motilit

Sistem Pencernaan dan absorbsi

Organ saluran pencernaan :
oral anal
Kelenjar pencernaan :
kel saliva : parotis,
submandibularis,
sublingualis
Hati dan kandung empedu
Pankreas

ORGAN SAL
SAL PENCERNAAN
PENCERNAAN
ORGAN

Dinding terdiri 3 lapis :

- serosa
- muskularis (otot polos
longitudinal dan sirkuler)
- mukosa (lipatan lipatan dan
villi/tonjolan)

Peristaltik : kontraksi relaksasi

otot polos, teratur dan mandiri
Mencampur dan mendorong
makanan

FISIOLOGI UMUM
UMUM
FISIOLOGI
UTAMA
PENCERNAAN : fisik dan kimia
ABSORBSI : semua bahan yang masuk
saluran pencernaan (makanan dan
bukan makanan)
TAMBAHAN
Motility (peristaltik)
SEKRESI : enzim dan getah pencernaan
EKSKRESI : bahan yan tidak diserap
dan sisa metab tertentu

Persarafan
intrinsik :
Meisners (submucous)
Auerbachs
(muskularis/myentricus)
ekstrinsik :
simpatis : hambat sekresi dan
kontraksi
parasimpatis : rangsang sekrsi
dan kontraksi
Cajal IntertitiilCell (pace maker)

Hubungan motilitas
sekresi dengan pencernaan
- absorbsi
Tidak ada yang secara langsung
mengendalikan pencernaan dan absorbsi,
tetapi dipengaruhi oleh motilitas dan
sekresi
Mitilitas dan sekresi dikendalikan oleh 3 hal
1. sistem saraf otonom
2. sistem hormonal
3. sistem pengendali lokal

Neural control of the

wall gut

LAMBUNG
Pencernaan karbohidrat
lanjutan dari alfa amilase saliva
Dinonaktifkan oleh asam lambung
Terjadi di korpus lambung
Pencernaan protein
Oleh pepsin
Terjadi di antrum
Penyerapan alkohol dan asam
salisilat

PENCERNAAN DAN
ABSORPSI
USUS HALUS

USUS HALUS
Terdiri dari : duodenum, jejenum dan
ilium
Panjang 5m, permukaan absorbsi 250m2
Pembuluh darah balik bergabung (v.
porta)
Duktus koledokus dan pankreatikus
bermuara di duodenum (ampula vateri)
yang dilengkapi sfingter oddi
Lapisan mukosa mengalami pembaharuan
secara cepat (kripta Liberkuhn berperan
sebagai penyedia sel punca)

The intestinal wall

Structure of villi small

intestine

ADAPTASI PENINGKATAN
KAPASITAS PENYERAPAN DI USUS
HALUS

Usus halus memiliki kapasitas

penyerapan yang luar biasa ok adaptasi
peningkatan luas permukaan dan
berbagai mekanisme transpor khusus
Peningkatan luas permukaan :
Lipatan mukosa sirkuler (peningkatan 3x
lipat)
Villus (tonjolan mikroskopis seperti jari
(meningkatkan 10x lipat)
Mikrovillus di permukaan luminal villus
(brush border (peningkatan 20x lipat)
Secara kolektif peningkatan 600x lipat)

Intestinal secretion
Mucus
preventing damage the intestinal wall from
HCL and chyme
secreted by Brunners gland and Goblets cell
Enzymes
Assosiated with epythelial cell lining the
intestin, not secreted into the intestin
Breaking down small peptides and
disaccharides
Water and electrolytes
Secreted by all the epythelial cell of the
intestin
excessive produced (cholera) : watery diarrhea

ABSORPSTION IN
THE SMALL
Several hundred grams
INTESTINE
(carbohydrate)
100 or more grams (fats)
50 to 100 grams (amino
acids)
50 to 100 grams (ions)
7 to 8 liters (water)

DIGESTION AND ABSORPTION OF

CARBOHYDRATES
INTAKE IS 250-800 G/DAY (50%-60% OF
THE DIET)
THREE MAJOR CARBOHYDRATES :
1. Disaccharides : sucrose (cane
sugar), lactose (milk sugar)
2. Polisaccharides : amylum (straight
chain form), amylopectin (branch
chain form)
3. Cellulose and ather dietary
fiber(no enzymes in human
digestive tract can digest)

Digestion of carbohydrates
Carbohydrates must be digest into
monosaccharides before being absorpbed
Almost all it digestion occurs within the
small intestin
Pancreatic amylase digest
polysaccaribdes into a variety of
oligosaccharides
The oligosaccharides are digest into
monosaccharides by brush border
enzymes (sach as maltase, lactase,
sucrase)
The end product are fructose, galactose,
glucose

Mecanism of absorption of
carbohidrates
Glucose and galactose : absorpbed by Na
dependent active transport system (SGLT 1)
Fructose : facilitated difussion (rapidly
converted into glucose) (GLUT 5)
Glucose, galactose, fructose out from
enterocyte by GLUT 2
Absorption is not regulated (can absorb over
5 kg sucrose)
exept cellulose and other dietary fiber
(cannot digest by human intestinal
Failure to absorb :
diarrhea (osmotic particle)
intestinal gas (H2, CH4, CO2) produced by the
flora of intestin and colon
lactose intolerance

PROTEIN
Requerement :
0,5-0,7 g/kg BW (adults)
4 g/kb BW (children 1-3 years old)
Sources :
endogeous proteins (30-40 g/day) :
secretary proteis and protein
component of descuamated cells
exogenous proteins (75-100 g
daily)

DIGESTION
10% 15% digested by gastric
pepsin
Pancreatic protease (tripsin,
kemotripsin) : play a mayor
role in protein digestion
Peptidase (secreted by the
intestinal epithelial cells) :
converting into small
polipeptides and amino acids

ABSORPTION
Na dependent active transport system.
Once inside the enterocytes,
intercelluler peptidases digest same
polipeptidases into amino acids.
Amino acids transported across
basolateral membran by facilitated or
simple duffusion.
Malabsorption :
Hartnup Disease (due to luck of
transporter)
Pancreatic Diseases

FATS
FATS
Intake varies widely : 30 160
g/day
Very litle lipid digestion occurs in
mouth or stomath
Absorbed by passive diffusion.
They must be made soluble in
water.
Bile salt is required for to
solubilization

DIGESTION
Emulsification : broken
down into small droplets by
bile acids and lechitin
(before digested)
Pancreatic lipase : cleaves
triglycerides into glycerol
and fatty acids
Cholesterol esterase :
Choleterol ester fatty

Transport of lipid by bile salt

ABSORPTION
Micelle formation : the emulsified
product must form micelle with bile
salt before absorption.
Abbsortion of lipids and bile salt
from micelles
Formation of chylomicrons by
enterocytes (triglycerides,
phospholipids, ester cholesterol
covered by -lipoprotein
Transport lipids into limphatic
circulation

Summary of fat absorption across the walls of the small

intestine

Enterohepatic circulation of bile

salt

LIPID MALABSORPTION
(steatorrhe)
Caused by one of them :
1.Pancreatic disease
2.Gastrin hipersecretion (cause
decreese the pH intestine)
3.Ileum resection
4.Growing of intestinal bacteria
5.Tropical sprue
6.Insufisiensi of apoferitin B sintese

WATER AND ELECTROLYTES

GI tract are secretion same water
and electrolyte (salivary, gastric,
biliary, pancreatic, small and
large intestine)
The mecanism of electrolyte
secretion in the cripta;
The mecanism of electrolyte
absorbtion in the villi
Small intestin absorb 7-8 L of water
(ingestion, salivary, gastric,
biliary and pancreatic secretion)
Scundary with solut absorbtion (Na
dependent)

Na, CL, H2O

ABSORBTION
NaCl enters the enterocytes:
1. Electorchemical gradient
2. Na-glucose, Na-amino acids, Napeptide cotransport system.
3. Na - CL cotransporter system
4. Na H exchange
Na transportted acrros basolateral
membran by transport active
Cl passively down the elecrochemical
gradient.
H2O absorbed pasivvely dependent
Na (osmosis) and diffusion

Mechanisms of electrolyte transport in

the Jejenum

Mechanisms of electrolyte
transport in the Ileum

VITAMINS AND MINERALS

Fat soluble vitamins (A D E K) :
Absorbed together with fat in the
proximal intestine.
Inhibited by false fat (Olestra) and
inhibitor lipase (Orlistat).
Water soluble vitamins : by
facilitated transport or Na
dependent ac. transp.
B12 : bound R protein in the stomach.
bound intrinsic factor in the
intestine

VITAMINS AND MINERALS

Calcium ions

650-1000 mg is absorbed

actively absorbed , especially from the duodenum

controlled to supply exactly the daily need of the

body for calcium. regulated by the vitamin D
and parathyroid hormone
Iron :

Fe2+ more efficiently than Fe3+

absorbed in ileum

controlled : dependent on the bodys need

for iron,

activ absorbed with divalent metal

transporter 1 (DMT1)

regulated by hepsidin (produced by hepar)

Absorption in the Large

Intestine
About 1500 milliliters of chyme
normally pass through into the large
intestine each day
The large intestine can absorb a
maximum of 5 to 8 liters of fluid and
electrolytes each day.
Most of the water and electrolytes in
this chyme are absorbed
less than 100 milliliters of fluid to be
excreted in the feces

Absorption in the Large

Intestine
The mucosa of the large intestine, has a
high capability for active absorption of
sodium, and the electrical potential
causes chloride absorption as well
aldosterone greatly enhances sodium
transport capability.
the mucosa of the large intestine secretes
bicarbonate ions while it simultaneously
absorbs an equal number of chloride ions
Absorption of sodium and chloride ions
creates an osmotic gradient, which in turn
causes absorption of water.

Hormonal regulation of pancreatic enzyme

secretion

Regulation of bile entry into the small

intestine

RANGKUMAN PENCERNAAN DAN

PENYERAPAN
NUTRIEN

PENCERNA LOKASI
MEKANISME
AN
PENYERAPA PENYERAPAN
N

Karbohidrat

Monosakarida
(glukosa,
galaktosa dan
fruktosa
Asama amino,
dipeptida,
tripeptida

Usus halus
(duodenum dan
jejenum)

Asam lemak,
monogliserida,
kolesterol

Usus halusn
(duodenum dan
jejenum)

Protein

Lemak

Usus halus
(duodenum dan
jejenum)

Kotransporter tergantung Na
( transport aktiv skunder)
(glukosa dan galaktosa)
Difusi fasilitasi (fruktosa)
Kotransporter tergantung Na
(as amino)
Kotransporter tergantung H
(di dan tripeptida)
Misel terbentuk dalam lumen
usus,
Difusi asam lemak,
monogliserida dan kolesterol
ke dalam sel enterosit
Re-esterifikasi dalam sel
menjadi trigiserid dan
fospolipid
Kilomikron terbentuk dalam
sel (memerlukan apoprotein)
dan ditrasver ke pembuluh
limfe

RANGKUMAN PENCERNAAN DAN

PENYERAPAN
NUTRIEN PENCERNA
AN
Vitamin
larut
lemak
Vitamin
larut air
Vit B12

LOKASI
PENYERAPAN
Usus halus
(duodenum
dan jejenum)
Usus halus
ileum

Ca

Usus halus

Fe2/Fe3

Reduksi
menjadi
Fe2

Usus halus
(ileum)

MEKANISME
PENYERAPAN
Misel dengan garam
empedu
Kotransporter
tergantung Na
Komplek dengan
factor intrinsic
lambung
Tergantung vit D
(kalbindin 28K)
Terikat dengan
apoferitin dalam sel

BEBERAPA KEADAAN YANG

MENYEBABKAN
MALABSORBSI

1.Defisiensi enzim pencernaan

2.Peningkatan transit time
makanan
3.Hipersekresi usus
4.Gangguan mekanisme transport
5.Diet serat
6.Reseeksi usus