dr.Yhusi Karina,MSc.

SISTEM PENCERNAAN

Tujuan Pembelajaran
Mahasiswa mampu menjelaskan:
Fisiologi pengecapan, mekanisme mengunyah dan menelan, motilitas saluran pencernaan Mekanisme kerja dan pengendalian sekresi saluran dan kelenjar pencernaan Mekanisme absorbsi nutrient dan peranan enzim pencernaan Mekanisme defekasi

Fungsi Sistem Pencernaan

Energy & nutrient intake
Merubah makanan CHO,protein,Lemak diserap ke pembuluh darah atau limfe

Excretion of waste products

Makanan yang tidak dapat dicerna&diabsorbsi, bakteri,pigmen SDM, obat

Protection from noxious intake

Hipersalivasi,muntah, asam lambung, diare

Protection from micro-organisms

Gastric acid & GALT

Regulatory function
stimulation or suppressing appetite

Proses Utama Pencernaan

Motility
Aktivitas otot saluran pencernaan yang memungkinkan pergerakan makanan pada saluran pencernaan

Secretion
Transfer air/ion dari ekstra sel ke lumen atau pengeluaran sintesa epitel saluran cerna

Digestion
Perubahan bentuk makanan (mekanis/kimia) menjadi molekul yang dapat diserap epitel saluran cerna

Absorption
Transport nutrient dari lumen saluran pencernaan ke cairan ekstra sel

Fase Regulasi Sistem Pencernaan

Fase Cephalic
Mulai dari melihat, mendengar, berfikir & mencium bau makanan, diperantarai oleh N.X, merangsang reflek salivasi, sekresi & kontraksi lambung Mempersiapkan sistem pencernaan untuk menerima makanan

Fase Gastric
Ketika makanan ada di lambung Isi dan volume lambung merangsang reflek untuk sekresi dan meningkatkan motilitas lambung

Fase Intestinal
makanan masuk ke usus kecil Isi&vol usus memulai reflek sekresi bikarbonat, enzim, empedu dan mengawali kontraksi segmental Reflek inhibisi usus yang memperlambat pengosongan lambung

Inervasi dan Regulasi Sistem Pencernaan

1. Extrinsic innervation 2. Intrinsic/enteric nervous system gut brain/little brain 3. Hormones 4. Paracrines 5. Neurocrines

CNS & Enteric Nervous System (ENS)

NAMES AND LOCATION OF THE MAJOR SALIVARY GLAND IN THE HUMAN

Parotid duct Parotid gland Watery,20%,N.IX Sublingual gland Viscous,5%,N.VII

Submandibular gland Moderately viscous,70%,N.VII

Adapted by:
dr. Yhusi

Proses Menelan
Fase oesophageal
Fase buccal

Fase pharyngeal

Proses Mengunyah&Menelan
Pola&Ritme mengunyah diatur oleh cortek & batang otak Menelan,diawali secara volunter, selanjutnya involunter Diawali oleh rangsangan taktil pada reseptor dekat faring N.V,IX medula oblongata (tractus solitarius, formatio reticularis) N.V,IX,X,XII makanan masuk ke esofagus Dua jenis peristaltik esofagus
Primer saat menelan setelah fase faringeal Sekunder terjadi bila bolus macet di esofagus atau jika ada refluk isi gaster

Sphincter Locations
Consider as traffic control devices Total of seven
Upper and lower esophageal sphincters Pyloric sphincter Sphincter of Oddi common bile duct entry into duodenum Ileocecal Internal and external anal sphincters

THE THREE REGIONS OF THE STOMACH : FUNDUS, BODY, AND ATRIUM

Esophagus Fundus Body/Corpus (secretes mucus Pepsinogen and HCI)

Duodenum

Pyloric sphincter

Antrium (secretes mucus Pepsinogen and gastrin)

Adapted by:
Dr.Yhusi

Cells in Gastric Mucosa

Gastric juice
Volume 2500mL/day; pH 1.0 Chemical composition:
Organic : Enzymes: pepsin, lipase, Rennin, Mucus, Intrinsic factor Inorganic: Cations (H+, Na+, K+, Mg 2+); Anions (Cl-, HpO4+, SO4) +

Increase secretion:Hypoglycaemia,Alcohol or caffeine, Histamine,Anxiety Decrease secretion:Sadness, fear, PGE2 Carbohydrate,Protein digestion & Absorption of alcohol

Sekresi Asam Lambung

30% pada fase sefalik 50% pada fase gastric 20% pada fase intestinal Netralisasi oleh pengenceran saliva dan reaksi dengan NaHCO3 Membentuk H2CO3 & NaCl H2CO3 H2O + CO2 Sendawa

Gastric Mucus-Bicarbonate Barrier

Figure 21-15

Integration of Gastric Secretion

Gastric Motility & Emptying

Receptive relaxation Mixing and kneading
Reduces particle size Mixes gastric secretions with gastric contents

Retropulsion - stomach throws contents against closed pyloric sphincter Nutrient content, osmolality and pH of chyme influence rate of gastric emptying Neural (N.X, myenteric reflex) & hormonal (gastrin,CCK,sekretin,GIP) signals control gastric emptying

Intestinal Phase

Pancreas Duct cells Secrete bicarbonate Endocrin cells Of pancreas

BLOOD

LUMEN OF GASTROINTESTINAL TRACT

Pancreatic duct

HCO3 + H+ H2CO3 CO2+H20

Stomach Parietal cell

HCO3 +

Pancreatic Duct cells And liver

H+ H2CO3 CO2+H20

Duodenum

Stomach Common bile Duct from gall bladder

STRUCTURE OF THE PANCREAS

ACID SECRETED

Pancreatic juice
Volume:1200-1500 mL/day;pH:8 Two important components :
Bicarbonate aqueous solution :
Neutralizes gastric acid, Optimal environment for luminal digestive enzymes Secretin major role in stimulating Major protein, fat CHO & other assorted digestive enzymes come from pancreas (Albumin, globulin, digestive enzymes:Proteases, pancreatic amylases & lipase,colipase,bile-salt avtivated lipase,etc) CCK (cholecytokinin) - major role in stimulating

Luminal digestive enzymes

3 phases; chepalic,gastric,intestinal

Activation of Pancreatic Enzymes

Prevention of Pancreatic Self-digestion

Digestive enzymes - made in zymogen or precursor form, require activation activated by trypsin, trypsin activator is enterokinase Enterokinase is physically separate from pancreas - on brush border of enterocytes Just-in-case - pancreas also makes a trypsin inhibitor

Liver & Biliary system

Bile:
Secreted by liver Stored, concetrated, acidified in the gall bladder Made up of: Bile salts for fat digestion & absorption Bile pigments biliverdin, bilirubin glucuronids

Control of secretion :
Major factor - enterohepatic circulation of bile salts CCK - gallbladder contraction, relaxes sphincter of Oddi Secretin stimulates HCO3 production

Diagram of Hepatic Lobule

Enterohepatic recirculation of bile

Usus Kecil
panjang 5m, bagian awal 5% disebut duodenum, 40% jejunum, 55% ileum Kimus menempuh waktu 2-4jam untuk melewati usus kecil Tempat terjadinya hampir semua pencernaan (KH,lemak,protein), absorbsi nutrient, cairan dan elektrolit Sekresi Hormon(CCK,Sekretin,Ghrelin), Enzymes(Enterokinase, Disakaridase, Peptidase), cairan H2CO3

Digestive Enzymes

Motility in Small Intestine

Types of Contractile Behavior
Segmental contractions - mixing, turning of chyme Peristaltic contrations - move chyme down GI tract, typically over small distances = 10 cm Migrating myoelectric complexes (MMC) occur only in fasted state (between meals)

Motility in the Small Intestine

Figure 21-4

Types of Colonic Motility

Colon : Absorbtion of Water&Electrolyte Segmental contractions - mixing Peristaltic contractions - move contents small
distances

Mass movements - usually only occur one to 3 times daily:Move contents longer distances than
simple peristalsis

Entero-enteric reflexes
Gastrocolic reflex Colonocolonic reflex

Defecation
Fecal material entering rectum
Relaxation of internal anal sphincter Concious awareness of need to go

If environmental conditions are favorable - voluntary & involuntary contractions defecation If conditions are not favorable conscious contraction of external anal sphincter - overcomes reflex, internal anal sphincter regains tone, sensations decrease/go away