12/2/2010

Maldigestion
Dr. H.Rustam Effendi YS,SpPD-KGEH
Divisi Gastroentero-Hepatologi Departemen Ilmu Penyakit
Dalam FKUSU/RSUP.H.Adam Malik-RSU Dr. Pirngadi Medan.

30-9-2010: Kelas A dan B

eso
lbg

Usus

colon

Anatomi saluran cerna

halus

Small bowel : 390-690 cm13-23ft.1ft=30cm)

Duodenum ( 5%): 50 cm (1,5ft)

Ligamentum Treitz

Jejunum

(35%): 160-280 cm (4-9ft),

( 60%): 240-420 cm (8-14 ft),

leum

Colon

: 150-180 cm (5-6 ft)

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Billiard tract obstruction caused by a gallstone in the

distal common bile duct.

Anatomy

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Proses Pencernaan

Gerakan saluran cerna.(Motilitas)

- smooth muscle  constant low level of contraction (tone).

- mendorong (propulsive movements) dgn kecepatan berbeda.
- Mengaduk (mixing movements) isi sal cerna.
- Mencampur makanan dgn getah pencernaan.
- Memudahkan absorpsi nutrisi.
Sekresi :
- Kelenjar eksokrin  getah pencernaan (enzim-enzim)
- Membutuhkan energi (transport aktif & sintesis)
- Getah pencernaan harus direabsorpsi ses. selesai digunakan
Pencernaan makanan : mekanikmemecah jadi ukuran kecil,
kimika(enzymatic hydrolysis)memecah jadi lebih sederhana.
(monomer, subunit), untuk memungkinkan absorpsi makanan.
Penyerapan : Transfer nutrisi hasil pencernaan dari lumen sal cerna ke dalam
pembuluh darah atau limfe.
Pembuangan (Tinja)

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FAKTOR ANATOMI DAN FISIOLOGI PENCERNAAN :

 Area permukaan yang panjang & luas (12 jt /2 x 108 cm persegi)
- Mulut : gigi & lidah, amilase (hidrosisa)
- Lambung: - menggiling, mencampur, dan mendorong (<1mm)
- asam
Hidrolisa
- pepsin
- Hati dan saluran empedu : cairan empedu (hidrolisa)
- Pankreas : - amilase
- lipase
Hidrolisa
- tripsin
- Usus halus : - motilitas :
- gross motiliti (besar)
Hidrolisa & absorbsi
- Motilitas villi

FISIOLOGI
 Saluran
 Kantongan / penyimpanan
 Pencernaan






Motilitas : - menggiling
- mendorong
- mencampur
Sekresi (enzim-enzim; air; asam)
Absorbsi (fold dan villi)
Eksresi (tinja)

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FUNGSI SALURAN CERNA :

1. AKOMODASI ( LAMBUNG )
2. PENCERNAAN
3. ABSORBSI
4. EKSKRESI ( BAB / DEFEKASI )

Fungsi Pencernaan
Two primary function

Digestion

Absorption of nutrients and water
 Digestion






Mainly in duodenum small intestine and

pancreatic enzymes
Bicarbonate from pancreas neutralizes acids
Mucous protects from acids
Bile emulsifies fats

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Mengunyah (mastication/chewing), berfungsi untuk :

Memecahkan & menghaluskan makanan 
memudahkan menelan
 Mencampur makanan dgn saliva
 Merangsang taste bud  menikmati rasa makanan,

salivasi;
sekresi gaster, pankreas & empedu 
mempersiapkan tahap pencernaan selanjutnya
Fungsi Saliva :
 salivary amylase
 Mengandung lysozyme sebagai antibakteri.
 Mengandung bikarbonat


 Makanan  sumber energi,diperlukan sel utk menghasilkan ATP. ATP perlu

utk kegiatan yg memerlukan energi : spt transport aktif, kontraksi, sintesis &
sekresi.
Makanan juga berperan dalam:
a. sistem immune. b. sistem regulasi
c. regenerasi sel d. proses pertumbuhan & perkembangan
Fungsi utama sistem pencernaan mentransfer nutrisi, air &elektrolit dari makanan ke dlm tbh dan berperan menjaga homeostasis.

food

Digested (GIT)
Biochemically Broken Down

Organic molecules
(smaller, simple)
Absorbed
(GIT)

cells

ECF

Circulatory system

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Control of Acid Secretion

May be considered as three separate phases.
1. Cephalic phase.
2. Gastric phase.
3. Intestinal phase.

1. CEPHALIC PHASE
Vagus nerve

Sight, smell or
thought of food

Parasympathetic activation
of gastric motility & gastric juice secretion

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2. GASTRIC PHASE
Food arrival causes
muscular reflexes &
gastrin secretion by G cells.

Gastrin

FOOD

GO

Gastrin stimulates secretion from both chief &

parietal cells.

3. INTESTINAL PHASE
Arrival of food in duodenum
triggers release of hormones
that inhibit gastric motility &
secretions.

Secretin &
Cholecystokinin (CCK)

Circulation

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Ggn. FUNGSI SALURAN CERNA DAN LOLOSNYA BAHAN2 GIZI KE

TINJA SERTA PENYEBABNYA.

PENYAKIT SISTEM SALURAN CERNA

GANGGUAN FUNGSI SALURAN CERNA
GANGGUAN FUNGSI PENCERNAAN
GANGGUAN FUNGSI ABSORBSI
LOLOS BAHAN GIZI KE TINJA (SINDROMA MALABSORBSI)

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Hormones & enzyme Important in

Small Intestine Digestive Activity
 Secretin
 Cholecyctokinin (CCK)
 Enterokinase
 Pancreatic enzymes


Lipase, Amylase, Peptidases, Trypsinogen, Trypsin

Hormones


Cholecystokinin secretion stimulated by fat in

duodenum



Contraction of gall bladder

Pancreatic secretion of enzyme rich material

Secretin secretion stimulated by low pH in

duodenum



Secretion of bile from the liver

Pancreatic secretion of HCO3- rich juice

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Digestive enzymes




Salivary amylase
Pepsin
Pancreatic enzymes:







Trypsin
Chymotrypsin
Carboxypeptidase
Nucleases
Pancreatic lipase
Pancreatic amylase

Intestinal enzymes:





Peptidases
Disaccharidases
Lipase
Nucleotidases

Digestion
 Most occurs by hydrolysis reactions -

reactions that add water to break chemical

bonds
 Enzymes involved:
 amylase - breaks complex sugars to
disaccharides
 lipases - breaks down lipids
 proteases - breaks down proteins

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Small Intestine
 Functions in digestion
 CHO digestion resumes and is completed here
 Protein digestion continues and completes here
 Fat digestion is initiated and completed here
 Also functions to absorb nutrients, fluids, and electrolytes
 Divisions (@ 12 feet long total length)
 duodenum = upper portion (@ 1 foot long) closest to
stomach
 jejunum = middle section
 ileum = lower section closest to large intestine

Small Intestine
 Inner surface (epithelial layer) extensively folded

and covered with smaller folds (villi) and even

smaller folds (microvilli) increase surface area for
absorption to occur
 Site of absorption of carbohydrates, lipids, amino
acids, calcium and iron in duodenum and jejunum
 Bile salts, Vit B12, water, and electrolytes mainly in
ileum

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CHO Digestion in Small Intestine

 Pancreatic amylase secreted into duodenum in

response to secretin
 Is active in the intestine because the acidic chyme
is neutralized by HCO3- also secreted from
pancreas in response to secretin
 Amylase converts complex CHOs to maltriose,

maltose, and short branched sugars

Fat Digestion in Small Intestine

 Limited fat digestion occurs prior to sm. Intestine
 Some lipases in saliva and gastric secretions
 Lipase = enzyme important in fat digestion
 Secreted into sm. intestine from pancreas in response to
secretin
 breaks down triglycerides to free fatty acids and
monoglycerides
 Activity is dependent upon the amount of surface area on
which it can work
 Phospholipase A2 digests phospholipids
 Bile is essential for proper fat digestion

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Digestion and Absorption of Lipids in

Small Intestine
 Fats stimulate Intestine cell release of CCK
 CCK triggers release of bile from gall bladder
 Bile emulsifies fats
 breaks large fat globules into smaller globules
 does not actually break bonds between glycerol and
fatty acids


Increases surface area available for pancreatic

lipase to act

Protein Digestion in Small Intestine

 Proteolytic enzymes are released (in inactive, zymogen

forms) from the pancreas in response to secretin

 Trypsinogen = inactive precursor that is converted (by
enterokinase) to trypsin in the brush border of the
small intestine
 Trypsin converts other zymogens to their active forms
 Collectively, the proteolytic enzymes break proteins
and peptides into single amino acids, or di- and
tripeptides

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Penyebab gangguan Pencernaan :

1. Kelainan lambung (Reseksi lbg, Gastritis atrofi(HCl
menurun), Gastritis autoimmune, pernicious
anemia
2. Kelainan Pankreas : Insufisiensi pankreas, Cystic
fibrosis,
3. Penyakit parenkim hati,
4. Obstruksi saluran empedu,
5. Pertumbuhan bakteri berlebihan dalam usus halus.
6. Penyakit mukosa yang luas (celiac disease, Crohn
disease)
7. Infeksi, cacing, dll.

GANGGUAN PENCERNAAN
(MAL DIGESTION) :
 Berkurangnya proses memecahkan makanan

( break down )
 Berkurangnya proses hidrolisa bahan 2 gizi
(hidrolisis )
 Diare
 Steatorrhoe
 Penyulit (anemia, kemunduran tulang dll )

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Dr. Rustam Effendi YS, SpPD-KGEH

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