FISIOLOGI

GASTROINTESTINAL

Bagian Fisiologi
Fakultas Kedokteran Unsoed
TUJUAN PEMBELAJARAN

1. Mahasiswa mampu menjelaskan fungsi umum sistem digesti

2. Mahasiswa mampu menjelaskan perjalanan makanan dalam saluran cerna
3. Mahasiswa mampu menjelaskan mekanisme mengunyah, menelan
4. Mahasiswa mampu menjelaskan fisiologi gaster
5. Mahasiswa mampu menjelaskan mekanisme sekresi kelenjar dan absorbsi zat gizi dari saluran cerna
6. Mahasiswa mampu menjelaskan mekanisme peristaltik saluran cerna
7. Mahasiswa mampu menjelaskan mekanisme kontrol saluran cerna
8. Mahasiswa mampu menjelaskan mekanisme defekasi
9. Mahasiswa mampu menjelaskan fungsi hepar dan sistem bilier
10. Mahasiswa mampu menjelaskan metabolisme bilirubin
11. Mahasiswa mampu menjelaskan integrasi sistem digestif dengan sistem lainnya
 Main Function:
• Digestion
• Absorbtion
Four Major Activities

1. Motility:
- propels ingested food from the mouth toward the rectum
- mixes and reduces the size of the food.
2. Secretions: add fluid, electrolytes, enzymes, and mucus to the lumen
- salivary glands
- pancreas
- liver
3. Digestion: Ingested foods are digested into absorbable molecules.
4. Absorbtion: nutrients, electrolytes, and water are absorbed
into the bloodstream.
FROM MACROMOLECULES INTO
MONOMERS
FROM MACROMOLECULES INTO MONOMERS

MACROMOLECULES:  MONOMERS:

Carbohydrates
polysaccarides Monosaccharides
maltose 2 glucose
lactose glucose + galactose
sucrose glucose+fructose

Proteins peptides Amino Acids (AA)

Fats
Tryglycerides Monoglycerides+ FFA
Phospholipids Lysophospholipids + FFA
ORGANIZATION
Gastrointestinal Tract
• Mouth
• Pharynx
• Esophagus
• Stomach
• Small Intestine
• Large Intestine

Accessory Organs
• Teeth
• Tongue
• Salivary Glands
• Liver
• Gallbladder
• Pancreas
The GI System
 GENERAL
STRUCTURE
 GI
REGULATION

(Sherwood, 2006)
GI HORMONES
 MOUTH

Including: teeth, tongue, palatum

• Digestion in mouth
• 1. Mechanical = mastication = Mechanical processing by the teeth,
tongue, and palatal surfaces

• 2. Chemical
salivary amylase
starch -----------------------> maltose
THE TONGUE

• Primary functions include:

– Mechanical processing
– Assistance in chewing and swallowing
– Sensory analysis by touch, temperature, and taste receptors
 SALIVARY GLANDS
Main Glands:
A. Parotid
B. Submandibular
C. Sublingual
Many tiny buccal glands

Daily secretion: between 800 and 1500 ml

SALIVARY GLANDS
Saliva contains two major types of protein secretion:

a. serous secretion that contains ptyalin (an α-amylase),which is

an enzyme for digesting starches
b. Mucus secretion that contains mucin for lubricating and for
surface protective purposes

 The parotid glands: secrete almost entirely the serous type of

secretion
 The submandibular and sublingual glands: secrete both serous
secretion and mucus
 The buccal glands: secrete only mucus
SALIVARY

Functions include:
• Lubrication: mastication, speech, deglutition
• hypotonicity of saliva: low levels of glucose, sodium, chloride, and urea
-----> provide the dissolution of substances allows the gustatory buds
to perceive different flavors.
• Protection against microorganism: igA, igG,igM, lysozyme, lactoferrin,
peroksidase
• Initiation of digestion of complex carbohydrates
α-amylase: 40-50% total salivary protein
SALIVARY
Functions include (cont):

 Buffer capacity : Sialin, urea, HCO3-

-->neutralize the acid from bacteria--.preventing
demineralization

• Integrity of tooth enamel : Ca, phospate, F

• Tissue repair: the bleeding time of oral tissues appears

to be shorter than other tissues.
--> Studies in mice have shown wound contraction is
significantly increased in the presence of saliva due to the
epidermal growth factor
Factors affecting salivary flow and composition

 Individual hidration
 Sleep
 Fear
 Medications
 Thinking of food and visual stimulation
 Mechanical and chemical stimuli (plain vs acid)
CONTROL OF SALIVA

There are two unusual features in the regulation of salivary secretion.

1. Salivary secretion is exclusively (only) under neural control by the autonomic
nervous system,
2. Salivary secretion is increased by both parasympathetic and sympathetic
stimulation, although parasympathetic stimulation is dominant.

• Three types of stimuli may initiate salivation:

1. Psychic
2. Chemical
3. Tactile
(Coztanzo, 2010)
 Stimulated vs Unstimulated

Gland Unstimulated (%) Stimulated (%)

Parotid 20 >50
Sumandibular 65-70
Sublingual 7-8
Minor salivary gland <10
CHARACTERISTICS OF SALIVA

Saliva is composed of 99.5% water,

used to dissolve foods, and 0.5%
solutes, including:
• 1. Salivary Amylase
• 2. Ions (Na, K, Cl, HCO3, HPO4)
Sialometry and sialochemistry : diagnose
• 3. Mucous systemic illnesses, monitoring general
• 4. Lysozyme health, and an indicator of risk for
diseases
Since several factors can influence
• Has a lower osmolarity, has higher salivary secretion and composition --> a
K+ and bicarbonate (HCO3−) strictly standardized collection must be
concentrations, and has lower Na+ made
and chloride (Cl−)
concentrations compared to plasma
 Characteristic of Saliva
Volume 1000-1500ml
Tonicity Hypotonic
pH 6-7
Electrolyte Na+, K+, Cl-, Ca2+, Mg2+, HPO4-, HCO3-, F
Secretory proteins/peptide Amylase, lingual lipase (inaktif), kallikrein, igA, igM,
igG, mucosal glycopropeins, lysozyme, lactoferrin,
defensis, peroxidase, cystatin, traces of albumin,
gustin, proline rich protein, histatin, statherins
Small organic Glucose, amino acids, ammonia, urea, uric acid, lipid
molecules

Other components Epidermal growth factors

PHARYNX
 The pharynx is composed of skeletal muscle and lined by mucous
membrane
 Divided into three parts: the nasopharynx, the oropharynx, and the
laryngopharynx.

 Swallowed food passes from the mouth into the oropharynx and
laryngopharynx
 The nasopharynx functions only in respiration

 The muscular contractions of these areas help propel food into the
esophagus
 SWALLOWING/DEGLUTITION

 Oral phase. The oral phase is initiated when the tongue forces a bolus of food
back toward the pharynx a high density of somatosensory receptors
initiates the involuntary swallowing reflex in the medulla.

 Pharyngeal phase. The food bolus propel from the mouth through the pharynx
to the esophagus

 Esophageal phase. Food is propelled through the esophagus to the stomach.

 ESOPHAGUS
A collapsible muscular tube, about 25 cm long, that lies posterior to
the trachea.
Function: to propel the food bolus from the pharynx to the
stomach.
The esophagus secretes mucus and transports food into the
stomach.
It does not produce digestive enzymes, and it does not
carry on absorption.

Sphincters
A. Upper esophageal spinchter
B. Lower esophageal spinchter
 Esophageal Motility

The steps:
1. The upper esophageal sphincter opens, allowing the bolus to move from the
pharynx to the esophagus.
2. The upper esophageal sphincter closes, prevents reflux into the pharynx.

3. A primary peristaltic contraction, each segment of esophagus contracts

-->creates an area of high pressure just behind the bolus-->pushing it
down the esophagus.
Gravity influence.

4. As the peristaltic wave and the food bolus approach the lower esophageal sphincter,
the lower esophagel sphincter opens.

5. If the primary peristaltic contraction does not clear the esophagus of food, a
secondary peristaltic contraction occurs
Intrathoracic location of the esophagus

 Intraesophageal pressure is equal to intrathoracic pressure

 It’s lower than atmospheric pressure.
 It is lower than abdominal pressure.

The lower intraesophageal pressure creates two problems:

 keeping air out of the esophagus at the upper end
 keeping the acidic gastric contents out at the lower end.

Function to prevent air from entering the upper esophagus, and to

prevent the acidic gastric contents from entering the lower
esophagus.

Prevent gastroesophageal reflux

Terimakasih