Accessory Organ Digestive

Irwan
Indri
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Content:

Vignette
What is a limb?
Upper Limb Skeleton
Clavicle
Scapula
Humerus
Radius
Ulna
Hand (Manus)
Joint of Upper Extremity

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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?

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Accessory Organ Digestive

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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

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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)
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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)

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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

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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
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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
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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
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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
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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
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Blood supply
Hepatic artery
delivers oxygenated
blood

Hepatic portal
circulation
delivers nutrient rich
blood from intestines

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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
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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)

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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)

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Created by:
dr. Irwan
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FK Unsri
Palembang

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