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1. Oral region 2. DIGESTIVE TRACT 3. DIGESTIVE GLANDS Indriati Dwi R, dr,M.Kes Available @: anatomi.lecture.ub.ac.id indri.lecture.ub.ac.id

1. Oral region 2. DIGESTIVE TRACT 3. DIGESTIVE GLANDSanatomi.lecture.ub.ac.id/files/2015/04/MIKROS-GIT-all.pdf · pars marginalis Labium. pars mucosa pars marginalis pars rubra Labium

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Page 1: 1. Oral region 2. DIGESTIVE TRACT 3. DIGESTIVE GLANDSanatomi.lecture.ub.ac.id/files/2015/04/MIKROS-GIT-all.pdf · pars marginalis Labium. pars mucosa pars marginalis pars rubra Labium

1. Oral region

2. DIGESTIVE TRACT

3. DIGESTIVE GLANDS

Indriati Dwi R, dr,M.Kes Available @: anatomi.lecture.ub.ac.id indri.lecture.ub.ac.id

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Oral Region (cavum oris)

Digestive tract/ alimentary canal

(extrinsic) Digestive glands

• lips,

• palate,

• teeth and

associated

structures,

• tongue,

• major salivary

glands,

• lingual tonsil

Esophagus

Gaster

Duodenum

Jejunum

Ileum

Colon

anus

Pancreas

hepar

pharynx

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DIGESTIVE SYSTEM

Cavum oris (Oral Cavity)

Labium (lip) (a.k.a bibir)

Dentis (Teeth ) (a.k.a Gigi)

Lingua (Tongue ) (a.k.a Lidah) Glandula salivatorius (Salivatory Glands )

pharynx

esophagus

Gaster (stomach)

Intestinum tenue (small intestine)

Intestinum crassum (large intestine)

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CAVUM ORIS

Anterior : labium orificium oris

Superior : palatum

Inferior : lingua

Posterior : oropharynx isthmus faucium

Spaces :

•Vestibulum oris

•Cavum oris propria

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Labium oris superior

Labium oris inferior

Palatum durum

Palatum molle

Cavum oris

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Pars cutanea

pars rubra

pars mucosa

pars marginalis Labium

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pars rubra pars mucosa pars marginalis

Labium

Pars cutanea

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Oral Mucosa

Epithelium. Stratified squamous keratinized

or nonkeratinized (depending on location)

Lamina propria

Muscularis mucosae is not present.

submucosa

dense connective tissue, containing the minor

salivary glands

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Regional variations

Masticatory mucosa :

• mastication [+]. Ex : gingiva and hard palate

• Stratified squamous epithelium, keratinized

• Underlying submucosa is lacking in some

locations.

Lining mucosa

• Ex : lining of lips and cheeks, soft palate, alveolar

mucosa, undersurface of tongue, and floor of

mouth

• Stratified squamous epithelium,nonkeratinized

Specialized mucosa

• Taste bud [+]

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Korelasi klinis :

Angular cheilitis (perlèche)

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DENTIS GIGI SUSU : 20

RAHANG ATAS/ BAWAH :

- 2 INSISIVUS

- 4 CANINUS

- 4 PREMOLAR

GIGI DEWASA : 32

RAHANG ATAS :

- 2 INSISIVUS

- 4 CANINUS

- 4 PREMOLAR

- 6 MOLAR

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BAGIAN GIGI GIGI DEWASA

MAHKOTA GIGI

- PULPA

- DENTIN

- EMAIL

AKAR GIGI

- PULPA

- DENTIN

- CEMENTUM

GIGI SUSU :

- ONTOGENIC GIGI

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odontoblasts, which later produce dentin

dental follicle

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Korelasi klinis

- Caries dentis

- Gangren pulpa

- Periodontitis

- Amelogenesis imperfecta : Defects of enamel

- Dentinogenesis imperfecta : Defects of dentin

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TONGUE/ LINGUA

LAPISAN :

EPITHEL : SQUAMOUS COMPL

LAM. PROPRIA/SUBMUCOSA

MUSCULARIS (otot skelet)

Dorsum lingua : Papila-Papila:

1. Filiformis taste bud ( - )

2. Fungiformis taste bud ( + ), superficial

3. Circumvalata taste bud ( + ), lateral

4. Foliata (rudimenter)

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Lingua ( dorsum linguae )

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Korelasi klinis :

Glossitis

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DIGESTIVE SYSTEM

Oral Cavity

pharynx

esophagus

Gaster (stomach)

Intestinum tenue (small intestine)

Intestinum crassum (large intestine)

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Divided into 3 part :

- nasopharynx - Ep. Pseudo str col ciliated

- tonsila pharyngeal

- Tuba Eustachius middle ear

- oropharynx - Ep. Str. Squamous

- tonsila palatina

- Laryngopharynx : - continuous with the esophagus

posteriorly & the larynx anteriorly.

- vocal cord

The pharynx is part of the digestive system and also

the respiratory system; it is also important in vocalization.

PHARYNX

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Pharynx ( posterior view )

Gld.parotis

Palatum molle

Dorsum linguae

Epiglottis

Nasopharynx

Oropharynx

Laryngopharynx

Oesophagus

Cavum nasi

Cavum oris

Cavum laryngis

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Korelasi klinis :

Pharyngitis

Tonsilitis

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DIGESTIVE SYSTEM

Oral Cavity

Teeth

the tongue

pharynx

esophagus

Gaster (stomach)

Intestinum tenue (small intestine)

Intestinum crassum (large intestine)

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PLEXUS AUERBACH

• MUSCULARIS EXTERNA (between CIRC & LONGIT.)

PLEXUS MEISSNER

• SUBMUCOSA

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Lapisan mukosa : Epitel tdd epitel berlapis pipih.

Lamina propria tdd jaringan longgar

Muskularis mukosa tdd otot polos.

Lapisan submukosa

Berupa jaringan longgar dg kelenjar esofageal yg bersifat

mucous

Tunika muskularis

Tdd : Otot bergaris (1/3 atas)

Campuran otot bergaris & otot polos ( 1/3 tengah )

Otot polos ( 1/3 bawah )

Tunika adventisia : Jaringan ikat longgar

Esophagus

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Korelasi klinis :

- Varices esophagus

- Esofagitis refluks

- Lesi korosif pada esofagus

- Atresia esofagus

- Akalasia

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DIGESTIVE SYSTEM

Oral Cavity

Teeth

the tongue

pharynx

esophagus

Gaster (stomach)

Intestinum tenue (small intestine)

Intestinum crassum (large intestine)

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Stomach (Gaster)

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Gaster

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Histology of Stomach & Gastric Pits mucosa :

(a)The simple columnar :

mucinogen-producing

surface lining cells

(b)Lamina propria : loose

connective tissue,

contains gastric glands.

(c) muscularis mucosae

(foveolae)

submucosa

(a)dense irreg. conn.tissue.

(b) Meissner (submucosal)

plexus + blood vessels.

muscularis externa

3 layers of smooth muscle

: an incomplete inner

oblique layer, a thick

middle circular, & an outer

longitudinal layer.

between the middle

circular and outer

longitudinal smooth

muscle layers.

Serosa

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Gastric glands :

tubular glands in the lamina propria

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CARDIAC ZONE

Cardiac glands

in lamina propria

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Fundic zone

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surface mucous cells : The most superficial cells are simple columnar

epithelial cells

the mucous neck cell : @entrance of pit, serve as stem cells

Parietal/oxyntic cell : centrally located nucleus, a brightly staining,

eosinophilic cytoplasm, and a distinctive round shape

chief cell : most abundant at the bottom of each pit, has a basophilic

cytoplasm

enteroendocrine cell (G cell) : usually has a light-staining cytoplasm,

produces peptide hormones that are secreted basally (=DNES =Argentaffin)

NOT GOBLET !

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PYLORIC PART OF THE

STOMACH

FUNDAL PART OF THE STOMACH

Cardiac and pyloric glands are different from

fundic glands in that they are coiled tubular

mucus-secreting glands and lack chief cells.

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Cardiac Fundus Pyloric

Pit & gland : equal length Shallow gastric pit Elongated glands (Pit gland ratio = 1:3) Dark stained cluster cells Several type of cells

Lack of parietal and chief cells Infiltrasi limfosit Pit gland ratio = 3:1

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Sel parietal - secrete hydrochloric acid (HCl) and gastric intrinsic factor (for absorption of vitamin B12 in the ileum)

-Sel utama/ Chief, • secrete pepsinogen (a precursor of the enzyme pepsin) and

the precursors of two other enzymes, rennin and lipase • pepsinogen ini bl dikeluarkan dalam lingkungan yg asam akan

diubah menjadi pepsin/ suatu enzim proteolitik yg sangat aktif.

DNES • = APUD (amine precursor uptake and decarboxylation

cells) • = Sel enteroendokrin/ argentaffin cell Hasil : hormone gastrointestinal.

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Korelasi klinis

• Gastritis

• GERD (Gastroesophageal reflux disease)

• Ulcus peptikum

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DIGESTIVE SYSTEM

Oral Cavity

Teeth

the tongue

pharynx

esophagus

Gaster (stomach)

Intestinum tenue (small intestine)

Intestinum crassum (large intestine)

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Tdd : - Duodenum : terpendek ( 25 cm),

- Jejunum (2/5 bagian) dan

- Ileum (3/5 bagian)

Dilapisi epitel selapis kolumnar dg sel goblet.

crypts of Lieberkühn

Terdapat villi intestinalis yg merupakan penonjolan epitel dan lamina propria.

Membran mukosa usus halus juga menunjukkan lipatan permanent, plika sirkularis yg tdd mukosa dan submukosa. Plika ini paling khas/banyak pd jejunum.

Intestinum tenue

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CELL(s)

• Enterocyte

• Goblet cell

• M cells

• stem cells

• Paneth cell

• enteroendocrine cells (DNES)

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Paneth cells possess large,

eosinophilic granules whose contents

lysozyme, defensins and tumor

necrosis factor α

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Pd submukosa terutama di bagian cranial/ duodenum didapatkan kelenjar yang menghasilkan mucous disebut kelenjar Brunner

Nodulus limfatikus terdapat sepanjang usus halus, lebih khas pada ileum yg disebut Patch of Peyer

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Duodenum 1- tunica mucosa

2 - tunica submucosa

3 - tunica muscularis propria

4 - tunica serosa

5 - villi

6 - glands (crypts) in the lamina

propria of the mucosa

7 - glands in the tunica submucosa

(Brunner's glands)

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Jejunum

1 - tunica mucosa

2 - tunica submucosa

3 - tunica muscularis propria

4 - tunica serosa

5 - villi

6 - glands (crypts) in the lamina

propria of the mucosa

1 - epithelium of the mucosa

(covers villi)

2 - lamina propria of the mucosa

3 - goblet cells in the epithelium

4 - parts of the muscularis mucosae

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Ileum 1 - tunica mucosa

2 - tunica submucosa

3 - tunica muscularis propria

4 - tunica serosa

5 - villi

6 - epithelium of the mucosa (covers villi)

7 - connective tissue of the lamina ropria of the mucosa

8 – patch of peyer

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Korelasi klinis

- Meckel’s Diverticulum

- Diverticula

- Ileus

- Hernia

- Malabsorbtion

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DIGESTIVE SYSTEM

Oral Cavity

Teeth

the tongue

pharynx

esophagus

Gaster (stomach)

Intestinum tenue (small intestine)

Intestinum crassum (large intestine)

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Goblet cells increase, enteroendocrine cells

reduced

(crypts of Lieberkuhn) are very straight

No villi or plicae circulares

Muscularis externa : Inner circular layer is

intact. Outer longitudinal layer is segregated

into three longitudinal bands taeniae coli,

The contraction of the taenia produces

permanent sacculations haustrae.

+/- appendices epiploicae in serosa

Intestinum crassum

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Colon 1 - tunica mucosa : vili ( - ), crypt L (+)

2 - tunica submucosa

3 - tunica muscularis propria

4 - tunica serosa

5 - lymphoid follicle in the lamina

propria of the mucosa

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• Rectum is a 12-cm-long tube continuing from the sigmoid colon.

– The mucosa of the rectum is similar to that of the majority of the large intestine. The rectum narrows abruptly to become the anal canal.

– Pd daerah hubungan dg anus, membrane mukosa mempunyai lipatan2 longitudinal disebut kolumna rectalis (Morgagni).

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• Anal canal. The terminal portion of the intestinal tract is about 4 cm long.

– The intestinal glands disappear

– the epithelium undergoes an abrupt transition from simple columnar to stratified squamous with sebaceous and apocrine sweat glands. (@ Sekitar 2 cm diatas lubang anus mucosa )

– Lamina propria mengandung pleksus vena2 besar

– The inner circular portion of the muscularis externa expands to form the internal anal sphincter.

– The external anal sphincter is composed of skeletal muscle.

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Korelasi klinis (a.l)

- Hemorrhoid

- Colorectal carcinoma

- Divertikulitis

- Proctitis (@rectum)

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Enteroendocrine = neuroendocrine = APUD

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Appendix

• Letak : pada 1/3 lateral hubungan SIAS kanan – Umbilicus ( titik Mc Burney )

• Terdapat pd hubungan dg ileum : ileocaecal junction

• Vili tidak ada

• Taenia coli tidak ada

• Ditandai dg banyaknya nodulus limfatik

• Kelenjar Intestinal Lieberkuhn ( + )

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No villi, no taenia coli Intestinal glands Lieberkuhn++ Lymphoid follicle ++

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Korelasi klinis :

- Appendicitis

- (Peri)appendicular abscess

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esophagus: Upper 1/3

Mid portion

Lower 1/3

Gaster: Intestinum

tenue :

Intestinum-

crasum:

Rectum –

anus

.

Card

ia

Fu

nd

us

Pylo

rus

Du

od

en

um

Je

jun

um

Ileum

Co

lon

Appendix

Mucosa:

Epitel

Lam.prop

Musc.muc

Submucosa

Muscularis

Serosa

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(extrinsic) Digestive glands

major salivary glands,

Pancreas

Hepar

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major salivary glands

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LIVER/ HEPAR • The function : Exocrine & endocrine

• Glisson’s capsule lobus lobulus

• The Component of liver :

- parenchym – hepatocyte plate

- sinusoid capillary – very large fenestrae, no BL

• sinusoid walls : * sel endotel

* sel Kupffer – macrophage

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Space of Disse

1) The space of Disse is the subendothelial space between

hepatocytes and sinusoidal lining cells.

2) It contains the short microvilli of hepatocytes, reticular

fibers (which maintain the architecture of the sinusoids),

and occasional nonmyelinated nerve fibers.

3) It also contains stellate fat-storing cells (Ito cells,

perisinusoidal stellate cells), which preferentially store

vitamin A. However, when the liver is compromised,

hepatocytes release tumor growth factor and, in response,

these fat-storing cells can divide, change their phenotype,

and begin to synthesize collagen, leading to fibrosis and, if

necessary, differentiate into myofibroblasts to control blood

flow into the sinusoids.

4) Function. The space of Disse functions in the exchange

of material between the bloodstream and hepatocytes.

Hepatocytes do not directly contact the bloodstream.

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LIVER LOBULES :

• 1. Classical lobule

• 2. Portal lobule

• 3. Acinar lobule

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Name Shape Model

classical lobule hexagonal; divided into concentric centrilobular, midzonal, periportal parts

anatomical

portal lobule triangular; centered around a portal triad

bile secretion

acinus

elliptical or diamond-shaped; divided into zone I (periportal), zone II (transition zone), and zone III (centrilobular) Hepatic acinus of Rappaport

blood flow and metabolic

The term "hepatic lobule", without qualification, typically refers to the classical lobule.

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Blood and bile flow

1. Blood flow into the liver : from two sources

a. A. Hepatica : 20% to 30% of the liver’s blood.

b. V. Porta : nutrient-rich blood, 70% to 80% of the liver’s blood.

2. Blood flow out of the liver : via the V.hepatica, formed by the union of

numerous sublobular veins, which collect blood from the central veins

3. Bile flow is directed toward the periphery of the classic liver lobule (in

the opposite direction of blood flow). Bile is carried in a system of ducts

that culminate in the left and right hepatic ducts, which leave the liver

and carry bile to the gallbladder.

V C

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- Membran between hepar cells :

canaliculi biliaris

canalis Hering

Ductus interlobularis

( ductus biliaris )

Hepatic duct

Common bile duct

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KORELASI KLINIS

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VESICA FELEA : • Bentuk spt buah pir, berongga,

• Kapasitas 30 – 60 cc

• Fungsi sbg reservoar empedu

• Letak dibelakang lobus kanan hepar

• Dinding spt saluran cerna umumnya :

* Epitelnya tdd ep. Columnar simplex

* tdk mempunyai muscularis mucosa.

Saluran ekskresinya : duktus sistikus

ductus choleduchus duodenum

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VESICA FELEA Muscularis mucosa ( - ),

diverticle ( + )

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PANCREAS • Mixed exocrine and endocrine gland

Endocrine/ P. Langerhans : lightly staining, large,

spherical cluster

Exocrine/ acini pancreas :

- Compound tubuloaciner gland,

- serous gland similar with parotis

- zymogen /secretion granule (proenzim)

digestive enzym

Ductus : intercalatus interlobularis interlobaris

d.Wirsungi & d.Santorini duodenum

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KORELASI KLINIS

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