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0810710103
1. Describe the structure of gastro intestinal tract
2. Draw the schematic of the hepatic classic lobules, hepatic acini and portal lobule
Hepatic lobule: Each hepatic lobule is shaped like a hexagon (six-sided structure). left at its center is
the central vein, and radiating out from it are rows of hepatocytes and hepatic sinusoids. Located at
three corners of the hexagon is a portal triad.
Portal lobule: The bile duct of a portal triad is taken as the center of the portal lobule. The portal
lobule is triangular in shape and is defined by three imaginary straight lines that connect three central
veins that are closest to the portal triad.
Hepatic acinus: Each hepatic acinus is an approximately oval mass that includes portions of two
neighboring hepatic lobules. The short axis of the hepatic acinus is defined by branches of the portal
triad branches of the hepatic artery, vein, and bile ductsthat run along the border of the hepatic
lobules. The long axis of the acinus is defined by two imaginary curved lines, which connect the two
central veins closest to the short axis. Hepatocytes in the hepatic acinus are arranged in three zones
around the short axis, with no sharp boundaries between them.
3. Describe the structure of hepatocyte organelles or inclusion involved in the following function:
o Protein synthesis and secretion
Hepatosit memiliki banyak retikulum endoplasma, baik
halus maupun kasar. Retikulum endoplasma kasar
membentuk agregat yang tersebar dalam sitoplasma
yang disebut badan basofilik. Beberapa protein (albumin
darah, fibrinogen) disintesis pada poliribosom di dtruktur
ini.
o Drug detoxification and inactivation
Retikulum endoplasma halus yang tersebar secara difus
di dalam sitoplasma bertanggung jawab dalam proses
oksidasi, metilasi, dan konjugasi yang diperlukan untuk
menonaktifkan atau mendetoksifikasi berbagai zat
sebelum di eksresi dari tubuh.
Septy Aulia Rahmy
0810710103
o Synthesis of bilirubin glucuronida
Bilirubin yang berasal dari hemoglobin, dibentuk di dalam
sistem fagosit mononuklear (yang menxakup sel-sel
kuffer di sinusoid hati) dan diangkut ke hepatosit. Di
dalam retikulum endoplasma halus hepatosit, bilirubin
hidrofobik dikonjugasi dengan asam glukuronat,
membentuk bilirubin glukuronida yang larut air dan
disekresikan ke dalam kanalikuli biliaris.
o Storage of glycogen
Karbohidrat disimpan sebagai glikogen dan biasanya
disimpan di retikulum endoplasma halus (SER). Ketika
glukosa diperlukan, glikogen akan dipecah.
Hepatosit memiliki satu atau dua inti bulat dengan satu atau dua anak inti. Hepatosit merupakan sel
dengan fungsi eksokrin dan endokrin sekaligus, sel ini juga mensintesis dan menimbun zat-zat
tertentu, mendetoksifikasi zat lain, dan mengangkut zat lainnya. Hepatosit juga menghasilkan
berbagai protein plasma untuk dihantarkan, diantaranya albumin, protrombin, fibrinogen, dan
lipoprotein.
Sekresi empedu merupakan suatu fungsi eksokrin karena hepatosit meningkatkan ambilan,
tranformasi, dan eksresi komponen darah ke dalam kanalikuli biliaris.
Hepatosit juga bertanggung jawab untuk proses glukoneogenesis dan juga merupakan tempat utama
berlangsungnya proses deaminasi asam amino, yang menghasilkan urea.
4. Describe the structure of the biliary tract from the liver cells to the duodenum
Empedu disekresi oleh sel hepar ke dalam ductulus biliaris yang bersatu menjadi ductulus biliaris
interlobularis yang bergabung untuk membentuk ductus hepaticus dexter dan ductus hepatikus
sinister.
Ductus hepaticus dexter menyalurkan empedu dari lobus hepatis dexter, dan ductus hepaticus
sinister menyalurkan dari lobus hepatis sinister, termasuk lobus caudatus dan lobus quadratus.
Setelah melewati porta hepatis, kedua ductus hepatis bersatu untuk membentuk ductus hepaticus
communis. Dari sebelah kanan, ductus cysticus bersatu dengan ductus choledochus (biliaris)
yang membawa empedu ke dalam duodenum.
Septy Aulia Rahmy
0810710103
ductus choledochus (biliaris) berawal di sisi bebas omentum minus dari persatuan ductus cysticus
dan ductus hepaticus communis. Ductus choledochus (biliaris) melintas ke kaudal disebelah dorsal
pars superior duodenum dan menempati alur pada permukaan dorsal caput pancreatis. Disebelah kiri
dari bagian duodenum yang menurun, ductus choledochus (biliaris) bersentuhan dengan ductus
pancreaticus, lalu bersatu membentuk ampulla hepatopancreatica.
Ujung distal ampulla hepatopancreatica bermuara ke dalam duodenum melalui papilla duodeni major.
Otot yang terdapat pada ujung distal ductus choledochus (biliaris) menebal untuk membentuk
musculus sphincter ductus choledochi.
Jika musculus sphincter ductus choledochi mengerut, empedu tidak dapat memasuki ampula dan
duodenum, maka empedu akan terbendung dan memasuki ductus cysticus ke dalam vesica biliaris
untuk dipekatkan dan disimpan.
Septy Aulia Rahmy
0810710103
GI4 :Anatomy of Anterior Abdominal Wall
1. Frequently, patient point the area that feel painful, as a doctor we have to know the diseased organs.
Could you draw surface marking of the alimentary tract at the abdomen?
The nine-region designation is used for anatomical studies; the quadrant designation is used to locate the
site of pain, tumor, or some other abnormality.
The extraperitoneal fascia, which separates the transversalis fascia from the peritoneum. Containing
varying amounts of fat, this layer not only lines the abdominal cavity, but is also continuous with a
similar layer lining the pelvic cavity. It is abundant on the posterior abdominal wall, especially around
the kidneys, continues over organs covered by peritoneal reflections, and, as the vasculature is
located in this layer, extends into mesenteries with the blood vessels. Viscera in the extraperitoneal
fascia are referred to as retroperitoneal.
Septy Aulia Rahmy
0810710103
3. Draw the formation of the Rectus Sheath, above and below ArcuateLine !
Ketiga otot pipih disebelah ventral beralih menjadi aponeurosis kuat yang berupa lembar. Di linea alba
serabut setiap aponeurosis membentuk jalinan dengan serabut serupa dari sisi yang lain, untuk
membentuk rectus sheat.
Rectus sheat memiliki:
- Lamina anterior yang dibentuk oleh aponeurosis m.obliquus externus abdominis dan m.obliquus
internus abdominis.
- Lamina posterior yang dibentuk oleh persatuan aponeurosis m.obliquus internus abdominis dan
m.transversus abdominis.
Garis peralihan antara fascia transversalis dan aponeurosis lamina posterior rectus sheat yang
menyerupai sabit dan dikenal sebagai linea arcuata.
The omenta consist of two layers of peritoneum, which pass from the stomach and the first part of the
duodenum to other viscera. There are two: the greater omentum derived from the dorsal mesentery;
the lesser omentum derived from the ventral mesentery.
The greater omentum is a large, apron-like, peritoneal fold that attaches to the greater curvature of
the stomach and the first part of the duodenum. It drapes inferiorly over the transverse colon and the
coils of the jejunum and ileum.
The other two-layered peritoneal omentum is the lesser omentum. It extends from the lesser
curvature of the stomach and the first part of the duodenum to the inferior surface of the liver. The
lesser omentum is divided into: a medial hepatogastric ligament,
which passes between the stomach and liver; and a lateral
hepatoduodenal ligament, which passes between the duodenum and
liver.
The hepatic portal system drains blood from the visceral organs of the abdomen to the liver. In normal
individuals, 100% of the portal venous blood flow can be recovered from the hepatic veins, whereas in patients
with elevated portal vein pressure (e.g. due to cirrhosis), there is significantly less blood flow to the liver. The
rest of the blood enters collateral channels, which drain into the systemic circulation at specific points. The
largest of these collaterals occur at:
1) the gastroesophageal junction around the cardia of the stomach-where the left gastric vein and its
tributaries form a portosystemic anastomosis with tributaries to the azygos system of veins of the
caval system;
2) the anus - the superior rectal vein of the portal system anastomoses with the middle and inferior
rectal veins of the systemic venous system;
3) Periumbilical region umbilicus - the para-umbilical veins anastomose with veins on the anterior
abdominal wall (left portal vein and the superficial veins of the anterior abdominal wall).
4) Retroperitoneal Areas colic veins (portal system) anastomosing with retroperitoneal veins
(systemic system)
When the pressure in the portal vein is elevated, venous enlargement (varices) tend to occur at and
around the sites of portosystemic anastomoses and these enlarged veins are called:
Hemorrhoids (2) at the anorectal junction;
esophageal varices (1) at the gastroesophageal junction;
caput medusae (3) at the umbilicus.
Ascites (4) is the accumulation of uid in the peritoneal space. Portal hypertension increases
hydrostatic pressure in intestinal and mesenteric capillaries, causing uid leakage.