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FAAL SISTEM PENCERNAAN
Dr. H. SONNY P LAKSONO M.Kes
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Overview of
GI Processes
Food
Secretion
Digestion
Absorption
Boo! "esses
Motiit#
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Mo$t%
•on# p&rt in'o'e! in ingestion
•Or& c&'it#( b$cc& c&'it#
•Lips) c%ee*s) %&r! &n! so+t p&&te &n!
tong$e
•Most &cti'it# re&te! to &ccessor#
org&ns ,teet%) s&i'&r# g&n!s) &n!
tong$e-
•Foo! is c%ee!) /i0e! it% s&i'&
cont&ining en1#/es) begins s&oing
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&ccessor# !igesti'e org&ns
•Organs
–teeth, tongue, gallbladder, glands
( salivary glands, liver, pancreas)•contribute to food breakdown
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P%&r#n0
•orop%&r#n0 to &r#ngop%&r#n0
•,n&sop%&r#n0 not in'o'e! in !igestion-
•Co//on p&ss&ge&# +or +oo!) +$i!s &n!&ir
•No p%#sic& or /ec%&nic& !igestion
•Absorption2 none
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Esop%&g$s
•/$sc$&r t$be &bo$t 34c/ ,56 inc%es- ong•Co&pse! %en not in $se•Ro$te! %ere &s epigottis coses o++ &r#n0 to+oo! entr#
•7oins sto/&c% &t c&r!i&c sp%incter •Secretes /ore /$c$s +or $bric&tion•No p%#sic& or /ec%&nic& !igestion•P%&r#n0 &n! esop%&g$s &re con!$its +ro//o$t% to sto/&c%
•Absorption2 none
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Digestion
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Cephalic Phase
• Anticipatory/Sensory
• Mediated via vags/Ach
! Chief cells secrete acid
! Parietal cells secrete pepsinogen
! G cells secrete gastrin
• "ags also #ediates via pancreas
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Gastric Phase
• $egins with arrival of food in sto#ach
• Two sti#li%
! stretch receptors in sto#ach
! digested protein
• G cells in antr# sti#lated &y vags and
&y protein
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Digesti'e process in'o'es 8 essenti& &cti'ities
5. ingestion2 t&*ing +oo! in – bo$s2 &n &/o$nt o+ +oo! p&ssing t%ro$g% tr&ct
3. prop$sion2 /o'es +oo! t%ro$g% tr&ct – s&oing2 'o$nt&r# – perist&sis2 in'o$nt&r# /$sc$&r &'es /o'es +oo! +or&r!
9. /ec%&nic& !igestion2 p%#sic& c%eing) /i0ing) c%$rning – seg/ent&tion2 r%#t%/ic oc& constrictions o+ intestine +or /i0ing
:. c%e/ic& !igestion2 c&t&bois/( bre&*!on o+ po#/ers into/ono/ers b# en1#/es – begins in /o$t%) essenti&# co/pete in s/& intestine
4. &bsorption2 p&ss&ge o+ !igeste! en! pro!$cts &cross & into boo!
– /ono/ers) 'it&/ins) /iner&s &n! &ter – p&ss t%ro$g% /$cos& ces ining tr&ct – s/& intestine /&;or &bsorption site
8. !e+ec&tion2 ei/in&tes in!igestibe s$bst&nces &n! ot%er &stes +ro/bo!# 'i& &n$s in +or/ o+ +eces
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Sto/&c%
•<%o!ing t&n*= i/port&nt in protein
!igestion
•Foo! con'erte! into c%#/e•M&0i/$/ c&p&cit# &bo$t :L or 5 g&on
•L&rge ongit$!in& +o!s c&e! r$g&e
•P#oric sp%incter contros e/pt#ing
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Microanato#y of the GtThe $asic Plan
• Mcosa
• S&#cosa
• Msclaris
• Serosa
• 'egional variations (
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Secretion of )ater and *lectrolytes
Na+
+
!l"
Na+
+
!l"
Na+
#$O
L
>M
EN
%nterocyte
%nterocyte &ight 'unction
+
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S/& Intestine
•/&;or !igesti'e org&n•Longest p&rt o+ &i/ent&r# c&n&
–,928 %o$r ;o$rne#-
•9 s$b!i'isions –5- !$o!en$/•s%ortest b$t ots going on•Hep&top&ncre&tic &/p$&2 bie !$ct &n! /&inp&ncre&tic !$ct enter
–3- ;e;$n$/•/i!!e portion
–9- ie$/•&st p&rt ;oins &rge intestine &t ieocec& '&'e
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+, Secretion &y Parietal Cells
+
#+
%nterocyte
%nterocyte
L
>M
EN
!O$ + #$O
#!O" + #+
!l"
#!O"
CA
!O$
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+CO-. Secretion &y Pancreatic Cells
%nterocyte
%nterocyte
+Na+
L
>M
EN
!l"
#!O"
CA
!O$ + #$O
#+
+ #!O
"
!O$
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A&sorption
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Pri#ary S&stances A&sor&ed
• Car&ohydrates
• Peptides
• ats
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Motility
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Two Types of Move#ent
• Peristaltic
! #oves food forward
• Seg#ental
! #i0ing
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So#e Selected GI Disorders
• Disorders of the GI Tract
! #ala&sorption 1lactase deficiency2
! #otility 1G*'D2 ! constipation/diarrhea
! &leeding and pain
• Disorders of Accessory Organs ! Ascites
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3actase Deficiency
• Deficiency of lactase
at &rsh &order
• Increased lactose provides car&on for
&acteria
• Presents as &loating4
cra#py pain4 os#oticdiarrhea Microvills
*n5y#es
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Constipation
• Many Cases
! 7erogenic
• eg% +irschsprng8s
! Mscle wea9ness
• eg% post.srgery
! 3ow.reside diets• T#t(
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Diarrhea . Three Mechanis#s• Os#otic
! os#oticant in intestine
• Secretory
! e0cessive #cosal secretion
! to0ins4 so#e t#ors
• Motility
! srgical
#$O
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3a0atives )e :now and 3ove
• A; Irritants and Sti#lants
! Castor oil4 aloe4 phenophthalein
• $; $l9ing Agents ! Psylli#4 &ran4 #agnesi#
• Stool softeners
! Dcosate4 #ineral oil4 glycerin