LO HAURA

Motility of the large intestine

The movement of intestinal contents through the colon is slower than that seen in
the rest of the gastrointestinal tract. This is partly due to the nature of the activity
and partly due to its absorptive function of water and electrolytes. The large
intestine has three main modes of movement:
• Segmental (or haustral) contractions • Peristalsis • Mass movement.
a. Segmental contractions
Segmental (or haustral) contractions are brought about by the contraction of
the taeniae coli. These three bands of longitudinal muscles gather the colon
into haustra. The haustra fill with intestinal contents and the distension
stimulates contraction. Contraction of adjacent haustra causes a mixing effect
and allows the contents to be in contact with the mucosal surfaces, thus
facilitating absorption. Segmental contractions are initiated by acetylcholine
and substance P release.
b. Peristalsis
Peristalsis is slower in the large intestine than in the small intestine. It provides
waves of propulsive contractions, slowly moving the intestinal contents
towards the anus. As in the small intestine, distension initiates the contractions
and vagal inhibitory and excitatory fibres control the movement.
c. Mass movement
Mass movement describes the intense contraction that begins halfway along
the transverse colon and pushes the intestinal contents towards the rectum.
This type of contraction occurs only a few times a day and is responsible for
colonic evacuation. It occurs shortly after a meal and if faeces are present in
the rectum, stimulates the urge to defecate. This is called the gastrocolic reflex.
It is partly neuronal and partly hormonal (via the action of cholecystokinin).
 Control of colonic motility As in other parts of the gastrointestinal tract,
Auerbach’s and Meissner’s plexuses are present in the walls of the colon (see Fig.
1.2). Their activity is modulated by parasympathetic and sympathetic activity.
Parasympathetic stimulation is via branches of the vagus and pelvic nerves from
the sacral spinal cord.
It increases contraction of the proximal colon, allowing greater absorption of salts
and water. Sympathetic innervation is via the superior and inferior mesenteric and
hypogastric plexuses. It decreases colonic movements. Colo-colonic reflexes occur
(mediated in part by the sympathetic system) causing one part of the colon to relax
if an adjacent part is distended (Fig. 5.5).

Kolon berfungsi sebagai reservoar untuk sisa makanan yang tidak dapat dicerna atau
diserap (Gambar 27–8). Motilitas di segmen ini juga melambat agar kolon dapat
menyerap air, Na+, dan mineral lain. Dengan mengeluarkan sekitar 90% cairan, kolon
mengubah 1000-2000 mL kimus isotonik yang memasukinya setiap hari dari ileum
menjadi sekitar 200-250 mL tinja setengah padat.
MOTILITAS KOLON Ileum terhubung ke kolon oleh suatu struktur yang dikenal sebagai
katup ileosekum, yang membatasi refluks isi kolon, dan terutama bakteri komensal yang
berjumlah besar, ke dalam ileum yang relatif steril. Bagian ileum yang mengandung katup
ileosekum menonjol sedikit ke dalam sekum, sehingga peningkatan tekanan kolon akan
menutupnya sedangkan peningkatan tekanan ileum akan menyebabkan katup tersebut
membuka. Katup ini dalam keadaan normal tertutup. Setiap kali gelombang peristaltik
mencapainya, katup ini terbuka sebentar, memungkinkan sebagian kimus ileum
tersembur masuk ke dalam sekum. Ketika makanan meninggalkan lambung, sekum
melemas dan terjadi peningkatan pemindahan kimus melalui katup ileosekum (refleks
gastroileum). Hal ini mungkin merupakan refleks vago-vagus. Gerakan kolon mencakup
kontraksi segmentasi dan gelombang peristaltik seperti yang terjadi pada usus halus.
Kontraksi segmentasi mencampur isi kolon dan, dengan terpajanannya lebih banyak isi
kolon ke mukosa, penyerapan meningkat. Gelombang peristaltik mendorong isi kolon
menuju rektum, walaupun kadang-kadang ditemukan antiperistalsis lemah. Kontraksi
jenis ketiga yang terjadi hanya di kolon adalah kontraksi kerja massal (mass action
contraction), yang berlangsung sekitar 10 kali sehari, di mana terjadi kontraksi simultan
otot polos di daerah-daerah yang luas. Kontraksi ini mendorong isi kolon dari satu bagian
kolon ke bagian lain (Boks Klinis 27–4). Kontraksi ini juga mendorong isi kolon ke rektum,
dan peregangan rektum kemudian mencetuskan refleks defekasi (lihat bawah).
Pergerakan kolon dikoordinasikan oleh BER kolon. Frekuensi gelombang ini, tidak seperti
gelombang di usus halus, meningkat di sepanjang kolon, dari sekitar 2/mnt di katup
ileosekum menjadi 6/mnt di sigmoid.

WAKTU TRANSIT DI USUS HALUS & KOLON Pada sebagian besar orang, bagian pertama
makanan mencapai sekum dalam waktu sekitar 4 jam, dan semua bagian makanan yang
tidak tercerna telah masuk kolon dalam 8 sampai 9 jam. Secara rerata, sisa makanan yang
pertama mencapai sepertiga pertama kolon dalam 6 jam, sepertiga kedua dalam 9 jam,
dan bagian akhir kolon (kolon sigmoid) dalam 12 jam. Dari kolon sigmoid ke anus,
pergerakan makanan jauh lebih lambat Bila manik-manik kecil berwarna dimasukkan ke
dalam makanan, rerata 70%-nya dikeluarkan di tinja dalam 72 jam, tetapi pengeluaran
seluruhnya memerlukan waktu lebih dari seminggu. Waktu transit, fluktuasi tekanan, dan
perubahan pH dalam kanal cerna dapat diamati dengan memantau kemajuan sebuah pil
kecil yang mengandung sensor dan pemancar radio miniatur.

1. Bagaimana mekanisme penyerapan air di kolon ?

Absorption of water in the colon is similar to the mechanism used to concentrate the
contents of the gall bladder described in Chapter 7. Na+ and Cl– are pumped into the
paracellular (lateral intercellular) spaces and water follows by osmosis. Water
molecules, Na+ and Cl– then flow through the lateral intercellular spaces away from the
lumen, and across the basement membrane of the epithelial cells of the colon. Some
Cl– from the colonic lumen also crosses the tight junction into the intercellular space
because of the potential difference.Ittravelsintheoppositedirection to Kþ and increases
the concentration of Cl– in the intercellular space and, therefore, the passage of water.
The concentration of ions in that part of the intercellular space closest to the lumen is
hypertonic, but the fluid at the basement membrane end is isotonic. It is the isotonic fluid
that crosses the basement membrane and moves into the intestinal capillaries. Absorbed
amino acids and sugars also increase the osmotic absorption of water. Abnormalities in
water absorption in the intestines can result in diarrhea

2. Bagaimana mekanisme penyerapan mineral di kolon ?

The main function of the colon is absorption. It absorbs over 90% of the water
from the contents passing through it, reducing the volume from 1–2 L to about
200 mL of semi-solid faecal matter. By the time they reach the end of the
gastrointestinal tract, faeces are about 50–75% water. The remainder is solid
material, which is partly composed of bacteria and desquamated mucosal cells.
Desquamated cells largely account for the fact that a starving person continues to
produce stools. The ion transport processes of the colon are shown in Fig. 7.5. Naþ
in the lumen is exchanged for Hþ (Naþ is pumped into the epithelial cells and
Hþpumped out of it). HCO3 is exchanged for Cl– (Cl– is
reabsorbed, bicarbonate pumped out).
5Functions and physiology
79
In addition, paracellular spaces exist into which Naþ and Cl– is pumped, and from
which Kþ passes out into the lumen. Kþ is pumped into the cells in exchange for
the Naþ pumped out into the paracellular spaces. The net result of this is the
creation of a potential difference of about –30 mV across the colonic mucosa (a
greater difference than that across the jejunal and ileal mucosa). It is this potential
difference that allows the passage of Kþ across the tight junctions from the
paracellular space into the lumen and accounts for the potassium-rich secretions
found in the colon. Urea synthesis is greater than its excretion by about 20%. The
excess is secreted into the colon for metabolism by bacteria. The products are then
absorbed. Metabolism occurs near the mucosa, rather than in the lumen. NH4þ
and HCO3 ions are produced and converted into
NH3,CO2 and water.These freelydiffuse across the mucosal epithelium into the
circulation. The NH3 is transported to the liver for synthesis of amino acids.
Electrolyte movement in the colon

Secretion of mucus
The colonic mucosa has many goblet cells in its crypts and surface epithelium.
They secrete mucus in response to mechanical irritation of the mucosa caused by
substances passing through it, and as a result of cholinergic stimulation.

Mucus lubricates the colon, preventing trauma from the contents passing through
it, which become increasingly solid as water is reabsorbed on the way through. The
ratio of mucous to aqueous secretion is greater in the colon than elsewhere in
the gastrointestinal tract. The aqueous component contains bicarbonate, which
plays an important role in buffering, and is rich in potassium. Chloride is absorbed
in exchange for bicarbonate
3. Apa yang terjadi pada makanan yang sudah sampai di kolon ?

Dietary fibre consists of indigestible carbohydrates, primarily cellulose but also lignin
and pectin. Cellulose cannot be digested as we do not have the enzymes necessary to
hydrolyse theb-glycosidic bonds linking its glucose molecules, unlike starch where the
glucose residues are linked by a-glycosidic bonds. Although it does not provide energy,
fibre adds bulk to the bowel contents and increases gut motility, thus preventing
constipation. It also decreases absorption of toxic compounds, e.g. some
carcinogens, due to its binding properties.

4. Mekanisme pengaturan defekasi

DEFEKASI Peregangan rektum oleh feses akan mencetuskan kontraksi refleks otot-
otot rektum dan keinginan buang air besar. Pada manusia, persarafan simpatis ke
sfingter ani internus (involunter) bersifat eksitatorik, sedangkan persarafan
parasimpatis bersifat inhibitorik. Sfingter melemas sewaktu rektum tere-gang.
Persarafan ke sfingter ani eksternus, suatu otot rangka, datang dari nervus
pudendus. Sfingter dipertahankan dalam keadaan kontraksi tonik, dan
peregangan sedang rektum meningkatkan kekuatan kontraksinya (Gambar 27–9).
Keinginan berdefekasi pertama kali muncul saat tekanan rektum meningkat
sampai sekitar 18 mm Hg. Ketika tekanan ini mencapai 55 mm Hg, sfingter
internus maupun eksternus melemas dan timbul refleks ekspulsi isi rektum. Hal
ini merupakan penyebab mengapa dapat terjadi refleks pengosongan rektum
meskipun terdapat cedera tulang belakang. Sebelum tekanan yang melemaskan
sfingter anus eksternus tercapai, defekasi volunter dapat dimulai dengan
mengejan. Dalam keadaan normal sudut antara anus dan rektum adalah sekitar
90° (Gambar 27–10), dan hal ini plus kontraksi otot puborektalis menghambat
defekasi. Dengan mengejan, otot abdomen berkontraksi, dasar panggul menurun
1-3 cm, dan otot puborektalis melemas. Sudut anorektum berkurang menjadi 15°
atau kurang. Hal ini terjadilah defekasi. Dengan demikian, defekasi adalah suatu
refleks spinal yang dengan sadar dapat dihambat dengan menjaga agar sfingter
eksternus tetap berkontraksi atau dibantu dengan melemaskan sfingter dan
mengkontraksikan otot-otot abdomen. Peregangan lambung oleh makanan
mencetuskan kontraksi rektum dan, sering, menimbulkan keinginan berdefekasi.
Respons ini disebut refleks gastrokolon, walaupun terdapat beberapa bukti bahwa
refleks ini disebabkan oleh kerja gastrin pada kolon dan tidak diperantarai oleh
saraf. Karena respons ini, defekasi setelah makan sering terjadi pada anak-anak.
Pada orang dewasa, faktor kebiasaan dan budaya.

Defecation
Control of defecation
The urge to defecate is felt because stretching of the rectum causes impulses in
the cholinergic parasympathetic nerves of the pelvis.These are transmitted to a
nerve centre in the sacral spinal cord. A pressure of about 18 mmHg in the rectum
is needed. Impulses are then conveyed to higher centres, allowing an individual to
decide whether to defecate, i.e. whether to voluntarily relax the external
sphincter, or not. In the latter case, the internal sphincter will recontract and the
urge to defecate will subside. As mentioned earlier, the external anal sphincter is
made up of striated (voluntary) muscle while the internal sphincter is composed of
involuntary smooth muscle.The latter relaxes as a reflex in response to distension
of the distal rectum. Intact Auerbach’s and Meissner’s plexuses are needed for this
reflex relaxation to occur. Thus in Hirschsprung’s disease (see later), the internal
sphincter does not relax in response to colonic distension as there is a congenital
absence of ganglion cells in these plexuses in the rectum. If there has been damage
to the spinal nerves and therefore to the control of the external sphincter, it will
relax when the pressure in the rectum reaches about 55 mmHg. The anal canal can
differentiate between air, liquid and solid contents, and allow the selective
release of air as flatus.

Mechanics of defecation
When a person 1. decides to defecate, i.e. when the 2. external sphincter is
voluntarily relaxed, an 3. increase in intraabdominal pressure must be achieved to
expel the faeces. Thus, a breath is taken in and the glottis closes over the trachea.
The respiratory muscles contract on lungs filled with air, which increases both the
intrathoracic and intra-abdominal pressures. The pelvic floor muscles relax and the
floor ‘drops’, thus straightening the rectum and preventing rectal prolapse. The
faeces are then expelled from the anus.
 5. Ciri ciri feses yang sehat dan pengelompokkannya.

6. Apa saja microbiota dan fungsi microbiota tersebut?

Most of the flora of the large intestine are anaerobes,e.g. Bacteroides fragilis. The large
intestine also supports coliforms such as Escherichia coli and faecal streptococci, including
Enterococcus faecalis. There are at least 400 species of bacteria in the large bowel, with
over 1010 organisms per gram of stool. Approximately one quarter of the weight of stool
is bacteria. Commensal bacteria keep pathogenic bacteria at bay by competing with them
for space and nutrients. The significance of this becomes apparent during antibiotic
administration. Antibiotics disrupt the normal flora and predispose to clostridial and
other gut infections. The intestinal flora convert conjugated bilirubin to urobilinogen,
some of which is reabsorbed and excreted in the urine. The flora also convert the
remainder of the urobilinogen to stercobilinogen which is excreted in the faeces.

ABSORPTION
Vitamins Fat-soluble vitamins Absorption of the fat-soluble vitamins A, D, E and K depends on the
absorption of fat and any condition in which fat digestion and absorption is decreased will eventually
lead to a deficiency of these vitamins.

Water-soluble vitamins At the concentrations present in a normal diet, most of these are taken up by
specific transport mechanisms, many of which are sodium-dependent.

An important example of a water-soluble vitamin is vitamin B12. On ingestion, it is bound to R protein

found in saliva and in gastric secretions, which protects it from digestion in the stomach. Once vitamin
B12 has been separated from R protein in the duodenum by the action of pancreatic proteases, vitamin
B12 binds to intrinsic factor (IF) secreted by gastric parietal cells. ReceptorsfortheIF–B12
dimerarepresentinthemembranes of the epithelial cells of the terminal ileum, which bind the complex
and allow uptake of vitamin B12. Vitamin B12 is then transported across the basal membrane of the
epithelial cells into the portal blood (Fig. 4.20). It is then bound to transcobalamin II and