Fisiologi Gastrointestinal

Amiruddin Eso
Department of Physiology
Faculty of Medicine
Halu Oleo University
 STRUCTURE
Structure of gastrointestinal system
Gastrointestinal tract; oral cavity, pharynx,
esophagus, stomach, small intestine, large
intestine, rectum, and anal canal
Accessory organs; tongue, teeth, salivary
glands, liver, and gall bladder
 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 movement
of muscle and secretion of various substances
 INGESTION

Placing food into the mouth

Chewing the food into smaller pieces (mastication)
Moistening the food with salivary secretions
Swallowing the food (deglutition)
 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
 LEARNING CONCEPT
ORAL CAVITY
PHARYNX
ESOPHAGUS
GI TRACT STOMACH
SMALL INTESTINE
LARGE INTESTINE
RECTUM
STRUCTURE ANAL CANAL

TONGUE
TEETH
ACCESSORY SALIVARY GLANDS
ORGANS PANCREAS
LIVER
GALL BLADDER

INGESTION
SECRETION
FUNCTION DIGESTION
MOVEMENT
ABSORPTION
MOTILITY OF GI TRACT
The basic mechanisms of GI movement is
peristaltic. Peristaltic is a coordinated pattern of
smooth muscle contraction and relaxation
Peristaltic helps move food through the pharynx
and esophagus and within the stomach. Peristaltic
plays a minor role in propelling food through the
intestine
During peristaltic, contraction of small section of
proximal muscle is followed immediately by
relaxation of the muscle just distal to it. The
resulting wavelike motion.
 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
 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
 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
 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
 MASTICATION
Mastication Reflex

Although mastication is a voluntary act, it is

coordinated by reflex centers in the brain stem that
facilitate the opening and closing of the jaw
When the mouth opens, stretch receptors in the jaw
muscle initiate a reflex contraction of the masseter,
medial pterygoide, 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
 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)
 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
Esophageal Muscle
Swallowing Mechanism and Regulation
 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
 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
 MOTILITY OF STOMACH

Innervation
Intrinsic innervation directly responsible for
peristaltis
The myenteric plexus (Auerbach’s) is located
between the layers of the circular and longitudinal
muscles of the stomach
The submucosal plexus (Meissner’s) 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)
 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
 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
 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
Vomiting Reflex
 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
 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
 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
 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
 SECRETORY FUNCTION OF
GASTROINTESTINAL SYSTEM
 INTRODUCTION
• Throughout the gastrointestinal tract secretory
glands serve two primary function;
– To produce digestive enzymes;
– To provide mucus for lubrication and protection
• 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.
 GENERAL PRINCIPLES
• Functions of gastrointestinal secretions
– Transport
– Digestion
– Protection
– Absorption
• 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
– Secretion of organic substances
– Water and electrolyte secretion
• Basic regulatory mechanism of glandular cells
 Basic Mechanism of Secretion
Secretion of Organic Substances (proteins)
1. The nutrient material needed for formation of secretion
must diffuse or actively transported from the capillary into
the base of glandular cell
2. ATP from the mitochondria, along with appropriate
substrates, is then used for synthesis of the organic
substances
3. The secretory materials are then transported to the Golgi
complex
4. In the Golgi complex the material are modified before
discharged into the cytoplasm in the form of secretory
vesicles, which are stored in the apical ends of the secretory
cells
5. These vesicles remain stored until nervous or hormonal
stimulation cause them to extrude their contents
 Basic Mechanism of Secretion
Secretion of Water and Electrolyte
1. Nerve stimulation on basal portion of the cell membrane,
causing active transport of Cl- ions to the inside the cell
2. The resulting increase in electronegativity inside the cell the
causes positive ions also move to the interior of the cell
3. The excess of both these ions inside the cell creates an
osmotic force that pulls water to the interior, thereby
increasing the hydrostatic pressure inside the cell and
causing the cell to swell
4. The pressure in the cell then results in ruptures of secretory
border of the cell causes flushing of water, electrolyte, and
organic materials out of the glandular cell into the lumen of
the gland
 Basic Regulatory Mechanism
of Glandular Cells
• Effect of Local Contact
– The mechanical present of food causes the glands to
secrete moderate to large quantities of digestive juice
• Effect of enteric nervous system
– Tactile stimulation
– Chemical irritation
– Distention of the gut wall
• Autonomic stimulation
– Parasympathetic increase the rate of secretion
– Sympathetic can have dual effect; increase or decrease
the secretion depend on the rate of stimulation
• Hormonal
 Basic Regulatory Mechanism
of Glandular Cells
Hormones that regulate secretion
• Gastrin
– Stimulates gastric acid/pepsinogen secretion
• Secretin
– Stimulates pancreatic and bile secretion
• Cholecysokinin (CCK)
– Stimulates pancreatic enzyme secretion and
bile secretion
 Basic Regulatory Mechanism
of Glandular Cells
CELLULAR MECHANISMS
• Second messengers
– IP3, calcium, cAMP
• Actions
– alter activity of ion transporters
– alter exocytosis rate of secretory vesicles
– regulate insertion of intracellular
canaliculi
 SALIVARY GLANDS AND
SALIVA
Saliva is secreted primarily by three pairs of glands:
1. Parotid, located near the angle of the jaw, are
largest glands and secrete a watery fluid
2. Submandibular, secrete a fluid that contains a
high concentration of proteins and so is
moderately viscous
3. Sublingual, produce viscous fluid
 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
 Composition of Saliva
• Salivary gland secrete saliva about 1-1.5
L/day containing:
– Electrolyte. In comparison with plasma, saliva is
hypotonic and contains higher concentrations of
K+ and HCO3- and lower concentration of Na+
and Cl-
– Proteins. Several proteins are found, -amylase
(ptyalin), lingual lipase, peroxidase, IgA and
growth factors (NGF, EGF)
– Mucin for food lubrication
 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
 GASTRIC SECRETION

• Gastric acid secretions aid in the breakdown of

food into small particles
• Continue the process of digestion begun by
salivary enzymes
• About 2 L/day of gastric secretion are produced
 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
 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
 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 HCO3-
• The 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
 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
 Phases of Gastric Secretion
• Cephalic
– vagal cholinergic stimulation of HCl secretion
– directly
– indirectly via gastrin
• Gastric
– gastrin, local distension, vagal input increase gastric
acid secretion
• Intestinal
– increased acid in duodenum stimulates secretin
release which feeds back to inhibit gastrin release
and inhibit gastric acid secretion
 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
 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
 INTRINSIC FACTOR
• Intrinsic factor is a glycoprotein secreted
by the parietal cells of the gastric
mucosa, mostly in fundus
• Intrinsic factor is required for the
absorption of vitamin B12
– Intrinsic factor forms a complex with
vitamin B12
– The complex is carried to the terminal ileum,
where the vitamin is absorbed
 PANCREATIC SECRETION
• Pancreas contains endocrine and exocrine cells
• The exocrine cells have an internal structure similar to
that of salivary glands
• The exocrine cells produce four types of digestive
enzyme:
– Protease (trypsin, chymotrypsin, carboxypeptidase)
– Amylase
– Lipases (lipase, cholesterol esterase, phospholipase)
– Nucleases
• Each day pancreas produce 1200-1500 ml of pancreatic
juice containing high concentration of HCO3-
Compostion 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
 Control of Pancreatic Secretion

Hormonal Control
• Secretin (from increased HCl in duodenum)
– stimulates fluid and electrolyte secretion
• CCK (from increased fatty acids, peptides,
amino acids)
– stimulates release of enzymes
Nervous System
• Parasympathetic input
– initiates secretion during cephalic and gastric phases
Thank You