
active forms
 Pancreatic enzymes
• Pancreatic alpha-amylase carbohydrase
identic dengan salivary amylase.
• Pancreatic lipase memecah lipids,
menghasilkan asam lemak yang mudah
diabsorbsi
• Nuclease yang memecah nucleic acids.
• proteases and peptidases enzyme yang
memecah protein
 Pancreatic Juice
Mengandung :
• Alkaline,
• watery,
• enzymes & electrolytes
Absorbsi Karbohidrat
Absorbsi Protein
Absorbsi lipid
Absorbsi Natrium
 Usus besar
• (1) cecum, bagian awal
• (2) colon, bagian terbesar
• (3) rectum, 15 cm terakhir
 Normal Microbial Flora of the
Digestive System
• Mouth
– 1 ml saliva = millions of bacteria
• Stomach and small intestine
– Few organisms due to HCl and rapid
movement of food
• Large intestine
– 100 billion bacteria per gram of feces
– 40 % of fecal mass is microbial cell
material
• Lactobacillus, Bacteriodes, Enterobacter, E.
coli. Proteus spp.