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FISIOLOGI SISTEM PENCERNAAN MAKANAN
AQSA SJUHADA
Graduate School of Medicine- Dept of Oral Biology- Dept of PhysiologyAirlangga University
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
FUNGSI UMUM
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
Ingestion
Propulsion
Mechanical Digestion
Chemical Digestion
Absorption
Defecation
TERDIRI DARI 6 AKTIVITAS
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
1. Gigi sulung (20)
2. Gigi permanen (32)
3. Lidah
a. otot skelet
b. menggerakkan massa makanan “bolus”
STRUKTUR RONGGA MULUT
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
STRUKTUR RONGGA MULUT (Cont’d)
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
1. orofaring
2. esofagus :
menghubungkan faring dan lambung
3. peristaltik - gerakan ritmis otot polos
FARING
"food tube" yang menghubungkan faring dan
lambung
Berhubungan denga lambung pada bagian cardia
lambung.
Diregulasi oleh sphincter cardia atau
gastroesophageal.
ESOFAGUS
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)
ESOFAGUS (Cont’d)
PENELANAN
(DEGLUTITION / SWALLOWING)
masticated food + saliva = BOLUS
Proses penelanan reflex
1. Stadium volunter
2. Stadium involunter
- Stadium pharyngeal
- Stadium oesophageal
PROSES MENELAN
STADIUM VOLUNTER(Stadium Bukal)
Bolus diletakkan di atas lidah
Didorong ke atas dan belakang pada palatum
Masuk faring
dapat dipengaruhi oleh kemauan
STADIUM PHARYNGEALBolus 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 detiktidak 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 detiktidak dipengaruhi oleh kemauan
PENGATURAN PROSES MENELANPENGATURAN 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
menelanmenelan
AEROPHAGIAAEROPHAGIAudara yg ikut tertelan pd saat menelanudara yg ikut tertelan pd saat menelan
RUCTUSRUCTUS FLATUSFLATUSdikeluarkan kembalidikeluarkan kembali diabsorbsidiabsorbsi
diteruskan ke diteruskan ke coloncolon
dikeluarkandikeluarkan
LAMBUNG
FUNGSI LAMBUNG
Penyimpanan makananPencampuran makanan dg gastric juice menjadi CHYMEPengosongan makanan periodikPencegahan masuknya kumanAbsorbsi 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 JUICEDisekresi oleh:1. Kel. Cardia
sekr mukus, pelindung mukosa2. 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 Pylorussekr mukus + gastrin (oleh G cell)
GASTRIC JUICE
- Volume 1.5-2 liter / hari- pH 1,8 – 3.5- Osmolaritas isotonis- Kandungan:1. Elektrolit2. Pepsin3. Mukoprotein4. Lipase5. Rennin6. Intrinsic factor7. Histamin8. Gelatinase
PEPSIN : suatu enzim proteolitik
PEPSINOGEN PEPSINHCl
PROTEIN POLIPEPTIDApepsin, 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 aktivitasregangan merangs N. Vagus/vagal reflex
2. Duodenumsifat menghambat aktivitasenterogastric reflex ok:distensi duodenum, iritasi duodenum, chyme mengandung banyak protein
GASTRITIS- Peradangan mukosa lambung
Sebab:Iritasi alkohol / obat aspirinInfeksi kumanIritasi 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
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
SEKRESI GASTRIC JUICE
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.
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.
DUODENUM
it’s extends from the jejunum to
the ileocecal valve
it’s about 12' long.
JEJUNUM
it’s about 8' long
extends between the duodenum
and the ileum
ILEUM
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.
HISTOLOGY
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
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.
THE LAYER OF 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 cecum
appendix
colon
rectum
and anal canal
the sac-like cecum lies below the ileocecal valve
and is the first part of the LI.
The LI is divided into :
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.
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