ANATOMI & FISIOLOGI

SISTEM PENCERNAAN MAKANAN

 FUNGSI UMUM

1. Menelan makanan
2. Memecah makanan secara kimia dan mekanik
menjadi molekul nutrien yang mudah diserap
3. Menyerap molekul tersebut menuju aliran darah
4. Membuang bahan-bahan yang tidak diserap
 DIBAGI MENJADI 2 KELOMPOK

ALIMENTARY CANAL :
Organ yang dilalui makanan (berupa
saluran panjang)

ACCESSORY ORGANS :
Membantu proses pencernaan tetapi tidak
benar-benar dilalui olah makan
ALIMENTARY CANAL
* rongga mulut
* faring
* esofagus
* lambung
* usus halus
* usus besar

ACCESSORY ORGANS
* gigi-geligi
* lidah
* kelenjar saliva
* pankreas
* hati
* kandung empedu
 TERDIRI DARI 6 AKTIVITAS

Ingestion = proses menelan

Propulsion = tng Penggerak
Mechanical Digestion = pencernaan makanik
Chemical Digestion = pencernaan kimiawi
Absorption = Penyerapan
Defecation = pengeluaran
Ingestion : memasukkan makanan ke dalam tubuh

Propulsion : pergerakan makanan sepanjang the

alimentary canal. Terjadi karena adanya gerakan
peristaltik dinding saluran cerna

Mechanical digestion : Pemecahan makanan

menjadi molekul kecil secara fisik (mekanik),
menjadikan permukaan makanan lebih luas
sehingga enzim bisa bekerja optimal
Chemical digestion : Pemecahan makanan secara kimia
(enzimatik) menjadi bentukan yang dapat diabsorbsi dengan
baik, misalnya monosakarida, asam amino, asam lemak dll

Absorption : Penyerapan dari produk akhir sistem cerna,

misalnya vitamin, mineral dan air dari lumen GI tract menuju
pembuluh darah. Sebagian besar terjadi di usus halus.

Defecation : eliminasi dari bahan-bahan yang tidak dapat

dicerna, sebagai feses.
RONGGA MULUT
 STRUKTUR RONGGA MULUT

1. Gigi sulung (20)

2. Gigi permanen (32)
3. Lidah
a. otot skelet
b. menggerakkan massa makanan “bolus”
 STRUKTUR RONGGA MULUT (Cont’d)

4. Kelenjar saliva (3 pasang)

a. parotis
- sebelah anterior to the ear dekat mm. masseter.
- muara saliva dekat molar kedua atas
- inflamasi parotis: mumps
b. submandibularis
- terletak pada medial dari mandibula.
- muara saliva pada dasar frenulum lingualis.
c. sublingual
- sebelah anterior kelenjar submandibular dan bawah lidah.
- muara saliva sebanyak 10-12 pada dasar mulut
d. rangsangan parasimpatis: sekresi saliva
 ORAL CAVITY STRUCTURES

5. saliva
99% air
membersihkan, melembabkan, membasahi dan melarutkan makanan
mengandung enzim :
* lysozyme
* salivary amylase – mencerna pati (awal, tidak signifikan)
* lingual lipase – mencerna lipid (awal, tidak signifikan)
* garam
* mucin
* antibodi.
 masih terdapat beberapa kelenjar saliva minor yang tersebar
sekresi saliva : reflex & parasympathetic
makanan dan minuman mengaktifkan kemoreseptor dalam rongga
mulut ---- mengaktifkan pusat penelanan pada pons---- signal menuju
kelenjar saliva (via n. facialis and n. glossopharyngeal) dan terjadilah
proses salivasi
higher brain centers juga dapat menyebabkan salivasi: misal melihat,
membau dan memikirkan
 FARING

1. orofaring
2. esofagus :
menghubungkan faring dan lambung
3. peristaltik - gerakan ritmis otot polos
 ESOFAGUS

"food tube" yang menghubungkan faring dan

lambung
Berhubungan denga lambung pada bagian cardia
lambung.
Diregulasi oleh sphincter cardia atau
gastroesophageal.
 ESOFAGUS (Cont’d)

Kolaps bila kosong

Mempunyai 4 lapisan histologis
Mokosanya dilapisi oleh non-keratinized stratified
squamous epithelium
Lapisan submukosa mengandung kelenjar mukus
yang membantu pelumasan
 ESOFAGUS (Cont’d)

1/3 bagian atas adalah otot skelet

1/3 bagian bawah adalah otot polos
1/3 bagian tengah adalah campuran
ESOFAGUS (Cont’d)
 PENELANAN
(DEGLUTITION / SWALLOWING)
PROSES MENELAN

masticated food + saliva = BOLUS

Proses penelanan reflex

1. Stadium volunter
2. Stadium involunter
- Stadium pharyngeal
- Stadium oesophageal
 STADIUM VOLUNTER
(Stadium Bukal)

Bolus diletakkan di atas lidah

Didorong ke atas dan belakang pada palatum

Masuk faring

dapat dipengaruhi oleh kemauan

 STADIUM PHARYNGEAL
Bolus pada mulut – pharynx merangsang reseptor

TIMBUL REFLEKS-REFLEKS :

Palatum molle ditarik ke atas menutup nasopharynx

Epiglottis bergerak ke belakang menutup larynx

Larynx bergerak ke atas depan membuka oesephagus

(sphincter pharyngo-oesephageal relaksasi)

Terjadi gelombang peristaltik dari otot-otot konstriktor pharynx

Nafas berhenti sejenak

Proses sekitar 1-2 detik

tidak dipengaruhi oleh kemauan
 STADIUM OESOPHAGEAL

Gelombang peristaltik primer; lanjutan dari

gelombang peristaltik faring

Gelombang peristaltik sekunder; berasal

dari dinding osophagus sendiri karena
regangan dinding vagal reflex

proses sekitar 5 - 10 detik

tidak dipengaruhi oleh kemauan
PENGATURAN PROSES MENELAN

rangsangan taktil pada reseptor mulut – pharynx

melalui N. V; N. IX

medulla oblongata
(jalur: tr. Solitarius , formatio reticularis)

melalui
N. V, IX, X, XII

menelan
 AEROPHAGIA
udara yg ikut tertelan pd saat menelan

RUCTUS FLATUS
dikeluarkan kembali diabsorbsi
diteruskan ke colon
dikeluarkan
LAMBUNG
 FUNGSI LAMBUNG

Penyimpanan makanan
Pencampuran makanan dg gastric juice
menjadi CHYME
Pengosongan makanan periodik
Pencegahan masuknya kuman
Absorbsi obat-obatan
CORPUS

Tonus dinding relatif rendah, mampu membesar (s/d 1-

1.5 l)
Storage makanan; tekanan lambung tetap rendah

Sebab:
1. Sifat PLASTICITY
2. LAW OF LAPLACE
3. VAGAL REFLEX
LAW OF LAPLACE

Bertambah besar diameter lambung karena isi

bertambah

Bertambah besar curvatura minor

Tekanan tidak meningkat atau meningkat sedikit

GERAKAN LAMBUNG

- MIXING CONTRACTION
dimulai dari bag tengah

ke antrum (terkuat)
freq setiap 20 detik

- PERISTALTIC MOVEMENT
lebih kuat dari mixing contr.
pyloric pump
Tidak terjadi regurgitasi dari duodenum
ke lambung karena:
Kontraksi segmen pylorus berakhir lebih
lama daripada segmen duodenum
 GASTRIC JUICE
Disekresi oleh:
1. Kel. Cardia
sekr mukus, pelindung mukosa
2. Kel. Fundus
mengandung 4 macam sel
- chief cell, sekresi pepsinogen
- parietal cell, sekr HCl +fact intrinsic
- mucous cell, sekr mukus
- argentaffin, sekr 5-OH- tryptamine
3. Kel Pylorus
sekr mukus + gastrin (oleh G cell)
 GASTRIC JUICE
- Volume 1.5-2 liter / hari
- pH 1,8 – 3.5
- Osmolaritas isotonis
- Kandungan:
1. Elektrolit
2. Pepsin
3. Mukoprotein
4. Lipase
5. Rennin
6. Intrinsic factor
7. Histamin
8. Gelatinase
PEPSIN : suatu enzim proteolitik

PEPSINOGEN PEPSIN
HCl

PROTEIN POLIPEPTIDA
pepsin, pH 1,8-3,5

RANGSANGAN SEKRESI
- N. Vagus
- Histamin
- Gastrin
MUKOPROTEIN
sekresi sel mukus
alkalis
melindungi dinding lambung gel
rangs sekresi:
- pH
- N. Vagus

RENNIN
menggumpalkan susu pada bayi
INTRINSIC FACTOR
suatu glocoprotein
membantu absorbsi vit B-12 di ileum

HISTAMIN
suatu derivat asam amino
reseptor H1 dan H2
H2 perangsang sekr gastric juice
blok H2 receptor: CIMETIDIN
REGULASI PENGOSONGAN LAMBUNG

Pyloric Pump, diatur oleh:

1. Lambung
sifat meningkatkan aktivitas
regangan merangs N. Vagus/vagal reflex
2. Duodenum
sifat menghambat aktivitas
enterogastric reflex ok:
distensi duodenum, iritasi duodenum,
chyme mengandung banyak protein
GASTRITIS
- Peradangan mukosa lambung

Sebab:
Iritasi alkohol / obat aspirin
Infeksi kuman
Iritasi makanan

Mukosa rusak

Permeabilitas meningkat

Peka thd H + / pepsin

Gastric athropy / tukak atau ulcus

GASTRITIS menimbulkan:
- Rasa nyeri
- Rasa panas
- Sekresi saliva meningkat

ditelan

udara masuk

kembung
HUNGER CONTRACTION

Lambung kosong pd waktu lama: 12-24 jam

Kontraksi ritmik intensive (=tetani)
Berlangsung 1-3 menit, interval 1-2 jam
Sensasi nyeri, lapar : HUNGER PANGS
Intensitas terkuat pada hari ke-3 dan 4,
kemudian turun
Lebih hebat pada orang dewasa muda
sehat, terutama dengan hipoglikemia
 SEKRESI GASTRIC JUICE

Cephalic Phase of Secretion

- Dirangsang oleh pandangan, pembauan, pengecapan.
- Sinyalnya direlay menuju feeding center ‘hypothalamus’
- Menstrimulasi vagal nuclei pada medulla spinalis
- Impuls kemudian dibawa menuju gastric glands via Nn.
vagus
SMALL INTESTINE
major organ of both :
digestion and absorption
this convoluted tube extends :
from the pyloric sphincter to the
ileocecal valve
almost 20 feet long!
(what is the importance of this?)
it's divided into 3 regions:
duodenum, jejunum, and ileum.
 DUODENUM

it’s about 10" long and curves around

the head of the pancreas
much of it is retroperitoneal
the common bile duct :
delivering bile from the liver and gallbladder
main pancreatic duct :
delivering pancreatic juice from the pancreas
 DUODENUM

the common bile duct and main pancreatic

duct unite in the wall of the duodenum :
at the hepatopancreatic ampulla
the entry of bile and pancreatic juice
into the duodenum is controlled by :
the hepatopancreatic sphincter.
JEJUNUM
it’s about 8' long
extends between the duodenum
and the ileum

ILEUM

it’s extends from the jejunum to

the ileocecal valve
it’s about 12' long.
 HISTOLOGY

mucosa has intestinal glands (cavities) :

for secretion of intestinal juice
mucosa also has circular folds, villi & microvilli :
for increased surface area
“brush border” has many enzymes
 HISTOLOGY

“brush border” has many enzymes

(embedded in plasma membranes) :
1. several carbohydrate-digesting enzymes
2. peptidases
3. nucleosidases
4. enterokinase is released by :
epithelial cell “shedding”
important enzyme activator.
the small intestine is built :
for digestion and absorption
it has lots of surface area
it contains 3 main surface area
enhancing adaptations:

Plicae Circulares
Villi
Microvilli
 PLICAE CIRCULARES

large deep
permanent folds of the mucosa and
submucosa
they slow the movement of chyme
(more time for digestion/absorption)
they increase the surface
 VILLI

fingerlike projections of the mucosa

they also increase the surface area
within the core of each villus is a capillary bed
and a lacteal :
for transport of the absorbed nutrients.
 MICROVILLI

tiny projections of the plasma membrane

of the absorptive cells
often called the "brush border" due to their appearance
they further increase the available surface area
and contain membrane-bound enzymes involved in
digestion
the SI epithelium is simple columnar absorptive cells
with goblet cells interspersede
enteroendocrine cells and T lymphocytes are also
interspersed amongst the aborptive cells
between the villi exist pits known as :
intestinal glands or ‘crypts of Lieberkuhn’
the cells lining these pits are epithelial cells :
that secrete intestinal juice (mucus, enzymes, etc.),
lysozyme-secreting cells, and stem cells.
 THE LAYER OF THE SI

it’s typical with an inner circular and an outer

longitudinal layer of smooth muscle
the majority of the SI is covered by a serosa
the submucosa is rather mundane save for
the proximal duodenum and terminal ileum
 THE LAYER OF THE SI

in the proximal duodenum :

the submucosa houses Brunner's glands which secrete
an alkaline mucus to help neutralize the acidic chyme
(coming from the stomach)
in the terminal ileum, we find Peyer's patches :
large lymphoid nodules that help prevent colonic
bacteria from entering the SI.
Here are 3 gross and one microscopic view of Peyer's patches.
 INTESTINAL PHASE
OF REGULATING DIGESTION

1. chyme enters duodenum

2. three hormones secreted from SI mucosa
3. receptors in SI mucosa sense food
or chemical presence in duodenum
4. neuronal activation of sympathetic NS
or inhibiton of parasympathetic NS
 REGULATING ABSORPTION

absorption of C L P, Ca2+, Fe2+ :

duodenum & jejunum
absorption of bile salt, vit.B12,H2O,electrolite
:
ileum
absorption of monosacharide & aa :
secreted into cappilar
absorption of lipid :
secreted into central lacteal
 REGULATING ABSORPTION

absorption of H2O within SI:

passive, depend on osmotic gradient
(from ion transport)
mucosa epithelial cell of intestine :
collect to form tubulus is like kidney :
* functions as Na+/K+ pump within basolateral
membrane
* can stimulates absorption of NaCl & H2O
within ileum
 THREE HORMONES SECRETED FROM SI MUCOSA

1. gastric inhibitory peptide (GIP)

i. fatty acids in chyme induce GIP secretion
ii. GIP inhibits gastric secretion
iii. GIP inhibits gastric “churning”
iv. GIP activates insulin secretion
2. secretin
secretin inhibits gastric secretion
3. cholecystokinin (CCK)
i. CCK fatty acids in chyme induce CCK secretion
ii. CCK slows gastric emptying
PROBLEM WITHIN SI

Diare
Colitis ulcerative
 DIARE

fast movement of fecal matter through colon

etio : enteritis, psychogenic, colitis ulcerative
enteritis :
* etio : virus or bacteria, cholera
* iritation of mucosa
* secretion , motility 
* cholera : electrolite & fluid
secretion from crypts Lieberkuhn   10-12 L/hr
reabsorp colon 6-8 L/hr
* Tx : replace fluid & electrolite that lost (saline iv & glucose)
excretion of excess fluid together feces
3 mechanism :
1. cholera : * enterotoxin released by bacteria of cholera
* enterotoxin stimulates active transport of
NaCl followed by osmotic movement of H2O
into lumen
2. celiac sprue : intestinal mucosa rupture
disturb of absorption
by consumption of gluten
3. lactose intolerance
 COLITIS ULCERATIVE

etiology : idiophatic, alergy/ destructive

immune effect
secretion 
motility 
colon wall : inflamation & ulcer
LARGE INTESTINE
the large intestine receives indigestible material
from the small intestine
its major function is :
* to absorb water from the food residues
* then eliminate them as feces
it frames the small intestine on 3 sides
and extends from the ileocecal valve
to the anal canal
compared to the small intestine :
its diameter is bigger but its length is far shorter
(only about 5').
THE LI HAS 3 DISTINCT CHARACTERISTICS

the longitudinal layer of the muscularis

is reduced to 3 bands of smooth muscle
called teniae coli
their tone causes the LI wall to pucker into
pocketlike sacs called ‘haustra’
 The LI is divided into :

the cecum
appendix
colon
rectum
and anal canal
the sac-like cecum lies below the ileocecal valve
and is the first part of the LI.
within the large intestine are significant numbers
of bacterial colonies
they enter via both the anal canal and the oral cavity
and colonize the LI
in the LI, they metabolize and ferment indigestible
carbohydrates
they also synthesize B vitamins as well as vitamin K.
water absorption occurs as materials pass thru the LI
haustral contractions move material from
one haustrum to another and aid in mixing
mass movements are slow waves of peristalsis
that move feces en masse into the rectum
it should be noted that one stimulus of colonic mass
movements is the presence of food within the
stomach
this is known as the gastrocolic reflex.
feces enter and stretch the rectal wall :
initiate the defecation reflex
this results in :
* the contraction of the sigmoid colon and rectum
muscularis
* the relaxation of the internal anal sphincter
higher input determines whether the external
sphincter remains :
contracted or relaxes.