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System Digestivus

Dr.Yani Istadi, M.Med.Ed

FK Unissula

Bagian Anatomi

A

B

D

C

E

F

G

H

I

J

K

Digestive System or Gastrointestinal TractGastrointestinal Tract or the

Alimentary canalAlimentary canal

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Mouth

Salivary glands

Stomach

Pancreas (behind

stomach)

Large intestine

Small intestine

Rectum

Gallbladder

(behind liver)

Liver

Esophagus

Pharynx

Figure 3810 The Digestive SystemSection 38-2

Human Digestive System

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The three Main functions of the Digestive System are:

1. DigestionDigestion:: Chemical and Mechanical break down of food products.

2. AbsorptionAbsorption:: into the blood stream

3. EliminationElimination:: of solid waste from the body

Mechanically by the teeth

Chemically by the saliva.

Digestive enzymes aid in the breakdown of complex nutrients

(such as fats, proteins, and sugars).

ProteaseProtease andand PeptidasePeptidase: Proteins Proteins amino acids

CarbohydraseCarbohydrase:: SugarsSugars glucose

LipaseLipase: FatsFats fatty acids

DIGESTION:DIGESTION:

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Cavum Oris (rongga mulut)1. Vestibulum oris: Bagian antara bibir dan pipi di sebelah

luar dengan gusi dan gigi geligi disebelah dalamnya

2. Cavitas oris propria Bagian yang terletak di dalam arcus

alveolaris, gusi, dan gigi geligi Ruangan ini dibentuk oleh: Atap palatum durum bagian depan dan

palatum mole pada bagian belakang Dasar 2/3 anterior lidah dan lipatan

membran mukosa dari tepi lidah ke gusi pada mandibula

Lipatan membran mukosa bagian medial frenulum linguae (menghubungkan permukaan bawah lidah dengan dasar mulut)

Gingiva merupakan jaringan lunak pendukung yang mengelilingi soket gigi

Gigi-geligi

Gigi desidua (6-12 tahun) 20 buah (4 incisivus, 2 caninus dan 4 molar pada setiap rahang)

Gigi permanen 32 buah

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Gigi terdiri dariGigi terdiri dari MahkotaMahkota diatas diatas gumline

AkarAkar sepanjangsepanjang gumlinegumline dan didalam dan didalam soket tulang gigisoket tulang gigi

EnamelEnamel lapisan pelindung mahkota yang berwarna putih; dan merupakan bagian terkeras dalam tubuh.

DentinDentin merupakanmerupakan a yellow softer boney tissue terdapat dibawah enamel terdapat dibawah enamel dan akar gigidan akar gigi.

CementumCementum lapisan pelindung yang melindungi bagian dentin yang ada di akar gigi. Bagian ini juga terdapat membran periodontalperiodontal yang mengelilingi yang mengelilingi sementum yang menyebabkan gigi tetap sementum yang menyebabkan gigi tetap berada di soketnyaberada di soketnya.

Pulpbagian tengah gigi, dibawah dentin. Pulpa merupakan jaringan kenyal yang terdapat canal gigi dan berisi pembuluh darah dan limfe, akhiran saraf, jaringan penghubung (saluran akar).

Cavities/Dental Caries

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Oral Cavity (contd.)

Kelenjar saliva Terdiri dari 3:

Kelenjar parotis: Berbentuk segitiga beraturan Saluranductus parotideus

stensonvestibulum oris yang berhadapan dengan gigi molar II (papilla parotidea)

Fascia colli superficialis serous

Kelenjar submandibularis Letak dalam trigonum

digastricum (superfisial) dan diantara m.mylohyoid dan m.hyoglossus (profunda)

Saluranductus whartonicaruncula sublingualis

Fascia colli superficialis serousmucous

Oral Cavity (contd.)

Kelenjar saliva Kelenjar sublingualis:

Letak dibawah membran mukosa dasar mulut dekatgaris tengah

Saluran:

Duktus sublingualis minordi dalam mulut pada plica sublingualis

Duktus sublibualis mayorke dalam ductus submandibularis atau langsung ke caruncula lingualis

Fascia colli superficialis

mucous

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The Pharynx

Skeletopibasis cranii-

VC.6

Merupakan saluran otot

yang panjangnya sekitar

5 inch

3 bagian: nasopharing,

ororpharing,

laryngopharing

Pharynx

Biasanya dilalui oleh udara dan makanan

Bagian oropharing terdapat bangunan: Tonsila

palatina, fossa supratonsilaris dan tonsila

lingualis

Inervasi: plexus pharyngeus dibentuk oleh

cabang n.IX dan X beserta serabut saraf

otonom. Motorikn.IX; sensorikn.IX dan X

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The Pharynx

DeglutitionDeglutition:: also called swallowing

Esophagus

Merupakan saluran otot yang panjangnya 9 to 10 inch.

Skeletopi: VC.6-VTh. 10 Serabut otot terdiri dari

sirkuler dan longitudinal yang memungkinkan pergerakan makanan. Gerakannya disebut Peristalsis. 1/3 proksimal (otot lurik), 1/3

medial (campuran otot lurik dan polos), 1/3 distal (otot polos)

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Esophagus 3 penyempitan: sfingter

oesophageal, belakang arcus aorta dan hiatus oesophagus

Vascularisasi: 1/3 proksimala.thyroidea

inferior 1/3 medialcab.aorta

descendens 1/3 distalcab.a.gastrica

sinistra

Inervasi: n.X dan truncus symphaticus

Makanan melewati esophagussekitar 5-8 detik, sampai menuju cincin otot yang disebut cardiac cardiac sphinctersphincter (ataulower esophageal sphincter).

Swallowing Reflex and Esophageal Peristalsis

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Gaster

Merupakan kantong otot yang berbentuk J-shaped

Terdiri dari 2 sphincters:

1. Cardiac sphincter pintu masuk makanan dari esophagus dan mencegah asam lambung tidak naik ke esophagus

2. Pyloric sphincter mengatur dan melepaskan sejumlah makanan masuk ke dalam usus

Gaster

Terdiri dari 2 curvatura:

mayor dan minor

Terdiri dari 2 permukaan:

anterior dan posterior

Bagian gaster lain terdiri

dari 3 yaitu: fundusundus

(upper), bodybody (middle),

and antrumantrum (lower)

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Gaster

Serabut otot mengandung:

Longitudinalletak paling

superfisial sepanjang curvatura

Sirkulerlebih dalam

mengelilingi fundus dan

menebal ke arah pylorus

Oblikpaling dalam, mengitari

fundus dan berjalan sepanjang

dinding anterior dan posterior,

derjalan sejajar dengan

curvatura minor

Gaster

Serabut otot yang berlipat-lipat

rugae

Dibungkus

peritoneumomentum

Vascularisasi :

A. gastrica dextra

A. gastrica sinistra

A. gastrica brevis

A. gastroepiploica dextra

A. gastroepiploica sinistra

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Gaster 2 tipe digestion: mekanik

Kimiawi (pepsinmerubah protein mjd polipetida dan asam hidroklorik (PH. 2)menghancurkan makanan dan membunuh mikroorganisme)

Makanan dapat bertahan di gaster sekitar 2-6 jam atau tergantung banyak dan apa yang dimakan (lama lagi jika makan sebelum tidur)

Menampung 2 liter makanan atau minuman

Stomach: Food Storage and Digestion

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Intestinum tenue Merupakan bagian yang terpanjang

dari sistem pencernaan yaitu sekitar 20ft mulai dari sphingter pylorususus besar (caecum)

Sebagian besar intestinum tenue berbentuk koil dan dilekati lembaran tipis yang memberikan usus lebih fleksibel dan mobile mesenteriummesenterium.

Dibagi menjadi 3 bagian:

1. Duodenum 25 cm setelah gaster

2. Jejunum 2 meter

3. Ileum 5 meter

Serabut otot: sirkuler, longitudinal, sirkuler

Fungsinya absorbsi nutrisi

Usus halus Duodenum:Duodenum:Berbentuk huruf CBerbentuk huruf CMelengkung sekitar Melengkung sekitar

pancreaspancreas4 bagian : 4 bagian :

pars superior (5 cm) pars superior (5 cm) pars descenden (8 cm)pars descenden (8 cm)

terdapat papilla duodeni mayor terdapat papilla duodeni mayor (muara duktus pankreatikus (muara duktus pankreatikus mayor dan duktus koledokus)mayor dan duktus koledokus) pars horizontal (8 cm)pars horizontal (8 cm) pars ascenden (5 cm)pars ascenden (5 cm)terlihat terlihat

lipatan2 peritoneum yang lipatan2 peritoneum yang disebut Ligamentum of TREITZdisebut Ligamentum of TREITZ

Vascularisasi: r.superior pancreaticoduodenalis dan a.mesenterika superior

Inervasi: plexus coeliacus

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The Small Intestines cont..

jejunumjejunum dan ileumileum Panjangnya 6Panjangnya 6--7 meter (dewasa), 4 7 meter (dewasa), 4

meter (anakmeter (anak--anak)anak)

2/3 bagian oral2/3 bagian oraljejenum (letaknya jejenum (letaknya bagian kiri atas cavum abdomen)bagian kiri atas cavum abdomen)

1/3 bagian anal1/3 bagian analileum (letaknya ileum (letaknya cenderung bagian kanan bawah cenderung bagian kanan bawah cavum abdomen dan diatas cavum cavum abdomen dan diatas cavum pelvis)pelvis)

KeduaKedua--duanya terletak duanya terletak intraperitonealintraperitoneal mesenteriummesenterium

Bedanya apa? (diameter, dinding, Bedanya apa? (diameter, dinding, vaskularisasi, villi chorialis, limfosit, vaskularisasi, villi chorialis, limfosit, lemak)lemak)

Small Intestine: Site of Digestion and Absorption

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Intestinum Crassum

Dimulai dari caecumanus (sekitar 1.5 meter atau 4 feet 9 inches)

Terdiri dari 3 bagian utama: CaecumCaecum, Colon , Colon dan Rectumdan Rectum.

Bedanya dengan intestinum tenue?

(Taenia, haustra, appendix epiploica, dinding, diameter, gambaran pembuluh darah)

Intestinum Crassum Caecum

Letak di regio inguinal dextra

Merupakan kantong buntu (p=6cm. L=7,5cm)

Mesenterium (-) tapi punya lipatan(recessus)

Terdapat valvula illeocaecalismencegah aliran balik fekal dari colon ke dalam intestinum tenue

Vascularisasi: a. Caecalis anterior dan posterior

Inervasi: parasimpatisn.vagus; simpatispleksus mesenterica superior

Makanan disini berisi:

The undigested food (such as fiber)

a small amount of water

non absorbed vitamins and minerals or salts

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Large Intestine

Appendix vermiformisAppendix vermiformis

Letak di regio iliaca dextraLetak di regio iliaca dextra

Otot sempit berbentuk tabung berisi Otot sempit berbentuk tabung berisi banyak jaringan limfoidbanyak jaringan limfoid

Panjang=8Panjang=8--13 cm, melekat di juncture 13 cm, melekat di juncture ileocaecalis sekitar 2,5 cmileocaecalis sekitar 2,5 cm

Punya penggantungPunya penggantungmesoappendixmesoappendix

Variasi letakVariasi letak

Vascularisasi: a. AppendicularisVascularisasi: a. Appendicularis

Inervasi: parasimpatisInervasi: parasimpatisn.vagus; n.vagus; simpatissimpatissegmen MS Vth Xsegmen MS Vth X

Belum diketahui fungsinya, tapi jika Belum diketahui fungsinya, tapi jika tersumbat atau tersumbat atau clogged dapat menyebabkan infeksi atau inflamasiAppendicitis

Intestinum Crassum

Colon terdiri dari

Colon Ascenden

Letak kuadran kanan bawah di regio inguinal dextra sampai lumbal dextra

Panjang 13-20 cm

Membentuk flexura colli dextra(hepatica)

Organ retroperitoneal

Vascularisasi: a.coli dextra dan a.ileocolica

Inervasi: parasimpatisn.vagus; simpatisMS VTh.X, pleksus mesentericus superior

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Intestinum Crassum Colon Tranversum

Letak di regio umbilicalis

Panjang 38 cm

Organ intraperitonealmesocolon transversum

Vascularisasi: a.coli media(2/3 proksimal), dan a.colica sinistra (1/3 distal)

Inervasi: 2/3 proksimal parasimpatisn.vagus; simpatispleksus mesentericus superior

1/3 distalparasimpatisn.splancnicus pelvicus; simpatis pleksus mesentericus inferior

Intestinum Crassum

Colon Descenden

Letak kuadran kiri atas dan bawah di regio lumbal sinistra

Panjang 20-25 cm

Organ retroperitoneal

Vascularisasi: a.coli sinistra dan a.sigmoidea

Inervasi: parasimpatisn.splanchnicus pelvicus; simpatispleksus mesentericus inferior

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Intestinum Crassum Colon Sigmoidea

Letak pelvis dextra

Berbentuk huruf S

Organ intraperitonealmesocolon sigmoidea

Vascularisasi: a.sigmoidea

Inervasi: parasimpatisn.splanchnicus pelvicus; simpatispleksus mesentericus inferior

Karena mobilirasnya tinggidapat terlipat ke dalam mesocolonnyavolvulus

Intestinum crassum RectumRectum

Panjang 12-13cm

Menembus diafragma pelviscanalis analis

Bagian bawahnya melebar disebut ampulla recti

Tunica muscularis: sirkuler(dalam) dan longitudinal (luar)

Tunica mucosa dan stratum sirkuler membentuk 3 lipatanplica transversa recti (variasi dalam jumlah dan posisinya)

Vascularisasi: a.rectalis superior, media dan inferior

Inervasi: parasimpatis dan simpatis oleh pleksus hypogastricus (peka terhadapa regangan)

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Intestinum crassum AnusAnus

Panjang 4-5 cm

Letak di cranial diafragma pelvisbagian caudal anus

Canalis analis ada lapisan khas

tunica mukosa

Tunica Submukosa (columna anales, berisi plexus venosus rectalis interna)

Tunica muscularis: sirkuler(dalam) dan longitudinal (luar)

Vascularisasi: a.rectalis superior dan inferior

Intestinum crassum AnusAnus

Punya 2 muskulus sphingter ani: Internusinvolunter

externus=volunter

Inervasi: Tunica mucosa bagian atas

canalis analispleksus hypogastricus (respon terhadap regangan0

Tunica bagian bawah canalis analisn.rectalis inferior(nyeri,raba,suhu,tekan)

M.sphincter ani internuspleksus hypogastricus inferior

M.sphincter ani eksternusn.rectalis inferior dan n.sacralis ke VI

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Food

enters

through

the oral

cavity

and exits

through

the anus

Food Pathway through the GI Tract

Gangguan sistem pencernaan

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Aphthous Stomatitis Aphthous Stomatitis is an illness that causes small ulcers to appear in the mouth,

usually inside the lips, on the cheeks, or on the tongue. This is also known as "canker sores."The exact cause of this disease is not known, but there are many factors that are thought to be involved with the development of canker sores, including:

weakened immune system

allergies to food such as coffee, chocolate, cheese, nuts and citrus fruits

stress

viruses and bacteria

trauma to the mouth

poor nutrition

certain medications

Ulcers An ulcer is erosion in the lining of the esophagus, stomach, or

duodenum. While acid is still considered significant in ulcer

formation, the leading cause of ulcer disease is currently believed to

be infection of the stomach by a bacteria called "Helicobacter

pyloricus" (H. pylori). Another major cause of ulcers is the chronic use

of anti-inflammatory medications.

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ConstipationWhen you are not physically active, consuming dietary fibers, and/or become

dehydrated, you are likely to suffer from constipation. It is common for a

constipated person to experience uncomfortable bowel movements and also

feelings of and/or bouts of bloating. This condition usually happens when waste

substance remains too long in the colon, causing more and more water being

absorbed from the waste which also means the feces/stool passes along the large

intestine too slowly. The end result is the dry, lumpy and hard feces, that causes

difficulty and pain during defecation

Diarrhea Diarrhea most commonly happens when the intestines and part of the body

gets infected. When this condition happens, the colon is unable to absorb

water quickly enough from liquid waste. The waste is then pushed out of the

anus quickly and simultaneously, causing spasms within the muscles of the

colon, and/or within the abdominal area. Therefore, the feces passes along the

large intestine too quickly and the water is not able to be absorbed from the

waste. Diarrhea causes mushy, loose, watery feces/stool.

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Colonic Polyposis A polyp is an extra piece of tissue that grows inside your body.

Colonic polyps grow in the large intestine, or colon. Most polyps are

not dangerous. However, some polyps may turn into cancer or

already be cancer. To be safe, doctors remove polyps and test them.

Polyps can be removed when a doctor examines the inside of the

large intestine during a colonoscopy.

Ulcerative Colitis Ulcerative colitis is a disease that causes ulcers in the lining of the rectum and

colon. It is one of a group of diseases called inflammatory bowel disease. Ulcers form where inflammation has killed the cells that usually line the colon.

Ulcerative colitis can happen at any age, but it usually starts between the ages of 15 and 30. It tends to run in families. The most common symptoms are pain in the abdomen and bloody diarrhea. Other symptoms may include anemia, severe tiredness, weight loss, loss of appetite, and bleeding from the rectum.

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Diverticulosis Diverticulosis is a term for small Diverticulosis is a term for small Diverticulosis is a term for small Diverticulosis is a term for small outpouchesoutpouchesoutpouchesoutpouches, or sacs, that develop along an , or sacs, that develop along an , or sacs, that develop along an , or sacs, that develop along an

intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be reversed, if one of the pouches becomes impacted with waste material, it can reversed, if one of the pouches becomes impacted with waste material, it can reversed, if one of the pouches becomes impacted with waste material, it can reversed, if one of the pouches becomes impacted with waste material, it can lead to infection and inflammation. weakening of the walls of the colon due to lead to infection and inflammation. weakening of the walls of the colon due to lead to infection and inflammation. weakening of the walls of the colon due to lead to infection and inflammation. weakening of the walls of the colon due to aging and obesity are causative factors. Diverticulosis occurs mostly in people aging and obesity are causative factors. Diverticulosis occurs mostly in people aging and obesity are causative factors. Diverticulosis occurs mostly in people aging and obesity are causative factors. Diverticulosis occurs mostly in people over the age of 60, and more than half of the patients who develop it are over the age of 60, and more than half of the patients who develop it are over the age of 60, and more than half of the patients who develop it are over the age of 60, and more than half of the patients who develop it are markedly overweight.markedly overweight.markedly overweight.markedly overweight.

Overuse of laxatives also weakens the colon. Overuse of laxatives also weakens the colon. Overuse of laxatives also weakens the colon. Overuse of laxatives also weakens the colon.

Colorectal CancerThe wall of the colon and rectum is made up of layers of tissues. Colorectal

cancer starts in the inner layer and can grow through some or all of the other

layers. The stage (extent of spread) of a cancer depends to a great degree on

how deep the cancer goes into these layers. Cancer that starts in these

different areas may cause different symptoms. But colon cancer and rectal

cancer have many things in common. In most cases, colorectal cancers

develop slowly over many years. It is now know that most of these cancers

start as a polyp -- a growth of tissue that starts in the lining and grows into

the center of the colon or rectum. This tissue may or may not be cancer. A

type of polyp known as an adenoma can become cancer. Removing a polyp

early may keep it from becoming cancer. Over 95% of colon and rectal

cancers are Adenocarcinomas.

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Anal Fistula An anal fistula is a small channel that develops between the end

of the bowel, known as the anal canal, and the skin near the anus

(opening where waste leaves the body).

On the surface of the skin around the anus, one or more of the

fistula ends may be seen as holes. An anal fistula is painful and

can cause bleeding and discharge when passing stools.

Hemorrhoids Hemorrhoids, also called piles, are swollen and inflamed veins in your

anus and lower rectum. Hemorrhoids may result from straining

during bowel movements, sitting on the toilet to long, or from the

increased pressure on these veins during pregnancy. Hemorrhoids

may be located inside the rectum (internal hemorrhoids), or they

may develop under the skin around the anus (external hemorrhoids).

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Anorexia: Anorexia nervosa is a type of Anorexia nervosa is a type of eating disorder. People who have anorexia have an intense fear of . People who have anorexia have an intense fear of

gaining weightgaining weight. They severely limit the amount of food they eat and can become dangerously thin. . They severely limit the amount of food they eat and can become dangerously thin.

Anorexia affects both the body and the mind. It may start as Anorexia affects both the body and the mind. It may start as dietingdieting, but it gets out of control. These , but it gets out of control. These

people think about food, dieting, and people think about food, dieting, and weightweight the majority of their day. They have athe majority of their day. They have a distorted body image.

When they look in the mirror, they see a fat person.

Literature

Human Anatomy, First Edition McKinley & O'Loughlin

Atlas Atlas sobotasobota

Ethel Sloane, Ethel Sloane, AnatomiAnatomi dandan FisiologiFisiologi, , PenerbitPenerbit EGCEGC

Kyung Won Chung, Gross Kyung Won Chung, Gross AnatomiAnatomi, , PenerbitPenerbit BinarupaBinarupaAksaraAksara

Keith Keith L.MooreL.Moore dandan Arthur Arthur F.DalleyF.Dalley. . 2010. 2010. Clinically Clinically oriented Anatomyoriented Anatomy. 6 Ed.. 6 Ed.

Seeley,R.R., Stephens,T.D., Tate,P.2003. Anatomy &

Physiology. McGraw Hill

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Eat up!