STRUKTUR DAN FUNGSI SISTEM PENGHADAMAN

Oral Cavity
1. Lips and Cheek

2. Tongue
3. 32 teeths 4. Palate and Tonsils 5. Salivary Glands

Oral Cavity
1. Bibir dan pipi - mengunyah dan bercakap 2. Lidah - bercakap, merasa, mengunyah, menelan 3. 32 gigi - mengerat, melumat/menghancur - crown, neck and root 4. Lelangit - keras dan lembut 5. Salivary Glands - menghasilkan serous dan mocous 3 glands - 1. Parotid, 2. Submandibular, 3. Sublingual glands

Oral Cavity
Functions:
A. Ingestion: cheeks lips and tongue mobilize food
B. Digestion: Mechanical Mastication Chemical 3 salivary glands Digests some starches and fat

Teeth
Incisor (cutting)

Canine (tearing)
Premolar (tearing and grinding) Molar (grinding)
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Salivary Glands
Parotid: Primarily serous with digestive enzymes and lysozymes Sublingual: Primarily mucous Submandibular: Mixed
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Salivary Glands

Pharynx (tekak)

1. Nasopharynx

2. Oropharynx

3. Laryngopharynx

Esophagus

Pharynx
Motility: pharyngeal constrictors force food down during swallowing

Esophagus
1. Salur memanjang dari pharynx ke stomach melalui diaphragm 2. Ukuran panjangnya 25 sm 3. Esophageal sphincters mengantar makanan keluar dan masuk esophagus 4. Cardiac sphincter - lower esophageal sphincter 5. Mucous glands - mucus

Heart

Esophagus

Stomach

Esophagus
Extends from pharynx through the diaphragm at the esophageal hiatus to the lower esophageal sphincter into the Body stomach
Diaphragm

Lower Esophageal Sphincter

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Esophagus
Straight muscular tube about 1 foot long Motility: muscular contraction moves food towards stomach
www.mywebmd.ca.com

Heartburn and the Esophagus

Heartburn, acid reflux, is caused by acid and food going from the stomach into the esophagus The diaphragm normally prevents acid reflux, in conjunction with the lower esophageal sphincter. When this fails, the burning sensation felt is known as heartburn May be linked to a rare type of cancer, adenocarcinoma

Stomach
1. Stomach - cardiac region and pyloric region 2. The wall of stomach 3 layers; i. longitudinal ii. circular iii. oblique 3. Gastric glands produce; i. mucus ii. hydrocloric acid iii. pepsin iv. gastrin v. intrinsic factor

Stomach

Stomach Rugae

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Position of Stomach

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Stomach

Stomach
Muscular sac on the left side of the peritoneal cavity

Functions: Food storage Mechanical digestion Chemical digestion

Rugae in the Stomach

Rugae- folds in the stomach lining that allow it to expand with more food How do we vomit?
http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion

Small Intestine
Small intestine - 3 parts:

i. duodenum
ii. jejunum

iii. ileum
Intestinal Lining - circular folds, villi dan microvilli Goblet cells & duodenal glands - mucus

Small Intestine

Small Intestine: Gross Anatomy

Runs from pyloric sphincter to the ileocecal valve Has three subdivisions: duodenum, jejunum, and ileum The bile duct and main pancreatic duct: Join the duodenum at the hepatopancreatic ampulla Are controlled by the sphincter of Oddi The jejunum extends from the duodenum to the ileum The ileum joins the large intestine at the ileocecal 24 valve

Small Intestine
Minor papilla

Plica Circularis

Ileum

Duodenum C-Loop

Major papilla
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Small Intestine: Ileum

Ileocecal valve

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Small Intestine
http://www.afns.ualberta.ca/bbo/1/ANATOMY/SI1.asp

2 meters long, 1 inch in diameter, 5-6 meters in cadaver Functions:

Chemical Digestion Nutrient Absorption Motility

Anatomy of the Small Intestine

Duodenum (25 cm):
1. Receives stomach contents, pancreatic juice and bile 2. Neutralizes stomach acid and pepsin 3. Pancreatic enzymes and bile take over chemical digestion

Fig 25.22

Anatomy of the Small Intestine

Jejunum (2.5m) Ileum (3.6 m)
Reabsorbs bile acids

Functions of the Small Intestine

Motility: smooth muscle contract
Digestion: chemical enzymes received from the pancreas, liver and gall bladder

Microvilli

Nutrient reabsorption: microvilli increase surface area

Duodenum

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Liver
1. Liver menerima darah daripada: i. hepatic artery ii. Hepatic portal vein 2. Liver produces bile. Bile leaves lever - hepatic duct system. 3. Liver devided into lobules - portal triads 4. Portal triads: I. hepatic portal vein ii. hepatic artery iii. hepatic duct

Liver

Pancreas
1. Pancreas adalah kelenjar endokrine dan exorine. 2. Tugasnya mengawal tahap nutrein darah 3. Exocrine menghasilkan; i. bicarbonate ions ii. digestive enzymes

Pancreas
Head Common Bile Duct Body Tail

Accessory Duct

Pancreatic Duct
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Liver, gallbladder, Pancreas and Duct System

Liver, gallbladder, Pancreas and Duct System

Liver Histology

Liver
The largest gland in the body Superficially has four lobes right, left, caudate, and quadrate The falciform ligament:
Separates the right and left lobes anteriorly Suspends the liver from the diaphragm and anterior abdominal wall
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Anatomy and Histology of the Pancreas

Large Intestine
1. Colon terdiri daripada; i. Ascending, ii. tranverse iii. descending iv. Sigmoid portions 2. Mengandungi mucus - crypts 3. Rectum adalah saluran lurus - anal canal 4. Cecum and appendix - blind sacs 5. Cecum - junction of small and large intestines.

Large Intestine

Peritoneum and Mesenteries

Large Intestine
Is subdivided into the
Cecum Appendix Colon Rectum Anal canal

The saclike cecum:

Lies below the ileocecal valve in the right iliac fossa Contains a wormlike vermiform appendix
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Large Intestine

Hepatic Portal Vein

Aorta

Superior Mesenteric Artery

Inferior Mesenteric Artery

Ileocecal valve is in here

Cecum Appendix Ileum

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Colon
Has distinct regions: ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, and sigmoid colon The sigmoid colon joins the rectum The anal canal, the last segment of the large intestine, opens to the exterior at the anus

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Colon
Hepatic Flexure

Transverse Colon

Splenic Flexure

Descending Colon Ascending colon

Rectum Anal Canal Sigmoid Colon

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Valves and Sphincters of the Rectum and Anus

Three valves of the rectum stop feces from being passed with gas The anus has two sphincters:
Internal anal sphincter composed of smooth muscle External anal sphincter composed of skeletal muscle

These sphincters are closed except during defecation

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Structure of the Anal Canal

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Large Intestine
Functions
Motility
Reabsorbtion of Water and Electrolytes

Symbiotic bacteria
Synthesis Vitamins B & K

Anatomy of the Large Intestine

Transverse Colon: right to left

Ascending Colon: up the right side

Descending Colon: down the left side

Cecum: sac on lower right side

Sigmoid Colon: S-shaped

Anatomy of the Large Intestine

Rectum: straight down Anal Canal: out the body Appendix: hangs off cecum
Important in Immunity

Enzymes Involved in Chemical Digestion

Saliva:
Amylase: breaks down starch Lipase: breaks down fats when it enters the stomach
Low pH of the stomach activates the enzyme

Enzymes Involved in Chemical Digestion

Stomach:
Digestive chemicals HCL: activates enzymes, breaks up foods Pepsin: digests proteins Renin: digests milk

Pepsin Formation
Interactions between Cells Chief Cells make pepsinogen Parietal Cells make HCl Pepsinogen is cleaved by HCl into Pepsin

Dynamic Human: Pepsin Formation

Enzymes Involved in Chemical Digestion

Small Intestine Two sources of enzymes
Liver and Gall bladder Pancreas

Enzymes Involved in Chemical Digestion in the Small Intestine

Liver secretes bile that is active in the small

intestine

Bile: aids in fat digestion and absorption

make your feces brown

Activates pancreatic enzymes Synthesized from cholesterol Bacteria in the small intestine use bilirubin to

Gall bladder stores and concentrates bile

Gall Stones
What is a gall stone? How do they treat gall stones? How is the gall bladder removed?

Enzymes Involved in Chemical Digestion in the Small Intestine

Pancreas: secretes pancreatic juice
1. 2. 3. 4. 5. Amylase: breaks down starch Lipase: breaks down fats Ribonuclease (RNAase): breaks down RNA Deoxyribonuclease (DNAase): breaks down DNA Zymogens: inactive enzymes that activate in the small intestine

Mechanism of Absorption
Membrane Transport:
Nutrients pass through membrane surface The greater the membrane surface area, the greater the amount of nutrients that can be transported

Surface Area
Rugae Microvilli

Final Destinations of Digestion Products

Starches bloodstream

Fats lymph vessels (lacteals)

Proteins bloodstream

PERGERAKAN BAHAN YANG DIHADAM

Sistem Penghadaman
1. Sistem Penghadaman di atur oleh: i. neural ii. hormonal mechanisms 2. Intramural plexuses bertanggungjawab kepada local reflexes

Oral Cavity, Pharynx and Esophagus

1. Amylase (saliva) mula penghadaman.
2. Mucin menghasilkan pelincir 3. Gigi - menghancurkan makanan 4. Voluntary phase: Bolus akan ditolak oleh lidah ke pharynx

Oral Cavity, Pharynx and Esophagus

5. Pharyngeal phase:
i. soft plate close nasopharynx ii. epiglottis close - larynx iii. pharyngeal muscles move the bolus to the esophagus

iv. Peritalsis ( a wave of constriction) moves the food down to the stomach

3 fasa Menelan (1)

3 fasa Menelan (2)

3 fasa Menelan (3)

Stomach
1. Secretion of the Stomach i. mucus protect the stomach lining

ii. hydrocloric acid kills microorganisms & activates pepsin iii. pepsin starts protein digestion
iv. intrinsic factor aids (vitamin B12 ) absorption v. Gastrin helps regulate stomach secretion and movements.

Stomach

Stomach

Stomach

Stomach
2. Regulation of stomach Secretion i. Cephalis phase - sight, taste, smell .. ii. Gastrin - stomach secretion iii. Gastric phase - promotes secretion iv. intrinsic factor aids (vitamin B12 ) absorption v. Gastrin helps regulate stomach secretion and movements. vi. Intestinal phase - acidic chyme

3 Fasa Perembesan Gastrik

3 Fasa Perembesan Gastrik

3 Fasa Perembesan Gastrik

Stomach
3. Movement in the stomach

i. Mixing wave mix the stomach contents

with the stomach secretion - chyme

ii. Peritalsis wave moves the chyme to the

duodenum

Small Intestine
1. Secretions of the small intestine
i. Mucus protects: - digestive enzymes - stomach acid ii. Chemical or tactile irritation

Small Intestine
2. Movement in the small intestine i. Segmental contraction occur - short distance - mix intestinal secretion ii. Peritalsis contraction occur - length distance - propel chyme 3. Most absorption occurs in the duodenum and jejunum

Liver
1. Liver produces;

i. bile - emulsify fats

ii. stores and processes nutrients

iii. produces new molecules

iv. detoxifies molecules v. produces blood proteins

Kawalan Rembesan Bile

Pancreas
1. Pancreas produces;

i. bicarbonate ions
ii. digestive enzymes

2. Acidic chyme - a watery bicarbonate solution

3. Fatty acids and amino acids (duodenum) pancreatic enzymes

Pancreas

Large Intestine
1. Functions:

i. feces production
ii. water absorption

2. Much longer to move

3. In the colon, chyme is converted to feces 4. Mass movements occur 3/4 times/day 5. Defecation - elimination of feces

Salivary Gland Histology

Demilune

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Parotid salivary gland

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Submandibular salivary gland

Serous Acini
Duct

Mucus Acini

Serous Acini Demilune

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GI Tract Histology
All of the hollow organs have the same basic 4 layers. 1. Mucosa (Lumen side)
Epithelial layer (remember from 231: stratified squamous, columnar ect) Lamina Propria: Base made of loose areolar connective tissue Muscularis Mucosa: Base of smooth muscle fibers

2. Submucosa
Dense irregular connective tissue This is where the blood vessels, nerves and the glands are.
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GI Tract Histology
3. Muscularis Externa
The main smooth muscle layer used for peristalsis Longitudinal and Circular layers with myenteric plexus (parasympathetic ganglion) in between

4. Serosa (Abdominal cavity side)

Epithelial layer (usually simple squamous) Also known as the visceral peritoneum

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GI Tract Histology

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Mucosa
Epithelial Cells

Lumen

Mucosa
Lamina Propria
(Loose areolar CT)

Muscularis Mucosa

Submucosa
(Dense irregular CT)
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Myenteric Plexus in Muscularis Externa

Longitudinal Muscle Layer Myenteric Plexus

Satellite Cell

Neuron Cell Body

Circular Muscle Layer

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Esophagus Histology
1. Mucosa Epithelium
Nonkeratinized Stratified Squamous

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Esophagus Histology
2. Submucosa (#2) Esophageal glands Vessels Submucosal Plexus

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Esophagus Histology
3. Muscularis Externa Upper 1/3=Skeletal Middle 1/3=Blend Lower 1/3=Smooth
4. Adventitia (Rest of GI tract: Serosa) Coarse Fibrous CT: binds/anchors

Skeletal Muscle

Smooth Muscle

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Esophagus Histology Muscularis Externa

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Stomach Histology
4 layers: Mucosa (inside layer)
Simple columnar epithelium

Submucosa Muscularis Externa smooth muscle in 3 layers Serosa (visceral peritoneum)

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Stomach Histology: Mucosa (Inside layer)

Mucosa: Simple columnar epithelium

103

Stomach Mucosa
Mucous neck cells
Alkaline mucus

Parietal cells
HCL Intrinsic factor

Chief cells
Pepsinogen Gastric lipase

G cells (in antrum)

Gastrin
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Stomach Mucosa
Mucus Neck Cells

Gastric Pits

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Lamina propria Lumen of pit

Parietal Cell

Chief Cell

Entroendocrine (G cell)
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Stomach

107

Small Intestine: Histology

Structural modifications of the small intestine wall increase surface area
Plica Circularis: Transverse folds on the mucosa Villi: Fingerlike extensions of the mucosa Microvilli (Brush border): Tiny projections of absorptive mucosal cells plasma membranes

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Small Intestine: Plica Circularis

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Small Intestine Histology: Mucosa

Plicae Circulares: Large deep, permanent folds of the mucosa and submucosa.

Slow the movement of chyme (more time for digestion/absorption) and increase the surface area.
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Small Intestine Histology

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Small Intestine Histology: Villi

Villi: Fingerlike projections of the mucosa. Made of simple columnar epithelium Increase the surface area. Within the core of each villus is a capillary bed and a lacteal for transport of the absorbed nutrients
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Small Intestine: Villi

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Small Intestine Histology: Mucosa

Microvilli: Tiny projections of the plasma membrane of the simple columnar absorptive cells. Often called the "brush border" due to their appearance. They further increase the available surface area and contain membrane-bound enzymes involved in digestion.
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Small Intestine

115

Small Intestine

116

Crypts of Liberkhn

Paneth Cells in a Crypt of Liberkhn secrete lysozymes

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Small Intestine Histology: Submucosa with Brunners Glands

Brunners glands in the proximal duodenum secrete alkaline mucus

Brunners glands

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Small Intestine Histology: Submucosa with Peyers Patches

Peyers patches are found in the submucosa of ilium Lymphoid tissue

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Large Intestine: Histology

Colon mucosa is simple columnar epithelium except in the anal canal Has numerous deep crypts lined with goblet cells Anal canal mucosa is stratified squamous epithelium Superficial venous plexuses are associated with the anal canal
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Large Intestine Histology

121

Large Intestine Histology

No Villi Many Goblets (mucus) Many surface absorptive cells (absorb water) Crypts of Lieberkhn
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Large Intestine Histology

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Anal Canal Histology

At the junction of the rectum and anus, the histology of the mucosa changes to stratified squamous

124

Liver Histology
Liver sinusoids enlarged, leaky capillaries located between hepatic plates Kupffer cells hepatic macrophages found in liver sinusoids

125

Liver Histology
Hexagonal-shaped liver lobules are the structural and functional units of the liver
Composed of hepatocyte (liver cell) plates radiating outward from a central vein (flows toward hepatic vein) Portal triads are found at each of the six corners of each liver lobule

Portal triads
Bile duct Hepatic artery supplies oxygen-rich blood to the liver Hepatic portal vein carries venous blood with nutrients from digestive viscera
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Liver Histology

127

Liver Histology

128

Liver: Portal Triad

129

Liver
Brach of Portal Vein Bile Duct

Hepatocytes

Branch of Hepatic Artery

130

Pancreas
Exocrine function: Acinar cells
Secretes pancreatic juice which breaks down all categories of foodstuff Acini (clusters of secretory cells) contain zymogen granules with digestive enzymes

Endocrine function: Islets of Langerhans

Release of insulin and glucagon

131

Pancreas Histology

132

Pancreatic ducts
The ducts leading into the duodenum Cuboidal or columnar Secrete HCO3Pancreatic Duct

Acinar Cells

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