Bahan Kuliah Pencernaan
description
Transcript of Bahan Kuliah Pencernaan
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Outline
Overview of GI Tract Movement of GI Tract Nutritional requirements Exocrine GI secretions Digestion, absorption, assimilation Endocrine control
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Sekilas saluran
pencernaan• Menerima• Menyalurkan (Conducting)
dan menyimpan• Digesti, absorpsi• Absorbsi air, defekasi
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Proses dasar1. Sekresi : menghasilkan & menyalurkan enzym, mucus, ions
dan sejenisnya ke lumen saluran pencernaan, and hormones ke aliran darah.
2. Absorpsi: Transport air, ion dan nutrient dari lumen melewati epithel kemudian masuk aliran darah.
3. Motilitas: Kontraksi otot polos dlm dinding saluran pencernaan untuk memotong, mencampur dan mengaduk isi saluran pencernaan.
peristaltik segmentasi
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Pengaturan Ekstrinsik
Sistim Syaraf Pusat Sistim Endokrin
Intrinsik Saraf intrinsik Endokrin intrinsik
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DISTRIBUSI SARAF OTONOM KE SALURAN PENCERNAAN
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The autonomic nervous system Sympathetic system:
Noradrenaline
Gut secretions (+) e.g acid, enzymes & electrolytes
Sp
inal co
rd
Pons/medulla
Midbrain
Gut sphincters (-) reflex relaxation
Pancreas (+) exocrine & endocrine secretion
ACTION
Rectum (+) defaecation
ACTION
Gut wall (+) increased motility and tone
adrenaline
EFFECTSEFFECTS
Salivary glands (+) secretion of saliva
X IX
VII
Cranial nerves
Parasympathetic system:
Acetylcholine (Ach)
(+) secretion of saliva salivary glands
(+) vasoconstriction gut blood 2 (-) vasodilation vessels
1/2 (-) decrease motility gut wall, (+) contraction sphincters
(+) secretion
Adrenal medulla
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The enteric nervous system
Deep muscular plexus
Submucosal artery
Muscularis mucosa
Submucosalplexus
MUCOSA
Myenteric plexus
Longitudinal muscle
Circular muscle
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CNS to gut connections
SPINAL CORD
dorsal root ganglion
Spinal afferent
Vagalafferent
Vagal efferent
nodose ganglion
BRAIN STEM
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The brain-gut axis
Gut- to- brain (afferent neurons)
Brain- to- gut (efferent neurons)
• autonomic reflexes
• e.g. vago-vagal reflex control of gastric tone
• Pain
• discomfort, bloating etc.
• cyto-protection
• reflex control of blood flow
• “Cephalic phase”
• thought, smell, taste stimulate H+
• autonomic reflexes
• e.g. vago-vagal reflex control of gastric tone
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Receptive relaxation of the body of the stomach (corpus) in response to a meal
nodose g.
BRAIN STEM
Vagal efferent fibres
Vagal afferent
CCK & DISTENSION
VIP Ach
AchAch
- +
Relaxation of corpus to
accommodate food
Satiety effects
CCK receptors
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I-cell
circulation
CCK
Cholecystokinin (CCK) cell physiology
Fatty acidProtein? Other
+
Small intestine lumen
-
-food intake
gastric emptying
pancreas
gallbladder
CNS
+
+
Apical
basolateral
+
Vagus nerve
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CCK: integrator of brain and gut
Cholecystokinin (CCK)
regulates digestion in the small intestine by:
• stimulating secretion of pancreatic juice• stimulating gallbladder contraction• inhibiting gastric emptying and food intake
CCK acts directly on pancreas and gallbladder, and modifies CNS function via the vagus nerve
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Kelenjar Ludah
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Gas can’t escape(Animal dies from suffocation because
of distended rumen )
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• Tongue – Used more by cattle and goats (also
use lips)• Teeth
– No upper incisors – Used more by sheep (use lips to “sort”
feed)• Saliva
– Continual production – Cattle: 12 gal/d vs Sheep: 2 gal/d – No enzymes; High pH
• Esofagus– No sphincter valve– Opens into reticulum and rumen– Muscle contractions move in both
directions
Sistem pencernaan ruminansiaPrimarily herbivores Cattle, sheep, goats, deer, elk Camelidsare “pseodu” ruminants60-75% of ingesta fermented by microbes before exposed to gastric juice
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Stomach Compartment:
•Reticulum •Rumen •Omasum •Abomasum
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Reticulum characteristics– Located next to heart – Honeycomb appearance
• Catches metal and hardware
– Pathways • Esophagus • Rumen • Omasum
– No enzymes secreted
Rumen Characteristics :– Left side of abdomen – Papillae lining – Muscular pillars – Fermentation vat
• Primarily anaerobic • Some aerobic microbes
– Not functional at birth Rumen Functions :
– Storage – Soaking – Physical mixing and
breakdown – Fermentation
• Synthesizes some vitamins
• Synthesizes AA and protein
• Breaks down fibrous feeds into VFAs
Omasum :– “Manyplies” – No enzymes from walls – Function
• Reduce particle size • Absorb some water
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Abomasum :• “True stomach”
that secretes enzymes from walls
• Glandular stomach like monogastric fundic region – HCL, Mucin – Pepsinogen,
Rennin and Lipase
Ruminant Differences: • Esophageal Groove
– By passes reticulum and rumen in young animals
• Rumination – Chew their cud (food bolus) – Up to 8 hours/day
• Decrease particle size for microbes
• Increases saliva production to buffer rumen
– About 30 times/day – Eructation (belching) – CO2and Methane – Produced by microbial population
in rumen – Rumen contracts and forces gas
out – Bloat can result if ruminant
doesn’t belch
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Rumen ActivitiesPembentukan VFA di
Rumen
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Volatile Fatty Acids (VFAs) Acetic Acid (Acetate)
Most comes from cellulose Important to milk fat in dairy cows
Propionic Acid (Propionate) Most comes from starch
Butyric Acid (Butyrate) Derived from Acetic acid
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End Products of Ruminant Digestion
1. VFAs (Main energy source for cows)2. CO2 3. CH4(Methane) 4. NH3(Ammonia) 5. Microbes
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Parietal cells: HCl and intrinsic factor
Chief cells: pepsinogen (converted to active enzyme, pepsin)
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Sistim Saraf Intrinsik Gastrointestinal
Mengandung banyak neuron Sistim syaraf intrisik mengandung badan sel dan
perlengkapannya Di dalam dinding usus badan sel tersusun dalam 2
ganglia: Pleksus Auerbach (mienterik), terletak antara otot
sirkuler dan longitudinal Pleksus Meissner (submukosal), terletak di lapisan
submukosa
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The Pharynx- receiving
Mechanical breakdown of food. Lubrication of food. Initial digestion of polysaccharides
(complex sugars). Salivary glands:
parotid (par= ear, otid=ear) submandibular submaxillary
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Kelenjar Ludah dan ludah
Saliva disekresikan oleh kelenjar ludah (salivary gland).
Unit sekretoris kelenjar ludah adalah acini. Sel ini mensekresikan cairan yang
mengandung: air, electrolytes, lendir (mucus) and enzymes.
Ada tipe sel epitel acinar: Serous cells, mensekresi a cairan banyak air
sedikit mucus (lendir) Mucous cells, memproduksi sekreta yg kaya
mucus Cairan disalurkan ke rongga mulut melalui saluran
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lanjutan
Didalam saluran cairan mengalami perubahan komposisi Natrium secara aktif diabsorbsi kembali, potassium disekresikan sejumlah besar bikarbonat disekresikan.
Kebanyakan hewan mempunyai 3 pasang kelenjar ludah utama yg berbeda pada jenis sekreta yg diproduksi: Kel. Parotid menghasilkan ludah yg serous (banyak
air) Kel. Submaxillary (mandibular) menghasilkan suatu
campuran serous and mucous Kel. Sublingual glands menghasilkan air liur yang
berlendir
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Fungsi saliva: Lubrikasi and pengikat: makanan yg dikunyah
menjadi bolus shg mudah ditelan dan tidak merusak mukosa esofagus. Saliva juga melapisi rongga mulut dan esofagus shg makanan tdk dapat bersinggungan langsung dg epitel. Melarutkan makanan kering.
Kesehatan mulut: Rongga mulut selalu dibasuh dengan air liur sehingga menjaga mulut tetap bersih. Sekresi saliva menurun bertahap selama tidur & membiarkan pertumbuhan populasi bakteri mulut sehingga mulut menjadi bau. Saliva juga mengandung lysozyme, suatu enzim melisis bacteria dan mencegah overgrowth populasi microbial.
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lanjutan Inisiasi pencernaan karbohidrat: pd
kebanyakan species, the sel acinar serous men-sekresi alpha-amylase yg dpt memulai pencernaan karbohidrat menjadi maltosa. Amylase tdk terdapat, atau sangat sedikit, di saliva carnivora atau sapi.
Menyediakan buffer alkali and cairan: ini sangat penting bagi ruminansia, memiliki lambung sepan yang tdk bersifat sekretoris.
Pendinginan secara evaporasi: penting pd anjing, yg kel. Keringat tdk berkembang dg baik.
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Histologi Kel. Ludah anjing
Acini pada kel. parotid hampir seluruhnya sel epitel serous, sedang kel. sublingual yang dominan adalah sel epitel mucus. Pada kel. submaxillary, acini tersusun dari sel epitel serous and mucus.
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Initial carbohydrate digestion Parotid gland -large exocrine gland,
releases water, mucous, and -amylase.
Esophagus- conducting and storage. Muscular, skeletal muscle in anterior part, smooth muscle as near stomach.
Crop is a pouch off of the esophagus, acts as a storage organ in birds.
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Stomach- protein digestion Stomach- cardiac region, fundus, pylorus Big washing machine, mechanically breaks up food 3 exocrine cell types
chief cells- secrete pepsinogen (inactive form pepsin)
parietal cells, secrete HCl, causes very low pH(~2 in adult)
Also produce a protein called intrinsic factor, which helps vitamin B12 absorption.
mucous cells Very acidic, aids in protein digestion Therefore both chemical and mechanical digestion
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GASTRIN
histamine
Parietal cell
ECL cell
Chief cell
D-cell
somatostatin -
+
noradrenaline,
CCK, VIP & CGRP
Ach
H+
-
+
+
Gland lumen+
Pengaturan Sekresi Asam
Corpus“acid-secreting”
Pepsinogen
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Sel G
GASTRINcirculation
Gastrinreleasing peptide (GRP)
somatostatin
Pengaturan Fungsi sel-G
Protein/peptides/ amino acids
+ +
+ -
Sel D
H+
ECL cell & parietal cell
Corpus
Antrum“muscular pump” -
H.pylori
Vagus nerve fibres
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Attack and defence in the stomach
HCO3-
Tight junctions between cells
slow H+
diffusion
Blood supply carries H+ away, helps antioxidant function
Mucus-HCO3-
barrier slows H+
diffusion
Acid & pepsin
MUCUS
Mucosal blood flow
Mucosal prostaglandins
Cell migration and regeneration
pH 2
pH 7
H+
Cell surface phospholipids
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Refleks Muntah
Efferent fibres: phrenic & vagus
nerve
Afferent fibres: pain, bloating, inflammation, irritants, toxins....
Vomit
Contraction of duodenum, pylorus and
antrum
Vomiting centremedulla oblongata
Diaphragm fixed for inspiration
LOS, UOS & pharynx relaxed
Intercostal muscles contracted…
High abdominal muscular pressure
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Receptive relaxation of the body of the stomach (corpus) in response to a meal
nodose g.
BRAIN STEM
Vagal efferent fibres
Vagal afferent
CCK & DISTENSION
VIP Ach
AchAch
- +
Relaxation of corpus to
accommodate food
Satiety effects
CCK receptors
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I-cell
circulation
CCK
Fisiologi Sel Cholecystokinin (CCK)
Fatty acidProtein? Other
+
Lumen Usus Halus
-
-food intake
gastric emptying
pancreas
gallbladder
CNS
+
+
Apical
basolateral
+
n. Vagus
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Small intestine- digestion and absorption
Receives secretory products from pancreas, liver (via gallbladder)
most absorption of nutrients and water takes place here
mostly alkaline digestion of proteins, fats, carbos, because bicarbonate (HCO-3 from pancreas) neutralizes stomach acid
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Small intestine- digestion and absorption
duodenum- receives liver and pancreas secretions, secretes digestive enzymes
jejunum and ileum-digestion and absorption secretion- transport away from body;
absorption, transport toward bloodstream
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Usus Halus
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BRUSH BORDER
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Glycocalyx
Protein rich coat that covers microvilli. Contains dipeptidases, enzymes that breakdown disaccharides, mucous.
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Intestinal surface area
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Usus Besar Most water reabsorbed in small
intestine, but- the principal role of the large
intestine is reabsorption of remaining water- 8 L of water may be secreted by GI tract in the course of a day.
Consolidation of waste.
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Gerakan saluran pencernaan
Three main functions for movement translocation of food from point A to B mechanical breakdown of food mix food for enzymatic digestion
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3 types of movement
Peristalsis- traveling wave of constriction
segmentation-asynchronous constriction of gut tube- breaks down large food particles
regurgitation- reverse peristalsis
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Control of motility
PSNS stimulates SNS inhibits. Exception- irritable
bowel syndrome- SNS stimulates movement of colon
hormonal control gastrin(stomach)- stimulates motility secretin (duodenum) inhibits motility
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Cellular basis for motility Smooth muscle throughout GI tract GI smooth muscle is myogenic- contracts
12-3 times per minute GI smooth muscle acts as a functional
syncytium- nexus or gap junctions connect muscle cells
neuronal and hormonal cues are not required for contraction, but are important for changing rate of contraction
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Nutritional Requirements
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Figure 4.1 The composition of the adult human body
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Figure 4.2 Amino acid chemistry (Part 1)
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Figure 4.2 Amino acid chemistry (Part 2)
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Figure 4.3 Fatty acids and triacylglycerols (Part 1)
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Figure 4.3 Fatty acids and triacylglycerols (Part 2)
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Figure 4.4 Carbohydrate chemistry
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Figure 4.5 Vitamin structures
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Exocrine Secretions
Salivary glands Stomach Pancreas Liver and gall bladder Small intestine
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Stomach
Chief cells Pepsinogen (inactive) converted to
pepsin (active) form of a proteolytic enzyme.
Parietal cells Intrinsic factor- required for vitamin B12
absorption Hydrochloric acid
Mucous cells
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Produksi HCl oleh Sel Parietal
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Small intestine
Kel. Brunners glands (duodenal glands)Ditemukan hanya di duodenum, sekresi mucous berair
Crypts of LieberkuhnSekresi banyak air dan bikarbonate
Brush borderMucous and digestive enzymes- peptidases, enterokinase, lipases, disaccharidases
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Disaccharide breakdown
Starches broken down into disaccharides by salivary amylase (30%) and pancreatic amylase (70%)
Maltase- breaks down maltose to two glucose molecules.
Lactase- breaks down lactose into galactose and glucose
Sucrase- breaks down sucrose into fructose and glucose.
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Peptides and carbohydrates are broken down by enzymatic hydrolysis
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PANCREATIC SECRETIONS
Endoproteases Cleave internal peptide bonds Trypsin- trypsinogen converted to
trypsin by enterokinase. Attacks on carboxyl side of arginine or lysine.
Chymotrypsin- chymotrypsinogen converted to chymotrypsin in small intestine by trypsin. Attacks on carboxyl side of tyrosine, phenylalanine, tryptophan, leucine or methionine.
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Pancreatic secretions (con’t) Carboxy- and aminopeptidases- cleave
outside amino acids. Lipases- break down triglycerides into
fatty acids and monoglycerides Trypsin inhibitor- stored in pancreatic
secretory granules. Prevents early intracellular activation of trypsin.
Also lots of water and bicarbonate ions to neutralize and dilute acids in S.I.
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Liver and bile Bile is produced in the liver, stored in gall
bladder. Bile salts- one of the most important
components of bile, required for fat digestion.
Bile is very alkaline, neutralizes acid in S.I. Bile transports waste products from liver,
cholesterol, bilirubin, drugs, steroids, and vitamins.
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Bile salts
Bile salts are amphipathic, help solubilize fatty acids for uptake.
Fatty acids and monoglycerides have a strong tendency to re-associate after lipolysis- bile salts prevent fatty acids and monoglycerides from reassociating.
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Digestion, absorption, and assimilation
Carbohydrate digestion and absorption.
Fat digestion and absorption. Protein digestion and absorption.
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SGLT- sodium dependent glucose transporter.
Glut- facilitated diffusion transporter
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FAT DIGESTION Emulsification- breaking up large
lipid droplets so that enzymes can digest them.
Enzymatic digestion (hydrolysis) of triglycerides- pancreatic lipase
Micelle formation-hydrolysis products form with bile salts to make micelles.
FAs and glycerol and monogycerides absorbed.
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PROTEIN DIGESTION
Pepsin –responsible for about 20% of all protein digestion.
Pancreatic proteases and peptidases- chymotrypsin, trypsin, carboxy- and aminopeptidases.
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Virtually all of the water secreted from exocrine glands is reabsorbed in the GI tract.
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Hormonal control of digestion
Phases of digestion. Cephalic phase-sensory input from
food. Gastric phase-food enters stomach. Intestinal phase-chyme enters
duodenum.
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Cephalic Phase
Increase acid secretion in stomach Increase enzyme secretion, decrease
volume from pancreas. Small increase in bile secretion and
contraction of gall bladder.
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Parietal cell
ECL cell
G cell
D cell
HCl
Histamine
Gastrin
Somatostatin
+
++
-
ACh
+
+
-
+
Vagus nerve
Sensory stimuli
ECL, enterochromaffin-like cell
Hormonal and neuronal control of stomach secretions
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Gastric hormones
Gastrin-stimulates HCl secretion, stimulates stomach motility
Somatostatin- inhbits HCl secretion and inhibits gastrin secretion
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Gastric phase
Identical to cephalic phase, but stimulus is stomach distention
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Cerebral cortex
Brain stem
Vagusnerve
Acid secretion
Stomach gastrin
Cephalic phase
Stomachdistention
gastric phase
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Intestinal phase
Chyme enters the duodenum-2 subphases
Early intestinal phase pH > 3.0, gastrin from duodenum stimulates
HCl secretion Late intestinal phase
pH < 2, acid stimulates secretin release from the duodenum
Fatty acids, amino acids, stimulate cholecystokinin secretion from duodenum
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Ulcer formation
• Acid-rebound theory– Acid and mucous production shuts down during
stress. When recovery occurs, acid starts before mucous production.
• Acid secretion hypothesis• Bacterial hypothesis
– Stress decreases immune system function, allows for an increase in stomach bacteria, specifically Helicobacter pylori, a bacterium that has been associated with ulcer formation.
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Reflexes pada Kolon dan Rektum
Mass movements+
+
Food in stomach
Food in
duodenum
Faeces
Defaecation reflex
Colonrectum
anus
Ach
Sp
inal co
rd
IAS
EAS
FAECES
+Distention
-
VIPATP
+
-Pudendal
nerve