Sunteți pe pagina 1din 29

ANATOMI & FISIOLOGI

SALURAN PENCERNAAN

Wound & Stoma Care Course F Siusanto Hadi Siloam Hospital Surabaya

ANATOMI & FISIOLOGI SALURAN PENCERNAAN Wound & Stoma Care Course F Siusanto Hadi Siloam Hospital Surabaya
ANATOMI & FISIOLOGI SALURAN PENCERNAAN Wound & Stoma Care Course F Siusanto Hadi Siloam Hospital Surabaya
SISTEMA DALAM TUBUH  Sel > Jaringan > Organ > Sistem > Organisma – Sistem

SISTEMA DALAM TUBUH

SISTEMA DALAM TUBUH  Sel > Jaringan > Organ > Sistem > Organisma – Sistem Syaraf
SISTEMA DALAM TUBUH  Sel > Jaringan > Organ > Sistem > Organisma – Sistem Syaraf

Sel > Jaringan > Organ > Sistem > Organisma

Sistem Syaraf

Sistem Kardiovaskuler Sistem Pencernaan

Sistem Perkemihan

Sistem Gerak

Sistem Integumen

Sistem Respirasi

Sistem Endokrin

dll

Sel

Sel

Sel
Sel
Sel
Human Structure – Level Organization

Human Structure Level Organization

Human Structure – Level Organization
Human Structure – Level Organization
System Relationship

System Relationship

System Relationship
System Relationship
System Relationship
DIGESTIVE SYSTEM  Function of Digestive System – Ingestion – Chewing – Swallowing – Digestion

DIGESTIVE SYSTEM

DIGESTIVE SYSTEM  Function of Digestive System – Ingestion – Chewing – Swallowing – Digestion –
DIGESTIVE SYSTEM  Function of Digestive System – Ingestion – Chewing – Swallowing – Digestion –

Function of Digestive System

Ingestion

Chewing

Swallowing

Digestion

Absorption Excretion of undigested food

anatomy

anatomy

anatomy
anatomy
anatomy
anatomy
 Organs of Digestive System – Mouth – Pharynx (Throat) – Oesophagus (Food tube) –
 Organs of Digestive System – Mouth – Pharynx (Throat) – Oesophagus (Food tube) –
 Organs of Digestive System – Mouth – Pharynx (Throat) – Oesophagus (Food tube) –

Organs of Digestive System

Mouth

Pharynx (Throat) Oesophagus (Food tube)

Stomach

Small intestine

Large intestine

Rectum

Anus

Layers of Digestive System  Inner Epithelial layer – Secretion of enzyme and mucus –

Layers of Digestive System

Layers of Digestive System  Inner Epithelial layer – Secretion of enzyme and mucus – Soft
Layers of Digestive System  Inner Epithelial layer – Secretion of enzyme and mucus – Soft

Inner Epithelial layer

Secretion of enzyme and mucus

Soft and pink in colour

Middle Muscular layer

Outer layer (Longitudinal muscles)

Inner layer (Circular muscle)

Peristalsis (Segmental contraction)

Outer Serous layer

Protective function

Diagram

(Circular muscle) – Peristalsis (Segmental contraction)  Outer Serous layer – Protective function – Diagram
 Stomach – Dilated part of Digestive system – Lies in upper abdomen below diaphragm
 Stomach – Dilated part of Digestive system – Lies in upper abdomen below diaphragm
 Stomach – Dilated part of Digestive system – Lies in upper abdomen below diaphragm

Stomach

Dilated part of Digestive system

Lies in upper abdomen below diaphragm

Slightly left to midline

Upper opening connected to Oesophagus

Lower opening connected to Duodenum

Both remain closed during gastric digestion

J shaped in standing position

Elastic muscular bag with capacity of 2 liters

3 muscular layer- vertical, circular, oblique

 Functions of the Stomach – Storage of food for 3 hours – Partial digestion
 Functions of the Stomach – Storage of food for 3 hours – Partial digestion
 Functions of the Stomach – Storage of food for 3 hours – Partial digestion

Functions of the Stomach

Storage of food for 3 hours

Partial digestion of proteins and fats

Semi digested food from stomach enters the Duodenum

 Oesophagus – 25cm long muscular tube – From pharynx to stomach – Behind trachea
 Oesophagus – 25cm long muscular tube – From pharynx to stomach – Behind trachea
 Oesophagus – 25cm long muscular tube – From pharynx to stomach – Behind trachea

Oesophagus

25cm long muscular tube

From pharynx to stomach

Behind trachea and in front of vertebral column

Major part passes to Thorax

Food passes to stomach by active muscular action

Solid food reaches stomach in 7 to 8 seconds

Liquids reaches stomach in 2 to 3 seconds

 Small intestine – 6 to 7 meter long, 2.5cm diameter – Lies in center
 Small intestine – 6 to 7 meter long, 2.5cm diameter – Lies in center
 Small intestine – 6 to 7 meter long, 2.5cm diameter – Lies in center

Small intestine

6 to 7 meter long, 2.5cm diameter

Lies in center of abdomen

Divided into 3 parts First part Duodenum (Bile & Pancreatic secretion)

Second part Jejunum

Third part ileum

Alkaline Secretions

Protects from acid contents of stomach

Small intestine

Mucosa

Deeply folded to increase the surface area

Helps in absorption of food.

Enterohepatic cycle

Enterohepatic cycle

Enterohepatic cycle
Enterohepatic cycle
 Large intestine – 1.5meter long, 5 to 6cm diameter – Divided into 3 parts
 Large intestine – 1.5meter long, 5 to 6cm diameter – Divided into 3 parts
 Large intestine – 1.5meter long, 5 to 6cm diameter – Divided into 3 parts

Large intestine

1.5meter long, 5 to 6cm diameter

Divided into 3 parts

Right ascending colon

Transverse colon

Left descending colon

Absorb water : faeces

Sigmoid Colon & Rectum

Temporary storage of faeces

Anus is guarded by external & internal sphincters

Microbe Microbial Populations in the Digestive Tract of Normal Humans   Stomach Jejunum Ileum Colon

Microbe

Microbe Microbial Populations in the Digestive Tract of Normal Humans   Stomach Jejunum Ileum Colon
Microbe Microbial Populations in the Digestive Tract of Normal Humans   Stomach Jejunum Ileum Colon

Microbial Populations in the Digestive Tract of Normal Humans

 

Stomach

Jejunum

Ileum

Colon

Viable bacteria per gram

0 - 10 3

0 - 10 4

10 5 - 10 8

10 10 - 10 12

pH

3.0

6.0-7.0

7.5

6.8-7.3

Stoma Physiology  Ileostomy  Colostomy  Urostomy

Stoma Physiology

Stoma Physiology  Ileostomy  Colostomy  Urostomy
Stoma Physiology  Ileostomy  Colostomy  Urostomy

Ileostomy

Colostomy

Urostomy

Making of Ileostomy

Making of Ileostomy

Making of Ileostomy
Making of Ileostomy
Type of Ileostomy

Type of Ileostomy

Type of Ileostomy
Type of Ileostomy
Type of Ileostomy
Ileostomy Output  Early Post op period : liquid & bilious  1500 – 2000

Ileostomy Output

Ileostomy Output  Early Post op period : liquid & bilious  1500 – 2000 cc/day
Ileostomy Output  Early Post op period : liquid & bilious  1500 – 2000 cc/day

Early Post op period : liquid & bilious

1500 2000 cc/day

Well established : 200 -700 cc/day

Hill :

Low stomal volume : <700 cc/day

High output volume : >1000 cc/day (Crohn’s ds)

6 months later : volume varies, porridge-like,yellow brom color,food particle

Grape juice/other fruit juice : increase wet weight stool

Dietary fiber : increase dry stool weight

Fasting : decrease stool volume

Skin complication

Ileostomy & Nutritional/Metabolic Effect  Malabsorption > osmotic diarrhea – Fat malabsorption : reduce

Ileostomy & Nutritional/Metabolic Effect

Ileostomy & Nutritional/Metabolic Effect  Malabsorption > osmotic diarrhea – Fat malabsorption : reduce
Ileostomy & Nutritional/Metabolic Effect  Malabsorption > osmotic diarrhea – Fat malabsorption : reduce

Malabsorption > osmotic diarrhea

Fat malabsorption : reduce bile salt absorption

Carbohydrate : lactase deficiency

Protein : enterokinase deficiency

B12 vitamin deficiency

Electrolyte depletion

Sodium loss : 60 mEq/day (Normal <10 mEq/day)

Higher in ileum resection

Potassium loss : 6-12 mEq/day (Normal 5 mEq/day)

Ileostomy & Nutritional/Metabolic Effect  Urinary calculi : 3%-13% – – Dehydration & Sodium

Ileostomy & Nutritional/Metabolic Effect

Ileostomy & Nutritional/Metabolic Effect  Urinary calculi : 3%-13% – – Dehydration & Sodium
Ileostomy & Nutritional/Metabolic Effect  Urinary calculi : 3%-13% – – Dehydration & Sodium

Urinary calculi :

3%-13%

Dehydration & Sodium loss

Gallstone formation :

Extensive terminal ileal resection

Enterohepatic circulation disrupted Prophylactic Cholecystectomy

Colostomy

Colostomy

Colostomy
Colostomy
Colostomy
 First day : liquid, steadily increase  10-14 days : become quite viscous 
 First day : liquid, steadily increase  10-14 days : become quite viscous 
 First day : liquid, steadily increase  10-14 days : become quite viscous 

First day : liquid, steadily increase

10-14 days : become quite viscous

High fiber food : increase fecal weight

Proximal : quite liquid, excessive bile acid in colon > promote colonic water & electrolyte secretion

More distally : more solid

DESENDEN KOLOSTOMI PROXIMAL COLOSTOMY SIGMOID KOLOSTOMI TRANSVERSUM KOLOSTOMI
DESENDEN KOLOSTOMI PROXIMAL COLOSTOMY SIGMOID KOLOSTOMI TRANSVERSUM KOLOSTOMI
DESENDEN KOLOSTOMI PROXIMAL COLOSTOMY SIGMOID KOLOSTOMI TRANSVERSUM KOLOSTOMI
DESENDEN KOLOSTOMI PROXIMAL COLOSTOMY SIGMOID KOLOSTOMI TRANSVERSUM KOLOSTOMI

DESENDEN

KOLOSTOMI

PROXIMAL

COLOSTOMY

DESENDEN KOLOSTOMI PROXIMAL COLOSTOMY SIGMOID KOLOSTOMI TRANSVERSUM KOLOSTOMI

SIGMOID

KOLOSTOMI

DESENDEN KOLOSTOMI PROXIMAL COLOSTOMY SIGMOID KOLOSTOMI TRANSVERSUM KOLOSTOMI

TRANSVERSUM

KOLOSTOMI

Summary  Small intestine & colon : Organs that maintain fluid & electrolyte homeostasis 

Summary

Summary  Small intestine & colon : Organs that maintain fluid & electrolyte homeostasis  Making
Summary  Small intestine & colon : Organs that maintain fluid & electrolyte homeostasis  Making

Small intestine & colon : Organs that maintain fluid & electrolyte homeostasis

Making stoma : change the homeostasis

Attention made for this consequencies

Anatomy & physiology knowledge is important