KONTROL

SISTEM PENCERNAAN

Rahmatina B. Herman
Bagian Fisiologi
Fakultas Kedokteran Universitas Andalas
 Basic Principle of GI Regulation
Neural Regulation:
- The enteric nervous system (ENS)
- The autonomic nervous system (ANS):
Hormonal Regulation:
- True hormone
- Candidate hormone
- Paracrine
- Neurocrine
Basic Principles of GI Regulation
Neural regulation:
The enteric nervous system (ENS):
- the myenteric plexus (Auerbach)
- the submucosal plexus (Meissner)
The autonomic nervous system (ANS):
- the parasympathetic
> cranial division: cranial nerves
> sacral division: SII SIV
> excitation through the ENS
- the sympathetic
> TV LII
> dual action
> direct excitation and also through the ENS
 Neural Regulation
Sensory stimulation by:
- irritation of the mucosa
- excessive distention of the wall
- the presence of specific chemical
substances
 Neural Regulation..
Afferent sensory nerve fibers from the gut:
1. All neurons within the ENS
2. Cell bodies in the ENS
sends its axon through the ANS to terminate in the
prevertebral sympathetic ganglia: celiac,
mesenteric, and hypogastric ganglia
3. Cell bodies in the dorsal root ganglia of the spinal
cord or in the cranial nerve ganglia
transmit signals directly into the spinal cord or brain
stem, traveling in the same nerve trunks along with
the ANS (80% of vagus nerves are afferent)
 Neural Regulation..
Reflexes:
1. Reflexes that occur entirely within the ENS
2. Reflexes from the gut to the prevertebral
sympathetic ganglia and then back to the GIT
- gastrocolic reflex, enterogastric reflex, colonileal reflex
3. Reflexes from the gut to the spinal cord or
brainstem then back to the GIT
- the stomach and duodenum brainstem stomach
through vagus, to control gastric activities
- pain reflexes that cause general inhibition of the GIT
- defecation reflex: rectum spinal cord to produce
colonic, rectal, and abdominal contractions
Neural Regulation..
Diagram of Efferent Autonomic Pathways
 Hormonal Regulation
Secreted by enteroendocrine cells
Mainly to control secretion, but may affect motility
Type of hormones
- true hormone:
cholecystokinin, secretin, gastric inhibitory peptide
(GIP), gastrin
- candidate hormone:
motilin, pancreatic polypeptide, enteroglucagon
- paracrine:
somatostatin, prostaglandin, histamine
- neurocrine:
vasoactive inhibitory peptide (VIP),bombesin,
enkephalin
 Hormonal Regulation.....
Gastrin
secreted by cells in gastric and duodenal mucosa in
response to the presence of food
Cholecystokinin
secreted by I cells in duodenal and jejunal mucosa in
response to breakdown products of fat
Secretin
secreted by S cells in the mucosa of duodenum in
response to acidic gastric juice
Gastric inhibitory peptide
secreted by the mucosa of upper small intestine in
response to fatty acid, amino acid and to a lesser extent in
response to carbohydrate
 Pathways Controlling Digestive System

External influences Local changes in

Digestive Tract (DT)

Receptors in DT

Extrinsic (ANS) Intrinsic (ENS) GI Hormones

Smooth Muscle (self excitable)

Exocrine gland cells (digestive juices)
Endocrine gland cells (GI & Pancreatic Hormones
 Regulation of Gastric Secretion
Acetylcholine:
excites secretion by all the secretory types in the
gastric glands
Gastrin and histamine :
stimulate strongly the secretion of HCL
A few other substances such as circulating amino
acids, caffeine, and alcohol
also stimulate the gastric secretory cells but the
stimulatory effects of these are slightly in comparison
with acetylcholine, gastrin, and histamine
Regulation of Stomach Emptying
The weak gastric factors that promote emptying:
- Nervous reflexes: vagovagal and myenteric reflexes
- Hormonal: gastrin
The powerful duodenal factors that inhibit emptying:
- Enterogastric nervous reflexes from duodenum
> degree of distention of duodenum
> especially sensitive to the presence of irritant and acids
> also breakdown products of protein digestion
> degree of osmolality
- Hormonal feedback from duodenum
cholecystokinin, secretin, gastric inhibitory peptide
Regulation of Pancreatic Secretion
Vagal stimulation
Causes release of pancreatic digestive enzymes
Secretin
- Stimulated by the presence of acid in the
duodenum
- Causes secretion of pancreatic fluid/bicarbonate
Cholecystokinin
- Stimulated by the presence of fats and amino acid
in the duodenum
- Causes secretion of pancreatic digestive enzymes
Regulation of pancreatic secretion
 Regulation of Small Intestinal Secretion

Local enteric reflex mechanisms

- in response to the presence of chyme in the
intestine
- dominant role

Hormonal regulation
Some of same hormones that promote secretion in GIT
especially secretin and cholecystokinin
 Gastrointestinal Reflexes
Reflexes that occur entirely within the enteric
nervous system
Reflexes from the gut to the prevertebral
sympathetic ganglia and then back to the GIT
Reflexes from the gut to the spinal cord/ brain
stem and then back to the GIT:
- Reflexes from stomach and
- pain reflexes
- defecation reflexes
 Gastrointestinal Reflexes..
Reflexes from the gut to the spinal cord/ brain
stem and then back to the GIT:
- Reflexes from stomach and duodenum to the
brain stem and back to the GIT: gastrocolic,
duodenocolic, gastroileal, enterogastric
- pain reflexes that cause general inhibition of GIT
- defecation reflexes that travel to the spinal cord
and back again to produce the powerful colonic,
rectal, and abdominal contractions required for
defecation (extrinsic)
 Defecation Reflex
Initiated by distention of the rectal wall
Intrinsic reflex:
- relatively weak
- mediated by the local enteric nervous system
Extrinsic reflex
- effective in causing defecation
- parasympathetic defecation reflex
- mediated by the sacral division of parasympathetic
nervous system
Defecation Reflexes..
 Autonomic Reflexes That Affect GIT
Autonomic reflexes that affect bowel activity:
From internal GIT
- gastrocolic and duodenocolic reflexes
- gastroileal reflex
- enterogastric reflex
- defecation reflex
From external GIT: inhibition
- peritoneo-intestinal reflex
- reno-intestinal reflex
- vesico-intestinal reflex
- somato-intestinal reflex
 Basic Principles of Protection
Immune system
- Lymphatic system:
B lymphocytes, T lymphocytes, plasma cells,
macrophages, mast cells, eosinophils
- Interepithelial lymphocytes
Rapid Growth of intestinal epithelial cells
Gastric acids: barrier
Healing of intestinal mucosal lesions:
- trefoil peptides