ANATOMO FISIOLOGI SISTEM GASTROINTESTINAL

Fungsi
4 activities dari GI tract
1. Motility
Propel ingested food from mouth toward rectum

2. Secretion
Aid in digestion and absorption

3. Digestion
Food broken down into absorbable molecules

4. Absorption
Nutrients, electrolytes, and water are absorbed

Structure of GI Tract
Arranged linearly in following sequence
Mouth, esophagus, stomach, small intestine, large intestine, and anus

Other structures of GI tract

Salivary glands, pancreas, liver, and gallbladder

Structure of GI Tract
Lapisan dinding GI tract 1. Mucosa Innermost layer (faces lumen) Layer of epithelial cells specialized for absorption and secretion 2. Submucosa Consists of collagen, elastin, glands, and blood vessels 3. Circular and Longitudinal Smooth Muscle Provides motility for GI tract 4. Serosa Faces the blood

STRUKTUR GI Tract

 Autonomic Nervous System has an extrinsic and an intrinsic component

Extrinsic
Sympathetic and Parasympathetic innervation of GI tract

Intrinsic
Called Enteric Nervous System Contained within wall of GI tract Communicates with Extrinsic component

Intrinsic Innervation
Can direct all functions of GI in absence of extrinsic innervation Controls contractile, secretory, and endocrine functions of GI tract Receives input from
1. Parasympathetic and sympathetic nervous systems 2. Mechanoreceptors and chemoreceptors in mucosa

Sends information directly to smooth muscle, secretory, and endocrine cells

Oral Cavity
Upper lip

Mouth or oral cavity Lips (labia)

Hard palate
Soft palate Uvula

Orbicularis oris

Cheeks
Buccinator Hard and soft
Palatine tonsil

Palate: Oral cavity roof Palatine tonsils Tongue

Involved in speech, taste, mastication, swallowing Skeletal muscles

Tongue
Salivary duct orifices Sublingual Submandibular Lower lip Teeth

Salivary Glands
Produce saliva Prevents bacterial infection Lubrication Contains salivary amylase
Breaks down starch

Three pairs Parotid: Largest Submandibular Sublingual: Smallest

Pharynx and Esophagus

Pharynx
Internal nares Opening of auditory tube Nasopharynx Oropharynx Laryngopharynx Esophagus Trachea Pharynx

Food passes through the oropharynx and laryngopharynx

Pharynx and Esophagus

Esophagus
Oral cavity Pharynx Esophagus

Transports food from pharynx to stomach Passes through esophageal hiatus (opening) of diaphragm and ends at stomach
Hiatal hernia

Liver

Stomach

Sphincters
Circular muscles

Upper Lower

Esophagus
Muscular tube that conveys food from pharynx to stomach
Inner circular muscle Outer longitudinal muscle

Food passes through quickly because of peristalsis

Esophagus

Esophagus
Pyrosis (heartburn)common esophageal discomfort Result of regurgitation of food and gastric fluid into lower esophagus Acid reflux can cause esophagitis

Stomach
Specialized for accumulation of food
Capable of considerable expansion (can hold 2-3L)

Gastric juice converts food into semiliquid called chyme 4 Parts

Cardia Fundus Body Pylorus

Stomach Anatomy
Fig. 26.12 Fundus Esophagus Cardia Pyloric sphincter Longitudinal layer (outer) Circular layer (middle) Oblique layer (inner)

Pyloric orifice

Three layers of smooth muscle

Duodenum
Pylorus Gastric folds Body

Openings

Gastroesophageal: to esophagus Pyloric: to duodenum

Parts

Cardia Fundus Body Pyloric

Stomach
Gastric mucosa has numerous openings called gastric pits
Gastric glands empty into bottom of pits

4 functionally different cell types compose glands

Mucous cells Chief cells Parietal cells Enteroendocrine cells

Stomach Histology
Layers Three layers of muscles
Outer longitudinal Middle circular Inner oblique
Fig. 26.13

24-19

Stomach Histology
Fig. 26.12

Rugae: Folds in stomach when empty Gastric pits: Openings for gastric glands Contain cells
Mucous cells: Mucus along surface and in pits Parietal cells: Hydrochloric acid Chief cells: Pepsinogen
Fig. 26.13
24-20

Stomach

Small Intestine
3 Parts
1. Duodenum 2. Jejunum 3. Ileum

Primary site for digestion and absorption of nutrients Bile duct and pancreatic duct empty into duodenum

Small Intestine
Duodenum Jejunum Ileocecal valve Ileum

Site of greatest amount of digestion and absorption Divisions

Duodenum Jejunum Ileum

Small Intestine Secretions

Mucus
Protects against digestive enzymes and stomach acids

Digestive enzymes
Disaccharidases: Break down disaccharides to monosaccharides Peptidases: Hydrolyze peptide bonds Nucleases: Break down nucleic acids
24-24

Small Intestine

Small Intestine
Intestinal lining increases absorptive surface area Villi
Finger-like projections of the mucosa

Microvilli
Tiny projections on luminal membrane of each intestinal cell Give the apical region striated appearance called brush border

Histology of Small Intestine

Circular folds, villi and microvilli increase surface area Epithelial cells produced by intestinal glands

Villi

Microvilli

Large Intestine
Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal Reabsorbs water and electrolytes Eliminates waste NO Villi Mucosa contains numerous tubular glands called crypts
Responsible for mucus secretion

Large Intestine

Large Intestine

Movement in Large Intestine

Mass movements
Common after meals
Rectal valve Rectum Anal canal Veins Internal anal sphincter Anus External anal sphincter

Defecation reflex
Distension of the rectal wall by feces

Defecation
Usually accompanied by voluntary movements to expel feces through abdominal cavity pressure caused by inspiration (breathing in) and contraction of abdominal wall muscles

Liver
Largest internal organ Receives major blood supply from hepatic portal vein
Brings venous blood rich in nutrients from digestive tract

Hepatocytes
Livers cells Capable of regeneration

Liver

Liver
Functions
1. 2. 3. 4. 5. 6. Protein synthesis (albumin, prothrombin) Bile formation and secretion Detoxification of drugs and steroids Lipoprotein synthesis Carbohydrate metabolism Urea formation from ammonium

Gallbladder
Attached to surface of the liver Blind pouch that stores bile Ducts
Hepatic Duct Cystic Duct Common Bile Duct

Gallbladder

Pancreas
Exocrine and Endocrine Gland 1. ExocrineAcinar Cells
Secretes essential digestive enzymes through pancreatic duct into duodenum

2. EndocrineIslets of Langerhans
Secretes insulin and glucagon into blood stream

Duodenum and Pancreas

Duodenum
25cm in adult Accessory glands empty secretions into duodenum

Pancreas

Pancreas

GI Peptides
Includes hormones, neurocrines, and paracrines Regulate functions of GI tract
Contraction and relaxation of smooth muscle wall and sphincters Secretion of enzymes for digestion Secretion of fluid and electrolytes Trophic (growth) effects Some regulate secretion of other GI peptides

GI Peptides
Hormones Peptides released from endocrine cells of GI tract Secreted into portal circulation and enter systemic circulation Target cells may be in GI tract or may be located elsewhere in body Paracrines Secreted by endocrine cells of GI tract Act locally within same tissue that secretes them Neurocrines Released by neurons of GI tract following an AP
Somatostatin (inhibitory actions)

Gastrin, Cholecystokinin, Secretin, and Gastric Inhibitory Peptide

ACh, norepinephrine, Vasoactive Intestinal Peptide (VIP), GastrinReleasing Peptide (GRP), Neuropeptide Y, and Substance P

GI Hormones
Gastrin
Secreted by G cells in stomach in response to eating
Stimuli include proteins, distention of stomach, and vagal stimulation
Gastrin-releasing peptide (GRP) is released from vagal nerve endings onto G cells

Secretion is inhibited by low pH in stomach

Promotes H+ secretion by gastric parietal cells Stimulates growth of gastric mucosa

GI Hormones
Cholecystokinin
Secreted by I cells of small intestine in response to fatty acids and small peptides

5 Actions: 1. Contraction of gallbladder

Eject bile from gallbladder into small intestine necessary for emulsification lipids Digest lipids, carbohydrates, and proteins

2. Secretion of pancreatic enzymes

3. Secretion of bicarbonate (HCO3-) from pancreas 4. Growth of exocrine pancreas and gallbladder 5. Inhibition of gastric emptying
Ensures adequate time for digestive and absorptive

GI Hormones
Secretin Secreted by S cells of duodenum in response to H+ and fatty acids Promotes secretion of pancreatic HCO3 Neutralizing H+ allows for pancreatic enzymes to digest fats

Inhibits effects of gastrin on parietal cells (H+ secretion and growth) Gastric Inhibitory Peptide (GIP) Secreted by small intestine in response to all 3 types of nutrients Stimulates insulin secretion by pancreas Inhibits gastric H+ secretion

GI Paracrines
Somatostatin
Secreted by endocrine cells in response to decreased luminal pH Inhibits secretion of other GI hormones Inhibits gastric H+ secretion

Histamine
Secreted in H+-secreting region of stomach Stimulates H+ secretion by gastric parietal cells (along with gastrin and ACh)

GI Neurocrines
Synthesized in cell bodies of GI neurons AP causes release of neurocrine which interacts with receptors on postsynaptic cell
ACh (released from cholinergic neurons) Norepinephrine (released from adrenergic neurons)

Motility
Contraction and relaxation of walls and sphincters of GI tract Mixes ingested food to prepare it for digestion and absorption Propels food along GI tract Contractile tissue of GI tract is Smooth Muscle Except pharynx, upper 1/3 esophagus, and external anal sphincter are striated muscle Smooth muscle cells coupled via gap junctions Permits rapid spread of APs for coordinated, smooth contraction

Motility
Segmentation Contraction
Circular muscle contracts sending chyme in both orad and caudad directions Intestine then relaxes allowing chyme to merge back together

Peristaltic Contractions
Longitudinal muscle contracts orad to bolus propeling chyme along small intestine Simultaneously, portion of intestine caudad to bolus relaxes

Motility

Secretion
Addition of fluids, enzymes, and mucus to lumen of GI tract Secretions produced by
Salivary glands (saliva) Gastric mucosal cells (gastric secretion) Pancreatic exocrine cells (pancreatic secretion) Liver (bile)

Salivary Secretion
Salivary glands produce 1 L/day of saliva Functions of saliva Initial digestion of starches and lipids by salivary enzymes Dilution and buffering of ingested foods Lubrication of ingested food to aid its movement Structure of Salivary Glands Parotid glands, submandibular glands, and sublingual glands Each gland delivers saliva to mouth through a duct

Salivary Glands

Gastric Secretion
Gastric mucosal cells secrete gastric juice HCl and pepsinogen initiate protein digestion Intrinsic factor required for absorption of vitamin B12 Mucus protects gastric mucosa from HCl Cell Types of Gastric Mucosa Body of stomach contains oxyntic glands
Parietal cells HCl and Intrinsic Factor Chief cells Pepsinogen

Antrum of stomach contains pyloric glands

G cells Gastrin into the circulation Mucous neck cells Mucus, HCO3-, and Pepsinogen

Gastric Secretion

Gastric Gland

HCl Secretion
Parietal cells secrete HCl which converts inactive pepsinogen to pepsin 1. Within cell, CO2 combines with H2O to form H+ and HCO32. At apical membrane, H+ secreted into lumen of stomach via H+-K+ ATPase Cl- follows H+ into the lumen by diffusing through Cl- channels 3. At basolateral membrane, HCO3- absorbed into blood via a Cl--HCO3- exchanger Eventually HCO3- secreted back into GI tract by pancreas

HCl Secretion

Regulation of HCl Secretion

ACh

Released from vagus nerve Binds to receptors on parietal cells Produces H+ secretion by parietal cells Atropine blocks muscarinic receptors on parietal cells
Released from mastlike cells in gastric mucosa Binds to H2 receptors on parietal cells Produces H+ secretion by parietal cells Cimetidine blocks H2 receptors

Histamine

Gastrin
Released into circulation by G cells of stomach antrum Binds to receptors on parietal cells Stimulates H+ secretion

Ulcers
Gastric Ulcers
Mucosal barrier is defective allowing H+ and pepsin to digest portion of mucosa Helicobacter pylori produces NH4+ from urea
NH4+ breaks down mucosal barrier to H+

Duodenal Ulcers
More common H+ secretory rates are higher than normal
Excess H+ damages duodenal mucosa

Pancreatic Secretion
Exocrine pancreas secretes ~1 L/day into duodenum Fluid consists of HCO3- and enzymes Structure of Pancreatic Exocrine Glands Comprises ~90% of pancreas Acinar Cells
Line blind end of branching duct system Secrete enzymatic portion Line the ducts Secrete aqueous HCO3- component HCO3- neutralizes H+ delivered to duodenum from stomach Enzymatic portion digests carbohydrates, proteins, and lipids into absorbable molecules

Rest of pancreatic tissue is endocrine pancreas and blood vessels

Ductal Cells

HCO3- Secretion
Apical membrane of ductal cells contains a Cl--HCO3exchanger Basolateral membrane contains Na+-K+ ATPase and a Na+-H+ exchanger 1. CO2 and H2O combine in cells to form H+ and HCO32. HCO3- is secreted into pancreatic juice by Cl--HCO3exchanger 3. H+ is transported into blood by Na+-H+ exchanger
Absorption of H+ causes acidification of pancreatic venous blood

Regulation of Pancreatic Secretion

Acinar cells (enzymatic secretion) Receptors for CCK and muscarinic receptors for ACh CCK is most important stimulant
I cells secrete CCK in presence of amino acids and fatty acids in intestinal lumen

ACh also stimulates enzyme secretion Ductal cells (aqueous secretion of HCO3-) Receptors for CCK, ACh, and secretin Secretin (from S cells of duodenum) is major stimulant
Secreted in response to H+ in intestine

Bile Secretion
Necessary for digestion and absorption of lipids in small intestine Mixture of bile salts, bile pigments, and cholesterol Bile salts emulsify lipids to prepare them for digestion Solubilize products of lipid digestion in packets called micelles

Bile Secretion and Recycling

1. 2. 3. 4. Produced and secreted by liver Stored in gallbladder Ejected into small intestine when gallbladder contracts After lipids absorbed, bile salts are recirculated to liver via enterohepatic circulation Absorption of bile salts from ileum into portal circulation Delivery back to liver 5. Extraction of bile salts from the portal blood by hepatocytes

Bile Secretion and Recycling