Anatomi & Fisiologi

Gastrointestinal System

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Sistem Pencernaan
Gastrointestinal (Gl) tract (Alimentary
canal)
Tube within a tube
Berhubungan langsung atau sebagian
dengan organ-organ
Structures
Mouth - Oral Cavity Pharynx
Esophagus Stomach - Duodenum
Jejenum Ileum Caecum Ascending colon - Transverse colon Descending Padoli,
colon
- Sigmoid colon
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GI Tract.
Rectum - Anus

Gastrointestinal System

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Processing of food
Types :
Mechanical (physical) : Mengunyah (Chew),
melumasi (Tear), menggiling(Grind), menghaluskan
(Mash), mencampur (Mix)

Chemical
Catabolic reactions
Enzymatic hydrolysis
Carbohydrate
Protein
Lipid

Phases : Ingestion Movement- DigestionAbsorption- Further digestion

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Accessory structures

Organs : Teeth, Tongue, Salivary glands,

Liver, Gall bladder, Pancreas

Batas-Batas Mulut adalah :
Atas : palatum mole dan palatum durum
Bawah : mandibula, lidah dan struktur dasar
mulut
Lateral :Pipi
Belakang : osteum ke dalam faring.
Di dasar mulut terdapat cekungan yang
dibawahnya terdapat kelenjar submandibula
kanan dan kiri, kelenjar sublingual kanan kiri
yang mensekresi saliva.
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Anatomy of the Mouth and Throat

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Dorsal Surface of the Tongue

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Deglutition (swallowing)
Sequence
Voluntary stage
Push food to back of
mouth

Pharyngeal stage
Raise
Soft palate
Larynx + hyoid
Tongue to soft palate

Esophageal stage
Contract pharyngeal
muscles
Open esophagus
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Deglutition (swallowing)
Control
Nerves
Glossopharyngeal
Vagus
Accessory

Brain stem
Deglutition center
Medulla oblongata
Pons

Disorders
Dysphagia
Aphagia
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The Major Salivary Glands

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Esophagus
Faring merupakan tuba fibromuskuler yang
melekat pada dasar tulang tengkorak disebelah
atas dan berlanjut dengan esofagus.
Faring terdiri dari nasofaring, orofaring dan
laringofaring yang berlanjut pada esofagus.
Esofagus mrp tube muskuler dengan panjang
sekitar 25 cm dan diameter 0,5 cm.
Esofagus dimulai dari bagian leher lanjutan
faring, menjalar ke bawah leher dan toraks
melewati persimpangan sebelah kiri diafragma
dan masuk ke lambung.
Functions :Secrete mucousTransport food
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Stomach (Lambung)
Lambung terdapat di kuadran kiri atas abdomen,
biasanya berbentuk J. terletak disebalah kiri
anterior limpa (spleen)
The wall of the stomach is lined with millions of
gastric glands, which together secrete 400800
ml of gastric juice at each meal.
Mucous membrane
G cells make gastrin
Goblet cells make mucous
Gastric pit Oxyntic gland Parietal cells Make
HCl
Chief cells Zymogenic cells :Pepsin, Gastric lipase
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Stomach (Lambung)

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The Stomach
Major Function:

Start of digestion by HCl & pepsin

Storage of nutrients
Controlled passage of bolus into duodenum
(*Also breakdown & absorption of Medications)
Its walls layered with powerful muscles, your
stomach churns to break food into smaller and
smaller pieces. Gastric juices, produced by the
glands that line your stomach, prepare the food
for absorption

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 3 muscle layers :
Oblique, Circular, Longitudinal

Regions
Cardiac sphincter, Fundus, Antrum (pylorus),
Pyloric sphincter

Vascular
Inner surface thrown into folds Rugae
Contains enzymes that work best at pH 1-2

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Stomach
Functions
Absorbs:
Menyampur makanan
Alcohol, Water,
Menampung makanan
(Reservoir)
Lipophilic acid,
Memulai pencernaan :
B 12
Protein, Nucleic acids,
Fats
Mengaktifkan bbrp enzym
Menghancurkan bakteri
Menghasilkan faktor
intrinsic u/ absorpsi B 12
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Small Intestine
Usus halus terdiri dari 3 bagian,
duodenum, jejunum dan ileum.
Panjang usus halus 6 m (4,6-9m).
Duodenum 25 cm (12 inchi), jejunum 2,5
m atau 2/3 panjang usus halus, dan ileum
3,5m atau 3/5 panjang usus halus.
Memanjang dari pyloric sphincter
ileocecal valve
Movements : Segmentation, Peristalsis
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Small Intestine
Absorbs
80% ingested water
Electrolytes
Vitamins
Minerals
Carbonates
Active/facilitated
transport
Monosaccharides

Proteins
Di-/tripeptides
Amino acids
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Lipids:
Monoglycerides
Fatty acids
Micelles
Chylomicrons

Small Intestine

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Small Intestine
Secretes digestive enzymes

Peptidases : Amino-, Di-, Tri Sucrases

Maltase
Lactase
Saccharidases: Di-, Tri Lipase
Nucleases
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Sebelum nutrient diabsorbsi villi usus halus,

nutrient harus dipecah menjadi manomer

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Large Intestine
5 feet long; 2 5/8 inch diameter
Extends from the ileum to the anus
Movement in the large intestine consists of
peristalsis, which is mild & slow, haustral
churning, & mass movements.

Regions
Cecum Appendix
Colon : Ascending, Transverse, Descending
Rectum
Anal canal
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Anatomy of the Large Intestine

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Large Intestine
Histology
No villi
No permanent circular folds
Smooth muscle
Taeniae coli
Haustra

Epiploic appendages
Otherwise like rest of Gl tract

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Large Intestine
ascending colon - lower right side of abdomen
becomes the transverse colon at the hepatic
flexure, crosses the mid-abdomen , bends down
at the splenic flexure on the left side & becomes
the descending colon
At the level of the iliac crest, colon curves like
"S" (sigmoid) colon - terminates at the:
Rectum
Anal canal - 1" long
Anal Sphincter (internal & external)-remain
closed x during defecation
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Feces Formation and

Defecation

Chyme dehydrated to form feces

Feces composition
Water
Control :
Inorganic salts
Parasympathetic
Epithelial cells
Voluntary
Bacteria
Byproducts of digestion
Defecation
Peristalsis pushes feces into
rectum
Rectal walls stretch
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Large Intestine
The large intestine receives the liquid
residue after digestion and absorption are
complete.
This residue consists mostly of water as
well as materials (e.g. cellulose) that were
not digested.
While the contents of the small intestine
are normally sterile, the colon contains an
enormous (~1014) population of
microorganisms. (Our bodies consist of
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only ~1013 cells!) Padoli, GI Tract.

Large Intestine
Most of the species live there perfectly
harmlessly; that is, they are commensals.
Some are actually beneficial, e.g.,
by synthesizing vitamins and
by digesting polysaccharides for which we
have no enzymes (providing an estimated
10% of the calories we acquire from our
food).
Bacteria flourish to such an extent that as
much as 50% of the dry weight of the
feces may consist of bacterial cells.
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Large Intestine
Reabsorption of water is the chief function of the
large intestine. The large amounts of water
secreted into the stomach and small intestine by
the various digestive glands must be reclaimed
to avoid dehydration. If the large intestine
becomes irritated, it may discharge its contents
before water reabsorption is complete causing
diarrhea. On the other hand, if the colon retains
its contents too long, the fecal matter becomes
dried out and compressed into hard masses
causing constipation.
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Liver
Location
R. Hypochondrium Dual blood supply :
Epigastric region 1. Hepatic portal vein ;
Direct input from small
4 Lobes
intestine
Left
2. Hepatic artery/vein;
Quadrate
Direct links to heart
Caudate
Right
Each lobe has lobules Contains hepatocytes
Surround sinusoids Feed into central vein
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Berat liver, 1,36 kg (3

pons)

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Liver

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Liver
Functions
1. The liver secretes
bile

2. Detoxifies/removes:

Drugs, Alcohol
3. Stores : Gycolgen,
Vitamins (A, D, E, K), Fe
and other minerals,
Detergent emulsifies
Cholesterol
fats

4.
Release promoted by:
5.
Vagus n., CCK,
6.
Secretin
7.
Contains : Water, Bile
salts, Bile pigments,
Electrolytes,
Cholesterol, Lecithin
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Activates vitamin D
Fetal RBC production
Phagocytosis
Metabolizes absorbed
food molecules :
Carbohydrates, Proteins,
Lipids

The hepatic portal system

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The capillary beds of most tissues drain into veins that lead
directly back to the heart. But blood draining the
intestines is an exception. The veins draining the
intestine lead to a second set of capillary beds in the
liver. Here the liver removes many of the materials that
were absorbed by the intestine:
1. Glucose is removed and converted into glycogen.
2. Other monosaccharides are removed and converted
into glucose.
3. Excess amino acids are removed and deaminated.
1. The amino group is converted into urea.
2. The residue can then enter the pathways of cellular respiration
and be oxidized for energy.

4. Many nonnutritive molecules, such as ingested drugs,

are removed by the liver and, often, detoxified.
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Accessory Organs: Pancreas

Pancreas terletak sebelah belakang
bagian atas duedenum. Pancreas dibagi
menjadi kaput, kolum, korpos dan ekor.
Panjang pankreas 6 dan lebar 1.
Sel-sel pancreas mensekresi cairan
pankreas yang menghasilkan enzym
pencernaan : amylase - starch , lipase fats , trypsin, chymotrypsin & other
proteases, which split proteases into
peptides
Endocrine functions - (insulin & glucagon)
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& Exocrine functions
high Bicarbonate

Pancreas

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The pancreas
The pancreas consists of clusters if endocrine
cells (the islets of Langerhans) and exocrine
cells whose secretions drain into the
duodenum.
Pancreatic fluid contains:
1. sodium bicarbonate (NaHCO3). This
neutralizes the acidity of the fluid arriving from
the stomach raising its pH to about 8.
2. pancreatic amylase. This enzyme hydrolyzes
starch into a mixture of maltose and glucose.
3. pancreatic lipase. The enzyme hydrolyzes
ingested fats into a mixture of fatty acids and
monoglycerides. ItsPadoli,
action
is enhanced by the
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detergent effect of bile

The pancreas
4 "zymogens" proteins that are precursors to active
proteases. These are immediately converted into the
active proteolytic enzymes:
trypsin. Trypsin cleaves peptide bonds on the C-terminal side of
arginines and lysines.
chymotrypsin. Chymotrypsin cuts on the C-terminal side of
tyrosine, phenylalanine, and tryptophan residues (the same
bonds as pepsin, whose action ceases when the NaHCO3 raises
the pH of the intestinal contents).
elastase. Elastase cuts peptide bonds next to small, uncharged
side chains such as those of alanine and serine.
carboxypeptidase. This enzyme removes, one by one, the
amino acids at the C-terminal of peptides.

nucleases. These hydrolyze ingested nucleic acids

(RNA and DNA) into their component nucleotides.
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The secretion of pancreatic fluid is controlled

by two hormones:
secretin, which mainly affects the release
of sodium bicarbonate, and
cholecystokinin (CCK), which stimulates
the release of the digestive enzymes.

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The Duodenum and Related

Organs

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Topografi Abdomen 9 Area

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Topografi Abdomen
Abdomen divided into four quadrants by
body mid-line, horizontal plane through
umbilicus
Organs can be located by quadrant

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Topografi Abdomen :4 Area

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System 4 Quadrant
LUQ

RUQ

Liver,
Gallbladder,
Kidney
Duodenum,
Ascending Colon
Transverse Colon

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Spleen
Stomach
Pancreas
Left Kidney
Transverse Colon
Descending Colon
Splenic Flexure

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Topografi Abdomen :4 Area

Right Lower
Quadrant
Ascending Colon
Appendix
Right Ovary
(female)
Right Fallopian
Tube (female)
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Left Lower
Quadrant
Descending Colon
Sigmoid colon
Left Ovary (female)
Left Fallopian Tube
(female)

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Topografi Abdomen
Periumbilical area
Located around (peri) the navel (umbilicus)
Small bowel lies in all quadrants in
periumbilical area

Suprapubic area
Located just above pubic bone
Urinary bladder, uterus lie in this area

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Peritoneum
Peritoneum adalah membran tipis, halus
dan lembab yang terdapat pada rongga
abdomen dan menutupi organ abdomen.
Peritoneum parietal : peritoneum yang
menutupi dinding abdomen; peritoneum
visceral menutupi organ-organ.
Peritoneum parietalis berlanjut dengan
peritoneum visceralis.
Mesenterika adalah lipatan ganda
peritoneum yang melekatkan yeyunum
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dan ileum pada dinding

 Omentum mayor adalah lipatan empat

peritoneum menggantung ke bawah dari
kurvatura mayor lambung dan menutupi organ
abdomen ke arah anterior.
Cavum peritoneum mrp rongga potensial yg
dapat terisi oleh udara atau cairan pada
keadaan tertentu.
Fungsi peritoneum: tempat perlekatan organorgan ke dinding abdomen posterior;
mempermudah organ saling bergerak diatas
lainnya; menutupi area terinfeksi dengan
omentum mayor, Memungkinkan
pembuluh
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darah dan persyarafan mencapai organ tanpa

Topografi Abdomen

Retroperitoneal
Peritoneal
Pancreas
Spleen
Kidney
Ureter
Liver
Inferior vena cava
Stomach
Abdominal aorta
Gall bladder
Urinary bladder
Reproductive organs
Bowel

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