1. oral region 2. digestive tract 3. digestive...
TRANSCRIPT
1. Oral region
2. DIGESTIVE TRACT
3. DIGESTIVE GLANDS
Indriati Dwi R, dr,M.Kes Available @: anatomi.lecture.ub.ac.id indri.lecture.ub.ac.id
Oral Region (cavum oris)
Digestive tract/ alimentary canal
(extrinsic) Digestive glands
• lips,
• palate,
• teeth and
associated
structures,
• tongue,
• major salivary
glands,
• lingual tonsil
Esophagus
Gaster
Duodenum
Jejunum
Ileum
Colon
anus
Pancreas
hepar
pharynx
DIGESTIVE SYSTEM
Cavum oris (Oral Cavity)
Labium (lip) (a.k.a bibir)
Dentis (Teeth ) (a.k.a Gigi)
Lingua (Tongue ) (a.k.a Lidah) Glandula salivatorius (Salivatory Glands )
pharynx
esophagus
Gaster (stomach)
Intestinum tenue (small intestine)
Intestinum crassum (large intestine)
CAVUM ORIS
Anterior : labium orificium oris
Superior : palatum
Inferior : lingua
Posterior : oropharynx isthmus faucium
Spaces :
•Vestibulum oris
•Cavum oris propria
Labium oris superior
Labium oris inferior
Palatum durum
Palatum molle
Cavum oris
Pars cutanea
pars rubra
pars mucosa
pars marginalis Labium
pars rubra pars mucosa pars marginalis
Labium
Pars cutanea
Oral Mucosa
Epithelium. Stratified squamous keratinized
or nonkeratinized (depending on location)
Lamina propria
Muscularis mucosae is not present.
submucosa
dense connective tissue, containing the minor
salivary glands
Regional variations
Masticatory mucosa :
• mastication [+]. Ex : gingiva and hard palate
• Stratified squamous epithelium, keratinized
• Underlying submucosa is lacking in some
locations.
Lining mucosa
• Ex : lining of lips and cheeks, soft palate, alveolar
mucosa, undersurface of tongue, and floor of
mouth
• Stratified squamous epithelium,nonkeratinized
Specialized mucosa
• Taste bud [+]
Korelasi klinis :
Angular cheilitis (perlèche)
DENTIS GIGI SUSU : 20
RAHANG ATAS/ BAWAH :
- 2 INSISIVUS
- 4 CANINUS
- 4 PREMOLAR
GIGI DEWASA : 32
RAHANG ATAS :
- 2 INSISIVUS
- 4 CANINUS
- 4 PREMOLAR
- 6 MOLAR
BAGIAN GIGI GIGI DEWASA
MAHKOTA GIGI
- PULPA
- DENTIN
AKAR GIGI
- PULPA
- DENTIN
- CEMENTUM
GIGI SUSU :
- ONTOGENIC GIGI
odontoblasts, which later produce dentin
dental follicle
Korelasi klinis
- Caries dentis
- Gangren pulpa
- Periodontitis
- Amelogenesis imperfecta : Defects of enamel
- Dentinogenesis imperfecta : Defects of dentin
TONGUE/ LINGUA
LAPISAN :
EPITHEL : SQUAMOUS COMPL
LAM. PROPRIA/SUBMUCOSA
MUSCULARIS (otot skelet)
Dorsum lingua : Papila-Papila:
1. Filiformis taste bud ( - )
2. Fungiformis taste bud ( + ), superficial
3. Circumvalata taste bud ( + ), lateral
4. Foliata (rudimenter)
Lingua ( dorsum linguae )
Korelasi klinis :
Glossitis
DIGESTIVE SYSTEM
Oral Cavity
pharynx
esophagus
Gaster (stomach)
Intestinum tenue (small intestine)
Intestinum crassum (large intestine)
Divided into 3 part :
- nasopharynx - Ep. Pseudo str col ciliated
- tonsila pharyngeal
- Tuba Eustachius middle ear
- oropharynx - Ep. Str. Squamous
- tonsila palatina
- Laryngopharynx : - continuous with the esophagus
posteriorly & the larynx anteriorly.
- vocal cord
The pharynx is part of the digestive system and also
the respiratory system; it is also important in vocalization.
PHARYNX
Pharynx ( posterior view )
Gld.parotis
Palatum molle
Dorsum linguae
Epiglottis
Nasopharynx
Oropharynx
Laryngopharynx
Oesophagus
Cavum nasi
Cavum oris
Cavum laryngis
Korelasi klinis :
Pharyngitis
Tonsilitis
DIGESTIVE SYSTEM
Oral Cavity
Teeth
the tongue
pharynx
esophagus
Gaster (stomach)
Intestinum tenue (small intestine)
Intestinum crassum (large intestine)
PLEXUS AUERBACH
• MUSCULARIS EXTERNA (between CIRC & LONGIT.)
PLEXUS MEISSNER
• SUBMUCOSA
Lapisan mukosa : Epitel tdd epitel berlapis pipih.
Lamina propria tdd jaringan longgar
Muskularis mukosa tdd otot polos.
Lapisan submukosa
Berupa jaringan longgar dg kelenjar esofageal yg bersifat
mucous
Tunika muskularis
Tdd : Otot bergaris (1/3 atas)
Campuran otot bergaris & otot polos ( 1/3 tengah )
Otot polos ( 1/3 bawah )
Tunika adventisia : Jaringan ikat longgar
Esophagus
Korelasi klinis :
- Varices esophagus
- Esofagitis refluks
- Lesi korosif pada esofagus
- Atresia esofagus
- Akalasia
DIGESTIVE SYSTEM
Oral Cavity
Teeth
the tongue
pharynx
esophagus
Gaster (stomach)
Intestinum tenue (small intestine)
Intestinum crassum (large intestine)
Stomach (Gaster)
Gaster
Histology of Stomach & Gastric Pits mucosa :
(a)The simple columnar :
mucinogen-producing
surface lining cells
(b)Lamina propria : loose
connective tissue,
contains gastric glands.
(c) muscularis mucosae
(foveolae)
submucosa
(a)dense irreg. conn.tissue.
(b) Meissner (submucosal)
plexus + blood vessels.
muscularis externa
3 layers of smooth muscle
: an incomplete inner
oblique layer, a thick
middle circular, & an outer
longitudinal layer.
between the middle
circular and outer
longitudinal smooth
muscle layers.
Serosa
Gastric glands :
tubular glands in the lamina propria
CARDIAC ZONE
Cardiac glands
in lamina propria
Fundic zone
surface mucous cells : The most superficial cells are simple columnar
epithelial cells
the mucous neck cell : @entrance of pit, serve as stem cells
Parietal/oxyntic cell : centrally located nucleus, a brightly staining,
eosinophilic cytoplasm, and a distinctive round shape
chief cell : most abundant at the bottom of each pit, has a basophilic
cytoplasm
enteroendocrine cell (G cell) : usually has a light-staining cytoplasm,
produces peptide hormones that are secreted basally (=DNES =Argentaffin)
NOT GOBLET !
PYLORIC PART OF THE
STOMACH
FUNDAL PART OF THE STOMACH
Cardiac and pyloric glands are different from
fundic glands in that they are coiled tubular
mucus-secreting glands and lack chief cells.
Cardiac Fundus Pyloric
Pit & gland : equal length Shallow gastric pit Elongated glands (Pit gland ratio = 1:3) Dark stained cluster cells Several type of cells
Lack of parietal and chief cells Infiltrasi limfosit Pit gland ratio = 3:1
Sel parietal - secrete hydrochloric acid (HCl) and gastric intrinsic factor (for absorption of vitamin B12 in the ileum)
-Sel utama/ Chief, • secrete pepsinogen (a precursor of the enzyme pepsin) and
the precursors of two other enzymes, rennin and lipase • pepsinogen ini bl dikeluarkan dalam lingkungan yg asam akan
diubah menjadi pepsin/ suatu enzim proteolitik yg sangat aktif.
DNES • = APUD (amine precursor uptake and decarboxylation
cells) • = Sel enteroendokrin/ argentaffin cell Hasil : hormone gastrointestinal.
Korelasi klinis
• Gastritis
• GERD (Gastroesophageal reflux disease)
• Ulcus peptikum
DIGESTIVE SYSTEM
Oral Cavity
Teeth
the tongue
pharynx
esophagus
Gaster (stomach)
Intestinum tenue (small intestine)
Intestinum crassum (large intestine)
Tdd : - Duodenum : terpendek ( 25 cm),
- Jejunum (2/5 bagian) dan
- Ileum (3/5 bagian)
Dilapisi epitel selapis kolumnar dg sel goblet.
crypts of Lieberkühn
Terdapat villi intestinalis yg merupakan penonjolan epitel dan lamina propria.
Membran mukosa usus halus juga menunjukkan lipatan permanent, plika sirkularis yg tdd mukosa dan submukosa. Plika ini paling khas/banyak pd jejunum.
Intestinum tenue
CELL(s)
• Enterocyte
• Goblet cell
• M cells
• stem cells
• Paneth cell
• enteroendocrine cells (DNES)
Paneth cells possess large,
eosinophilic granules whose contents
lysozyme, defensins and tumor
necrosis factor α
Pd submukosa terutama di bagian cranial/ duodenum didapatkan kelenjar yang menghasilkan mucous disebut kelenjar Brunner
Nodulus limfatikus terdapat sepanjang usus halus, lebih khas pada ileum yg disebut Patch of Peyer
Duodenum 1- tunica mucosa
2 - tunica submucosa
3 - tunica muscularis propria
4 - tunica serosa
5 - villi
6 - glands (crypts) in the lamina
propria of the mucosa
7 - glands in the tunica submucosa
(Brunner's glands)
Jejunum
1 - tunica mucosa
2 - tunica submucosa
3 - tunica muscularis propria
4 - tunica serosa
5 - villi
6 - glands (crypts) in the lamina
propria of the mucosa
1 - epithelium of the mucosa
(covers villi)
2 - lamina propria of the mucosa
3 - goblet cells in the epithelium
4 - parts of the muscularis mucosae
Ileum 1 - tunica mucosa
2 - tunica submucosa
3 - tunica muscularis propria
4 - tunica serosa
5 - villi
6 - epithelium of the mucosa (covers villi)
7 - connective tissue of the lamina ropria of the mucosa
8 – patch of peyer
Korelasi klinis
- Meckel’s Diverticulum
- Diverticula
- Ileus
- Hernia
- Malabsorbtion
DIGESTIVE SYSTEM
Oral Cavity
Teeth
the tongue
pharynx
esophagus
Gaster (stomach)
Intestinum tenue (small intestine)
Intestinum crassum (large intestine)
Goblet cells increase, enteroendocrine cells
reduced
(crypts of Lieberkuhn) are very straight
No villi or plicae circulares
Muscularis externa : Inner circular layer is
intact. Outer longitudinal layer is segregated
into three longitudinal bands taeniae coli,
The contraction of the taenia produces
permanent sacculations haustrae.
+/- appendices epiploicae in serosa
Intestinum crassum
Colon 1 - tunica mucosa : vili ( - ), crypt L (+)
2 - tunica submucosa
3 - tunica muscularis propria
4 - tunica serosa
5 - lymphoid follicle in the lamina
propria of the mucosa
• Rectum is a 12-cm-long tube continuing from the sigmoid colon.
– The mucosa of the rectum is similar to that of the majority of the large intestine. The rectum narrows abruptly to become the anal canal.
– Pd daerah hubungan dg anus, membrane mukosa mempunyai lipatan2 longitudinal disebut kolumna rectalis (Morgagni).
• Anal canal. The terminal portion of the intestinal tract is about 4 cm long.
– The intestinal glands disappear
– the epithelium undergoes an abrupt transition from simple columnar to stratified squamous with sebaceous and apocrine sweat glands. (@ Sekitar 2 cm diatas lubang anus mucosa )
– Lamina propria mengandung pleksus vena2 besar
– The inner circular portion of the muscularis externa expands to form the internal anal sphincter.
– The external anal sphincter is composed of skeletal muscle.
Korelasi klinis (a.l)
- Hemorrhoid
- Colorectal carcinoma
- Divertikulitis
- Proctitis (@rectum)
Enteroendocrine = neuroendocrine = APUD
Appendix
• Letak : pada 1/3 lateral hubungan SIAS kanan – Umbilicus ( titik Mc Burney )
• Terdapat pd hubungan dg ileum : ileocaecal junction
• Vili tidak ada
• Taenia coli tidak ada
• Ditandai dg banyaknya nodulus limfatik
• Kelenjar Intestinal Lieberkuhn ( + )
No villi, no taenia coli Intestinal glands Lieberkuhn++ Lymphoid follicle ++
Korelasi klinis :
- Appendicitis
- (Peri)appendicular abscess
esophagus: Upper 1/3
Mid portion
Lower 1/3
Gaster: Intestinum
tenue :
Intestinum-
crasum:
Rectum –
anus
.
Card
ia
Fu
nd
us
Pylo
rus
Du
od
en
um
Je
jun
um
Ileum
Co
lon
Appendix
Mucosa:
Epitel
Lam.prop
Musc.muc
Submucosa
Muscularis
Serosa
(extrinsic) Digestive glands
major salivary glands,
Pancreas
Hepar
major salivary glands
LIVER/ HEPAR • The function : Exocrine & endocrine
• Glisson’s capsule lobus lobulus
• The Component of liver :
- parenchym – hepatocyte plate
- sinusoid capillary – very large fenestrae, no BL
• sinusoid walls : * sel endotel
* sel Kupffer – macrophage
Space of Disse
1) The space of Disse is the subendothelial space between
hepatocytes and sinusoidal lining cells.
2) It contains the short microvilli of hepatocytes, reticular
fibers (which maintain the architecture of the sinusoids),
and occasional nonmyelinated nerve fibers.
3) It also contains stellate fat-storing cells (Ito cells,
perisinusoidal stellate cells), which preferentially store
vitamin A. However, when the liver is compromised,
hepatocytes release tumor growth factor and, in response,
these fat-storing cells can divide, change their phenotype,
and begin to synthesize collagen, leading to fibrosis and, if
necessary, differentiate into myofibroblasts to control blood
flow into the sinusoids.
4) Function. The space of Disse functions in the exchange
of material between the bloodstream and hepatocytes.
Hepatocytes do not directly contact the bloodstream.
LIVER LOBULES :
• 1. Classical lobule
• 2. Portal lobule
• 3. Acinar lobule
Name Shape Model
classical lobule hexagonal; divided into concentric centrilobular, midzonal, periportal parts
anatomical
portal lobule triangular; centered around a portal triad
bile secretion
acinus
elliptical or diamond-shaped; divided into zone I (periportal), zone II (transition zone), and zone III (centrilobular) Hepatic acinus of Rappaport
blood flow and metabolic
The term "hepatic lobule", without qualification, typically refers to the classical lobule.
Blood and bile flow
1. Blood flow into the liver : from two sources
a. A. Hepatica : 20% to 30% of the liver’s blood.
b. V. Porta : nutrient-rich blood, 70% to 80% of the liver’s blood.
2. Blood flow out of the liver : via the V.hepatica, formed by the union of
numerous sublobular veins, which collect blood from the central veins
3. Bile flow is directed toward the periphery of the classic liver lobule (in
the opposite direction of blood flow). Bile is carried in a system of ducts
that culminate in the left and right hepatic ducts, which leave the liver
and carry bile to the gallbladder.
V C
- Membran between hepar cells :
canaliculi biliaris
canalis Hering
Ductus interlobularis
( ductus biliaris )
Hepatic duct
Common bile duct
KORELASI KLINIS
VESICA FELEA : • Bentuk spt buah pir, berongga,
• Kapasitas 30 – 60 cc
• Fungsi sbg reservoar empedu
• Letak dibelakang lobus kanan hepar
• Dinding spt saluran cerna umumnya :
* Epitelnya tdd ep. Columnar simplex
* tdk mempunyai muscularis mucosa.
Saluran ekskresinya : duktus sistikus
ductus choleduchus duodenum
VESICA FELEA Muscularis mucosa ( - ),
diverticle ( + )
PANCREAS • Mixed exocrine and endocrine gland
Endocrine/ P. Langerhans : lightly staining, large,
spherical cluster
Exocrine/ acini pancreas :
- Compound tubuloaciner gland,
- serous gland similar with parotis
- zymogen /secretion granule (proenzim)
digestive enzym
Ductus : intercalatus interlobularis interlobaris
d.Wirsungi & d.Santorini duodenum
KORELASI KLINIS
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