Fisiologi saluran

pencernaan bawah

Suyasning HI
Department of Physiology
& Biochemistry
 Physiological GI tract anal

Motility
Secretion
Digestion and absorption
proces
Regulation

2
 GI motility pattern
1. Mixing
segmentation contraction(nonpropulsionN
- Enhance digestion and absorption
Propulsion ; move ingesta aborally
Storage; stomach and large intestine act as reservoirs
2. Kind of contraction
Phasic (rhytmic; alterniting contraction &relaxation
(secnds)
Tonic; sustained, minutes to hours

3
 Regulation of motility
Nerves
Enteric nervous system (ENS)
sympaticus, parasympaticus
partly also somatic motoneurons
Hormones
made in GIT
gastrin, secretin, cholecystokinin,..
partly also other
e.g. glucocorticoids & catecholamines in stress
 Regulation of motility

Mediators of the GI immune system

has at least as many cells as the immune
system of the rest of the body

Histamin, PGs, LTs, cytokines,...

Lymphatic node

Epithelium

Lymphatic nodule

Circular muscle layer

Longitudinal
muscle layer

Plexus
myentericus

Plexus
submucosus Submucosal
gland
 ENTERIC NERVOUS
SYSTEM
Anatomy 19. century ~ relay ganglia
Bayliss, Starling 1899: peristaltic reflex,
persists after denervation
other organs are stopped by denervation
Today:
ENS: autonomous, complex system
neurogastroenterology
 Sensoric
neuron
(stretch)

Excitatory
motoneuron Inhibitory
motoneuron

Sensoric
neuron
(mechanical
Oral direction & chemical Anal direction
stimuli)

Mucosa

Mechanical & chemical stimuli

Peristaltic reflex
Mech. or chem. stimulation of
enterochromafinne cells in the
mucosa
5-HT release
5-HT stimulates nerve endings
in the plexus submucosus

Therefore: GI problems often

accompany antidepressive
therapy
 ENTERIC NERVOUS
SYSTEM
Governs many GIT functions without
external inervation (modulation only)
motility
secretion
collaboration with immune system on
defense
growth regulation
 Local reflexes of ENS
sensoric neuron in ENS
mechano-
chemo-
thermo-
noci-
interneuron(s) in ENS
efferent neuron in ENS

e.g. peristaltic reflex

 ENS
~108 neurons - similar to spinal cord
no distinct neuromuscular junctions (nerve
endings freely distributed among SMC)
innervates also the vessels (mainly
vasodilation) & surrounding organs (bladder,
pancreas)
perhaps phylogenetically older than CNS
(food needed before locomotion)
 ENS & CNS: similarities
Glial instead of Schwann cells (similar to
astrocytes in CNS)
All neurotransmitters so far known in CNS:
excitatory motoneurons: mainly ACh
(muscarinic receptors on SMC)
inhibitory motoneurons: VIP & NO
interneurons: mainly ACh (nicotinic receptors
on target neurons) & GABA
serotonin (95 % of all)
 ENS & CNS: similarities
Similar sensitivity to toxins, drugs, and
diseases
Antidepressants: 5-HT re-uptake in brain & ENS
- nausea, diarrhea,
then constipation (desensitization)
can be used to calm down GIT
(ENS more sensitive than CNS)
Lewys bodies (Parkinsons disease) & amyloid
plaques & neurofibrilar clusters (Alzheimers
disease) also in the gut (diagnosis by rectal
biopsy?)
Therefore: GI & psychic problems often co-exist
 ENS & CNS: similarities
Can learn
Hirschsprungs disease - genetically
determined absence of nerves in the most
distal GIT part - inability to defecate
within 18 months after resection of the
defect, the more proximal part learns to
defecate (it couldnt do it at the beginning)
 ENS & CNS: communication
~10x more AP ENS -> CNS than CNS -> ENS

e.g. gastric ulcers:

history: psychosomatic (soul -> GI)
today: vice versa - Helicobacter pylori is primary, psychic
discomfort follows ENS irritation (GI -> soul)

afferentation from ENS to CNS can act antidepressively, support

learning
(c.f. mood when hungry vs. after a good meal)
 Vegetative innervation

Mainly co-ordination of remote parts

e.g. gastrocolic reflex:
stomach filling colon activity

Sympathicus

Parasympathicus
 Small intestine

Duodenum first 5% of length, jejunum next 40, ileum

the rest

Most of digestion in duodenum & jejunum, ileum not

necessary

Peristalsis simultaneously only in short segments

(~10 cm) (except MMC)
 Emptying of ileum

Ileocecal sphincter (valve) normally closed (e.g.

because of bacteria)

Opened by distension of end of ileum (local

reflex)

Closed by distension of proximal colon (local

reflex)
 SUCCUS ENTERICUS
(Intestinal Juice/ Getah Usus Halus)

KELENJAR :
Brunner
Lieberkuhn
Komposisi :
Enzim
Erepsin : dipeptidase, tripeptidase
Disacharida :Sukrase, laktase, maltase
lipase
Mukus
Air + elektrolit
 PENCERNAAN PROTEIN
LAMBUNG USUS HALUS

Proteosa 2 Tripeptida
1 Dipeptida
Protein Pepton
Polipeptida As. amino

1 = pepsin As. amino

2 = tripsin, khemotripsin,
karboksipeptidase, dll
3 = erepsin (dipeptidase,
tripeptidase)
 PENCERNAAN KARBOHIDRAT

LAMBUNG USUS HALUS

1 Polisa- 2 Limit dextrin

Polisa- kharida maltotriose
kharida lebih maltosa
pendek laktosa
sukrosa
3
1 = ptyalin
2 = amilase pankreas Monosakharida
glukosa,
3 = disakharidase
galaktosa,
fruktosa
 PENCERNAAN LEMAK

LAMBUNG USUS HALUS

Lemak Monogliserida
Lipase, gliserol
garam
empedu
asam lemak
 Nutrient Absorption
Passive diffusion: driven by concentration;
fats, water, some minerals
Active absorption: uses energy; glucose and
amino acids
Phagocytosis and pinocytosis: absorptive
cells engulf compounds, generally larger
molecules, as in immune substances in
breast milk
 SUCCUS ENTERICUS
(Intestinal Juice/ Getah Usus Halus)

KELENJAR :
Brunner
Lieberkuhn
Komposisi :
Enzim
Erepsin : dipeptidase, tripeptidase
Disacharida :Sukrase, laktase, maltase
lipase
Mukus
Air + elektrolit
 Regulation GI function
 PENGATURAN SISTEM PENCERNAAN

REFLEK LOKAL SARAF

INTRAMURAL
PERABAAN
1. Pl.
PEREGANGAN
myenterikus
IRITASI (Pl.
Auerbach)

HORMONAL 2. Pl.
submukosa
Gastrin
(pl.
Pankreozimin/kholesistokinin Meissner)
Sekretin SSO
1. Simpatis
Enterokrinin
2. Parasimpatis
Enterogastron (n.X)
Gbr. Persarafan Usus
 RANGSANGAN PADA PARASIMPATIS
DAN SIMPATIS

PARASIMPATIS : SIMPATIS :
Meningkatkan kontraksi Menurunkan aktivitas
tonus otot polos dd.sp usus
Meningkatkan intensitas Meningkatkan aktivitas
kontraksi ritmis
spinkter :
Meningkatkan frekuensi
kontraksi ritmis Ileosaekal

Meningkatkan Ani interna

kecepatan hantaran
impuls
 PERSARAFAN SAL. PENCERNAAN

PLEXUS INTRAMURAL SARAF OTONOM

Oesophagus anus, Simpatis (Th8- L3)
bertanggung jawabatas reflex Parasimpatis :
neurogenik (lokal) :
- bag. Kranial : n
aktivitas otot polos dan sekresi vagus
getah pencernaan
- bag. Sakral (S2-4)
Koordinasi
Terdiri dari :
- Pl. myentericus (Auerbach)
- Pl. submukosa (Meissner)
 Organization and control of the
gastrointestinal system
Digestive processes motility,
secretion, digestion & absorption
Phases cephalic, gastric, intestinal
& interdigestive period
Contacts external environment
Excretes steroid metabolites
Sphincters - Upper and lower
esophageal sphincters, pylorus,
ileocecal valve, internal and external
anal sphincters
Organs Teeth, Salivary glands,
esophagus, stomach, liver, pancreas,
duodenum, ileum, jejunum, colon
 Large intestine
Main functions:
water absorption (400-1000 ml/day) & ions (much water
has been invested into digestion),
storage of food remnants that are not needed (typically
16-20 hr, but up to 30% can stay in colon ~1 week)

Mixing is more difficult because of increasing

density

Haustrations, mass movement

Haustrations
Similar to segmentation,
but more marked & in
anatomicaly pre-defined
locations of circular
muscle layer
Governed by BER from
interstitial cells (~6/min)
Usually no AP
Stronger contractions (e.g
ACh) by prolonging BER
GERAKAN USUS BESAR (KOLON)
MENGADUK= HAUSTRASI
Regangan menyebabkan kontraksi melingkar
spj 2,5 cm berupa kontraksi m.longit. Pada
lokasi regangan dan disertai relaksasi pada
bagian lain : HAUSTRA
MENDORONG = MASS MOVEMENT
Regangan menyebabkan kontraksi serentak
sepanjang 20 cm selama 10-20 detik, kemudian
mendorong massa ke distal
Rangsangan lain : reflek
gastrokolika, duodenokolika (via pl. myent.
gastrin
 Colon motility
Mass movement: 1-3x/day (usually after meal) wave
of contraction moves content to larger distances,
colon remains contracted for a while

Overall movement is slow (max 5-10 cm/hr)

Controlled by ENS, sympathicus blunts movements,

parasympathicus stimulates haustrations of proximal
parts & expulsive movements of distal parts
 Reflexes of large intestine
Colono-colic - distension of one part relaxes the rest
(partly sympathicus)

Gastro-colic - filling of stomach increases frequency

of mass movements (sympathicus, parasympathicus,
CCK, gastrin)

Similarly duodeno-colic
 Rectum & anal channel
Rectum usually (almost) empty (retrograde
contractions return content to sigmoideum, until
there is too much of it)
Just before defecation mass movement in
sigmoideum fills rectum pressure reflex
relaxation of inner sphincter (smooth muscle) &
contraction of outer sph. (skeletal muscle controlled
intentionally via pudendal nerves)
Stretch receptors in rectal wall can adapt - urge to
defecate can temporarily subside id suppressed
 Defecation - the END
Reflex controlled from sacral spinal cord, modulated from
higher levels (conscience, will)
Efferent branch - ACh parasympathetic fibres in pelvic nerves
Highly propulsive contraction of descending colon &
sigmoideum
Relaxation of both sphincters (outer voluntary)
Inspiration pushes the diaphragm downwards
Contraction of expiratory muscles with full lungs &
contraction of abdominal muscles increase abdominal pressure
(up to 200 mmHg)
 REFLEK DEFEKASI
(Lokal)
RANGSANG :
Feses dalam rektum
Reflek gastrokolika dan duodenokolika
Gastrin

Pengeluaran feses dicegah oleh

spingter ani int. dan ext.
DEFEKASI TERJADI :

Feses
pl. myenterikus
(rektum)

kontraksi mm kolon
(peristaltik)

Receptive
Sp ani int relaxation and
Sp ani ext
terbuka low of gut
terbuka

DEFEKASI
Summary GI T function
Oral cavity

Ingestion. Solid food and fluids are taken into the digestive tract through
the oral cavity.
Taste. Tastants dissolved in saliva stimulate taste buds in the tongue.
Mastication. Movement of the mandible by the muscles of mastication
cause the teeth to break food down into smaller pieces. The tongue and
cheeks help to place the food between the teeth.
Digestion.
Amylase in saliva begins carbohydrate (starch) digestion.
Swallowing. The tongue forms food into a bolus and pushes the bolus
into the pharynx.
Communication. The lips, cheeks, teeth, and tongue are involved in
speech. The lips change shape as part of facial expressions.
Protection. Mucin and water in saliva provides lubrication, and
lysozyme kills microorganisms.
Pharynx

Swallowing. The involuntary phase of swallowing moves the bolus

from the oral cavity to the esophagus. Materials are prevented
from entering the nasal cavity by the soft palate and from entering
the lower respiratory tract by the epiglottis and vestibular folds.
Breathing. Air passes from the nasal or oral cavity through the
pharynx to the lower respiratory tract.
Protection. Mucus provides lubrication.
Esophagus
Propulsion. Peristaltic contractions move the bolus from the
pharynx to the stomach. The lower esophageal sphincter limits
reflux of the stomach contents into the esophagus.
Protection. Glands produce mucus that provides lubrication and
protects the inferior esophagus from stomach acid
Stomach
Storage. Rugae allow the stomach to expand and hold food until it
can be digested.
Digestion. Protein digestion begins as a result of the actions of
hydrochloric acid and pepsin. Intrinsic factor prevents the
breakdown of vitamin B12 by stomach acid.
Absorption. Except for a few substances (e.g., water, alcohol,
aspirin) little absorption takes place in the stomach.
Mixing and propulsion. Mixing waves churn ingested materials
and stomach secretions into chyme. Peristaltic waves move the
chyme into the small intestine.
Protection. Mucus provides lubrication and prevents digestion of
the stomach wall. Stomach acid kills most microorganisms.
Small intestine
Neutralization. Bicarbonate ions from the pancreas and bile from
the liver neutralize stomach acid to form a pH environment
suitable for pancreatic and intestinal enzymes.
Digestion. Enzymes from the pancreas and the lining of the small
intestine complete the breakdown of food molecules. Bile salts from
the liver emulsify fats.
Absorption. The circular folds, villi, and microvilli increase surface
area. Most nutrients are actively or passively absorbed. Most of the
ingested water or the water in digestive tract secretions is
absorbed.
Mixing and propulsion. Segmental contractions mix the chyme,
and peristaltic contractions move the chyme into the large
intestine.
Excretion. Bile from the liver contains bilirubin, cholestrol, fats,
and fat-soluble hormones.
Protection. Mucus provides lubrication, prevents the digestion of
the intestinal wall, and protects the small intestine from stomach
acid. Peyers patches protect against microorganisms.
 Large intestine

Absorption. The proximal half of the colon absorbs salts (e.g., sodium
chloride), water, and vitamins (e.g., K) produced by bacteria.
Storage. The distal half of the colon holds feces until it is eliminated.
Mixing and propulsion. Slight segmental mixing occurs.
Mass movements propel feces toward the anus and defecation eliminates the
feces.
Protection. Mucus and bicarbonate ions protect against acids produced by
bacteria
Thank you