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A.Anatomi Lambung (Gaster)

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f381

Gaster terletak di bagian atas abdomen, terbentang dari permukaan bawah arcus costalis

sinistra sampai regio epigastrica an umbilicalis. Sebagian besar gaster terletak di bawah costae

bagian bawah. Secara kasar gaster berbentuk huruf J dan mempunyai dua lubang, ostiumcardiacum dan ostium pyloricum; dua curvatura, curvatura major dan curvatura minor; dan dua

dinding, paries anterior dan paries posterior.

Secara umum lambung di bagi menjadi 3 bagian:

1. kardia/kelenjar jantung ditemukan di regia mulut jantung. Ini hanya mensekresi mukus

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2. fundus/gastric terletak hampir di seluruh corpus, yang mana kelenjar ini memiliki tiga tipe

utama sel, yaitu :

• Sel zigmogenik/chief cell, mesekresi pepsinogen. Pepsinogen ini diubah menjadi

pepsin dalam suasana asam. Kelenjar ini mensekresi lipase dan renin lambung yangkurang penting.

• Sel parietal, mensekresi asam hidroklorida dan factor intrinsic. Faktor intrinsic

diperlukan untuk absorbsi vitamin B12 dalam usus halus.

• Sel leher mukosa ditemukan pada bagian leher semua kelenjar lambung. Sel ini

mensekresi barier mukus setebal 1 mm dan melindungi lapisan lambung terhadap

kerusakan oleh HCL atau autodigesti.

3. pilorus terletak pada regia antrum pilorus. Kelenajr ini mensekresi gastrin dan mukus, suatu

hormon peptida yang berpengaruh besar dalam proses sekresi lambung.

Lapisan Lapisan Lambung

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Lambung terdiri atas empat lapisan :

1. Lapisan peritoneal luar atau lapisan serosa yang merupakan bagian dari peritoneum viseralis.

Dua lapisan peritoneum visceral menyatu pada kurvatura minor lambung dan duodenum,

memanjang kearah hati membentuk omentum minus. Lipatan peritoneum yang kelaur dari organ

satu menuju organ lain disebut ligamentum. Pada kurvatura mayor peritoneum terus kebawah

membentuk omentum mayus.

2. Lapisan berotot yang terdiri atas tiga lapis:

• serabut longitudinal, yang tidak dalam dan bersambung dengan otot esofagus,

• serabut sirkuler yang paling tebal dan terletak di pilorus serta membentuk otot

sfingter; dan berada di bawah lapisan pertama, dan

• serabut oblik yang terutama dijumpai pada fundus lambung dan berjalan dari

orifisium kardiak, kemudian membelok ke bawah melalui kurvatura minor (lengkung

kecil).

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3. Lapisan submukosa yang terdiri atas jaringan areolar berisi pembuluh darah dan saluran limfe.

Lapisan mukosa yang terletak di sebelah dalam, tebal, dan terdiri atas banyak kerutan atau rugue,

yang hilang bila organ itu mengembang karena berisi makanan.

4. Membran mukosa dilapisi epitelium silindris dan berisi banyak saluran limfe. Semua sel-selitu mengeluarkan sekret mukus. Permukaan mukosa ini dilintasi saluran-saluran kecil dari

kelenjar-kelenjar lambung. Semua ini berjalan dari kelenjar lambung tubuler yang bercabang-

cabang dan lubang-lubang salurannya dilapisi oleh epithelium silinder. Epithelium ini

bersambung dengan permukaan mukosa dari lambung. Epithelium dari bagian kelejar yang

mengeluarkan sekret berubah-ubah dan berbeda-beda di beberapa daerah lambung.

Persarafan dan Aliran Darah Pada Lambung

Persarafan pada lambung umumnya bersifat otonom. Suplay saraf parasimpatis untuk

lambung di hantarkan ke dan dari abdomen melalui saraf vagus. Trunkus vagus mencabangkan

ramus gastric, pilorik, hepatic dan seliaka.

Persarafan simpatis melalui saraf splangnikus mayor dan ganglia seliakum. Serabut-

serabut afferent simpatis menghambat pergerakan dan sekresi lambung. Pleksus auerbach dan

submukosa ( meissner ) membentuk persarafan intrinsic dinding lambung dan mengkoordinasi

aktivitas motorik dan sekresi mukosa lambung.

Suplai darah dilambung berasal dari arteri seliaka. Dua cabang arteri yang penting dalam

klinis adalah arteri duodenalis dan pankreas tikoduodenalis (retroduodenalis) yang berjalan

sepanjang bulbus posterior duodenum. Tukak dinding posterior duodenum dapat mengerosi

arteri itu menyebabkan perdarahan. Darah vena dari lambung dan duodenum serta berasal dari

pankreas, limpa dan bagian lain saluran cerna berjalan ke hati melalui vena porta.

B. Fisiologi Lambung

Secara umum gaster memiliki fungsi motorik dan fungsi pencernaan & sekresi, berikut fungsi

Lambung:

1. Fungsi motorik

• Fungsi reservoir

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Menyimpan makanan sampai makanan tersebut sedikit demi sedikit dicernakan dan bergerak ke

saluran pencernaan. Menyesuaikan peningkatan volume tanpa menambah tekanan dengan

relaksasi reseptif otot polos yang diperantarai oleh saraf vagus dan dirangsang oelh gastrin.

• Fungsi mencampur

Memecahkan makanan menjadi partikel-partikel kecil dan mencampurnya dengan getah

lambung melalui kontraksi otot yang mengelilingi lambung.

• Fungsi pengosongan lambung

Diatur oleh pembukaan sfingter pylorus yang dipengaruhi oleh viskositas, volume, keasaman,

aktivitas osmotis, keadaan fisisk, emosi, obat-obatan dan kerja. Pengosongan lambung di atur

oleh saraf dan hormonal

2. Fungsi pencernaan dan sekresi

• Pencernaan protein oleh pepsin dan HCL

• Sintesis dan pelepasan gastrin. Dipengaruhi oleh protein yang di makan, peregangan

antrum, rangsangan vagus

• Sekresi factor intrinsik. Memungkinkan absorpsi vitamin B12 dari usus halus bagian

distal.

• Sekresi mucus. Membentuk selubung yang melindungi lambung serta berfungsi

sebagai pelumas sehingga makanan lebih mudah untuk diangkut.

Proses Pencernaan Makanan Di Lambung

1. MEKANIK

Beberapa menit setelah makanan memasuki perut, gerakan peristaltik yang lembut dan

berriak yang disebut gelombang pencampuran (mixing wave) terjadi di perut setiap 15-25 detik.

Gelombang ini merendam makanan dan mencampurnya dengan hasil sekresi kelenjar lambung

dan menguranginya menjadi cairan yang encer yang disebut chyme. Beberapa mixing wave

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terjadi di fundus, yang merupakan tempat penyimpanan utama. Makanan berada di fundus

selama satu jam atau lebih tanpa tercampur dengan getah lambung. Selama ini berlangsung,

pencernaan dengan air liur tetap berlanjut.

Selama pencernaan berlangsung di perut, lebih banyak mixing wave yang hebat dimulaidari tubuh dan makin intensif saat mencapai pilorus. Pyloric spinchter hampir selalu ada tetapi

tidak seluruhnya tertutup. Saat makanan mencapai pilorus, setiap mixing wave menekan

sejumlah kecil kandungan lambung ke duodenum melalui pyloric spinchter. Hampir semua

makanan ditekan kembali ke perut. Gelombang berikutnya mendorong terus dan menekan sedikit

lagi menuju duodenum. Pergerakan ke depan atau belakang (maju/mundur) dari kandungan

lambung bertanggung jawab pada hampir semua pencampuran yang terjadi di perut.

2. KIMIAWI

Prinsip dari aktivitas di perut adalah memulai pencernaan protein. Bagi orang dewasa,

pencernaan terutama dilakukan melalui enzim pepsin. Pepsin memecah ikatan peptide antara

asam amino yang membentuk protein. Rantai protein yang terdiri dari asam amino dipecah

menjadi fragmen yang lebih kecil yang disebut peptide. Pepsin paling efektif di lingkungan yang

sangat asam di perut (pH=2) dan menjadi inaktif di lingkungan yang basa. Pepsin disekresikan

menjadi bentuk inaktif yang disebut pepsinogen, sehingga tidak dapat mencerna protein di sel-sel

zymogenic yang memproduksinya. Pepsinogen tidak akan diubah menjadi pepsin aktif sampai ia

melakukan kontak dengan asam hidroklorik yang disekresikan oleh sel parietal. Kedua, sel-sel

lambung dilindungi oleh mukus basa, khususnya setelah pepsin diaktivasi. Mukus menutupi

mukosa untuk membentuk hambatan antara mukus dengan getah lambung.

Enzim lain dari lambung adalah lipase lambung. Lipase lambung memecah trigliserida

rantai pendek menjadi molekul lemak yang ditemukan dalam susu. Enzim ini beroperasi dengan

baik pada pH 5-6 dan memiliki peranan terbatas pada lambung orang dewasa. Orang dewasa

sangat bergantung pada enzim yang disekresikan oleh pankreas (lipase pankreas) ke dalam usus

halus untuk mencerna lemak. Lambung juga mensekresikan renin yang penting dalam mencerna

susu. Renin dan Ca bereaksi pada susu untuk memproduksi curd. Penggumpalan mencegah

terlalu seringnya lewatnya susu dari lambung menuju ke duodenum (bagian pertama dari usus

halus). Rennin tidak terdapat pada sekresi lambung pada orang dewasa

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Enzim dan Hormon yang Berperan dalam Pencernaan di Lambung

1. Hormon Gastrin

2. Enzim pepsin: mengubah protein menjadi pepton

3. Enzim rennin: mengendapkan kasein dalam susu

4. Enzim lipase: memecah lemak menjadi asam lemak

5. HCl: mmbunuh kuman dan mengasamkan makanan

Kerja Makna Fisiologis

merangsang sekresi asam dan pepsin mempermudah pencernaan

merangsang sekresi factor intrinsic mempermudah absorpsi dalam usus

merangsang sekresi enzim pancreas mempermudah pencernaan

merangsang peningkatan aliran empedu hati mempermudah pencernaan

merangsang pengeluaran insulin mempermudah metabolisme glukosamerangsang pergerakan lambung dan usus mempermudah pencampuran

mempermudah relaksasi reseptif lambunglambung dapat dengan mudah meningkatkan volume, tanpa meningkatkan tekanan

meningkatkan tonus istirahat SEB mencegah refluks lambung waktu pencampuran dan pangadukan