DIGESTIVE SYSTEM (microscopic)

1. DIGESTIVE TRACT 2. DIGESTIVE GLANDS

PLEXUS AUERBACH

• PARASYMPHATIC

• MUSCULARIS EXTERNA (between CIRC & LONGIT.)

PLEXUS MEISSNER

• SYMPHATIC

• SUBMUCOSA

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)

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

- EMAIL

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)

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)

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

propria 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.

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

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