Accessory Organ Digestive

Irwan
Indri
Bagian Anatomi FK Unsri
 Vignette
Content: Accessory Organ Digestive
Mouth
Pharynx
Esophagus
Pancreas
Liver
Gall bladder

Bagian Anatomi FK Unsri

 Vignette
Five year old boy complain pain
when he swallowing and
mastication. Pain became more
severe when he swallowing
acid solution, like orange and
vinegar. Body temperatur 39C.
He is never get vaccination
below 1 year old.
What is the diagnosis and
pathophysiology?

Bagian Anatomi FK Unsri

Accessory Organ Digestive

Arial Font

Bagian Anatomi FK Unsri

 Mouth - Salivary glands
Mucous membranes of
mouth and tongue secrete
small amount of saliva
Most saliva secreted by
major salivary glands which
lie outside the mouth
Parotid
Submandibular
Sublingual

Bagian Anatomi FK Unsri

 Mouth - composition and
functions of saliva
Saliva is ~99.5% water
contains:
IgA
Lysozyme
Salivary amylase
Various solutes, organic substances, etc
Saliva functions to:
keep mucous membranes of mouth and pharynx moist
cleanse mouth and teeth
dissolve food
begin chemical digestion of carbohydrates (salivary
amylase)
Bagian Anatomi FK Unsri
 Mouth - control of salivation

Salivation under nervous control

salivary nuclei in brain stem
Receive input from cortex, taste buds, olfactory
apparatus
Parasympathetic output increases salivation
Sympathetic output reduces salivation (dry mouth when
stressed)

Bagian Anatomi FK Unsri

 Mouth digestion
Mechanical and chemical digestion occur in the
mouth
Mechanical digestion results from mastication
Chemical digestion begins
Salivary amylase
Initiates breakdown of starch

Lingual lipase
Hydrolyses triglycerides into fatty acids and glycerol
Secreted in inactive form by glands in tongue
Becomes activated in acid environment of stomach

Bagian Anatomi FK Unsri

 Pharynx - deglutition
Swallowing occurs in 3
stages:
Voluntary stage
Bolus passed into oropharynx
by tongue
Pharyngeal stage
Bolus stimulates stretch
receptors in oropharynx
Send impulses to deglutition
centre in brain stem
Involuntary passage of bolus
into esophagus
Esophageal stage
Involuntary passage of bolus
through esophagus into
stomach
Bagian Anatomi FK Unsri
 Esophagus
Collapsible muscular tube behind trachea
Secretes mucus and transports food into stomach
Passes through mediastinum
Pierces diaphragm through esophageal hiatus
Upper and lower sphincters
lower sphincter is physiological sphincter
Diaphragm helps keep lower sphincter closed when not swallowing

Food moves via peristalsis

Controlled by neurons in medulla oblongata

Bagian Anatomi FK Unsri

 Pancreas
Pancreas connected to
duodenum
Secretes pancreatic juice
into duodenum

99% of cells arranged in

clusters called acini
Exocrine portion of gland
Secrete pancreatic juice

Bagian Anatomi FK Unsri

 Pancreas pancreatic juice
Pancreatic juice contains:
Water
Salts
Sodium bicarbonate
Several enzymes which digest:
carbohydrates
Pancreatic amylase
Proteins
Trypsin - secreted in inactive form and activated by brush-border enzyme called
enterokinase
Chymotrypsin secreted in inactive form and activated by trypsin
Cartboxypeptidase secreted in inactive form and activated by trypsin
Elastase secreted in inactive form and activated by trypsin
Triglycerides
Pancreatic lipase
Nucleic acids
Ribonuclease
Deoxyribonuclease

Bagian Anatomi FK Unsri

 Liver
Heaviest gland in body
Two lobes
Large right lobe
Smaller left lobe
Lobes made up of functional units
called lobules
Six-sided structure with
hepatocytes arranged around
central vein
Blood from hepatic artery and
hepatic portal circulation passes
through sinusoids and drains into
central veins
Bile enters bile canaliculi and
moves to gallbladder

Bagian Anatomi FK Unsri

 Blood supply
Hepatic artery
delivers oxygenated
blood
Hepatic portal
circulation
delivers nutrient rich
blood from intestines

Bagian Anatomi FK Unsri

 Liver
Functions of liver:
CHO metabolism
glycogenolysis
gluconeogenesis
glycogenesis
Lipid metabolism
Synthesise lipoproteins and cholesterol
Store triglycerides
-oxidation
Protein metabolism
Deaminate amino acids
Synthesise plasma proteins
Bile production
Detergent-like acidic buffer
Emulsifies lipids
Process drugs and hormones
Excrete bilirubin
Derived from heme of worn out RBC (secreted into bile)
Store vitamins and minerals
Phagocytosis of RBC, WBC and bacteria (Kupffers cells)
Activation of vitamin D
Bagian Anatomi FK Unsri
 Gall bladder
Bile production signalled by
parasympathetic activity

secretin - released when acidity in

duodenum (secretin also inhibits
gastric secretion)

Bile stored and concentrated in

gallbladder
released when fatty acids and
amino acids enter duodenum
signalled by CCK (also inhibits
gastric emptying)

Bagian Anatomi FK Unsri

 Gall bladder
Bile production signalled by
parasympathetic activity

secretin - released when acidity in

duodenum (secretin also inhibits
gastric secretion)

Bile stored and concentrated in

gallbladder
released when fatty acids and
amino acids enter duodenum
signalled by CCK (also inhibits
gastric emptying)

Bagian Anatomi FK Unsri

Hepatic portal vein tributaries

Bagian Anatomi FK Unsri

Portal system

Bagian Anatomi FK Unsri

 Created by:
dr. Irwan
dr. Indri Seta Septadina, M.Kes.
Bagian Anatomi
FK Unsri
Palembang

Bagian Anatomi FK Unsri