FISIOLOGI

GASTROINTESTINAL
IRAWAN YUSUF
M.E.RACHMAN
BLOK X
SISTEM GASTROINTESTINAL
Motto : The Anatomi-Physiology Of To-day Is
The Medicine OfTo-morrow
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Tujuan Instruksional Khusus

Setelah kuliah ini mahasiswa akan dapat :

Mengetahui tujuan pencernaan

Mengetahui proses-proses sistem gastrointestinal
Mengetahui fungsi traktus gastrointestinal
Mengetahui fungsi accesory Organs
Mengetahui mekanisme sekresi sistem gastrointestinal
Mengetahui regulasi sistem gastrointestinal .
Mengetahui mekanisme gangguan pada sistem
gastrointestinal

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LEARNING CONCEPT

GI TRACT

STRUCTURE
ACCESSORY
ORGANS

ORAL CAVITY
PHARYNX
ESOPHAGUS
STOMACH
SMALL INTESTINE
LARGE INTESTINE
RECTUM
ANAL CANAL
TONGUE
TEETH
SALIVARY GLANDS
PANCREAS
LIVER
GALL BLADDER

INGESTION
SECRETION

FUNCTION

DIGESTION
ABSORPTION

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MOVEMENT

FUNCTION

Breaking down food and supplying the

body with the water, electrolytes, and
nutrients to sustain life.
Before can be used, food must be:
ingested
digested
absorbed
All of these processes involve coordinated
movemen of muscle and secretion of
various substances
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INGESTION

Placing food into the mouth

Chewing the food into smaller pieces
(mastication)
Moistening the food with salivary
secretions
Swallowing the food (deglutition)

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DEGLUTITION
(SWALLOWING)

Deglutition or swallowing consists of three

phase:
Oral

(voluntary) phase. During this phase, the

tongue forms a bolus of food and forces it into
the oropharynx by pushing up and back against
the hard palate
Pharyngeal phase. This phase coordinated by a
swallowing center in the medulla and lower pons
Esophageal phase. After reaching the esophagus,
food is propelled into stomach by peristaltis
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Pharyngeal Phase

This phase begins when the food reaches the

oropharynx and progresses as follows:
The

nasopharynx is closed by the soft palate,

preventing regurgitation of food in to nasal
cavities
The palatopharyngeal folds are pulled medially,
forming a passageway for the food to move into
the pharynx
The glottis and vocal cords are closed and the
epiglottis swing down over the larynx, guiding
the food toward the esophagus

Respiration is inhibited for the duration of

the pharyngeal phase (1-2 seconds)
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DIGESTION

Food is broken down into small particle by

grinding action
Food is degraded by digestive enzymes
into usable nutrient
Starches

are degraded by amylase into

monosaccharides
Proteins are degraded by variety of enzymes
(pepsin, trypsin) into dipeptides and amino
acids
Fats are degraded by lipases and esterases into
monoglyserides and free fatty acids
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MOTILITY OF GI TRACT

The basic mechanisms of GI movement is peristaltis.

Peristaltis is a coordinated pattern of smooth muscle
contraction and relaxation
Peristaltis helps move food through the paharynx and
esophagus and within the stomach. Peristaltis plays a
minor role in propelling food through the intestine
During peristaltis, contraction of small section of
proximal muscle is followed immediately by relaxation of
the muscle just distal to it. The resulting wavelike motion.

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MOTILITY OF STOMACH
Innervation

Intrinsic innervation
peristaltis

directly

responsible

for

The myenteric plexus (Auerbachs) is located between the

layers of the circular and longitudinal muscles of the
stomach
The submucosal plexus (Meissners) is located between the
layers of the circular muscle and mucosa on the luminal
surface of the stomach

Extrinsic through autonomic nervous system:

Sympathetic, via the celiac plexus (inhibits motility)

Parasympathetic, via the vagus nerve (stimulates motility)

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Electrical Activity and

Regulation of Motility

The smooth muscle of GI tract has spontaneous rhytmic

fluctuations (basic electrical rhytm; BER) which is
initiated by the interstitial cells of Cajal
The rate of BER is 4/min in the stomach, 12/min in
duodenum and fall to about 8/min in distal ileum
Spike potensials playing important role in BER
Ionic basis of spike potentials is due to Ca 2+ influx, and K+
efflux
Many neurotransmitter and hormone affect the BER.
Acetylcholine increases BER and Epinephrine decrease
BER

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Basic Electrical Activity (BER) of

Gastrointestinal Sooth Muscle

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Migrating Motor Complex

Modification of motor activity during fasting

between periods of digestion
Each cycle of this activity starts with quiescent
period (phase I), continues with period of
irregular activity (phase II), and ends with a
burst of regular activity (phase III)
MMCs migrate at a rate of about 5 cm/min, with
interval of 90 minutes
The function of MMC is to clear the stomach and
small intestine luminal contents in preparation of
the next meal
MMC immediately blueberry
stopped by ingestion

Migrating Motor Complexes

Stomach

III
II

Meal

I
Propagatian
rate 5cm/min

Distal
Ileum
90 minute

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MASTICATION
Function of Mastication

Breaks food into smaller pieces, which:

Makes

it easier for the food to be swallowed

Breaks
off the undigestible cellulose
coatings of fruits and vegetables
Making easier for food to be digested by
digestive enzymes

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MASTICATION
Function of Mastication

Mixes the food with salivary gland

secretions, which:
Initiates

the process of starch digestion by

salivary amylase
Initiates the process of lipid digestion by
lingual lipase
Lubricates and softens the bolus of food,
making it easier to swallow

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MASTICATION
Function of Mastication

Brings food into contact with taste

receptors and release odors that stimulate
the olfactory receptors
The sensations generated by these receptors
increase the pleasure of eating and initiate
gastric secretions

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MASTICATION
Mastication Reflex

Although mastication is a voluntary act, it is

coordinated by reflex centers in he brain stem that
facilitate the opening and closing of the jaw
When the mouth opens, stretch receptors in the
jaw muscle initiate a refkex contraction of the
masseter, medial pterygoid, and temporal muscle,
causing mouth to close
When the mouth closes, food comes into contact
with buccal receptors eliciting a reflex
contraction of digastric and lateral pterygoid
muscles, causing the mouth to open
When the jaw drops, the stretch reflex causes the
entire cycle to be repeated
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Esophageal Phase

Sphincters involved in esophageal peristaltis:

The

upper esophageal sphincter (striated muscle)

The lower esophageal sphincter (smooth muscle)

Types of esophageal peristaltis:

Primary

esophageal peristaltis is initiated by

swallowing
Secondary peristaltis is initiated by the presence
of food within the esophagus

Coordination of esophageal peristaltis:

Primary

esophageal peristaltis is coordinated by

vagal fibers
Secondary esophageal peristaltis is coordinated
by the intrinsic nervous system
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Swallowing Mechanism and Regulation

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Disorders of Swallowing

Esophageal reflux, may occur if the

intragastric pressure rise high enough to force
the lower esophageal sphincter open
During

pregnancy
Reflux of stomach acid causes esophageal pain

Belching (eructation), following a heavy meal

or ingestion of large amount of gas (e.g., from
carbonated beverages)
Achalasia, is a neuromuscular disorder of the
lower two-thirds of the esophageal that leads
to absence of peristaltis and failure of the
lower esophageal sphincter to relax
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MOTILITY OF STOMACH
Functional components

The three functional parts of the stomach are the

fundus, corpus, and antrum
Gastric contents are isolated from other parts of
the GI tract by the lower esophageal sphincter
proximally and by the pylorus distally
The antrum and pylorus are anatomically
continous and respond to nervous control as a unit

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MOTILITY OF STOMACH
Musculature

Each muscle layer forms a functional syncytium

and therefore acts as a unit
In the fundus, where the layers are relatively thin,
strength of contraction is weak; in the antrum,
where the muscle layers are thick, strength of
contraction is strong
The stomach and duodenum are divided by a
thickened muscle layer called the pyloric
sphincter

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MOTILITY OF STOMACH
Innervation

Intrinsic innervation
peristaltis

directly

responsible

for

The myenteric plexus (Auerbachs) is located between the

layers of the circular and longitudinal muscles of the
stomach
The submucosal plexus (Meissners) is located between the
layers of the circular muscle and mucosa on the luminal
surface of the stomach

Extrinsic through autonomic nervous system:

Sympathetic, via the celiac plexus (inhibits motility)

Parasympathetic, via the vagus nerve (stimulates motility)

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Function of Motility
Gastric motility serves three basic function

Storage. When food enters the stomach, the upper

region - primarily fundus - enlarges to accommodate
the food by
receptive relaxation
Mixing. Combination of peristaltis and retropulsion
mixes the food with acid and enzymes. When the
food is mixed into pasty consistency, it is called
chyme
Emptying. When the chyme is broken down into
small enough particles, it is propelled through the
pyloric sphincter into intestine
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Function of Motility
Receptive relaxation

Initiated as apart of the peristaltic process

causing swallowing and esophageal motility
or in response to food entering the stomach
Strecth receptors in the upper portion of
stomach detect the presence of food and
initiate a vago-vagal reflex producing
relaxation
This process regulate by postganglionic fibers
within the enteric nervous system release a
noncholinergic nonadrenergic transmitter,
may be ATP or VIP
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Function of Motility
Peristaltis

Produced by periodic change in BER originate in a

pace maker within longitudinal muscle
BER or slow wave occur at a rate of approximately 34/min and velocity is 1 cm/sec at the corpus and
increase to 3-4 cm/sec in the antrum
Ca2+ play an important role in BER, and the force of
peristaltis contractions is regulated by gastrin and
acetylcholine

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Function of Motility
Retropulsion

Is the back and forth movement of the chyme

caused by the forceful propulsion of food
against the closed pyloric sphincter
The forward and backward movement of the
chyme (caused by peristaltis and retropulsion)
breaks the chyme into smaller and smaller
pieces and mixes it with the gastric secretions
present within stomach
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Function of Motility
Gastric emptying

Each time the chime pushed against the

pyloric sphincter, a small amount (2-7 ml)
may escape into duodenum
The amount of chyme passing the pylorus
depends on the size of the particles
Liquids empty much faster than solids. The
rate of liquids emptying is proportional to
pressure within the upper portion of stomach,
which increase slowly during the digestive
period
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Function Disorder of Motility

Vomiting or emesis

Initiation

The vomiting center. Directly activated by afferent fibers

or by irritation due to injury or increases in intracranial
pressure
Chemoreceptor trigger zone. Activated by afferent nerves
originating within the GI tract or by circulating emetic
agents

Mechanical sequence of vomiting

Begins with deep inspirasion followed by the closing of

the glottis
Intestine propels chyme into upper region of stomach
Increase in abdominal pressure forces the chyme into
esophagus and out of the mouth
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Vomiting Reflex

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INTESTINAL MOTILITY
Contractile activity

Contractile activity of the smooth muscle lining the

small intestine serve two functions:

Mixing the chyme with digestive enzymes and bile to

facilitate digestion and absorption
Propelling the chyme from the duodenum to the colon

It usually takes about 2-4 hours for the chyme to

move from one end of the small intestine to the
other

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INTESTINAL MOTILITY
Types of movements

Segmentation is the most common type of intestinal

contraction
Peristaltic contractions is not considered to be an
important component of intestinal transit
MMC spreads over the intestine during
interdigestive period

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INTESTINAL MOTILITY
Segmentation contractions

During segmentation, about 2 cm of the intestinal wall

contracts, forcing the chyme throughout the digestive
period
When the muscle relaxes, the chyme returns to the area
from which it was displaced
This back-and-forth movement enables the chyme to
become mixes with digestive enzymes and to make
contact with the absorptive surface of the intestinal
mucosa
Segmentation occur about 12 times/min in the duodenum
and 8 times/min in the ileum. The contraction last for 5-6
seconds
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INTESTINAL MOTILITY
Regulation of intestinal motility

Segmentation occur only if the slow waves produce spikes

potentials which is controlled by pacemaker cells within
the wall of the intestine and is not infuenced by neural
activity or circulating hormones
The frequency of segmentation is directly related to the
frequency of the slow wave
The strength of segmentation is proportional to the
frequency of the spike potentials generated by slow wave
Slow wave amplitude is increased by gastrin, CCK,
motilin, and insulin; and decreased by secretin and
glucagon

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FUNGSI SEKRESI SALURAN

CERNA
IRAWAN YUSUF
M.E.RACHMAN
BLOK X
SISTEM GASTROINTESTINAL
Motto : The Anatomi-Physiology Of To-day Is
The Medicine OfTo-morrow
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INTRODUCTION

Throughout the gastrointestinal tract

secretory glands serve two primary
function;

To produce digestive enzymes;

To provide mucus for lubrication
protection

and

Most digestive secretions are formed

only in response to the presence of food
in the gastrointestinal tract
The types of enzyme and its component
are varied according to the types of food
present.
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Functions of gastrointestinal secretions

GENERAL
PRINCIPLES

The type of secretory glands

Mucus gland or mucus cells (Goblet cells)

Pits; invagination of surface lining epithelial
Tubular glands (stomach and upper duodenum)
Complex glands (Salivary glands, pancreas and
liver)

Basic mechanism of secretion by glandular cells

Transport
Digestion
Protection
Absorption

Secretion of organic substances

Water and electrolyte secretion

Basic regulatory mechanism of glandular cells

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Daily Secretion of Gastrointestinal Fluid

Fluid

Daily volume (ml)

Saliva
Gastric secretion
Pancreatic secretion
Bile
Small intestinal secretion
Brunners gland secretion
Large intestinal secretion

1000
1500
1000
1000
1800
200
200

Total

6700

Guyton, AC; 2000

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pH
6.0 7.0
1.0 3.5
8.0 8.3
7.8
7.5 8.0
8.0 8.9
7.5 8.0

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PENGATURAN FUNGSI SEKRESI

Kontak dengan makanan dan saraf

enterik
Pengaruh susunan saraf otonom
Pengaruh hormonal

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SALIVA

Ludah 95% terutama terdiri atas air,

elektrolit, dan sedikit protein
Osmolalitasnya rendah
Konsentrasi ion K tinggi
Mengandung bahan organik amilase, lipase, dan faktor
pertumbuhan

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Saliva Function

Protection the mouth by:

Cooling hot food
Diluting gastric acid or bile regurgitated into
the mouth
Washing food away from the teeth
Antibacterial and antiviral effects (IgA and
peroxidase)
Aids speech by facilitating movement of the
lips and tongue
Digestion of glucose by amylase (ptyalin) and
fat by lingual lipase
Lubrication; for easier swallowing, moisten
the mouth
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Karakteristik ludah yang dihasilkan oleh perangsangan

kolinergik dan adrenergik

Parameter

Kolinergik

-adrenegik

-adrenergik

Volume
Viskositas
Protein
Musin

banyak
rendah
rendah
rendah

sedikit
rendah
tinggi
rendah

sedikit
tinggi
tinggi
sangat tinggi

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Control of Salivary Secretion

Autonomic Nervous System

Parasympathetic cause secretion of watery
fluid, high electrolyte but low in protein

Increases secretion of amylase with large

volumes of fluid

Sympathetic cause secretion of small

volume of fluid containing high mucin
Stimulates small volume of saliva rich in
amylase, bicarbonate and K+

Salivary reflexes. Thought, aroma, or taste

cause salivary reflexes

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MUKUS

Melekat kuat pada makanan/partikel

lainnya, menutupi permukaan dinding
sal cerna
resistensi rendah ----> pergerakan
makanan menjadi mudah terjadi
Resisten thd enzim pencernaan
Buffer asam atau alkali
Mengandung ion bikarbonat untuk
netralisir asam
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ESOFAGUS

Sepanjang esofagus umumnya

kelenjarnya bersifat mukoid untuk
fungsi lubrikasi (agar mudah
menelan) dan proteksi (mencegah
ekskoriasi mukosa akibat makanan
atau asam lambung

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Gastric Secretory Cells

Gastric secretory cells are located on the surface

of the stomach and in glands that are buried
within the mucosa consits of:
Oxyntic glands are located in the fundus and
corpus. They contain three types of secretory
cells:

The parietal (oxyntic) cells, secrete HCl and

intrinsic factor
Peptic (chief) cells secrete pepsinogen, the
precursor of pepsin
Mucous cell secrete mucus

Pyloric glands are located in antrum and pyloric.

They contain G cells and some mucous cell. G
cells produce gastrin hormone
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Secretion of the Stomach

Hydrochloric Acid (HCl)

Pepsinogen
Intrinsic Factor
Mucus
Glycoprotein

products which primary

function as lubricant, but can also
have many other regionally specialized
function

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FASE SEKRESI ASAM

Chepalic phase : penglihatan, penciuman,

menelan makanan, terapi ADO atau
pemberian insulin ---> 1/3-1/2 sekret HCL
Gastric phase : saat makanan masuk ke
lambung -----> distensi lambung, sekresi
gastrin
-----> 2/3 sekret HCL
Intestinal phase : adanya makanan dalam
duodenum disebabkan duodenum
menghasilkan gastrin

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HCl Secretion
Mechanism HCl secretion

HCl is secreted into the parietal cells canaliculi

by three step process:

The active transport process is begun by the

transport of K+ and Cl- into the canaliculi
H+ is then exchanged for K+ by a H+-K+ ATPase
Water enters the canaliculi down the osmotic
gradient created by movement of HCl-

The H+ entering the canaliculi is supplied by the

dissociation of H2CO3 into H+ and HCO3The active transport process involved in the
generation of HCl- secretion require a large
amount of ATP
The pH of acid secretion as low as 0.8
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Control of HCl Secretion

Stimulation of HCl secretion

Acetylcholine

(Ach)
Histamine; histamine can stimulate
HCl secretion directly or can
potentiate the secretion produced
by ACh or gastrin
Gastrin

Inhibition of HCl secretion

Somatostatin

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PEPSINOGEN SECRETION

Function of pepsinogen. Pepsin the

active
form
of
pepsinogen
is
proteolytic enzyme that begins the
process of protein digestion
Regulation of pepsinogen secretion.

Cephalic state, vagal nerve stimulate

secretion of pepsinogen
Gastric phase, low pH stimulate secretion
Intestinal
phase,
secretin
stimulate
pepsinogen release

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MUCOSAL BARRIER

The gastric mucosal barrier protects

the gastric lining cells from damage
The main component of mucus is a
thick viscous alkaline mucous layer
secreted by the mucous cells
Mildly injury results in increased
mucus
secretion
and
surface
desquamation
More serious injury denudes the
mucosal surface, forming an ulcer,
and produce bleeding
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PANKREAS

Enzim pankreas sangat penting untuk proses

digesti, dan sekresi enzim ini diatur oleh kontrol
hormon sekretin dan CCK
Secretin merangsang duktus pakreas
menghasilkan juice yang alkalis (HCO3 banyak,
enzim )
CCK merangsang sel acinus produksi juice
pankreas yg volumenya sedikit tapi enzimnya
Stimulasi vagus merangsang sekresi pankreas

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Anatomy and Histology of Pancreas

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Pancreatic Secretory Cells

Pancreatic exocrine cells are

arranged in grape-like clusters
called acini.
The exocrine cells themselves are
packed
with
membrane-bound
secretory granules which contain
digestive
enzymes
that
are
exocytosed into the lumen of the
acinus.
From there these secretions flow
into larger and larger, intralobular
ducts, which eventually coalesce
into the main pancreatic duct which
drains directly into the duodenum.

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Composition of Pancreatic Secretion

Pancreatic juice is composed of two

secretory products critical to proper
digestion:

Digestive enzymes, secreted by acinar cells

Bicarbonate (HCO3-), secreted from epithelial
cells

Digestive enzymes digesting all three

major types of nutrients
HCO3- play important role in neutralizing
the acid chyme from the stomach

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Enzim Pankreas dan fungsinya

ENZIM

FUNGSI

Enzim proteolitik (protease)

Tripsinogen

Memecah ikatan peptida

antara arginin dan lisin
Memecah ikatan peptida
asam amino aromatik

Khimotripsin
Elastase

Memecah ikatan peptida

asam amino alifatik
Memecah ikatan karboksil
asam amino aromatik dan
alifatik

Karboksipeptidase A

Enzim amilolitik (amilase)

Alfa-amilase

Hidrolisa glikogen, gula

Enzim lipolitik (lipase)

Lipase

Hidrolisa monogliserida,
asam lemak

Fosfolipase

Memecah asam lemak dan

fosfolipid

Kholesterol esterase

Hidrolisis kolesterol
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Phase of Pancreatic Secretion

Cephalic phase
Vagal stimulation
Stimulates enzyme secretion
Non-cholinergic
HCO3- secretion
Gastric phase
Distension of the antrum and corpus
Secretion of low volume of enzymes and HCO 3 Food breakdown (primarily amino acids)
Secretion of pancreatic secretion
Intestinal phase
Cholecystokinin
Secretin
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Control of Pancreatic Secretion

Hormonal Control
Secretin
(from
duodenum)

increased

in

stimulates fluid and electrolyte secretion

CCK
(from
increased
peptides, amino acids)

HCl

fatty

acids,

stimulates release of enzymes

Nervous System
Parasympathetic input

initiates secretion during cephalic and gastric

phases

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HATI & BILIARY SYSTEM

Empedu dibuat di hati dan disekresi lewat

duktus biliaris menuju duodenum saat
makan.
Saat tdk makan, empedu dibawa ke
kandung empedu, dan akan disekresi saat
makan oleh pengaruh CCK (kontraksi kdg
empedu)
Sekresi empedu meningkat oleh pengaruh
vagus, secretin
Empedu sangat penting pada proses
emulsifikasi lemak
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Usus halus

Sel goblet, kelenjar Brunner

(duodenum), kel. Lieberkun
menghasilkan mucin yang alkalis
pada mukosa usus halus,
Mucin ini gel-hydrat untuk melapisi
usus, lubrikasi, mengandung
antibakteria dan Ig,
Hormon TGI (VIP) dan stimulasi
vagus menstimulasi sekresi mucin
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Sekian
Mohon Maaf dan Terimah
Kasih
Wassalamu Alaikum WrWb

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