Microsoft PowerPoint - Digestive 2013

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System Digestivus

dr.H.Yani Istadi, M.Med.Ed

FK Unissula

Bagian Anatomi

A

B

D

C

E

F

G

H

I

J

K

Digestive System or Gastrointestinal TractGastrointestinal Tract or the

Alimentary canalAlimentary canal

Mouth

Salivary glands

Stomach

Pancreas (behind

stomach)

Large intestine

Small intestine

Rectum

Gallbladder

(behind liver)

Liver

Esophagus

Pharynx

Figure 38–10 The Digestive SystemSection 38-2

Human Digestive System

• The three Main functions of the Digestive System are:

1. DigestionDigestion:: Chemical and Mechanical break down of food products.

2. AbsorptionAbsorption:: into the blood stream

3. EliminationElimination:: of solid waste from the body

• Mechanically� by the teeth

• Chemically� by the saliva.

– Digestive enzymes aid in the breakdown of complex nutrients

(such as fats, proteins, and sugars).

•• ProteaseProtease andand PeptidasePeptidase: Proteins Proteins → amino acids

•• CarbohydraseCarbohydrase:: SugarsSugars → glucose

•• LipaseLipase: FatsFats → fatty acids

DIGESTION:DIGESTION:

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Cavum Oris (rongga mulut)1. Vestibulum oris:– Bagian antara bibir dan pipi di sebelah

luar dengan gusi dan gigi geligi disebelah dalamnya

2. Cavitas oris propria– Bagian yang terletak di dalam arcus

alveolaris, gusi, dan gigi geligi– Ruangan ini dibentuk oleh:• Atap� palatum durum bagian depan dan

palatum mole pada bagian belakang• Dasar� 2/3 anterior lidah dan lipatan

membran mukosa dari tepi lidah ke gusi pada mandibula

– Lipatan membran mukosa bagian medial� frenulum linguae (menghubungkan permukaan bawah lidah dengan dasar mulut)

• Gingiva� merupakan jaringan lunak pendukung yang mengelilingi soket gigi

• Gigi-geligi

– Gigi desidua (6-12 tahun)� 20 buah (4 incisivus, 2 caninus dan 4 molar pada setiap rahang)

– Gigi permanen� 32 buah

•• Gigi terdiri dariGigi terdiri dari–– MahkotaMahkota�� diatas diatas gumline

–– AkarAkar�� sepanjangsepanjang gumlinegumline dan didalam dan didalam soket tulang gigisoket tulang gigi

–– EnamelEnamel �� lapisan pelindung mahkota yang berwarna putih; dan merupakan bagian terkeras dalam tubuh.

–– DentinDentin �� merupakanmerupakan a yellow softer boney tissue terdapat dibawah enamel terdapat dibawah enamel dan akar gigidan akar gigi.

–– CementumCementum�� lapisan pelindung yang melindungi bagian dentin yang ada di akar gigi. Bagian ini juga terdapat membran periodontalperiodontal yang mengelilingi yang mengelilingi sementum yang menyebabkan gigi tetap sementum yang menyebabkan gigi tetap berada di soketnyaberada di soketnya.

– Pulp�bagian tengah gigi, dibawah dentin. Pulpa merupakan jaringan kenyal yang terdapat canal gigi dan berisi pembuluh darah dan limfe, akhiran saraf, jaringan penghubung (saluran akar).

Cavities/Dental Caries

Oral Cavity (cont’d.)

Kelenjar saliva• Terdiri dari 3:

� Kelenjar parotis:� Berbentuk segitiga beraturan� Saluran�ductus parotideus

stenson�vestibulum oris yang berhadapan dengan gigi molar II (papilla parotidea)

� Fascia colli superficialis� serous

� Kelenjar submandibularis� Letak dalam trigonum

digastricum (superfisial) dan diantara m.mylohyoid dan m.hyoglossus (profunda)

� Saluran�ductus whartoni�caruncula sublingualis

� Fascia colli superficialis� serousmucous

Oral Cavity (cont’d.)

Kelenjar saliva� Kelenjar sublingualis:

� Letak dibawah membran mukosa dasar mulut dekatgaris tengah

� Saluran:

• Duktus sublingualis minor�di dalam mulut pada plica sublingualis

• Duktus sublibualis mayor�ke dalam ductus submandibularis atau langsung ke caruncula lingualis

� Fascia colli superficialis

� mucous

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The Pharynx

• Skeletopi�basis cranii-

VC.6

• Merupakan saluran otot

yang panjangnya sekitar

5 inch

• 3 bagian: nasopharing,

oropharing,

laryngopharing

Pharynx

• Biasanya dilalui oleh udara dan makanan

• Bagian oropharing terdapat bangunan: Tonsila

palatina, fossa supratonsilaris dan tonsila

lingualis

• Inervasi: plexus pharyngeus dibentuk oleh

cabang n.IX dan X beserta serabut saraf

otonom. Motorik�n.IX; sensorik�n.IX dan X

The Pharynx

DeglutitionDeglutition:: also called swallowing

Esophagus

• Merupakan saluran otot yang panjangnya 9 to 10 inch.

• Skeletopi: VC.6-VTh. 10• Serabut otot terdiri dari

sirkuler dan longitudinal yang memungkinkan pergerakan makanan. Gerakannya disebut Peristalsis.– 1/3 proksimal (otot lurik), 1/3

medial (campuran otot lurik dan polos), 1/3 distal (otot polos)

Esophagus• 3 penyempitan: sfingter

oesophageal, belakang arcus aorta dan hiatus oesophagus

• Vascularisasi:– 1/3 proksimal�a.thyroidea

inferior– 1/3 medial�cab.aorta

descendens– 1/3 distal�cab.a.gastrica

sinistra

• Inervasi: n.X dan truncus symphaticus

• Makanan melewati oesophagussekitar 5-8 detik, sampai menuju cincin otot yang disebut cardiac cardiac sphinctersphincter (ataulower esophageal sphincter).

Swallowing Reflex and Esophageal Peristalsis

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Gaster

• Merupakan kantong otot yang berbentuk J-shaped

• Terdiri dari 2 sphincters:

1. Cardiac sphincter – pintu masuk makanan dari esophagus dan mencegah asam lambung tidak naik ke esophagus

2. Pyloric sphincter – mengatur dan melepaskan sejumlah makanan masuk ke dalam usus

Gaster

• Terdiri dari 2 curvatura:

mayor dan minor

• Terdiri dari 2 permukaan:

anterior dan posterior

• Bagian gaster lain terdiri

dari 3 yaitu: fundusundus

(upper), bodybody (middle),

and antrumantrum (lower)

Gaster

• Serabut otot mengandung:

– Longitudinal�letak paling

superfisial sepanjang curvatura

– Sirkuler�lebih dalam

mengelilingi fundus dan

menebal ke arah pylorus

– Oblik�paling dalam, mengitari

fundus dan berjalan sepanjang

dinding anterior dan posterior,

derjalan sejajar dengan

curvatura minor

Gaster

• Serabut otot yang berlipat-lipat

� rugae

• Dibungkus

peritoneum�omentum

• Vascularisasi :

– A. gastrica dextra

– A. gastrica sinistra

– A. gastrica brevis

– A. gastroepiploica dextra

– A. gastroepiploica sinistra

Gaster • 2 tipe digestion: – mekanik

– Kimiawi (pepsin�merubah protein mjd polipetida dan asam hidroklorik (PH. 2)�menghancurkan makanan dan membunuh mikroorganisme)

• Makanan dapat bertahan di gaster sekitar 2-6 jam atau tergantung banyak dan apa yang dimakan (lama lagi jika makan sebelum tidur)

• Menampung 2 liter makanan atau minuman

Stomach: Food Storage and Digestion

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Intestinum tenue• Merupakan bagian yang terpanjang

dari sistem pencernaan yaitu sekitar 20ft mulai dari sphingter pylorus—usus besar (caecum)

• Sebagian besar intestinum tenue berbentuk koil dan dilekati lembaran tipis yang memberikan usus lebih fleksibel dan mobile�mesenteriummesenterium.

• Dibagi menjadi 3 bagian:

1. Duodenum – 25 cm setelah gaster

2. Jejunum – 2 meter

3. Ileum – 5 meter

• Serabut otot: sirkuler, longitudinal, sirkuler

• Fungsinya absorbsi nutrisi

Usus halus •• Duodenum:Duodenum:––Berbentuk huruf CBerbentuk huruf C––Melengkung sekitar Melengkung sekitar

pancreaspancreas––4 bagian : 4 bagian : •• pars superior (5 cm) pars superior (5 cm) •• pars descenden (8 cm)pars descenden (8 cm)��

terdapat papilla duodeni mayor terdapat papilla duodeni mayor (muara duktus pankreatikus (muara duktus pankreatikus mayor dan duktus koledokus)mayor dan duktus koledokus)•• pars horizontal (8 cm)pars horizontal (8 cm)•• pars ascenden (5 cm)pars ascenden (5 cm)��terlihat terlihat

lipatan2 peritoneum yang lipatan2 peritoneum yang disebut Ligamentum of TREITZdisebut Ligamentum of TREITZ

– Vascularisasi: r.superior pancreaticoduodenalis dan a.mesenterika superior

– Inervasi: plexus coeliacus

The Small Intestines cont..

•• jejunumjejunum dan ileumileum–– Panjangnya 6Panjangnya 6--7 meter (dewasa), 4 7 meter (dewasa), 4

meter (anakmeter (anak--anak)anak)

–– 2/3 bagian oral2/3 bagian oral��jejenum (letaknya jejenum (letaknya bagian kiri atas cavum abdomen)bagian kiri atas cavum abdomen)

–– 1/3 bagian anal1/3 bagian anal��ileum (letaknya ileum (letaknya cenderung bagian kanan bawah cenderung bagian kanan bawah cavum abdomen dan diatas cavum cavum abdomen dan diatas cavum pelvis)pelvis)

–– KeduaKedua--duanya terletak duanya terletak intraperitonealintraperitoneal��mesenteriummesenterium

–– Bedanya apa? (diameter, dinding, Bedanya apa? (diameter, dinding, vaskularisasi, villi chorialis, limfosit, vaskularisasi, villi chorialis, limfosit, lemak)lemak)

Small Intestine: Site of Digestion and Absorption

Intestinum Crassum

• Dimulai dari caecum—anus (sekitar 1.5 meter atau 4 feet 9 inches)

• Terdiri dari 3 bagian utama: CaecumCaecum, Colon , Colon dan Rectumdan Rectum.

• Bedanya dengan intestinum tenue?

(Taenia, haustra, appendix epiploica, dinding, diameter, gambaran pembuluh darah)

Intestinum Crassum• Caecum

– Letak di regio inguinal dextra

– Merupakan kantong buntu (p=6cm. L=7,5cm)

– Mesenterium (-) tapi punya lipatan(recessus)

– Terdapat valvula illeocaecalis�mencegah aliran balik fekal dari colon ke dalam intestinum tenue

– Vascularisasi: a. Caecalis anterior dan posterior

– Inervasi: parasimpatis�n.vagus; simpatis�pleksus mesenterica superior

– Makanan disini berisi:

• The undigested food (such as fiber)

• a small amount of water

• non absorbed vitamins and minerals or salts

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Large Intestine

•• Appendix vermiformisAppendix vermiformis

–– Letak di regio iliaca dextraLetak di regio iliaca dextra

–– Otot sempit berbentuk tabung berisi Otot sempit berbentuk tabung berisi banyak jaringan limfoidbanyak jaringan limfoid

–– Panjang=8Panjang=8--13 cm, melekat di juncture 13 cm, melekat di juncture ileocaecalis sekitar 2,5 cmileocaecalis sekitar 2,5 cm

–– Punya penggantungPunya penggantung��mesoappendixmesoappendix

–– Variasi letakVariasi letak

–– Vascularisasi: a. AppendicularisVascularisasi: a. Appendicularis

–– Inervasi: parasimpatisInervasi: parasimpatis��n.vagus; n.vagus; simpatissimpatis��segmen MS Vth Xsegmen MS Vth X

–– Belum diketahui fungsinya, tapi jika Belum diketahui fungsinya, tapi jika tersumbat atau tersumbat atau clogged dapat menyebabkan infeksi atau inflamasi�Appendicitis

Intestinum Crassum

Colon terdiri dari

– Colon Ascenden

• Letak kuadran kanan bawah di regio inguinal dextra sampai lumbal dextra

• Panjang 13-20 cm

• Membentuk flexura colli dextra(hepatica)

• Organ retroperitoneal

• Vascularisasi: a.coli dextra dan a.ileocolica

• Inervasi: parasimpatis�n.vagus; simpatis�MS VTh.X, pleksus mesentericus superior

Intestinum Crassum– Colon Tranversum

• Letak di regio umbilicalis

• Panjang 38 cm

• Organ intraperitoneal�mesocolon transversum

• Vascularisasi: a.coli media(2/3 proksimal), dan a.colica sinistra (1/3 distal)

• Inervasi: – 2/3 proksimal �parasimpatis�n.vagus; simpatis�pleksus mesentericus superior

– 1/3 distal�parasimpatis�n.splancnicus pelvicus; simpatis� pleksus mesentericus inferior

Intestinum Crassum

– Colon Descenden

• Letak kuadran kiri atas dan bawah di regio lumbal sinistra

• Panjang 20-25 cm

• Organ retroperitoneal

• Vascularisasi: a.coli sinistra dan a.sigmoidea

• Inervasi: parasimpatis�n.splanchnicus pelvicus; simpatis�pleksus mesentericus inferior

Intestinum Crassum– Colon Sigmoidea

• Letak pelvis dextra

• Berbentuk huruf “S”

• Organ intraperitoneal�mesocolon sigmoidea

• Vascularisasi: a.sigmoidea

• Inervasi: parasimpatis�n.splanchnicus pelvicus; simpatis�pleksus mesentericus inferior

• Karena mobilitasnya tinggi�dapat terlipat ke dalam mesocolonnya�volvulus

Intestinum crassum•• RectumRectum

– Panjang 12-13cm

– Menembus diafragma pelvis�canalis analis

– Bagian bawahnya melebar disebut ampulla recti

– Tunica muscularis: sirkuler(dalam) dan longitudinal (luar)

– Tunica mucosa dan stratum sirkuler membentuk 3 lipatan�plica transversa recti (variasi dalam jumlah dan posisinya)

– Vascularisasi: a.rectalis superior, media dan inferior

– Inervasi: parasimpatis dan simpatis oleh pleksus hypogastricus (peka terhadapa regangan)

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Intestinum crassum•• AnusAnus

– Panjang 4-5 cm

– Letak di cranial diafragma pelvis�bagian caudal anus

– Canalis analis ada lapisan khas�

• tunica mukosa

• Tunica Submukosa (columna anales, berisi plexus venosus rectalis interna)

– Tunica muscularis: sirkuler(dalam) dan longitudinal (luar)

– Vascularisasi: a.rectalis superior dan inferior

Intestinum crassum•• AnusAnus– Punya 2 muskulus sphingter

ani:• Internus�involunter

• externus=�volunter

– Inervasi:• Tunica mucosa ½ bagian atas

canalis analis�pleksus hypogastricus (respon terhadap regangan)

• Tunica ½ bagian bawah canalis analis�n.rectalis inferior(nyeri,raba,suhu,tekan)

• M.sphincter ani internus�pleksus hypogastricus inferior

• M.sphincter ani eksternus�n.rectalis inferior dan n.sacralis ke VI

Peritoneum

• Suatu memebran tipis yang melapisi dinding cavitas abdominalis dan melingkupi sebagian besar viscera

• 2 macam: peritoneum viscera dan parietal

• Ruang potensial (cavum peritoneum)

• Intraperitoneal: organ yang tertahan di cavum

• Retropeitoneal: organ-organ di luar cavum dengan hanya satu permukaan atau sebagian saja tertutup oleh peritoneum

• Cavum peritoneum dibagi 2: saccus major dan saccuc minor (bursa omentalis)

• Peritoneum dipersarafi oleh afferentes somatis yang dibawa oleh rami nervi spinalis�olehkarenanya sensitif terhadap rasa nyeri yang terlokalisasi

• Peritoneum visceralis dipersarafi oleh afferentes visceralis yang bersama dengan saraf otonom (simpatis dan parasimpatis) kembali ke SSP�aktivasi serabut-serabut saraf ini menyebabkan nyeri alih dan sensasi rasa tidak nyaman yang terlokalisasi dan menimbulkan refleks aktivitas motorium visceralis

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Omentum, mesenterium, dan

ligamentum• Ketiga struktur ini merupakan lipatan-lipatan

peritoneum yang menghubungkan organ-

organ satu dengan yang lain atau dengan

dinding abdomen

• Beberapa lipatan berisi pembuluh dan saraf

yang menyuplai viscera, sedangkan lipatan

yang lain membantu menjaga posisi viscera

sesungguhnya

• Omentum�terdiri dari dua lapisan

peritoneum, yang berjalan dari gaster dan

bagian pertama diodenum menuju viscera

lain. Ada dua jenis:

1. Mayus�berasal dari mesenterium dorsalis

2. Minus� berasal dari mesenterium ventralis

Omentum mayus

• Berisi akumulasi lemak, yang dapat membesar pada individu-individu tertentu

• Terdapat dua arteri dan vena:1. Vasa gastroepiploica dextra

2. Vasa gastroepiploica sinistra

• Struktur ini sering disebut sebagai “policeman of the abdomen”karena kemampuannya untuk bermigrasi ke daerah yang terkena inflamasi dan membungkus dinding organ yang terkena proses inflamasi tersebut

Omentum minus

• Membran tipis yang berkesinambungan dengan penutup peritoneum permukaan anterior dan posterior gaster dan bagian pertama gaster

• Terbagi dua:– Lig.hepatogastricum

– Lig.hepatoduodenale

• Terdapat Vasa gastrica dextra dan sinistra

• O.minus membungkus Trias porta (arteri hepatica propria, duktus choledochus, dan vena porta hepatis)

Mesenterium

• Lipatan ganda peritoneum yang luas, berbentuk kipas, yang menghubungkan jejenum dan ileum dengan dinding posterior abdomen

• Fungsinya: memungkinkan adanya pergerakan dan menyediakan tempat untuk lewatnya vasa, nervi dan lymphaticus untuk mencapai viscera

• Struktur ini adalah– Mesenterium�berhubungan dengan sebagian intestinum

tenue

– Mesocolon transversum�berhubungan dengan colon transversum

– Mesocolon sigmoideum�berhubungan dengan colon sigmoid

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Ligamentum

• Terdiri dari dua lapis peritoneum yang

menghubungkan dua organ satu dengan yang

lain atau melekatkan organ pada dinding

tubuh, dan dapat membentuk bagian dari

omentum

• Biasanya penamaan ligamentum ini sesuai

dengan struktur yang dihubungkan.

Food

enters

through

the oral

cavity

and exits

through

the anus

Food Pathway through the GI Tract

Gangguan sistem pencernaan

Aphthous Stomatitis• Aphthous Stomatitis is an illness that causes small ulcers to appear in the mouth,

usually inside the lips, on the cheeks, or on the tongue. This is also known as "canker sores."The exact cause of this disease is not known, but there are many factors that are thought to be involved with the development of canker sores, including:

• weakened immune system

• allergies to food such as coffee, chocolate, cheese, nuts and citrus fruits

• stress

• viruses and bacteria

• trauma to the mouth

• poor nutrition

• certain medications

Ulcers• An ulcer is erosion in the lining of the esophagus, stomach, or

duodenum. While acid is still considered significant in ulcer

formation, the leading cause of ulcer disease is currently believed to

be infection of the stomach by a bacteria called "Helicobacter

pyloricus" (H. pylori). Another major cause of ulcers is the chronic use

of anti-inflammatory medications.

ConstipationWhen you are not physically active, consuming dietary fibers, and/or become

dehydrated, you are likely to suffer from constipation. It is common for a

constipated person to experience uncomfortable bowel movements and also

feelings of and/or bouts of bloating. This condition usually happens when waste

substance remains too long in the colon, causing more and more water being

absorbed from the waste which also means the feces/stool passes along the large

intestine too slowly. The end result is the dry, lumpy and hard feces, that causes

difficulty and pain during defecation

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Diarrhea• Diarrhea most commonly happens when the intestines and part of the body

gets infected. When this condition happens, the colon is unable to absorb

water quickly enough from liquid waste. The waste is then pushed out of the

anus quickly and simultaneously, causing spasms within the muscles of the

colon, and/or within the abdominal area. Therefore, the feces passes along the

large intestine too quickly and the water is not able to be absorbed from the

waste. Diarrhea causes mushy, loose, watery feces/stool.

Colonic Polyposis• A polyp is an extra piece of tissue that grows inside your body.

Colonic polyps grow in the large intestine, or colon. Most polyps are

not dangerous. However, some polyps may turn into cancer or

already be cancer. To be safe, doctors remove polyps and test them.

Polyps can be removed when a doctor examines the inside of the

large intestine during a colonoscopy.

Ulcerative Colitis• Ulcerative colitis is a disease that causes ulcers in the lining of the rectum and

colon. It is one of a group of diseases called inflammatory bowel disease. Ulcers form where inflammation has killed the cells that usually line the colon.

• Ulcerative colitis can happen at any age, but it usually starts between the ages of 15 and 30. It tends to run in families. The most common symptoms are pain in the abdomen and bloody diarrhea. Other symptoms may include anemia, severe tiredness, weight loss, loss of appetite, and bleeding from the rectum.

Diverticulosis• Diverticulosis is a term for small Diverticulosis is a term for small Diverticulosis is a term for small Diverticulosis is a term for small outpouchesoutpouchesoutpouchesoutpouches, or sacs, that develop along an , or sacs, that develop along an , or sacs, that develop along an , or sacs, that develop along an

intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be intestinal wall, usually the colon. Once diverticulosis occurs, it cannot be reversed, if one of the pouches becomes impacted with waste material, it can reversed, if one of the pouches becomes impacted with waste material, it can reversed, if one of the pouches becomes impacted with waste material, it can reversed, if one of the pouches becomes impacted with waste material, it can lead to infection and inflammation. weakening of the walls of the colon due to lead to infection and inflammation. weakening of the walls of the colon due to lead to infection and inflammation. weakening of the walls of the colon due to lead to infection and inflammation. weakening of the walls of the colon due to aging and obesity are causative factors. Diverticulosis occurs mostly in people aging and obesity are causative factors. Diverticulosis occurs mostly in people aging and obesity are causative factors. Diverticulosis occurs mostly in people aging and obesity are causative factors. Diverticulosis occurs mostly in people over the age of 60, and more than half of the patients who develop it are over the age of 60, and more than half of the patients who develop it are over the age of 60, and more than half of the patients who develop it are over the age of 60, and more than half of the patients who develop it are markedly overweight.markedly overweight.markedly overweight.markedly overweight.

• Overuse of laxatives also weakens the colon. Overuse of laxatives also weakens the colon. Overuse of laxatives also weakens the colon. Overuse of laxatives also weakens the colon.

Colorectal CancerThe wall of the colon and rectum is made up of layers of tissues. Colorectal

cancer starts in the inner layer and can grow through some or all of the other

layers. The stage (extent of spread) of a cancer depends to a great degree on

how deep the cancer goes into these layers. Cancer that starts in these

different areas may cause different symptoms. But colon cancer and rectal

cancer have many things in common. In most cases, colorectal cancers

develop slowly over many years. It is now know that most of these cancers

start as a polyp -- a growth of tissue that starts in the lining and grows into

the center of the colon or rectum. This tissue may or may not be cancer. A

type of polyp known as an adenoma can become cancer. Removing a polyp

early may keep it from becoming cancer. Over 95% of colon and rectal

cancers are Adenocarcinomas.

Anal Fistula• An anal fistula is a small channel that develops between the end

of the bowel, known as the anal canal, and the skin near the anus

(opening where waste leaves the body).

• On the surface of the skin around the anus, one or more of the

fistula ends may be seen as holes. An anal fistula is painful and

can cause bleeding and discharge when passing stools.

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Hemorrhoids• Hemorrhoids, also called piles, are swollen and inflamed veins in your

anus and lower rectum. Hemorrhoids may result from straining

during bowel movements, sitting on the toilet to long, or from the

increased pressure on these veins during pregnancy. Hemorrhoids

may be located inside the rectum (internal hemorrhoids), or they

may develop under the skin around the anus (external hemorrhoids).

Anorexia: Anorexia nervosa is a type of Anorexia nervosa is a type of eating disorder. People who have anorexia have an intense fear of . People who have anorexia have an intense fear of

gaining weightgaining weight. They severely limit the amount of food they eat and can become dangerously thin. . They severely limit the amount of food they eat and can become dangerously thin.

Anorexia affects both the body and the mind. It may start as Anorexia affects both the body and the mind. It may start as dietingdieting, but it gets out of control. These , but it gets out of control. These

people think about food, dieting, and people think about food, dieting, and weightweight the majority of their day. They have athe majority of their day. They have a distorted body image.

When they look in the mirror, they see a fat person.

Literature

• Human Anatomy, First Edition McKinley & O'Loughlin

•• Atlas Atlas sobotasobota

•• Ethel Sloane, Ethel Sloane, AnatomiAnatomi dandan FisiologiFisiologi, , PenerbitPenerbit EGCEGC

•• Kyung Won Chung, Gross Kyung Won Chung, Gross AnatomiAnatomi, , PenerbitPenerbit BinarupaBinarupaAksaraAksara

•• Keith Keith L.MooreL.Moore dandan Arthur Arthur F.DalleyF.Dalley. . 2010. 2010. Clinically Clinically oriented Anatomyoriented Anatomy. 6 Ed.. 6 Ed.

• Seeley,R.R., Stephens,T.D., Tate,P.2003. Anatomy &

Physiology. McGraw Hill

Eat up!