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8/15/2019 Fisiologi Digestif
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FISIOLOGI PENCERNAAN
dr. Rhiza Mohammad Ishaq SobariDept. Physioo!y
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". #ELAS$AN ME$ANISME A%SORPSI
MA$ANAN DI &S&S 'AL&S DAN &S&S%ESAR ($AR%O'IDRA)*LEMA$*ASAMAMINO*ION*DAN AIR+,
-. %AGAIMANA$A' PENGA)&RAN
SAL&RAN PENCERNAAN*#ELAS$AN,
. APA I)& PERIS)AL)I$*#ELAS$AN ,
/. #ELAS$AN ME$ANISME PER#ALANAN
MA$ANAN DI SAL&RAN CERNA,
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FUNGSI TGI
Fungsi umum: memindahkan a!nu!rien" air dan garam dari a!
makanan ke #ingkungan da#am un!uk
didis!ri$usikan ke se#%se# me#a#ui
sis!em sirku#asi
&'( a! makanan: energi" )em$angun"
)enggan!i se# rusak*
Fungsi eksresi han+a 'unsi ke,i# sis!em
)en,ernaan &'( eksresi !u o#eh )aru
dan in a#*
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F01!si )GI mer0pa2a1 ra1!2aia1 teri1te!rasi dari
beberapa 2e!iata13
".Gera2a1 (Motiity+3 !era2a1 me14amp0r*
me1!ad02 da1 me1doro1! isi 0me1 o2 ada1ya
2o1tra2si otot poos di1di1! )GI.
Gera2a1 me1doro1! ( propulsif)*mer0pa2a1
!era2a1 me1doro1! isi 0me1 2e depa1
de1!a1 berba!ai 2e4epata1 tida2 sama ses0ai
501!si tiap se!me1
Gera2a1 me14amp0r ada - !Me14amp0r de1!a1 !etah pe14er1aa1 01t02 memba1t0
pe14er1aa1
!Me1de2at2a1 se0r0h isi 0me1 2e perm02aa1 )GI 01t02
memperm0dah pe1yerapa1+
KEGIATAN DASAR TGI
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. /en,ernaan &diges!ion* 0 )roses
)eme,ahan se,ara mekanik
mau)un kimia mo#eku#%mo#eku#
$esar +ang masuk TGI men-adi
mo#eku# ke,i# shg da)a! dia$sor$si
e)i!e# sa# ,erna
6 me4ha1i4a brea2do71 by 4he7i1!
6 4hemi4a brea2do71 by 'C a1d di!esti8e e1zymes
1. Sekresi &se,re!ion* 0sekresi air"
e#ek!ro#i!" enim" #iur em)edu" mukus
ke sa#uran )en,ernaan
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2. A$sor$si &a$sor)!ion* 0 )roses
)en+era)an3 )emindahan mo#eku#
hasi# )en,ernaan &a! nu!rien
organik3anorganik" air * dari #umen
TGI menem$us dinding usus un!uk
masuk ke )em$u#uh darah a!au
#im'e
passi8e di90sio1 a1d a4ti8e tra1sport
4. Ekskresi% E#iminasi makanan +ang
!idak da)a! di,erna dan )roduk
sisa dike#uarkan dari !u$uh.
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%AGIAN &)AMA SIS)EM
PENCERNAAN sa0ra1 !astroi1testi1a (GI)+
M00t* 5ari1!* eso5a!0s* amb01!* 0s0sha0s* 0s0s besar* re2t0m* a10s
Or!a1:or!a1 2ee1;ar ter2ait
$ee1;ar sai8a* hati* 2a1d01! emped0
da1 pa12reas
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Many functions in the
gut are found in specific
locations along its
length. Most of the
absorption of nutrientsoccurs in the sall
intestine! so ost of
digestion is
accoplished there or
upstrea.
"igure #$%&
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S)R&$)&R &M&M )GI
Pa1;a1! /*< m (de7asa+Perm02aa1 biasa1ya tida2 datar = i4i1 tapi
ber2eo2:2eo2* me1ambah 0as perm02aa1
absorbsi
Str02t0r ;ari1!a1 berbeda tetapi mirip
/ Lapisa1 GI)
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The gut 'all has a layered organi(ation! 'ith the absorpti)e cells lining
the luen and neural and uscular coponents belo'. *lood and
lyph )asculature is abundant to transport absorbed nutrients.
nutrients
"igure #$%+
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". M02osa
M0ai dari amb01!
M02osa 3 se# e)i!e# 3 se2resi m020s >
hormo1
I18a!i1asi ;ari1!a1 epite 2edaam1ya
membe1t02 2ee1;ar e2so2ri1
$ee1;ar e2so2ri1 3 se2resi asam* e1zim*
io1:io1 2edaam 0me1
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Di ba7ah apisa1 epite3 5amina /ro)ia" #ari1!a1 i2at 3 dia0i pemb00h darah 2e4i*
serat sara5 > sa0ra1 im5e
Lami1a propria dipisah2a1 ;ari1!a1 i2at di
ba7ah1ya oeh s0at0 apisa1 tipis otot
poos yait0 musku#aris mukosa
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-. S0b M02osa
#ari1!a1 i2at 2ed0a di ba7ah1ya
Lapisa1 i1i dia0i pemb00h darah > im5e
ebih besar* 4aba1!1ya me1emb0s apisa1
m02osa di atas > apisa1 otot di ba7ah1ya
)erdapat ;aa sara5 diseb0t pe2s0s s0b
m02osa ( meiss1er+
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. M0s20aris E2ster1a
#ari1!a1 otot poos
$o1tra2si1ya me1imb02a1 !aya me1doro1! >
memi1dah2a1 isi sa0ra1 GI
)erdiri - apisa1
a. Otot sir20er 3 sebeah daam* teba* 2eii1!i
0me1* ;i2a 2o1tra2si 0me1 me1yempit
b. Otot o1!it0di1a 3 sebeah 0ar * ebih tipis*
bia 2o1tra2si sa0ra1 GI meme1de2
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Dia1tara 2ed0a otot poos terdapat pe2s0ssara5 ai1 ya1! ebih e2se1ti5 yait03
Pe2s0s mie1teri20s (A&ER%AC'+
$esem0a1ya (de1!a1 Pe2s0s s0b m02osada1 Ne0ro1 ai1 di Sa0ra1 GI+ membe1t02
sistem sara5 e1teri2 ya1! me1!e1dai2a12ea2ti5a1 motori2 da1 se2retori2(pemotot1!a1 simpatis da1 parasimpatis td2me1!hia1!a2a1 a2ti8itas motori2 da1se2retori2+
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/. Serosa
Seapis ;ari1!a1 i2at * diip0ti se !epe1! *
me1!eii1!i perm02aa1 0ar sa0ra1 GI Se2resi 4aira1 serosa* 01t02 membasahi >
me14e!ah !ese2a1 de1!a1 or!a1 ai1
Lembar ;ari1!a1 i2at tipis- ( Mese1teri0m+*
h0b01!2a1 serosa 2e di1di1! abdome1*
me1opa1! se!me1 GI 2e ro1!!a abdome1
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Pe1!at0ra1 501!si
pe14er1aa1 %ersi5at 2ompe2s da1 si1er!is.
)ersedia i1!201!a1 ya1! optima 01t02
per14er1aa1 da1 absorbsi* sehi1!!a per0pe1!e1daia1 se2resi 2e1;ar da1 2o1tra2asi otot
)ida2 ba1ya2 dipe1!ar0hi 2eadaa1 10trisi t0b0h
tapi sa1!at dipe1!ar0hi 8o0me da1 2omposisi
2a1d01!a1 0me1 )GI
%a1ya2 reseptor ya1! me1dete2si 2eadaa1
i1!20a1!a1 0me1
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Re?e2s ya1! ada di )GI 0m0m1ya
dira1!sa1! oeh3 ! Re!a1!a1 di1di1! oeh isi 0me1
! Osmoaritas 2im0s (2o1se1trasi zatterar0t+
! $easama1 2im0s (2o1se1trasi io1 '+
! 'asi pe14er1aa1 $'* L* P (mo1osa2arida*asam ema2* peptida* asam ami1o+
Ra1!sa1! diterima reseptor @ a5ere1 @pe1!oaha1 @ e5ere1 @ e5e2tor(apisa1 otot )GI da1 2e; e2so2ri1+
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The enteric ner)ous syste coordinates digestion!
secretion! and otility to optii(e nutrient absorption.
Its acti)ity is odified by inforation fro the ,NS
and fro local cheical and echanical sensors.
"igure #$%#&
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". #eural controls $araf %&trinsic '() * +erasal dari luar TGI, caang
saraf otonom, ungsi otonom otot polos*Irama listri
dasar saluran pencernaan.") $ympathetic
/) Parasympathetic
() $omatic
$araf Intrinsic '/)* 0emampuan mengatur dirinyasendiri, 1angsung pengaruhi motilitas, seresi getahpencernaan, hormon pencernaan
") Myenteric ple&us
/) $umucosal ple&us
$#$ and P#$ modulate the enteric ner2ous systemas opposed to directly controlling smooth muscle ofowel
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me2a1oreseptor* osmoreseptor ya1!
a2a1 memi40 re?e2s sara5 ata0 se2resi
hormo1
)erdapat re?e2s pe1de2 (se2resi hormo1
y! dipe1!ar0hi sara5 i1tri1si2+ da1
Re?e2s pa1;a1! bia ya1! teribat ;a0r
sara5 oto1om
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". Me2a1isme 1e0ra (pe1!at0ra1 sara5+
! Ne0ro1 se1soris > i1ter1e0ro1 pada pe2s0s
mie1teri20s ta1!!ap thd re?e2 o2a* i1i
diseb0t re?e2 pe1de2* me1!at0r a2ti8itas sat0daerah sa 4er1a3 peristati2 o2a* se2resi 2e
di!esti5
! Ne0ro1 motoris pada pe2s0s mei1teri20s
me1!at0r 2o1tra2si otot poos da1 se2resi
2ee1;ar
! I15ormasi se1soris dari reseptor ;! dia1;0t2a1
2e SSP y! me1!hasi2a1 re?e2s pa1;a1!32o1tro ti1!2at ti1!!i sa 4er1a > 2e;. Ne0ro1
motoris3 sara5 I* * sara5 pe8i20s
! Dapat dipe1!ar0hi hormo1 di!esti5
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-. Me2a1isme hormo1a3
! Pai1! sedi2it "B hormo1
! 'ormo1 i1i mempe1!ar0hi sem0aaspe2 501!si di!esti5 da1 sistem y! ai1
! Peptid y! dihasi2a1 se 1e0roe1do2ri1
y! didistrib0si2a1 mea0i sir20asi ! Masi1!:masi1! hormo1 memp01yai
or!a1 tar!et
)er0tama respo1 terhadap o2a spesi2
isi 0me1 y! be2er;a a1!s01! pada se
e1do2ri1 ata0 ta2 a1!s01! m pes0s
i1tri1si2 da1 e2stri1si2
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,,K -
,holecytoinin
GI/-
Gluc%dep. Insulino%
Tropic peptide
Each horone-
"eedbac
Multiple Targets
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. Me2a1isme o2a3
! Prosta!a1di1* histami1* da1 baha1
2imia ai1 y! diepas2a1 2e 4aira1i1terstitia dapat berpe1!ar0h pada sese2itar
! Mese1!er o2a i1i pe1ti1! daam
2ordi1asi ta1!!ap terhadap per0baha1p' o2a* ra1!sa1! si2 ata0 2imia ai1.
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FASE:FASE PENGENDALIAN )GI
Pe1!e1daia1 1e0ra* hormo1a da1 o2apada !aris besar1ya diba!i m;d 5aseberdasar ra1!sa1! ya1! mem0ai3
".Fase se5ai23 ra1!sa1! reseptor di 2epaa3pe1!ihata1* pe1!hid0* pe1!e4apa1*me1!01yah* 2eadaa1 emosi
;a0r e5ere1 1ya meibat2a1 sara5parasimpatis da1 simpatis* 2md1me1!a2ti52a1 sara5 e1teri2 da1 pe1!ar0hise2resi da1 2o1tra2si
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-. Fase !astri23
Ra1!sa1! dari amb01!3 pere!a1!a1*asam* peptide.
. Fase i1testi1a
Ra1!sa1! dari daam 0s0s ha0s3 pere!a1!a1*
2easama1* osmoaritas* berba!ai hasipe14er1aa1
Fase i1i td2 bera1!s01! ber0r0ta1
2e40ai pada perm0aa1 ma2a1
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Gera2a1 )GI
Otot poos sa0ra1 4er1ame101;022a1 si20s ritmi2 ya1!disebab2a1 ada1ya pa4esetter 4es
daam m0s20aris m02osa da1m0s20aris e2ster1a
$o1tra2si ter2oordi1asi dari
m0s20aris e2ster1a pe1ti1! daamper!era2a1 ma2a1a1 daam sa 4er1am peristati2 da1 se!me1tasi
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Peristati2=prop0si53
! $o1tra2si otot ber!eomba1! ya1!memi1dah2a1 bo0s sepa1;a1! sa 4er1a
! Ma1i5estasi - re?e2 0tama daam sistemsara5 e1teri2 dira1!sa1! oeh ada1ya bo0sdaam 0me1 0s0s
! %o0s ⇒ diste1si me2a1i2 > iritasi m02osa0s0s⇒ ra1!sa1! 1e0ro1 e1teri2 a5ere1⇒si1ap3
I1ter1e0ro1 y! me1!a1d01! aseti2oi1 da1
s0bsta1si P ra1!sa1! 2o1tra2si otot poos diatas bo0s
I1ter1e0ro1 y! me1!a1d01! 1itri2 o2sid*8asoa2ti5 i1testi1a peptid da1 A)P ra1!sa1!rea2sasi otot poos di ba7ah bo0s
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Peristasis
%o0s o5 5ood @Me4ha1i4adiste1sio1 a1d m04osairritatio1 @ stim0atesa9ere1t e1teri4 1e0ro1s @ -e9e4ts
". E4itatory motor 1e0ro1sabo8e the bo0s a4ti8ated@ ,on!ra,!ion o' smoo!hmus,#e a$o6e !he $o#us
ia A4h* s0bsta14e P
-. I1hibitory motor 1e0ro1s @s!imu#a!e re#a(a!ion o'
smoo!h mus,#e $e#o7!he $o#us
ia 1itri4 oide*8asoa4ti8e i1testi1apeptide a1d A)P
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Se!me1tasi 3
! &s0s ha0s da1 0s0s besar
! Me1!o4o2 da1 memb0at 5ra!me1 daribo0s 01t02 me14ap0r de1!a1 se2resi0s0s
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Per;aa1a1 ma2a1a1
". Di!esi pre!astri2
-. Lamb01!
. &s0s ha0s
/. &s0s besar
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Di!esi pre!astri23Pe1!e1daia1 ma2a1* prehe1si*
masti2asi* me1ea1
". Pe1!e1daia1 ma2a1 )0b0h daam 2eadaa1 stat0s apar*
2em0dia1 me1!hia1! de1!a1 ada1yama2a1a1 daam sa 4er1a* aira1 10trisi
2e daam darah > 5a2tor ai1. $eseimba1!a1 i1i dipe1!ar0hi3
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a. Pera1a1 s0s01a1 sara5 p0sat3
P0sat pe1!e1daia1 ma2a1 tereta2 pada3
'ipotaam0s atera 3 p0sat apar(esi⇒a1ore2si⇒ost 7ei!ht+
'ipotaam0s 8e1tromedia 3 p0sat2e1ya1! (esi⇒o8er eat⇒obese+
b. Fa2tor pre!astri2 Pe1ampia1 ma2a1a1
Rasa* ba0 ma2a1a1
Pe1!aama1 2es02aa1 da1 pe1oa2a1terhadap ma2a1a1
Fa2tor psi2oo!is3 2eta20ta1* depresida1 i1tera2si sosia
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MA$AN FEEDING
FISIO5OGISDia!ur o#eh o!ak
S!imu#i ade8ua!sa#uran ,erna
Mekanismemengon!ro#keseim$angan energi
/SIO5OGIS Mo!i6asi makanan
esenangan makanan
am$a!an $uda+a
!erhada) makanan
INGES)I 6 FOOD IN)A$E
LAPAR ('&NGER+
SELERA (APPE)I$+
$ENHANG (SA)IE)H+
$0aitas
Ma2a1a1
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/USAT /ENGATUR FOOD INTAE
". N4. Latera 'ipothaam0s
a.Stim0i* ma2a1 ter0s me1yebab2a1obesitas
b.Detr02si* i1a1isi (20ra1! 1a5s0 ma2a1+
Ma2a N4. Laterais ya1! mer0pa2a1 p0satapar me1;adi h01!er 4e1ter da1 5eedi1!4e1ter
-. N4. e1tromedia 'ypothaam0s
a.Stim0i* merasa 2e1ya1!* i1a1isi
b.Detr02si* ma2a1 ter0s me1yebab2a1
obesitas
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P&SA) LAIN HANG %ER'&%&NGANDENGAN PROSES MA$AN
". Med0a Obo1!ata: A2ti8itas ma2a1 3 sai8asi* masti2asi*
de!0tisi
-. N4. Amy!daa
: Stim0i* a2ti8itas me2a1i2
: Detr02si* me1i1!2at1ya prod02sima2a1* me10r011ya ma2a1 da1 b0tadaam memiih
. $orte sistim imbi2
: stim0i* me1i1!2at1ya prod02sima2a1a1 ata0 me10r011ya prod02si
ma2a1 serta doro1!a1 me14ari
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F,. ;ANG MENGATUR FOODINTAE
". REG&LASI N&)RI)IONAL (Re!0asi #a1!2aPa1;a1!+
: Me1!at0r setiap persediaa1 10trie1t terseb0t
: Persediaa1 me10r01 ma2a stim0i 4epat apar
: Persediaa1 me1i1!2at ma2a apar hia1! da12e1ya1!
: F4. N0tritio1a ya1! berh0b01!a1 de1!a1
p0sat apar yait0 !04osa* asam ami1o da1ema2
: F4. N0tritio1a ya1! berh0b01!a1 de1!a1s0h0 yait0 ;i2a di1!i1 ma2a 1a5s0 ma2a1
bertambah1ya seda1!2a1 s0h0 pa1as ma2aMa2a ada h0b01!a1 p0sat re!0asi s0h0 de1!a1 p0sat 5oodi1ta2e
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PSI$OLOGI$ $&L)&RAL SOSIAL
$OR)E$S CERE%RAL
$ELAPARAN
P&SA)$EP&ASAAN
(SA)IE)H CEN)ER+N4.
EN)ROMEDIAL
P&SA) MA$AN(FEEDINGCEN)ER+
'ypothaam0s
e1troatera".Pe1!isia1 Lamb01!-.Perbedaa1 besar !04osa
daam sistemartesio8e1o0s
.Amphetami1e
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$o1tro pemas02a1 ma2a1a1
!'ipotaam0s
)erdapat p0sat apar (atera+ da1 p0sat
2e1ya1! (8e1tromedia+
%a1ya2 5a2tor ya1! mempe1!ar0hi2ed0a p0sat terseb0t
!$o1tro pemas02a1 ma2a1a1 ;a1!2a
pe1de2 i1te!rasi ba1ya2 mas02a1ya1! memberitah0 stat0s e1er!i
Fa2tor ya1! berpe1ar0h daam 2o1tro
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Fa2tor ya1! berpe1ar0h daam 2o1tromas02a1 ma2a1a1
". &20ra1 simpa1a1 ema2 )eori ipostati2 3 pe J simpa1a1 ema2 di
;ar adiposa memberi si1ya rasa 2e1ya1!
$o1tro ;a1!2a pa1;a1!@ %% 2o1sta1
!isero daam darah (i1di2ator ;0mah
tota ema2 tri!iserida daam ;ar ema2+
memberi si1ya 2e1ya1!
Perse1tasi pi1!isia1 tiap se ema2
(!em02 se ema2 ba1ya2+
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. )i1!2at pema2aia1 !02osa
! )eori !02ostati2 3 2e1ya1! 2r1 si1ya
ya1! ditimb02a1 oeh pe J
pe1!!01aa1 !02osa oeh se
! Pe1i1!2ata1 se2resi i1s0i1 (me1yertai
2eebiha1 10trie1 da1 me1doro1!
pe1!!01a1a1 !02osa+ memberi si1ya
2e1ya1!
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K. Pe1!ar0h 1e0rotra1smiter
! Norepi1epri1 da1 1e0ro peptida H3
meJ2o1s0msi 2arbohidrat
! Dopami1 seroto1i1 me1e2a1 2o1s0msi
2arbohidrat
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. Pe1!ar0h psi2ososia
! Si1ya i18o01ter
! Ma2a1 b02a1 2are1a apar ata0 berhe1ti2are1a 2e1ya1!
! Ma2a1 har0s 2ai sehari
! Ma2a1 01t02 hib0ra1* bis1is ! Ma2a1 2are1a 2e1i2mata1
! )ida2 ma2a1 2are1a stres* 4emas*
depresi* rasa bosa1
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-. Proses prehe1si3 Proses memas02a1 ma2a1a1 2e daam
m00t. Proses masti2asi=me1!01yah Me1!01yah 3 peme4aha1 parti2e besar
me1;adi 2e4i ya1! dapat ditea1 ta1pa
me1imb02a1 rasa ter4e2i2 )0;0a1 me1!01yah3 me1!ha140r2a1 ma2a1a1 (me2a1i2+
sai8a mei4i12a1 da1 membasahi ma2a1a1ya1! 2eri1!* me14ap0r ma2a1a1 meratade1!a1 zat ya1! ada daam sai8a*
Stim0asi a5ere1 5ase se5ai2 pe14er1aa1
Membe1t02 bo0s
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Meibat2a1 1e0rom0s20ar da1
2ee1;ar sai8a
Ma2a1a1 hasi proses me1!01yah
diseb0t bo0s
Me1!01yah mer0pa2a1 ti1da2a1
ritmis* 2o1tro oeh sara5 somati2 ya1!
di2e1dai2a1 se4ara sadar (8o01ter+*
;0!a re?e2s 2are1a te2a1a1 ma2a1a1
pada !0si
$ ; i
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$ee1;ar sai8a
Sekresi mukus ke da#am mu#u!
Fungsi mem$asahi < me#umas
)ar!ike# makanan se$e#um di !e#an
Disekresi 1 ke#en-ar eksokrin a. /aro!is:4 =
$. Su$mandi$u#aris:>?=
,. Su$#ingua#is:4=
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#0mah se2resi sai8a = hari "" Diham$a! asam
#am$ung
b. %aha1 A1or!a1i2 sai8a3 Na* $* C* bi2arbo1at
h i2 i i2 i d
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4. %aha1 or!a1i2 ai1 (!i2oprotei1+ daam
sai8a3 m0si1* ;i2a ber4amp0r air
membe1t02 ar0ta1 2e1ta (8is2o0s+
yait0 m020s
d. A1tibodi (I!A+ysozim3 2o1tropop0asiba2teri ora
! F01!si sai8a
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!
Membasahi da1 meemb0t2a1 ma2a1a1*
mem0dah2a1 proses me1ea1
Membasahi m00t* memba1t0 proses
bi4ara
Mear0t2a1 moe20 ya1! mera1!sa1!
reseptor 2e4ap Mem0ai pe14er1aa1 2arbohidrat
A1ti ba2teri
Mempertaha12a1 Ph m00t ( *+ Me1!a1d01! hormo13 epiderma !ro7th
5a2tor* 1er8e !ro7th 5a2tor*
somastotati1* bradi2i1i1
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Also! dissol)e olecules for Taste0and 'oundhealing1
Pe1!e1daia1 se2resi sai8a 2o1ti10e mea0i
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Pe1!e1daia1 se2resi sai8a* 2o1ti10e mea0i
sara5 oto1om. P0sat sai8a di med0a
obo1!ata ! Re?e2s tida2 bersyarat=sederha1a3 dari
idah=m00t da1 eso5a!0s=amb01!=0s0s
ha0s atas
! Re?e2s bersyarat=didapat3 ta1pa ra1!sa1!
ora* tp dari 2orte2s serebri (meihat*
me1de1!ar* memi2ir2a1 ma2a1a1+
Ra1!sa1! parasimpatis3 e14er 8o0me besar
Ra1!sa1! simpatis3 8o 2e4i* by2 baha1 or!a1i2
/ P
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/. Proses me1ea1
Proses 2ompe2 sara5 8o01ter da1
i18o01ter da1 sistem otot
me1ea1 mer0pa2a1 re?e2s ya1!
ditimb02a1 oeh pera1!sa1!a1reseptor di1di1! 5ari1! oeh bo0s*
a5ere13 N. * II* II* e5ere1 N * e5e2tor
otot eso5a!0s
! 4osey 4oordi1ated 7ith breathi1! a1d
asso4iated a4ti8ities (i.e. ta2i1!+
F
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Fase me1ea13
". Fase ora3 ti1da2a1 8o01ter* bo0sdidoro1! 2e oro5ari1! oeh idah*ra1!sa1! reseptor ta2ti sp 2e bata1!ota2* ya1! mem0ai re?e2 me1ea1
-. Fase 5ari1!ea3 20ra1! dari " deti2*seama 5ase 5ari1!ea per1a5asa1dihambat se4ara re?e2s (0me1 ari1!me10t0p* epi!otis berp0tar 2earahbea2a1! 01t02 me10t0p ari1!* ari1!tera1!2at 2edepa1 sh! 0ba1! eso5a!0s
meebar (i18o01ter+*. Fase eso5a!ea3 idah me1e2a1 2e arah
bea2a1!* 2o1tra2si peristati2 5ari1!*bo0s terdoro1! 2e eso5a!0s (i18o01ter+
fase faringeal
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g
palatum molle keatas
lipatan palatopharyngeal ke medial
(mencegah refluks makanan ke nasofaring) pita suara berdekatan
seluruh larynx didorong ke atas depan kearah epiglotis, epiglotis berputar ke
belakang menutupi laring, mencegah bolusmasuk trachea & meregangkan pintuoesophagus (spinter esophangeal atasmelemas)
5. saat larynx terangkat & spinter esophangeal
melemas), m.konstr. faring superiorkontraksi kuat mendororng bolus jauh kedalam faring
setelah bolus melewati !", !" menutup# mulai gelombang peristaltik berjalansepanjang esofagus
Main 'un,!ions o' s7a##o7ing
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Main 'un,!ions o' s7a##o7ing
! to tra1sport the 5ood bo0s 5rom the phary1
i1to the stoma4h
! to pre8e1t eso)hago)har+ngea# re?0
a1d gas!roeso)haga# re?0
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FOREGUT: Conduction and Storage of Food in Humans
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FOREGUT: Conduction and Storage of Food in Humans
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Eso5a!0s ma10sia3
! "= atas3 otot ra1!2a* -= ba7a! ototpoos
! Pa1;a1! -< 4m ! Istirahat s1!ter eso5a!0s atas da1
ba7ah tert0t0p* 2o1tra2si se4ara to1i2
01t02 4e!ah re?02s dari amb01!
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M01tah 2are1a pera1!sa1!a1
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M01tah 2are1a pera1!sa1!a14hemore4eptor tri!!er zo1e oeh
obat* motio1 si421ess M01tah 2are1a pera1!sa1!a1 ota2di0ar p0sat m01tah oeh
ra1!sa1! istri2* obat (mor1*deri8at di!itais+
Me2a1isme,
Obat-obat : Morphin, Digitalis
Motion Sickness
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Motion Sickness
Chemoreceptor
Trigger Zone
Pusat Muntah
Vagal afferent
Vagal
off
Smpahicoff
! - Psikis, "elisah, #au Pusat Muntah
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MEKANISME MUNTAH
#ernafas $alam larn% men$orong sampai
Oesopaghus terbuka menutup glotis
palatum mole menutup nases post
&ontraksi kuat otot ab$omen $an $iafragma
memeras lambung kemu$ian tekanan intragastrik
meningkat sehingga isi lambung keluar melalui
oesophagus
LAM%&NG = GAS)ER
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LAM%&NG = GAS)ER $a1t01! m0s20er tereta2 a1tara eso5a!0s
> 0s0s
Lamb01! pe10h3 ":"*< L
%a!ia1 2orp0s > 501d0s (berdi1di1! tipis+*
$e;.1ya se2resi m020s* asam 'CL*
proe1zim pepsi1o!e1* 5a2tor i1stri1si2
(4aste+
%a!ia1 ba7ah amb01! (a1tr0m+memp01yai otot ebih teba* $e;.1ya se2resihormo1 !astri1
"igure #$%#+
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The abundant sooth uscle in the
stoach is responsible for gastric otility.
Speciali(ed cells
in the stoach
synthesi(e andsecrete ucous
fluid! en(ye
precursors!
hydrochloric acid!
and horones.
S i b d 2
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Se epite amb01! tda se m020s y!
me1se2resi m020s y! 2aya
bi2arbo1at.
M020s (abar bi2arbo1at:m02osa+
ber501!si meapisi da1 mei4i12a1
perm02aa1 amb01!* pe1ti1! daam
mei1d01!i epite dari asam* pepsi1
da1 2imia ai1
Qat ya1! dapat mer0sa2 abar3 eta1o*
402a* !aram emped0* aspiri1* OAINS
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Se2resi di amb01!
a.pada 501d0s > 2orp0s3
". se parieta 3 se2resi 'CL* 5a2tori1tri1si2 (mera1!sa1! absorbsi
8it %"-+
- se 4hie5 3 se2resi pepsi1o!e1
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-. se 4hie5 3 se2resi pepsi1o!e1
(proe1zim i1a2ti5* oeh asam
amb01! di0bah me1;adi pepsi1s0at0 e1zim proteooti2 a2ti5+*
Pada bayi me1se2resi re1i1=2himosi1
(me1!!0mpa2a1 s0s0+ > ipase
!astri2 (m0ai pe14er1aa1 ema2 dm
s0s0+
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b. Pada a1tr0m > pyor0s3
". Se G3 se2resi hormo1 !astri1 y!
mera1sa1! se2resi se parieta da1
se 4hie5* ra1!sa1! se2resi di1di1!
amb01! (me14ap0r > me1!ad02 isi
amb01!+
-. Se D3 se2resi hormo1 somatostati1
y! me1!hambat se2resi !astri1
"igure #$%#6
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/arietal cells synthesi(e and secrete the hydrochloric acid
responsible for the acidic p5 in the gastric luen.
,hief cells synthesi(e
and secrete the proteaseprecursor no'n as
pepsinogen.
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Fungsi #am$ung
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Fungsi #am$ung
! Men+im)an" me#aru!kan < men,erna
)arsia# makanan +ang masuk #am$ung.
! Meneruskan makanan ke usus da#am
-um#ah o)!ima# un!uk di a$sor$si se,ara
maksima#
! Sekresi # ! Sekresi enim )e)sinogen +ang
memu#ai )en,ernaan )ro!ein
! /roduksi 'ak!or in!rinsik +ang
di$u!uhkan un!uk a$sor$si 6i!amin B@
! Menghasi#kan kimus &,am)uran ken!a#*
'C amb01!
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!
! Mem0s1ah2a1 ba2teri ya1! mas02 amb01! (
tida2 e5e2ti5 "+
! Meme4ah parti2e ma2a1a1 (memba1t0
meme4ah di1di1! se t0mb0ha1 da1 ;ar i2at
pada da!i1!+*
! Membe1t02 ar0ta1 moe20 ya1! diseb0t
$IM&S
! A2ti8asi pepsi1
! Sehari se2itar - L
"igure #$%#8
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F
O
O
D
Acid production by the parietal cells in the stoach
depends on the generation of carbonic acid7
subse3uent o)eent of hydrogen ions into the
gastric luen results fro priary acti)e transport.
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#. ,arbon dio2ide 0,9:1 diffuses into the cell.
Duct of
gastric
gland
To stoach
K;
5;
,I <
AD/
AT/5:,9&
,A
,9: ; 5:9
5,9
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,arbon dio2ide 0,9:1 diffuses into the cell.
To stoach
,9:
/arietal cell
Serosal
surface
*lood
)essel
,9:
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To stoach
5:,9&,A
,9:
/arietal cell
,9: is cobined 'ith 'ater 05:91 in an en(yatic reaction that is
cataly(ed by carbon anhydrase 0,A1 to for carbonic acid 05:,9&1.
; 5:9
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To stoach
5:,9&
5,9
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To stoach
,I
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Duct of
gastric
gland
To stoach
5;
AD/
AT/
/arietal cell
The hydrogen ion 05;1 is acti)ely transported into the duct of
gastric gland.
5;
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Duct of
gastric
gland
To stoach
5;
AD/
AT/
/arietal cell
,hloride ions 0,l
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Duct of
gastric
gland
To stoach
K;
5;
AD/
AT/
/arietal cell
Serosal
surface
K;
K;
Soe potassiu 0K;1 are counter transported into the cell in
e2change for the hydrogen ions.
5;
,I <
,I <
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Setaah ma2a1* se2resi 'CL 1ai2*2adar bi2arbo1at darah ya1! berasadari amb01! 1ai2* p' darah da1 p'
0ri1 1ai2 (postpra1dia a2ai1e tide+ Se2resi asam 'CL dira1!sa1! oeh3
histami1* aseti2oi1* !astri1
"igure #$%#=
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9ne inhibitory and
three stiulatory
signals that alter
acid secretion by
parietal cells
in the stoach.
F O O D
The acidity in the gastric luen con)erts the protease
"igure #$%:#
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The acidity in the gastric luen con)erts the protease
precursor pepsinogen to pepsin7 subse3uent con)ersions
occur 3uicly as a result of pepsin>s protease acti)ity.
F O O D
Pe1!e1daia1 se2resi
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!amb01!
". Me2a1isme sara53 re?e2s pe1de2*re?e2s pa1;a1!+ meibat2a1 1e0ro12oi1er!i2* mera1!sa1! se2resi 'CL*
pepsi1* m020s-. Me2a1isme hormo1a3 !astri1 ra1!sa1!
se2resi 'CL* pepsi1* da1 pert0mb0ha1
m02osa amb01!. Me2a1isme o2a3 a2oho da1 2a5ei1
a1!s01! mera1!sa1! m02osa*me1i1!2at2a1 se2resi amb01!
Pe1!at0ra1 a2ti8itas (motiitas > se2resi+ amb01!
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di0raia2a1 daam 5ase3
". Fase se5ai23 respo1 mea0i parasimpatis >
N 8a!0s ya1! dii1d02si 2ea2ti5a1 di SSP.
ra1!sa1!3 ma2a1a1 daam m00t* ra1!sa1!
8is0a* pe1!hid0* pi2ira1
Stat0s emosi dpt ra1!sa1!=hambat 5ase i1i
(marah me1i1!a2t* stress* 4emas me10r01+
-. Fase !astri23 respo1 mea0i re?e2s o2a.
Ra1!sa1!3 ma2a1a1 daam amb01!3re!a1!a1* 2imia t.0. asam ami1o da1 hasi
4er1a protei1 ai1*2a5ei1*a2oho
. Fase i1testi1a3ra1!sa1! di d0ode10m:
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prod02 pe14er1aa1 protei1
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"igure #$%:@
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?ocal and distant
0,NS1 inforation
odulates theEnteric Ner)ous
Syste>s acti)ity
regarding gastric
otility and secretion.
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,ephalic /hase
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The taste or sell of food! tactile sensations of food in the outh! or
e)en thoughts of food stiulate the edulla oblongata 0green arrow 1.
Taste or sell of food
Tactile sensation in outh
Medulla oblongata
,ephalic /hase
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/arasypathetic action potentials are carried by the )agus
ner)es to the stoach 0 pink arrow 1.
agus ner)es
,ephalic /hase
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/reganglionic parasypathetic )agus ner)e fibers stiulate
postganglionic neurons in the enteric ple2us of the stoach.
agus ner)es
,ephalic /hase
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/ostganglionic neurons stiulate secretion by parietal and chief
cells and stiulate gastrin secretion by endocrine cells.
Gastrin
Stoach
,ephalic /hase
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Gastrin is carried through the circulation bac to the stoach 0 purple
arrow 1! 'here it stiulates secretion by parietal and chief cells.
Gastrin
,irculation
Secretions
stiulated
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Stoach
?ocal refle2es
stiulated by
stoach
distention
Distention
Secretions
stiulated
agus ner)esMedulla
oblongata
#. Distention of the stoach acti)ates a parasypathetic refle2. Action potentials
are carried by the )agus ner)es to the
edulla oblongata 0green arrow 1.
:. The edulla oblongata stiulates stoach secretions 0 pink arrow 1.
&. Distention of the stoach also acti)ates local refle2es that increase stoach
secretions 0 purple arrow 1.
Gastric /hase
#
:
&
Gastric /hase
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?ocal refle2es
stiulated bystoach distention
Distention
agus ner)esMedulla
oblongata
Distention of the stoach acti)ates a parasypathetic refle2.
Action potentials are carried by the )agus ner)es to the edulla
oblongata 0green arrow 1.
Stoach
Gastric /hase
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Secretions
stiulated
The edulla oblongata stiulates stoach secretions 0 pink arrow 1.
agus ner)es
Stoach
Decreasedgastric
secretions
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"igure #$%:4
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Deli)ery of acid and nutrients into the sall intestine initiates
signaling that slo's gastric otility and secretion! utili(ing
neural counication and endocrine signals no'n as the
enterogastrones7 this slo'do'n in deli)ery helps to allo'
ade3uate tie for digestion and absorption in the duodenu.
I t ti l /h
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#. ,hye in the duodenu 'ith
a p5 less than : or containingfat digestion products 0lipids1
inhibits gastric secretions by
three echaniss.
:. Sensory )agal action potentialsto the edulla oblongata
0green arrow 1 inhibit otoraction potentials fro the
edulla oblongata 0 pink arrow 1.
&. ?ocal refle2es inhibit gastricsecretion 0orange arrows1.
4. Secretin! gastric inhibitorypolypeptide! and cholecystoinin
produced by the duodenu
0brown arrows1 inhibit gastric
secretions in the stoach.
Intestinal /hase
Secretin! gastric inhibitory
peptide! cholecystoinin,irculation
p5B:
or lipids
?ocal
refle2es
Decreased
gastric
secretions
Medulla oblongata
agus
ner)es
agus
ner)es
#:
&
4
Intestinal /hase
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,hye in the duodenu 'ith a p5 less than : or
containing fat digestion products 0lipids1 inhibits gastric
secretions by three echaniss.
p5B:
or lipids
Intestinal /hase
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Sensory )agal action potentials to the edulla oblongata 0green
arrow 1 inhibit otor action potentials fro the edulla oblongata
0 pink arrow 1.
p5B:
or lipids
Medulla
oblongata
agus
ner)es
agus
ner)es
Mechanis 9ne
Decreased
gastric
secretions
Intestinal /hase
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?ocal refle2es inhibit gastric secretion 0orange arrows1.
p5B:
or lipids
?ocal
refle2es
Decreased
gastric
secretions
Mechanis T'o
Intestinal /hase
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Secretin! gastric inhibitory polypeptide! and cholecystoinin
produced by the duodenu 0brown arrows1 inhibit gastric
secretions in the stoach.
Secretin! gastric inhibitory
peptide! cholecystoinin
p5B:
or lipids
Decreased
gastric
secretions
,irculation
Mechanis Three
Gastri4 Motiity
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Gastri4 Motiity
Ee4tri4 a4ti8ity !peristati4 7a8es o440r =mi1*
!a4tio1 pote1tias are myogenic
!A4h* !astri1* CC$ i14rease
!epi1ephri1e a1d IP de4reasestre1!th
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Gastrod0ode1a ;014tio1 ! ee4tri4a rhythm 3 ":"- S=mi1
! 5014tio1s
! sympatheti4 : 4o1stri4tio1 ! parasympatheti4 : both e4itatory
(4o1stri4tio1+ a1d i1hibitory(reaatio1+
! hormo1a 4o1stri4tors (so7s !astri4emptyi1!+
"igure #$%::
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Ca)es of sooth uscle contraction i2 and propel the
ingested contents of the gastric luen! but only a sall
aount of the aterial enters the sall intestine 0duodenu1
as a result of each 'a)e cycle.
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"igure #$%:&
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Rhythic 'a)es of sooth uscle contraction in the
gut are the result of 'a)es of action potentials o)ing
along )ia gap unctions.
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7hat so7s !astri4 emptyi1!3 ! 'yperto1i4 4hyme
! d0ode1a p' .<
! prese14e o5 ami1o a4ids a1d peptides i1d0ode10m
! 5atty a4ids a1d mo1o!y4erides
si!1as3 7hat promotes emptyi1! ! stoma4h diste1sio1 a1d !astri1
'01!er 4o1tra4tio1s
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!
7he1 stoma4h empty 5or o1! time rhythmi4
4a0se teta1i4 4o1tra4tio1 5or -:
mi1* si20s1ya :"- me1it
most i1te1se i1 yo01! perso1s
! hi!h de!ree o5 GI to10s
! o7 bood s0!ar e8e
be!i1s "-:-/ hrs a5ter ast 5oodi1ta2e
S0mmary o5 !astri4 emptyi1!4o1tro
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4o1tro
Stoma4h 5a4tors3 de!ree o5 i1! a1de4itatory e9e4t o5 !astri1 o1 peristasis
d0ode1a 5a4tors3 e1teri4 1er8o0s a1d
hormo1a re?ees emptyi1! so7s 7he13
! too m04h 4hyme i1 d0ode10m
!4hyme is e4essi8ey a4idi4* 01pro4essedprotei1=5at* hypo: or hyperto1i4 or irritati1!
Gas!ri, em)!+ing
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)he pyori4 sphi14ter remai1s partiay ope1 :
e1o0!h to ao7 7ater a1d other ?0ids to ea8e thestoma4h
i1te1se a1tra peristati4 4o1tra4tio1s 5or4i1!4hyme thro0!h the to1i4ay 4o1tra4ted pyor0s :
the peristati4 7a8es pro8ide a p0mpi1! a4tio1 :the so:4aed Tpyori4 p0mpU
i1 additio1 the to1e o5 the pyori4 sphi14ter itse54a1 be mod0ated by both h0mora a1d 1e0rasi!1as
Gas!ri, em)!+ing
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Rate o5 !astri4 emptyi1! is determi1ed by si!1as5rom the stoma4h a1d the d0ode10m
stoma4h si!1as are either 1er8o0s si!1as 4a0se
by diste1sio1 or by !astri1
!astri1 has stim0atory e9e4ts o1 motor 5014tio1so5 the stoma4h as 7e as e1ha14i1! the pyori4
p0mp
En!erogas!ri, ReCe(es
7he1 5ood e1ters the d0ode10m m0tipe 1er8o0sre?e es are i1itiated 5rom the d0ode1a a that
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re?ees are i1itiated 5rom the d0ode1a 7a thatpass ba42 to the stoma4h to so7 or stop stoma4h
emptyi1! i5 the 8o0me o5 4hyme has be4ome too!reat these !o 8ia either e1teri4* etri1isi4 1er8esor 8ia the 8a!0s a1d ha8e - stro1! e9e4ts
"+ i1hibitio1 o5 a1tra prop0si8e 4o1tra4tio1s
-+ i14rease si!hty the to1e o5 the pyori4sphi14ter
5a4tors that are 4o1ti10ay mo1itored that 4a1e4ite the e1tero!astri4 re?ees are3 ! de!ree o5 diste1sio1 o5 d0ode10m
! irritatio1 o5 the d0ode10m
! de!ree o5 a4idity o5 d0ode10m
! osmoaity o5 4hyme
! prese14e o5 brea2do71 prod04ts
Migra!ing Mo!or om)#e(
de8eops /:< ho0rs a5ter a mea a1d re40rs e8ery :
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de8eops / < ho0rs a5ter a mea a1d re40rs e8ery "- mi1 01ti 5ood is o14e more i1!ested
4y4e 4o1sists o5 a1 i1a4ti8e phase : 5oo7ed by a brie5
phase o1te1se peristati4 a4ti8ity 7hi4h mi!rates ao1!the i1testi1e a1d may be!i1 7ither i1 the proimastoma4h or d0ode10m
a 1e7 4ompe starts 7he1e8er a1 earier 4ompeapproa4hes the termi1a ie0m
5014tio1 o5 MMC is housekee)ing : the mea1s by 7hi4h
the resid0es (ie i1di!estibe a1d ar!e parti40atematter+ are remo8ed 5rom the stoma4h bet7ee1 meas aso heps to 4o1tro ba4teria !ro7th i1 the sma bo7e:
a 4ommo1 4o1sq0e14e o5 ba4tria o8er!ro7th iss!ea!orrhea 7hi4h res0ts 5rom madi!estio1 o5 dietary5at
Absorbsi pada amb01! hampir tida2ada
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ada3
! se epite dib01!20s m020s a2ai* td2a1!s01! berh0b d! 2hime
! Se epite tida2 p01ya me2a1ismetra1spor spt 0s0s ha0s
! Perm02aa1 amb01! reati5 tida2 daptditemb0s air
! Pe14er1aa1 daam amb01! ha1ya
seba!ia1
&s0s 'a0s
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Diameter V / 4m* pa1;a1! K m M0ai dari amb01! sampai 0s0s
besar
se!me1 3 d0ode10m* ;e;e10m*ie0m
Memp01yai ba1ya2 ipata1= 8ii
Pe1ti1! 01t02 absorbsi ma2a1a13
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3453%#4M
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#e;e10m
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ileum
i0s
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P0sat 8i0s berisi pemb00h im5eya1! b01t0
La2tea* 2apier mer0pa2a1 4aba1!
arterioa serta berm0ara 2e 8e10a Setiap < hari di!a1ti
nutrients
"igure #$%6
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*y proectinginto the luen!
the )illi increases
the surface area
for absorption ofnutrients.
the The absorpti)e cells
on )illi are fringed
'ith icro)illi! 'hich
further increase the
absorpti)e surface.
nutrients
Li0r pe14er1aa1 ya1! diair2a1 2e0s0s ha0s
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0s0s ha0s
Li0r Pa12reas Emped03
Li0r 0s0s ha0s
Li0r 0s0s ha0s
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"*B L =hari". $ee1;ar %r011er3 di m02osa d0ode10m*
mera1!sa1! se2resi3 ! M020s 3mei1d01!i m02osa d0ode10m dari iritasi
'C > pepsi1 ! %09er 3me ↑ p' (2hime dm d0ode10m p'3 ":- sp :
B+
! 'ormo1 0ro!astro1 3me1se2resi !astri1 da1ra1!sa1! pembeaha1 se i1d02 sepa1;a1! sa 4er1a
-. $ripte Lieber20h1
Prod02si e1zim* 4aira1 isoto1i2 da1 a2ai1
. E1terosit 8ii
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me1!hasi2a13 amiase*
e1tero2i1ase* ipase* peptidase*disa2aridase* ya1! tida2di2e0ar2a1 2e 0me1 1am01 a2a1
meme4ah ema2* protei1*2arbohidrat be!it0 absorbsi dim0ai
Li0r Pa12reas
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"
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hormo1. %ia 2hime mas02
d0ode10m* ma2a d0ode10mme1!e0ar2a1 hormo1 3
". se2reti13 mema40 pa12reas se2resi
b09er air de1!a1 p' *
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the duodenu is triggered
by the arri)al of acidicchye fro the stoach.
Secretin is a horone-
its receptors are found in
the pancreas! 'hichresponds 'ith additional
bicarbonate deli)ery! and
its receptors are also
associated 'ith the
stoach7 thisenterogastrone inhibits
gastric otility and
secretion.
,holecystoinin secretion
fro the sall intestine is
"igure #$%:8
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fro the sall intestine is
triggered by the arri)al of
aino acids and fatty acidsin the chye.
,holecystoinin is a
horone- its receptors are
in the pancreas! 'hichresponds 'ith additional
en(ye deli)ery! and
in the gall bladder! 'hich
contracts to deli)er ore
bile! and in the sphincter of 9ddi! 'hich rela2es to
facilitate deli)ery of the
en(yes and bile salts 0it is
also an enterogastrone1.
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Cere digesti)e en(yes synthesi(ed in their acti)e for! they
'ould digest the )ery cells that ae the 5ence inacti)e
"igure #$%:+
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'ould digest the )ery cells that ae the. 5ence! inacti)e
precursors 0e.g.! trypsinogen1 becoe acti)ated 0trypsin!
'hich acti)ates anyother precursors1 only after
they are transported to
the appropriate place.
F O O D
/hases o' )an,rea!i, se,re!ion
h #i h "
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,e)ha#i, )hase W"
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se4retes abo0t - o5 ?0id=day i1to d0ode10m 8iasphi14ter o5 Oddi (se4retio1 i14reases W"
postpra1diay+ se4retes di!esti8e e1zymes 5rom the a4i1i a1d a1
a2ai1e ('CO ri4h+ ;0i4e 5rom the d04ts
a2ai1e ;0i4e ser8es to 1e0traise a4id 5rom
stoma4h a1d to pro8ide the 4orre4t p' 5or e1zymea4ti8ity
i1teresti1!y : pa14reas 4o1tai1s 1o myoepitheia4es th0s 7he1 i1trad04ta press0res rise a4i1ar4es may r0pt0re reeasi1! di!esti8e e1zymes i1to
the i1terstiti0m eadi1! to 4hro1i4 pa14reatitis (iei1 CF 7here d04ta se4retio1s are ab1ormay8is4o0s+
/an,rea!i, en+mes
di!esti8e e1zymes se4reted as i1a4ti8e
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di!esti8e e1zymes se4reted as i1a4ti8epre40rsors (+mogens+ to pre8e1t a0todi!estio1
importa1t proteoyti4 e1zymes are !r+)sin*,h+mo!r+)sin a1d ,ar$o(+)e)!idases
other e1zymes are:
)an,rea!i, #i)ase
)an,rea!i, am+#ase !r+)sinogen is a4ti8ated by en!ero)e)!idase
7hi4h is se4reted by i1testi1a m04osa i1respo1se to 4hyme
trypsi1 the1 a4ti8ates the other proe1zymes !r+)sin inhi$i!or se4reted to deay a4ti8atio1 o5
trypsi1o!e1
/an,rea!i, Cuid se,re!ion
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a4i1i se4rete a C: ri4h se4retio1 simiar tosai8ary !a1ds
d04ts se4rete 'CO (7he1 i1s0X4ie1ta2a2i1e ?0id is prod04ed 5or maim0me1zyme a4ti8ity is red04ed eadi1! tomaabsorptio1 a1d ma10tritio1+
I1 CF there is 4hro1i4 pa14reatitis 7ithred04ed 'CO
be4a0se ipases a1d bie sats are se1siti8e
to p' : staetorrhea is a 4ommo1 probem i1patie1ts 7ith CF (i1s0X4ie1t a2ai+ orpatie1ts 7ith !astri1omas 7ho se4retee4ess a4id i1 the stoma4h
/an,rea!i, Cuid se,re!ion
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'CO se4retio1 is a se4o1dary a4ti8e
tra1sport pro4ess CO- di90ses i1 5rom the bood a1d is
4ombi1ed 7ith 7ater by the e1zme 4arbo1i4a1hydrase (CA+ to 5orm 'CO a1d ' : the
' is e4ha1!ed 5or Na by the Na:'e4ha1!er 0si1! the Na !radie1tmai1tai1ed by the Na=$ A)Pase. ie Na:'e4ha1!er a1d A)Pase 2eep o1 4reati1! a!radie1t 5or ' to dri8e CA.
'CO ea8es the 4e 8ia a1 api4a C='COe4ha1!er 7ith C re4y4i1! 8ia a C 4ha11e
S!imu#i o' /an,rea!i, Se,re!ion
Ah : parasympathi4 8a!0s 1er8es as 7e
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Ah : parasympathi4 8a!0s 1er8es as 7eas mye1teri4 4hoi1er!i4s
Gas!rin : iberated d0ri1! !astri4 phase o5stoma4h se4retio1
(4hoe4ysto2i1i1+ : se4reted byd0ode1a a1d 0pper ;e;01a m04osa 7he15ood e1ters sma i1testi1e
these a stim0ate prod04tio1 o5 di!esti8ee1zymes by the a4i1i a1d a4t 8ia IP toreease i1tra4e0ar Ca
Se,re!in : same d0ode1a a1d 0pper ;e;01a
m04osa b0t se4reti1 a4ts 8ia 4AMP o1 thed04ta 4es to i14rease 'CO se4retio1
F01!si 'ati
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Or!a1 8ita3". hepatosit 3 mea202a1 501!si se2resi
(emped0+
-. Se $0p9er3 5a!osit pato!e1* se debris*se darahr0sa2*
pe1yimpa1a1 besi* beberapa ema2*
o!am beratSe2resi emped0
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5ati
'A)I
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5ATI
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SE? 5ATI
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$a1d01! emped0
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Kandung epedu
$ee1;ar emped0
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"igure #$%:=
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*ile foration by cells in the li)er includes + coponents-bile salts! lecithin! bicarbonate ions! cholesterol! bile
pigents! and trace etals.
The bile is funneled into the gall bladder and then deli)ered
into the duodenu upon stiulation fro ,,K.
"igure #$%4
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Digesti)e secretions fro the li)er and the pancreas are
deli)ered into the duodenu of the sall intestine through
the sphincter of 9ddi.
Emped0
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*
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d a a e d0ode 0 se4a a e e
bia 2hime me1!a1d01! ipid d!ra1!sa1! 2hoesisto2i1i1
Pada 5ase i1terdi!esi3 emped0 disimpa1
daam 2a1d01! emped0* sehi1!!a2o1se1trasi me1i1!2at* asam da1 pe2at
Pe1!at0ra1 se2resi emped03
5ood e1teri1! the d0ode10m 4a0ses
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! 5ood e1teri1! the d0ode10m 4a0ses
!abadder to empty*: Ada1ya ema2 daam d0ode10m ra1!sa1!
se2resi hormo1 CC$
: CC$ me1!i1d02si 2o1tra2si ritmi2 2a1d01!
emped0
: CC$ me1!i1d02si rea2asasi sphi14ter o5Oddi
: Ada1ya asam daam d0ode10mmera1!sa1! se2resi 'CO dari sa0ra1emped0.
,holecystoinin
"igure #$%
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,holecystoinin
0,,K1 stiulates thegall bladder! 'hich
responds by
contracting and
deli)ering ore
bile to the duodenuthrough the sphincter
of 9ddi! 'hich rela2es
0opens1 in response to
,,K.
5i6er and Bi#e
O1e mai1 5014tio1 o5 i8er is to se4rete $i#e (K:
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("-m=day+
%ie has a1 importa1t roe i1 'a! diges!ion anda$sor)!ion
$i#e sa#!s (7hi4h are 4hoestero metaboitessythesised i1 hepato4ytes+ em0si5y ar!e 5at parti4esi1to mi10te parti4es that 4a1 be atta42ed by ipases
aso aid i1 the tra1sport a1d absorptio1 o5 thedi!ested 5at prod04ts to a1d i1to the i1testi1am04osa
bie ser8es as a mea1s 5or e(,re!ion o5 se8era 7asteprod04ts 5rom the bood* espe4iay $i#iru$in a1d the
e(,ess ,ho#es!ero sy1thesised by the i8er
Bi#e se,re!ion
%ie is se4reted i1 - sta!es by the i8er
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"+ %ie is se4reted i1itiay by the hepato4ytes a1d4o1tai1s ar!e amo01ts o5 bie a4ids* 4hoestero*e4ithi1 et4 a1d is se4reted i1to the bie 4a1ai40ithe ie bet7ee1 the hepati4 4es i1 the hepati4pates
-+ )he bie empties i1to the termi1a bie d04ts*the hepati4 d04t a1d 1ay 4ommo1 bie d04t :here the bie either empties dire4ty i1to the
d0ode10m or is di8erted thro0!h the 4ysti4 d04ti1to the !abadder :
o1 its 7ay thro0!h the d04t a se4o1dary se4retio1is added : a 7atery so0tio1 o5 Na a1d 'CO
Ga##$#adder
i i d i h b dd i
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%ie is 1ormay stored i1 the !abadder 01ti
it is 1eed i1 the d0ode10m
)he 8o0me o5 the !abadder is o1y -:K mho7e8er it 4a1 store 0p to "- ho0rs 7orth o5bie se4retio1 (W/ C a1d osmoti4ayremo8i1! the 7ater 4o14e1trati1! the other4o1stit0e1ts : 1ormay < 5od b0t 4a1 be ashi!h as -:5od
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on!ro# o' $i#e sa#! se,re!ion $+ $i#e sa#!s
i1 bie:sat depe1de1t ?o7 : (W/ o5 tota ?o7+ :
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bie sats are etra4ted 5rom the porta bood by a
Na:bie sat 4otra1sporter a1d bo01d to a 4ytosoi4protei1 7hi4h bri1!s them to the api4a membra1e7here they are se4reted by a Na:i1depe1de1t4arrier : th0s it is a sat0rabe pro4ess
bie:sat i1depe1de1t ?o7 :(/+ : 0121o71me4ha1ism depe1di1! o1 the se4retio1 o5 or!a1i44atio1s : this step is importa1t 5or the e4retio1 o5steroids
a2ai se4retio1 by bie d04t epithei0m : W-
as the 4o14e1tratio1 o5 bie sats i1 the pasmarises so does the rate o5 bie sat se4retio1 : these4retio1 rate bei1! hi!hest d0ri1! di!estio17he1 the e8es o5 bie sats are hi!hest
aemog#o$in $reakdo7n
'aem is bro2e1 do71 to biir0bi1 by ma4ropha!es
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y p !
biir0bi1 (yeo7+ is the1 absorbed by hepato4ytesa1d 4o1;0!ated 7ith !04oro1i4 a4id to 5ormbiir0bi1 !04ori1ide 7hi4h is e4reted i1to thebie 4a1ai40i
o14e i1 the i1testi1e it is 4o18erted by ba4teria to
0robii1o!e1 7hi4h is hi!hy 7ater so0be : someis reabsorbed i1to the bood 7hi4h is the1 re:e4reted i1to the !0t by the i8er
abo0t
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p ytra1sport i1 the dista iie0m
they e1ter the porta bood a1d pass to the i8er7here they are reabsorbed by the 8e1o0ssi10soids
W?g o5 bie sats are req0ired to di!est >
absorb "! dietary 5at ho7e8er the tota amo01t o5 bie sats is W4 g
a1d o1y ?.4g =day is sy1thesised by the i8er
the rest is d0e to re4ir40atio1 (o1 a8era!e ea4h
bie sat moe40e re4ir40ates "B times be5orebei1! ost i1 the 5ae4es+
p to =$F of the
cholesterol based bile
"igure #$%&@
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cholesterol%based bile
salts are recycledH byreabsorption along
the intestine.
Increasing dietary fiber
is thought to reduce
blood cholesterol
content by trapping a
greater percentage of
the bile in bulier!
ore fibrous feces.
Sma## In!es!ine
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ma;or site o5 di!estio1 a1d absorptio1 o5 10trie1ts di8ided i1to se!me1ts
! duodenum (- 4m+
! -e-unum (-.< m+
! i##eum (.Km+
Sma## in!es!ina# mo!i#i!+
postpra1diay the sma i1testi1e has se8era8ita 5014tio1s
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8ita 5014tio1s
: to mi 5ood 7ith di!esti8e se4retio1s:to 4ir40ate 4hyme so that m04osa 4o1ta4t is maima
: to prope 4o1te1ts i1 a 1et dista dire4tio1
:to 4ear resid0a e5t o8er 5rom the di!esti8e pro4es
:to tra1sport 4o1ti10i1! se4retio1s 5rom the 0pper !0t
d0ri1! 5asti1!
regiona# mo!or s)e,ia#isa!ion o5 the smabo7e
:;e;010m (/ o5 sma bo7e+ a4ts primariy as a mii1!
a1d 4o1d0it se!me1t:iie0m (dista K+ retai1s 4hyme 01ti di!estio1 a1dabsorptio1 are 4ompete
:termi1a ie0m a1d ieo4oo1i4 ;014tio1 4o1tro emptyi1!o5 4o1te1ts i1to the 4oo1 > mi1imise 4ooiea re?0
"igure #$%&:
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Most of the contractions
of the sall intestine are
of the i2ing and churning
actions portrayed here as
segentation contractions7peristalsis and the
do'nstrea o)eent
of aterials is infre3uent.
Sma## in!es!ina# mo!i#i!+
mus,u#aris e(!erna o5 the sma i1testi1e
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mus,u#aris e(!erna o5 the sma i1testi1e
4o1sists o5 - ayers ! thi42 i11er ayer o5 4ir40ar m0s4e a1d thi1 o0tero1!it0di1a ayer
there is a basa so7 7a8e a1d 7he1 spi2esare s0perimposed rhythmi4 m0s40ar4o1tra4tio1s o440r 7ith the same 5req0e14y asthe so7 7a8es
the so7 7a8es ha8e a hi!her 5req0e14y at theproima e1d (""=mi1+ a1d o1y B=mi1 distay :this mea1s that the ne! mo6emen! o5i1testi1a 4o1te1ts is i1 the dire4tio1 o5 the
ar!e i1testi1e
Gas!ro%i#ea# reCe(
the motor respo1se o5 the termi1a iie0m to 5eedi1!
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the motor respo1se o5 the termi1a iie0m to 5eedi1!
4hyme may remai1 i1 the termi1a iie0m 5or se8eraho0rs 01ti a1other mea is eate1 : 7he1 si!1as 5rom the 0pper GI) i1te1si5y
peristasis i1 the iie0m epes the remai1i1!4hyme.
as i1 the stoma4h : the prese14e o5 10trie1ts i1 theiie0m eert a 1e!ati8e e9e4t o1 ;e;01a motiity a1dtra1sit : the Tiiea bra2eU
parti40ary i1 the 4ase o5 5at a1d partiay di!ested4arbohydrate
this proo1!s the stay o5 4hyme i1 the iie0m
5a4iitati1! absorptio1
on!ro# o' sma## in!es!ine mo!i#i!+
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poory 01derstood b0t both both etri1si4 a1di1tri1si4 1er8es as 7e as h0mora 5a4tors arei18o8ed
i1itiatio1 a1d mai1te1a14e o5 postpra1dia motor
patter1s req0ires a1 i1ta4t 8a!0s
!astri1 a1d CC$ both e1ha14e motiity : !astri1reaes sphi14ter
se4reti1 i1hibits motiity
NANC 1e0ro1es may be importa1t i1 reai1!sphi14ter
Absopsi 0s0s ha0s
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Pe1!irima1 baha1:baha1 sa0ra14er1a 2e sir20asi* ter0tama t;d di 0s0sha0s* o2 daerah perm02aa1 y! 0as
Absopsi esie1 bia3
". %e1t02 hasi pe14er1aa1 bai2
-. Perm02aa1 absorpsi ade20at
. $e4epata1 baha1:baha1 daam 0s0s ha0s
/. $o5a2tor da1 ata0 2arier spesi2
MEKANISME ERCERNAAN ! A"SOR"SI
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&'
()M*'
P+OT)
P+OS)S
P)C)+**
S).*/*
&)C(
D*#SO+PS
P+OS)S D*S*+ P)C)+** :
'.D+O(SS
+0 - +1 2 '3O +0O' 2 +1'
P+SP D*S*+ *#SO+PS
4 Cairan ang $iabsorpsi 5 6 liter 7hasil sekresi8 $an 9 6 liter
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4 Cairan ang $iabsorpsi 5,6 liter 7hasil sekresi8 $an 9,6 liter
7makanan8 maka menghasilkan s;$; ,6 liter $iabsorpsi $iusus halus;
4 (ambung mengabsorpsi
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4 T+*SPO+T *&T> : memberi energi, ang bergerak
mela?an potensial listrik
4 D>@SS : Transport melalui membran akibat pergerakan
molekul
A"SORSI #A$AM USUS HA$US
&' A +*T@S* "+*M
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()M*& A 9BB "+*M** A 6B - 9BB "+*M
O A 6B - 9BB "+*M
*+ A - (T)+
*#SO+PS *+ :
*bsorpsi soosmotik berupa Diffusi $an Osmosis
Digesti)e secretions
are ostly 'ater!
'ith the a)erage
"igure #$%$
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'ith the a)erage
aounts indicatedhere. Note that only
#@@ l are e2creted
in feces! so the
echaniss for 'ater
absorption are efficient
0recall the idneys>
priary role in 'ater and
osotic hoeostasis1.
:@@@ g in! #$@ g out
Me2a1isme pe14er1aa1 da1absorpsi
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". Absorbsi air da1 ee2troit ! i1testi1a membra1e hi!hy permeabe
to 7ater
!7ater there5ore ?o7s a44ordi1! toosmoti4 !radie1t
! absorptio1 mo8eme1t o5 7ater a1d10trie1ts 5rom !0t to ymph a1d bood
! most 10trie1ts absorbed by 0pper ha5 o5 i1testi1e
! br0sh border o5 sma i1esti1e !reaty
i14reases s0r5a4e area 5or absorptio1
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! mai1 pro4ess is absorptio1 o5 Na (a1dC+
! Na 4a1 !o 8ia Na 4ha11es or Na:
10trie1t 4otra1sporters
! Na is the1 p0mped i1to the bood by
Na:$ A)Pase 7hi4h mai1tai1s a 1et
!0tbood Na !radie1t
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-. Pe14er1aa1 > absorpsi 2arbohidrat
! i1!ested per day as
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! ,om)#e( )o#+sa,,harides: K/star4h* .
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oi!osa44harides
br0sh border o#igosa,,haridases br0sh border a4tase* s04rase:isomatase
a1d matase reease mo1osa44harides(!04ose* !aa4tose a1d 5r04tose+
!04ose a1d !aa4tose ta2e1 0p by SGL)" 5r04tose by GL&)< a three tra1sported 8ia GL&)- o0t i1to the
porta 8ei1 a1d to the i8er
ENCERNAAN KAR"OHI#RAT
KHPtalin A EBF
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MA$TOSE
ISOMA$TOSE
G$UCOSA
$ACTOSA
GA$ACTOSA
SUCROSA
FRUKTOSA
$ACTASE
%INTESTINE&
SUCRASE
%INTESTINE&
MA$TOSE
ISOMA$TOSE%INTESTINE&
'Cl A GPanc; *mlase A 6BF
ntestinae *mlase A G
M@(@T
4 Sali=a menHa$i ptalin 7 *lpha - *milase8
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4 Sebagian besar &' ang $imakan menHa$i pelin$ung tipisaitu sellulosa $an ti$ak $apat $icernakan
(*M#@"
4 Ptalin $ari sali=a : p' E;B tak aktif
4 'Cl : Menghi$rolisis &'
- *mlase Pancreas - Sukrase
- (actase - Maltase
- somaltase
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In a noral diet! bul is ,arbs! :$@%8@@ g 0e2. Atins1
; #:$ g protein! ;:$%#+@ g fat.
LEMA$
K:" ! perhari*
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ipids: mai1y tria4y!y4eros Di4er1a m0ai dim00t oeh e1zim #i)ase i1!0a
da1 pa12reas m;d asam ema2 da1 mo1o!iserida
Garam em)edu* membe1t02 em0si ema2 ebihha0s diseb0t mise
Mise' difusi m'' mem(ran )e sito*'asma
Se' usus +a'us sintesa Trig'iserida (aru, (erga(ung dengansteroid dan fosfo'i*id mem(entu) KI$OMIKRON
Se' usus +a'us se)resi )i'omi)ron )e interstitia' me'a'uie)sositosis
Ki'omi)ron difusi )e 'a)tea' a)+irn-a )e *. 'imfe
USUS HA$US
4 )M@(S>&*S O()' *S*M )MP)D@
#*"* 'D+OI( "*+*M )MP)D@ S*"*T (*+@T
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4 #*"* 'D+OI( "*+*M )MP)D@ S*"*T (*+@TD*(*M *+
4 #*"* ST)S) (*+@T D*(*M ()M*& #)+"@*@T@& M)@+@&* T)"*"* P)+M@&**()M*&
(P*S) P*C+)*S
()M*& )M@(S ()M*&
>;*; J "(S)+*(A EBF
"(C)+D* A KBF
)MP)D@
ancreatic$i*ase
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Fa! a$sor)!ion
i id i t i
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ipids: mai1y tria4y!y4eros
" : ar!e oi dropets (sheari1! 5or4es i1 !0t+
- : em0sied oi drops 7ith bie sats
pa14reati4 ipase at oi:7ater i1ter5a4e
: 5ormatio1 o5 mi4eesmi4ees4ome to the absorpti8e s0r5a4e o5 !0tmo1o!y4erides a1d 5ree 5atty a4ids are the1absorbed
/ i id th i 5 t i
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/. i1side 4es resy1thesis o5 tria4y!y4eros*4hoestero a1d phosphoipids to 4hyomi4ro1s
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of a bile salt! 'ith thecholesterol%deri)ed
coreH in yello'.
A space%filling odel
of a bile salt. Thenon%polar surface
helps eulsify fats! and
the polar surface
prootes 'ater solubility.
"igure #$%#@
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*ile salts and
phospholipids
con)ert large fat
globules into sallerpieces 'ith polar
surfaces that inhibit
reaggregation.
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*ig *lobs of "at
"igure #$%#:
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Sall *lobs of "at
Micelles
"atty Acids and
Monoglycerides
,hyloicron Assebly
Distribution and /rocessing
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/ROTEIN
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"! i1!ested daiy as oi!opeptides Sa1!at 2ompe2s
di!ested by proteoyti4 e1zymes* PEPSIN
proteoyti4 e1zymes se4reted as +mogens
(i1a4ti8e proe1zeymes+
endo)e)!idases : 4ea8e i1ter1a peptide
bo1ds
e(o)e)!idases : 4arboy or ami1o termi1a4ea8a!e
%EN)&$ ASAM AMINO⇒ 2apier
ami1opeptidases i1 br0sh borders
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ami1opeptidases i1 br0sh borders
peptides are bro2e1 do71 to i1di8id0a ami1o
a4ids (as 7e as di > tripeptides+ by
oi!opeptidases
reabsorptio1 b0t !0t 4es simiar to that o5 s0!ars
both Na:depe1de1t a1d i1depe1de1t 0pta2e
path7ays
ERCERNAAN ROTEIN
ROTEIN %HE/ANI #AN NA"ATI& ASAM AMINO
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RANTAI AN0ANG #ENGAN IKATAN ETI#A
P+OT)Pepsin
p' 3 (ambungProteosa
Pepton
Polpepti$a
PO(P)PTD* 2
*S*M *MO
*S*M *MO
Pepti$ase
Tripsin
Chmotropsin
Coerbo%pepti$ase
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ROTEIN
Asam Amino (eri)atan I)atan e*tida
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Pencernaan protein $engan proses 'i$rolisis
+ C' C O' 2 ' C' COO'
'3
O
'
+
+ C' C C' COO' 2 '3O
O
'
+
?ocation Secretion product
,arbohydrates Mouth Sali)ary Aylase
pper%stoach Sali)ary Aylase
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pper stoach Sali)ary Aylase
Sall intest. /ancreatic aylase
,arbs 0fiber1 ?arge intestine 0*acterial digestion1
/rotein Stoach /epsin
Sall intest. Trypsin! ,hyotrypsin
"at Sall intest. /ancreatic ?ipase
itains 0fat1 Sall intest.
itains 0'ater1 Sall intest.
/roduct Absorption path'ay
,arbohydrates "ru "acilitated diffusion
GluGal Acti)e Transport Sodiu
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GluGal Acti)e Transport Sodiu
/rotein Aino Acids Acti)e transport Sodiu
/roteins 0e2cept.1 endo%e2ocytosis
0infants ainly1
"at "ree "atty Acids DiffusionMonoglyc. Diffusion
itains 0fat1 A! D! E! K Diffusion 0)ia icelles1
itains 0'ater1 *%#: *inds to Intrin. "actor. Endocytosis
Iron Acti)e Transport
then into ferritin
&S&S besar
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SS *ESAR
)erdiri atas3
! se20m
! Ape1di2s3 ;ari1!a1 im5oid
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pe d s ;a !a o d
! $oo13 ase1de1* tra15ers0m* dese1de1*2oo1 si!moid (a2hir 2oo1 dese1de13+
! re2t0m
Fungsi usus $esar 3 ko#on
! F01!si 0tama me1yimpa1 5eses sebe0m
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de5e2asi da1 me1!at0r pe1!e0ara1 5eses ! Absorbsi 3
air > ee2troit de1!a1 proses perbedaa1osmoti2
8itami1 y! dihasi2a1 2er;a ba2teri3 ! itami1 $3 ar0t ema2* 01t02 pembe20a1 darah
! %ioti13 ar0t ema2* pe1ti1! 01t02 metabois1e !02osa
! itami1 % beberapa 1e0rotra1smiter
%a2teri me1!0bah biir0bi1 me1;adi 0robii1o!e1(diabsorpsi 2e sir20asi* dib0a1! mea0i 0ri1+da1 ster2obii1
! Se2resi3
m020s ya1! diprod02si oeh se !obet
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01t02 Tpe0masU 5eses da1 epite 'CO * 01t02 me1yeimba1!2a1 asam
prod02si ba2teri
! %a2teri 2oo1 memba1t0 pe14er1aa1
se0osa da1 2arbohidrat ! %a2teri 2oo1 meme4ah peptid
me1;adi3amo1ia* i1do* s2ato
! metha1e a1d '- dari diit 6 prod02si !as
"igure #$%&&
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In the large intestine! acti)e transport of sodiu! coupled 'ith
osotic absorption of 'ater! are the priary acti)ities.
Microbes here are acti)e in the production of )itain K.
O!o! ko#on
Lapisa1 otot poos o1!it0di1a di sebeah
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0ar tida2 me10t0pi 0s0s besar sepe10h1ya*
ha1ya pita otot ya1! terpisah yait0 tae1ia
2oi
)ae1ia ebih pe1de2 dari otot sir20er di
ba7ah1ya sehi1!!a apisa1 di ba7ah1ya
membe1t02 2a1t01!* ha0stra Gera2a1 ambat3
! mai1tai1i1! a1 appropriate i1tra0mi1a ba4teria mass
AN&S
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Sphi14ters
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I1ter1a a1a sphi14ter ! o01tary or i18o01tary,
I18o01tary
! )ype o5 m0s4e,
Smooth m0s4e
! )o1i4ay 4o1tra4ted
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Gerakan ko#on
Fre27e1si re1dah
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:/ times=day Gerakan masa 3 mass mo6emen!s:
kon!raksi masi' mendorong isi ko#onke $agian dis!a# UB dan disim)an s)!-d de'ekasi
Gera2a1 masa dira1!sa1! oeh ma2a1a1daam amb01! diseb0t re?e2s !astro2oo1
&m0m1ya dii20ti de5e2asi
De'e,a!ion/enge#uaran 'eses me#a#ui reCek de'ekasi
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! Massa 5eses ber!era2 me10;0 re2t0m6 mera1!sa1! reseptor re!a1! di re2t0m
! Memi40 re?e2s de5e2asi da1 2ei1!i1a1 %A%
! S1!ter a10s i1ter10s (otot poos+ meemah*
re2t0m serta 2oo1 si!moid ber2o1tra2si 20at.
! Apabia s1!ter a10s e2ster10s (otot
ra1!2a=2o1tro sadar+ meemas ter;adi
de5e2asi
! De5e2asi diba1t0 !era2a1 me1!e;a1
8o01ter3 2o1tra2asi otot abdome1 da1
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e2spirasi pa2sa * !otis me10t0p*
sehi1!!a te2a1a1 i1traabdome1
me1i1!2at
Norma De5e4atio1
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Re4tosi!moid diste1tio1 stim0atesre4tore4ta re?e ! %o7e proima to bo0s
4o1tra4ts
! %o7e dista to bo0s reaes
Re?e reaatio1 o5 i1ter1a a1a sphi14ter ! Re4toa1a i1hibitory re?e
! Correates 7ith the T0r!e to !oU
oitio1a 4o1tra4tio1 o5 e8ator a1i
Norma De5e4atio1
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oitio1a 4o1tro o5 e8ator a1i ! Ope1s proima a1a 4a1a
! Reaes eter1a sphi14ter a1dp0bore4tais
! Ao7s strai!hter a1ore4ta passa!e
May i14rease 7ith
! asa8a
! I14reasi1! i1traabdomi1a press0re(sq0at+
Norma De5e4atio1
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De5e4atio1 de5erred by 8oitio1ay4o1tra4ti1! (-+Y
! P0bore4tais
! Eter1a a1a sphi14ter
! )he1* i1ter1a a1a sphi14ter reaatio1re?e 7i 5ade (7ithi1 appro "< se4+a1d 0r!e 7i reso8e 01ti tri!!ered
a!ai1
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,olon
/resence of chye
in the duodenu
/resence of food
in the stoach
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The presence of food in
the stoach and chye in
the duodenu stiulate
ass o)eent in thecolon.Mass o)eents
Rectu
Stiulatesass
o)eent
,olon
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Mass o)eents
Mass o)eents are
integrated by the
enteric ple2us.
Rectu
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Stoach
,olon
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Mass o)eents
The presence of feces in the
rectu stiulates
parasypathetic and local
refle2es that result in defecation.
Stiulation of
parasypathetic
controlled
defecation
refle2es
"eces
Rectu
Stiulation
of local
defecation
refle2es
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