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
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
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 FUNCTION
Breaking down food and supplying the body
with the water, electrolytes, and nutrients to
sustain life. = Dobrak/Memerinci makanan dan menyediakan badan
[itu] dengan air, asam aki, dan bahan gizi untuk mendukung hidup
Before can be used, food must be:
Ingested
digested
absorbed
All of these processes involve coordinated
movemen of muscle and secretion of various
substances = Semua proses ini melibatkan movemen pengeluaran
dan otot [yang] dikoordinir berbagai unsur

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 INGESTION

Placing food into the mouth = Menempatkan makanan

ke dalam mulut
Chewing the food into smaller pieces
(mastication) = Mengunyah makanan [itu] ke dalam
potongan lebih kecil ( kunyahan)
Moistening the food with salivary secretions =
Melembabkan makanan [itu] dengan pengeluaran berhubungan
dengan ludah
Swallowing the food (deglutition) = Menelan
makanan [itu] ( deglutition)

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 DEGLUTITION
(SWALLOWING)
Deglutition or swallowing consists of three phase:
Oral (voluntary) phase Tongue forms a bolus of food
and forces it into the oropharynx by pushing up and
back against the hard palate = Lidah membentuk suatu pil besar
makanan dan memaksa ia/nya ke dalam oropharynx dengan mendorong atas
dan kembali melawan terhadap langit-langit keras
Pharyngeal phase.This phase coordinated by a
swallowing center in the medulla = Tahap ini yang dikoordinir
oleh suatu menelan pusat di (dalam) medulla
Esophageal phase. After reaching the esophagus, food
is propelled into stomach by peristaltis = Setelah mencapai
kerongkongan [itu], makanan didorong ke dalam perut oleh 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 = Nasopharynx tertutup
oleh langit-langit lunak, mencegah regurgitasi makanan di (dalam) ke rongga
hidung
The palatopharyngeal folds are pulled medially, forming a
passageway for the food to move into the pharynx =
Palatopharyngeal [Kali] lipatan ditarik secara di tengah-tengah, membentuk suatu
jalan terusan untuk makanan untuk pindah ke hulu kerongkongan [itu]
The glottis and vocal cords are closed and the epiglottis
swing down over the larynx, guiding the food toward the
esophagus = Celah suara dan tali berkenaan dengan suara tertutup dan
ayunan katup napas menurun/jatuh (di) atas pangkal tenggorokan, memandu
makanan [itu] ke arah kerongkongan
Respiration is inhibited for the duration of the
pharyngeal phase (1-2 seconds) = Pernapasan dilarang untuk
jangka waktu tahap yang berkenaan rongga tenggorokan ( 1-2 [detik / barang bekas])
 DIGESTION
Food is broken down into small particle by grinding
action = Makanan dipecah ke dalam partikel nsur/butir kecil dengan
penggerindaan tindakan
Food is degraded by digestive enzymes into usable
nutrient = Makanan diturunkan pangkat oleh enzim pencernaan ke dalam bahan
gizi dapat dipakai
Starches are degraded by amylase into monosaccharides =
Tajin diturunkan pangkat oleh amylase ke dalam monosaccharides
Proteins are degraded by variety of enzymes (pepsin,
trypsin) into dipeptides and amino acids = Protein diturunkan
pangkat oleh variasi enzim ( pepsin, trypsin) ke dalam dipeptides dan amino cuka
Fats are degraded by lipases and esterases into
monoglyserides and free fatty acids = gemuk Turunkan pangkat
oleh lipases dan esterases ke dalam monoglyserides dan zat asam yang
mengandung gemuk cuma-cuma
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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
= Mekanisme DASAR GI pergerakan adalah peristaltis. Peristaltis adalah suatu
dikoordinir pola teladan [dari;ttg] relaksasi dan singkatan otot lembut
Peristaltis helps move food through the paharynx and esophagus
and within the stomach. Peristaltis plays a minor role in propelling
food through the intestine = Peristaltis membantu makanan gerak
melalui/sampai paharynx dan kerongkongan dan di dalam perut [itu]. Peristaltis
main suatu peran (pelajaran) pelengkap di (dalam) mendorong makanan
melalui/sampai usus
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 = . Selama peristaltis, singkatan
[dari;ttg] bagian proximal otot [yang] kecil diikuti dengan seketika oleh relaksasi
otot [hanya;baru saja] distal untuk itu. Hasilkan gerak gelombang
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 MOTILITY OF STOMACH
Innervation
Intrinsic innervation directly responsible for
peristaltis
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
III
Stomach Meal
II
I
Propagatian
rate 5cm/min

Distal
Ileum
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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 directly responsible for
peristaltis
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 3-
4/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 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.

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 Functions of gastrointestinal secretions
GENERAL

PRINCIPLES
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

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 Daily Secretion of Gastrointestinal Fluid

Fluid Daily volume (ml) pH

Saliva 1000 6.0 7.0

Gastric secretion 1500 1.0 3.5
Pancreatic secretion 1000 8.0 8.3
Bile 1000 7.8
Small intestinal secretion 1800 7.5 8.0
Brunners gland secretion 200 8.0 8.9
Large intestinal secretion 200 7.5 8.0

Total 6700
Guyton, AC; 2000
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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 banyak sedikit sedikit

Viskositas rendah rendah tinggi
Protein rendah tinggi tinggi
Musin rendah rendah 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 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

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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
Khimotripsin Memecah ikatan peptida
asam amino aromatik

Elastase Memecah ikatan peptida

asam amino alifatik
Karboksipeptidase A Memecah ikatan karboksil
asam amino aromatik dan
alifatik

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 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

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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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