Professional Documents
Culture Documents
of
Digestion
Dr. Yudi Herlambang
Prof dr Abdul Majid
Dr Nur Aiza
Department of Physiology
School of Medicine
University of Sumatera Utara
Nutrient
Assimilated
Digestive
system
Food
Non Nutrient
Eliminated
Secretio
n
Digestio
n
Absorptio
n
Motility
Movement of food through tract ,includes
ingestion, mastication (chewing food and
mixing with saliva), deglutition
(swallowing) and peristalsis (rhythmic
contractions along GI tract that propel
food)
Secretio
muscular contraction.
n
Endocrine (secretion of hormones that
regulate digestive process)
Exocrine (secretion of water, enzymes,
acid, bicarbonate, into GI tract enzyme &
other digestive juices.
Digestio
n
Absorptio
n Transfer of monomer subunits across wall
of small intestine into blood or lymph
transport modified nutrients.
Regulation;
Neural:
There are two nerve nets (plexuses)
in GI tract that contain neurons and
interneurons
sub mucosal (Meissner)
Myenteric (Auerbach)
Sympathetic
reduces motility and secretory activity and
stimulates sphincter contraction
Hormonal.
Paracrine regulation
production of hormone-like molecules that
are produced in one cell and travel
through interstitial fluid (not bloodstream)
to affect activity of nearby cells
Hormone regulation
production of hormones that are released
into the bloodstream and carried to target
tissues within digestive system where
they affect digestive activity
Mout
h:
Mouth:
Teeth
Salivary glands
(parotid, submaxillary,
sublingual)
secrete
saliva
parotid gland
parotid duct
lubricates and softens sublingual gland
submandibular gland
SALIVARY GLANDS
Sympathetic and parasympathetic responses are not antagonistic
1. Parasympathetic system has the dominant role - continuous
2. Increased parasympathetic stimulation produces a watery saliva
rich in enzymes
3. Increased sympathetic stimulation produces a smaller volume of
thick saliva rich in mucus inhibits secretion (dry mouth when
nervous)
NB Salivary secretion is the only digestive secretion
completely under neural control
salivary centre
in medulla
pressure receptors
and chemoreceptors
in the mouth
simple
reflex
other inputs
Conditioned
reflex
autonomic nerves
salivary glands
salivary secretion
Oropharynx
To convey food
into the
esophagus.
Important role
in swallowing.
Esophagus.
Hollow muscular tube
connecting pharynx and
stomach.
Bounded by sphincters.
Lined w/ stratified
squamous epithelium.
Lower esophageal
(gastro esophageal)
sphincter ; transition
from low pressure
( intrathoracic ) high
pressure (intraabdominal).
Disorder o/t LES tone
major cause
Stomach wall
Secretion/Digestion
Stomach:
Stomach:
lower region of stomach (antrum) secretes the hormone
gastrin.
Additional secretions:
Histamine (ECL cell)
Somatostatin
HCl
Gastrin
Histamine
Pepsinogen
Gastric lipase.
Pepsinogen HCl
Pepsin
Parietal (oxyntic) cells,
secrete :
- HCl .
- Intrinsic factor binds
Pyloric gland Alkaline
vit. B12
mucus.
Gastrin
Pepsinogen
1. CEPHALIC PHASE
Vagus nerve
Sight, smell or
thought of food
Parasympathetic activation
of gastric motility & gastric juice secretion
2. GASTRIC PHASE
Food arrival causes
muscular reflexes &
gastrin secretion by G
cells.
Gastrin
FOOD
GO
3. INTESTINAL PHASE
Arrival of food in duodenum triggers release of
hormones that inhibit gastric motility &
secretions.
Secretin &
Cholecystokinin (CCK)
Circulation
Intestinal phase
signals come from intestine and have inhibitory effect i.e. slow
the rate of gastric secretion
stretch of duodenum, and increase in osmolality stimulate nerve
reflex that inhibits gastric motility and secretion
presence of fat in duodenum stimulates secretion of inhibitory
hormones (enterogastrones)
1. Secretin
2. Cholecystokinin (CCK)
Small
Intestine
Functions in digestion
CHO digestion resumes
and is completed here
Protein digestion
continues and completes
here
Fat digestion is initiated
and completed here
Physiology
Two primary function
Digestion
Absorption of nutrients and water
Digestion
Physiology
Digestive enzymes
Salivary amylase
Pepsin
Pancreatic enzymes:
Trypsin
Chymotrypsin
Carboxypeptidase
Nucleases
Pancreatic lipase
Pancreatic amylase
Intestinal enzymes:
Peptidases
Disaccharidases
Lipase
Nucleotidases
Physiology
Hormones
Cholecystokinin secretion stimulated by
fat in duodenum
Physiology
Absorption
Pancreatic Enzymes
Amylase - breaks CHO starch to maltose,
Pancreatic Enzymes
(continued)
Liver
Largest organ in body
Blood supply
hepatic artery delivers oxygenated blood
hepatic portal vein
products absorbed into capillaries in the
intestines do not directly enter general
circulation
this blood is delivered first to the liver by the
hepatic portal vein, and then passed on to
the general circulation
liver has first crack at absorbed nutrients,
except lipids
Liver (continued)
Digestive functions
secretes bile - essential for digestion and
absorption of fats
Function - overall is to filter and process
nutrient-rich blood, not just a digestive function
regulates carbohydrate metabolism through glycogen
storage and release
regulates many aspects of lipid metabolism, eg.,
cholesterol synthesis and release of ketones
detoxifies blood
urea and bile synthesis
Liver (continued)
Non-digestive functions
circulatory functions; destroys aged or
abnormal blood cells and produces clotting
factors
converts protein metabolites to urea for
elimination by kidneys
immune function (Kupffer cells)
functions as blood reservoir in regulation of
blood volume
Gall Bladder
Located on underside of liver
Bile produced in liver is carried to gall
Bile
Product of the liver cells
bile contains bile pigment, bile salts,
phospholipids, cholesterol, and inorganic ions
bile pigment = bilirubin = breakdown product of
hemoglobin
bile salts = derivatives of cholesterol that are
combined with taurine or glycine, form micelles =
lipid aggregates with non-polar parts in central
region and polar regions toward water
Bile Synthesis
This is the main digestive function of the liver;
Segmentation:
Major contractile
activity of the
small intestine.
Contraction of
circular smooth
muscle.
Mix chyme.
Brush border
enzymes
reassembly
Large
Intestine
Anatomy and
Physiology
Functions (converts
chyme to feces)
Water 80-90%
Food residue
Bacteria
Cells
Unabsorbed minerals
neutralized by bicarbonate
Bacterial fermentation of carbohydrates
produces CO2, H2, CH4
~1000 ml expelled each day
Excess occurs with aerophagia and diets high in
indigestible carbohydrates
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE
Mucosa
ACTIVITY
Secretes
mucus
RESULT
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE
Lumen
ACTIVITY
Bacterial
activity
RESULT
Breaks down
undigested
carbohydrates,
protein, & amino acids
into products that can
be expelled in feces
or absorbed &
detoxified by liver
Synthesizes certain B
vitamins & vitamin K
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE
Muscularis
ACTIVITY
RESULT
Haustral
churning
Contractions move
contents from haustrum
to haustrum
Peristalsis
Contractions of circular
& longitudinal muscles
move contents along
length of colon
DIGESTIVE ACTIVITIES OF
LARGE INTESTINE
STRUCTURE
Muscularis
ACTIVITY
RESULT
Mass
peristalsis
Defecation
reflex
Eliminates feces by
contractions in sigmoid
colon & rectum
Secretion&
H2O
absorption
2000ml150ml=?
Ion&Vitamin
absorption
Rectum
The
Defecation
Reflex
Defecation process
Reflex relaxation of internal sphincter
Valsalva maneouvre raising
intraabdominal pressure
Relaxation of puborectalis (anorectal
angle)
Voluntary relaxation of external
sphincter
Defecationreflex
>15mmHg
Stricture
Tumors
Motor causes
Impaired peristalsis
Dysfunction of UES or LES
Common motor disorders achalasia, scleroderma, diffuse
esophageal spasm
Odynophagia
Regurgitation
Achalasia - cont.
Treatment
Palliative, measures to relieve obstruction of
lower esophagus
Treatment
Avoid cold foods and large meals
Antacids, sedatives, nitroglycerine
Esophageal dilation is symptoms persistent and
distressing
Scleroderma
Esophagitis
esophageal mucosa
May be acute or chronic
Esophagitis
Esophagitis cont.
Esophagitis cont.
Clinical manifestations
Vague abdominal discomfort
Epigastric tenderness
Bleeding
Vomiting
Hematemesis
Gastritis - cont.
This of gastric mucosa reveals the presence of many short, curved rod-like organisms
overlying the mucosa. These are Helicobacter pylori organisms, whose home is the
gastric mucus. The incidence of H. pylori infection increases with age, with half of
American adults infected by age 50. H. pylori organisms break down mucosal
glycoproteins and damage epithelial cells, leading to inflammation--a chronic gastritis
that is asymptomatic in most cases. Peptic ulcer disease, particularly duodenal
ulceration, is strongly associated with H. pylori infection, which may also play a role in
development of gastric carcinoma. Antibiotic treatment of H. pylori reduces these
complications
Gastritis - cont.
PENDAHULUA
Penyebab gastritis
N dan tukak peptik
adalah multifaktor
II.
III.
HP
IV. NSAID
V.
Other ulcerogenic
Multiple causes of PUD
NSAIDs
Gastric acid
Defense
H. Pylori
Inflammation
Stress
Complications
Hemorrhage
Most frequent complication 15-20%
Most common in ulcers of the posterior wall of duodenal
Perforation
Approximately 5% of all ulcers perforate -
Intestinal obstruction
Definition = an interference with the
normal flow of intestinal contents
through the intestinal tract
result of a tumor
Most obstructions involve SI
Complete is serious and requires early diagnosis
and emergency surgery to save life
Intestinal obstruction
Etiology
Non-mechanical
Common after abdominal surgery
Can be caused by peritonitis
Accompanies many traumatic conditions (rib fracture,
concussion of spinal cord or fracture of spine)
Mechanical
About 50% of all are in adults and result from
Thank You
Pengaturan salivasi
Struktur oesophagus
Proses menelan
Sekresi &
Gerakan
Lambung
Gerakan Lambung
Muntah
(Vomitus)
Pancreas
Pengaturan
sekresi pancreas
Fungsi Hati
Pengaturan
sekresi empedu
Usus Halus
Physiology of
Digestion
Dr. Yudi
Herlambang
Department of Physiology
School of Medicine
University of Sumatera Utara