ANATOMI & FISIOLOGI

SALURAN PENCERNAAN

Wound & Stoma Care Course

F Siusanto Hadi
Siloam Hospital Surabaya
SISTEMA DALAM TUBUH

 Sel > Jaringan > Organ > Sistem > Organisma

– Sistem Syaraf
– Sistem Kardiovaskuler
– Sistem Pencernaan
– Sistem Perkemihan
– Sistem Gerak
– Sistem Integumen
– Sistem Respirasi
– Sistem Endokrin
– dll
Sel
Human Structure – Level Organization
System Relationship
DIGESTIVE SYSTEM

 Function of Digestive System

– Ingestion
– Chewing
– Swallowing
– Digestion
– Absorption
– Excretion of undigested food
anatomy
 Organs of Digestive System
– Mouth
– Pharynx (Throat)
– Oesophagus (Food tube)
– Stomach
– Small intestine
– Large intestine
– Rectum
– Anus
Layers of Digestive System

 Inner Epithelial layer

– Secretion of enzyme and mucus
– Soft and pink in colour
 Middle Muscular layer
– Outer layer (Longitudinal muscles)
– Inner layer (Circular muscle)
– Peristalsis (Segmental contraction)
 Outer Serous layer
– Protective function
– Diagram
 Stomach
– Dilated part of Digestive system
– Lies in upper abdomen below diaphragm
– Slightly left to midline
– Upper opening connected to Oesophagus
– Lower opening connected to Duodenum
– Both remain closed during gastric digestion
– J shaped in standing position
– Elastic muscular bag with capacity of 2 liters
– 3 muscular layer- vertical, circular, oblique
 Functions of the Stomach
– Storage of food for 3 hours
– Partial digestion of proteins and fats
– Semi digested food from stomach enters
the Duodenum
 Oesophagus
– 25cm long muscular tube
– From pharynx to stomach
– Behind trachea and in front of vertebral column
– Major part passes to Thorax
– Food passes to stomach by active muscular
action
– Solid food reaches stomach in 7 to 8 seconds
– Liquids reaches stomach in 2 to 3 seconds
 Small intestine
– 6 to 7 meter long, 2.5cm diameter
– Lies in center of abdomen
– Divided into 3 parts
 First part – Duodenum (Bile & Pancreatic secretion)
 Second part – Jejunum
 Third part – ileum
 Alkaline Secretions
– Protects from acid contents of stomach
 Small intestine
– Mucosa
 Deeply folded to increase the surface area
 Helps in absorption of food.
Enterohepatic cycle
 Large intestine
– 1.5meter long, 5 to 6cm diameter
– Divided into 3 parts
 Right ascending colon
 Transverse colon
 Left descending colon
– Absorb water : faeces
 Sigmoid Colon & Rectum
– Temporary storage of faeces
– Anus is guarded by external & internal sphincters
Microbe

Microbial Populations in the Digestive Tract of Normal Humans

Stomach Jejunum Ileum Colon

Viable bacteria per gram 0 - 103 0 - 104 105 - 108 1010 - 1012

pH 3.0 6.0-7.0 7.5 6.8-7.3

Stoma Physiology
 Ileostomy
 Colostomy
 Urostomy
Making of Ileostomy
Type of Ileostomy
Ileostomy Output

 Early Post op period : liquid & bilious

 1500 – 2000 cc/day
 Well established : 200 -700 cc/day
 Hill :
– Low stomal volume : <700 cc/day
– High output volume : >1000 cc/day (Crohn’s ds)
 6 months later : volume varies, porridge-like,yellow brom
color,food particle
 Grape juice/other fruit juice : increase wet weight stool
 Dietary fiber : increase dry stool weight
 Fasting : decrease stool volume
 Skin complication
Ileostomy & Nutritional/Metabolic Effect

 Malabsorption > osmotic diarrhea

– Fat malabsorption : reduce bile salt absorption
– Carbohydrate : lactase deficiency
– Protein : enterokinase deficiency
 B12 vitamin deficiency
 Electrolyte depletion
– Sodium loss : 60 mEq/day (Normal <10 mEq/day)
– Higher in ileum resection
– Potassium loss : 6-12 mEq/day (Normal 5 mEq/day)
Ileostomy & Nutritional/Metabolic Effect

 Urinary calculi :
– 3%-13%
– Dehydration & Sodium loss
 Gallstone formation :
– Extensive terminal ileal resection
– Enterohepatic circulation disrupted
– Prophylactic Cholecystectomy
Colostomy
 First day : liquid, steadily increase
 10-14 days : become quite viscous
 High fiber food : increase fecal weight
 Proximal : quite liquid, excessive bile acid in
colon > promote colonic water & electrolyte
secretion
 More distally : more solid
 DESENDEN
PROXIMAL KOLOSTOMI
COLOSTOMY

SIGMOID
TRANSVERSUM
KOLOSTOMI
KOLOSTOMI
Summary

 Small intestine & colon : Organs that

maintain fluid & electrolyte homeostasis
 Making stoma : change the homeostasis
 Attention made for this consequencies
 Anatomy & physiology knowledge is
important