SISTEM

PENCERNAAN

dr. Sri Kartika Sari, SpPK

20 Nopember 2013

Function of the Digestive

System
Ingestion

Taking food and water into the mouth

Break down the food

Mechanical digestion: chewing, mixing, and

churning food
Chemical digestion: digestive enzymes
breakdown food

Absorb nutrients

Movement of nutrients from the GI tract to the

blood or lymph

Release of waste

Elimination of indigestible solid wastes

 The GI tract
(gastrointestinal tract)

The muscular alimentary

canal
Mouth
Pharynx
Esophagus
Stomach
Small intestine
Large intestine
Anus

The accessory
digestive organs
Supply secretions
contributing to the
breakdown of food
Teeth & tongue
Salivary glands
Gallbladder
Liver

The Digestive
Process

Ingestion

Taking in food through the mouth

Propulsion (movement of food)

Swallowing
Peristalsis propulsion by alternate
contraction &relaxation

Mechanical digestion

Chewing
Churning in stomach
Mixing by segmentation

Chemical digestion

By secreted enzymes: see later

Absorption

Transport of digested end products

into blood and lymph in wall of canal

Defecation

Elimination of indigestible substances

from body as feces
4

 Chemical digestion
Complex food molecules
(carbohydrates, proteins and lipids)
broken down into chemical building
blocks (simple sugars, amino acids, and
fatty acids and glycerol)
Carried out by enzymes secreted by
digestive glands into lumen of the
alimentary canal
5

Ways to divide.
The more common

Plus:
epigastric
periumbilical
suprapubic
flank

Histology of alimentary canal wall

Same four layers from esophagus to anal
canal

1. Mucosa
2. Submucos
a
3. Muscularis
externa
4. Serosa
from lumen (inside)
out
7

Inner layer: the mucosa*

(mucous membrane)

Three sub-layers
*

1. Lining
epithelium
2. Lamina propria
3. Muscularis
mucosae

More about the mucosa

Epithelium: absorbs nutrients, secretes
mucus
Continuous with ducts and secretory cells of
intrinsic digestive glands (those within the
wall)
Extrinsic (accessory) glands: the larger ones
such as liver and pancreas

Lamina propria
Loose connective tissue with nourishing and
absorbing capillaries
Contains most of mucosa-associated lymphoid
tissue (MALT)

Muscularis mucosae

Second layer: the submucosa*

Connective
tissue
containing
major blood and
lymphatic
vessels and
nerves
Many elastic
fibers so gut can
regain shape
after food
10

Next in, the muscularis externa*

(AKA just muscularis)
Two layers of smooth
muscle
responsible for
peristalsis and
segmentation
Inner circular
*
layer
(circumferential)
Squeezes
In some places
forms sphincters
(act as valves)

Outer longitudinal11

Last (outer), the serosa*

(the visceral peritoneum)

Simple squamous
epithelium
(mesothelium)

Thin layer of
areolar connective
tissue underneath

Exceptions:
*

Parts not in
peritoneal cavity
have adventitia,
lack serosa
Some have both,
e.g. retroperitoneal
organs
12

Smooth muscle

Smooth muscle

Muscles are spindle-shaped cells

One central nucleus
Grouped into sheets: often running
perpendicular to each other
Peristalsis
No striations (no sarcomeres)
Contractions are slow, sustained and
resistant to fatigue
Does not always require a nervous
signal: can be stimulated by stretching
6 major locations:
or hormones
1. inside the eye 2. walls of vessels 3. respiratory
tubes
13
4. digestive tubes 5. urinary organs 6. reproductive

Review of some definitions.

Peritoneum: serous membranes of
the abdominopelvic cavity
Visceral peritoneum: covers external
surfaces of most digestive organs
Parietal peritoneum: lines body wall
Peritoneal cavity: slit-like potential
space between visceral and parietal
peritoneum
Serous fluid lubricating
14

The Mouth
Mouth = oral
cavity
Lining: thick
stratified
squamous
epithelium

Lips- orbicularis
oris muscle
Cheeks
buccinator

15

 Vermillion border or
red border

Between highly
keratinized skin of face
and mucosa of mouth
Needs moisture

Note frenulums (folds

of mucosa)
Palate roof of mouth
Hard plate anteriorly
Soft palate posterioly

Uvula

16

Tongue

Mostly muscles

Grip and reposition food

Forms bolus of food (lump)
Help in swallowing
Speech help form some consonants

Note frenulum on previous slide: can be too tight

Taste buds contained by circumvallate and fungiform papillae
Lingual tonsil back of tongue

17

Teeth
Called dentition (like dentist)
Teeth live in sockets (alveoli) in the
gum-covered margins of the
mandible and maxilla
Chewing: raising and lowering the
mandible and moving it from side to
side while tongue positions food
between teeth
18

Teeth
Two sets
Primary or deciduous
Baby teeth
Start at 6 months
20 are out by about 2
years
Fall out between 2-6
years

Permanent: 32 total
All but 3rd set of molars
by end of adolescence
3rd set = wisdom teeth
Variable

Some can be

19

Teeth are classified according to shape

and function

incisor

canine

premolar
molar

Incisors: chisel-shaped
for chopping off pieces
Canines: cone shaped
to tear and pierce
Premolars (bicuspids)
and
Molars - broad crowns
with 4-5 rounded cusps
for grinding
Cusps are surface bumps

20

Tooth structure

Two main regions

A. Crown (exposed)
B. Root (in socket)
C. Meet at neck

Enamel

. 99% calcium crystals

. Hardest substance in
body

Dentin bulk of the

tooth (bone-like but
harder than bone,
with collagen and
mineral)
Pulp cavity with
vessels and nerves

. Root canal: the part of

21

Tooth structure

Cementum bone
layer of tooth root
Attaches tooth to
periodontal ligament

Periodontal
ligament
Anchors tooth in
boney socket of the
jaw
Continuous with
gingiva (gums)

Cavities or caries rot

Plaque film of

22

Salivary glands
(tuboalveolar glands)
Intrinsic salivary
glands within
mucosa
Secrete saliva all the
time to keep mouth
moist

Extrinsic salivary
glands
Paired (2 each)
Parotid
Submandibular
Sublingual

Saliva: mixture of water, ions, mucus, enzymes

keep mouth moist
dissolves food so can be tasted
External to mouth
moistens food
Ducts to mouth
starts enzymatic digestion
Secrete saliva only
buffers acid
23
right before or during
antibacterial and antiviral

Extrinsic salivary glands

Parotids* - largest (think mumps)
Facial nerve branch at risk during surgery here

Submandibular # - medial surface

mandible
Sublingual + - under tongue; floor of
mouth
*

+
#

Compound = duct branches

Tubo = tubes
Alveolar = sacs
24

Pharynx
___oropharynx

___laryngopharynx

Oropharynx and
laryngopharynx
Stratified squamous
epithelium

Three constrictor
muscles*
Sequentially squeeze
bolus of food into
esophagus
Are skeletal muscles

*
*
*

Voluntary action
Vagus nerve (X)

25

Esophagus
Continuation of pharynx
in mid neck
Muscular tube collapsed
when lumen empty
Esophagus___________
Descends through
thorax
On anterior surface of
vertebral column
Behind (posterior to)
trachea

26

Esophagus continued
Passes through esophageal hiatus in the
diaphragm to enter the abdomen
Abdominal part only 2 cm long
Joins stomach at cardiac orifice*

Cardiac sphincter at cardiac orifice to prevent

regurgitation (food coming back up into esophagus)
Gastroesophageal junction and GERD

___________________esophageal hiatus
(hiatus means opening)

27

Microscopic anatomy of esophagus

Contains all 4
layers (see
right)

Epithelium: nonkeratinized stratified squamous epithelium

At GE junction thin simple columnar epithelium

Mucus glands in wall

Muscle (muscularis externa) changes as it goes down

Superior 1/3 of esophagus: skeletal muscle (like pharynx)

Middle 1/3 mixture of skeletal and smooth muscle
Inferior 1/3 smooth muscle (as in stomach and intestines)

When empty, mucosa and submucosa lie in longitudinal folds

28

Esophagus histology

29

Stomach
J-shaped; widest part of alimentary canal
Temporary storage and mixing 4 hours
Into chyme

Starts food breakdown

Pepsin (protein-digesting enzyme needing acid

environment)
HCl (hydrochloric acid) helps kill bacteria
Stomach tolerates high acid content but
esophagus doesnt why it hurts so much
when stomach contents refluxes into
esophagus (heartburn; GERD)

Most nutrients wait until get to small

intestine to be absorbed; exceptions are:

Water, electrolytes, some drugs like aspirin and

alcohol (absorbed through stomach)
30

Stomach
Lies mostly in LUQ

epigastrium

But pain can be epigastric

or lower

Just inferior to (below)

diaphragm
Anterior (in front of)
spleen and pancreas
Tucked under left lower
margin of liver
junction
Anchored at both ends
with
but mobile in between
esophag
contains
Main regions in drawing
us
pyloric
to
sphincter
right---------------------------funnel shaped
--- Capacity: 1.5 L food;

dome

31

32

Stomach Regions
Cardiac region
Fundus (dome shaped)
Body
Greater curvature
Lesser curvature

Pyloric region
Antrum
Canal
Sphincter

dome
junction
with
esophag
contains
us
pyloric
sphincter
funnel shaped
33

 Rugae: longitudinal
folds on internal
surface (helps
distensibility)
Muscularis: additional
innermost oblique
layer (along with
circular and
longitudinal layers)

34

Histology of
stomach
Simple columnar
epithelium: secrete
bicarbonatebuffered mucus
Gastric pits opening
into gastric glands
Mucus neck cells
Parietal cells

HCL
Intrinsic factor
(for B12 absorption)

Chief cells

Pepsinogen
(activated to pepsin
with HCL)
Stimulated by
gastrin: a stomach
hormone
35

Small intestine
Longest part of alimentary canal
(2.7-5 m)
Most enzymatic digestion occurs
here
Most enzymes secreted by pancreas, not
small intestine

Almost all absorption of nutrients

3-6 hour process
Small intestine___________
Runs from pyloric sphincter
to RLQ

36

 Small intestine has 3 subdivisions

Blood supply: superior
Duodenum 5% of length
Jejunum almost 40%
Ileum almost 60%

mesenteric artery;
Veins drain into hepatic
portal vein

Duodenum is retroperitoneal (stuck down under peritoneum); others are loose

Duodenum receives
bile from liver and gallbladder via bile duct*
enzymes from pancreas via main pancreatic duct*

37

Small intestine designed for absorption

Huge surface area because of great length

Structural modifications also increase absorptive area
Circular folds (plicae circulares)
Villi (fingerlike projections) 1 mm high simple columnar
epithelium: velvety
Microvilli

*
Lacteal*: network of
blood and lymph
capillaries
-Carbs and proteins into blood
to liver via hepatic portal vein
-Fat into lymph: fat-soluble
toxins e.g. pesticides circulate
systemically before going to

Absorptivie
cell with
microvilli to
increase
surface
area &
many
mitochondr
ia: nutrient
uptake is
energydemanding

38

Intestinal crypts

* (of Lieberkuhn) inbetween villi

Cells here divide every 3-6 days to renew epithelium (most rapidly dividing
cells of the body)
Secrete watery intestinal juice which mixes with chyme (the paste that food
becomes after stomach churns it)

Intestinal flora the permanent normal bacteria

Manufacture some vitamins, e.g. K, which get absorbed

Duodenal glands
Mucus to counteract
acidity from stomach
Hormones:
Cholecystokinin (stimulates
GB to release stored bile, also
pancreas)
Secretin (stimulates

*
*

-have
many
mitochon
dria:
nutrient
-produce
uptake
is
mucus
energydemandin
39

General histology of digestive tract

40

41

42

Large intestine
Digested residue reaches it
Main function: to absorb water
and electrolytes

Subdivisions
Cecum
Appendix
Colon
Rectum
Anal canal
43

Three
special
features

1. Teniae coli (3 longitudinal

muscle strips)
2. Haustra (puckering into
sacs)
3. Epiploic appendages
(omental or fat pouches)

3.
2.
1.

44

Colon has segments: ascending, transverse and descending colon; then sigmoid colon
Right angle turns: hepatic flexure* in RUQ and splenic flexure* in LUQ

*
*

Between
ileum and
cecum
1st part

S-shaped

Blind tube

Movement sluggish and weak except for a few mass peristaltic

movements per day to force feces toward rectum powerfully

45

Rectum

In pelvis
No teniae
Strong longitudinal
muscle layer
Has valves

Anal canal

Pectinate line*

Inferior to it:
sensitive to pain

Hemorrhoids (enlarged
veins)

Superior to
pectinate line:
internal
Inferior to pectinate
line: external

Sphincters (close
opening)
Internal*

*
*

smooth muscle
involuntary

External*

skeletal muscle
voluntary

46

Defecation

1. Triggered by stretching
of wall, mediated by
spinal cord
parasympathetic reflex
2. Stimulates contraction of
smooth muscle in wall
and relaxation of
internal anal sphincter
3. If convenient to defecate
voluntary motor neurons
stimulate relaxation of
external anal sphincter
(aided by diaphragm
and abdominal wall
muscles -called Valsalva
47
maneuver)

Histology large intestine

No villi

Fewer nutrients
absorbed

Columnar cells in
pic = absorptive
cells
Take in water and
electrolytes

A lot of goblet cells

for mucus
Lubricates stool

More lymphoid
tissue

A lot of bacteria in

48

The Liver
Largest gland in the
body (about 3 pounds)
Over 500 functions
Inferior to diaphragm
in RUQ and epigastric
area protected by ribs
R and L lobes
Plus 2 smaller lobes

Falciform ligament

Mesentery binding liver

to anterior abdominal
wall

2 surfaces

Diaphragmatic
Visceral

Covered by
peritoneum

Except bare area

49

posterior

Fissure on visceral surface

Porta hepatis: major vessels and
nerves
enter and leave - see pics
Ligamentum teres: remnant of
umbilical vein in fetus, attaches to

anterior

50

Fetal
circulation

___________
Umbilical vein

Ligamentum
teres__________

Navel_______

51

52

Just some of the livers repertoire

Produces bile
Picks up glucose from blood
Stores glucose as glycogen
Processes fats and amino acids
Stores some vitamins
Detoxifies poisons and drugs
Makes the blood proteins
53

Liver histology
Liver lobules (about one million of them)
Hexagonal solid made of sheets of
hepatocytes (liver cells) around a central vein
Corners of lobules have portal triads
(see next pic)

54

Portal triad

Portal arteriole
Portal venule

Branch of hepatic
portal vein
Delivers
substances from
intestines for
processing by
hepatocytes

Bile duct

Carries bile away

Liver sinusoids

Large capillaries
between plates of
hepatocytes
Contribute to
central vein and
ultimately to
hepatic veins and
IVC

Kupffer cells

Liver macrophages
Old blood cells and
microorganisms
removed

55

56

Hepatocytes (liver cells)

Many organelles

Rough ER manufactures blood proteins

Smooth ER help produce bile salts and
detoxifies blood-borne poisons
Peroxisomes detoxify other poisons, including
alcohol
Golgi apparatus packages
Mitochondria a lot of energy needed for all
this
Glycosomes - role in storing sugar and
regulation of blood glucose (sugar) levels

Produce 500-1000 ml bile each day

Secrete into bile canaliculi (little channels) then

ducts

Regeneration capacity through liver stem

cells

57

Gallbladder*

Bile is produced in the liver

Bile is stored in the
gallbladder
Bile is excreted into the
duodenum when needed
(fatty meal)
Bile helps dissolve fat and
cholesterol
If bile salts crystallize, gall
stones are formed
Intermittent pain: ball
valve effect causing
intermittent obstruction
Or infection and a lot of
pain, fever, vomiting, etc.

58

Lies in LUQ kind of behind stomach

Is retroperitoneal
Pancreas
Has a head, body and tail
(exocrine and
Head is in C-shaped curve of duodenum
Tail extends left to touch spleen
endocrine)
Main pancreatic duct runs the length of the
pancreas, joins bile duct

59

60

one acinus

Pancreatic
exocrine function
Compound acinar
(sac-like) glands
opening into large
ducts (therefore
exocrine)
Acinar cells make 22
kinds of enzymes
Stored in zymogen
granules
Grape-like
arrangement

Enzymes to

61

Pancreatic endocrine function

(hormones released into blood)
Islets of Langerhans (AKA islet
cells) are the hormone secreting
cells
Insulin (from beta cells)
Lowers blood glucose (sugar)

Glucagon (from from alpha cells)

Raises blood glucose (sugar)
(more later)

62

Endocrine cells:

63

thankyou