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Integumentary System
PPT (P), Module (M), Book (B)
| Term | Definition |
|---|---|
| integumentary system | - consists of the skin and accessory structures, such as hair, glands, and nails - one of the more familiar systems of the body to everyone because it covers the outside of the body and is easily observed |
| Integument meaning | - covering |
| Major function of integumentary system | 1. Protection. 2. Sensation. 3. Vitamin D production. calcium homeostasis. 4. Temperature regulation. 5. Excretion. |
| two major tissue layers | (1) the epidermis and (2) the dermis |
| Epidermis | - the most superficial layer of skin - a layer of epithelial tissue that rests on the dermis - provides protection- - stratified squamous epithelium; in its deepest layers, new cells are produced by mitosis - avasucalar |
| Dermis (True skin/Corium) | - layer of dense connective tissue - 10 to 20 times thicker than the epidermis - responsible for most of the skin’s structural strength |
| subcutaneous tissue | - skin rests on it - a layer of connective tissue - is not part of the skin, but it does connect the skin to underlying muscle or bone |
| Analogy of epidermis, dermis and subcutaneous tissue | the subcutaneous tissue is the foundation on which a house rests, the dermis forms most of the house and the epidermis is its roof. |
| keratinization | -the cells change shape and chemical composition - the cells become filled with the protein keratin - cells move to surface, lose water and nuclei change |
| keratin | - makes them more rigid and durable |
| 5 strata of the epidermis | From the deepest to the most superficial, the five strata are the (1) strata basale, (2) stratum spinosum, (3) stratum granulosum, (4) stratum lucidum, and (5) stratum corneum |
| Stratum basale | - consists of cuboidal or columnar cells that undergo mitotic divisions about every 19 days. As cells move to the surface, changes in the cells produce intermediate strata |
| Stratum spinosum | - cells take on a flattened appearance and accumulate lipid-filled vesicles called lamellar bodies. |
| Stratum granulosum | - cells are flat and diamond shaped - cells accumulate more keratin and release the contents of the lamellar bodies to the extracellular space. - this layer have a characteristic of grainy appearance |
| Stratum lucidum | - thin, clear zone between the stratum granulosum and stratum corneum - present in certain areas of the body - no longer have nuclei or organelles, and as a result, the cells stain more lightly |
| Classification of skin based on the structure of the epidermis | thick skin & thin skin |
| Thick skin | has all five strata and is found in areas subject to pressure or friction, such as the palms of the hands, the soles of the feet, and the fingertips |
| Thin skin | lacks the stratum lucidum and covers the rest of the body. The terms thick skin and thin skin only refer to the number of epidermal strata and not to the overall thickness of the skin, which is determined by the dermis. |
| Stratum corneum | - most superficial stratum of the epidermis. It consists of dead squamous cells filled with keratin. - cells are also coated and surrounded by lipids released from the lamellar bodies of the skin cells. - lipids act as waterproofing material |
| structure of stratum corneum | - composed of 25 or more layers of dead squamous cells joined by desmosomes . Eventually, the desmosomes break apart, and the cells are sloughed from the skin. |
| Dandruff | - Excessive sloughing of stratum corneum cells from the surface of the scalp |
| Callus | - In skin subjected to friction, the number of layers in the stratum corneum greatly increases, producing a thickened area |
| Corn | - Over a bony prominence, the stratum corneum can thicken to form a cone-shaped structure called |
| Composition of dermis | - composed of dense collagenous connective tissue containing fibroblasts, adipocytes, and macrophages. - Nerves, hair follicles, smooth muscles, glands, and lymphatic vessels extend into the dermis |
| Collagen and elastic fibers | responsible for the strength of the dermis |
| Cleavage lines or tension lines | - more collagen fibers are oriented in some directions than in others. - and the skin is most resistant to stretch along these lines |
| Importance of cleavage lines | It is important for surgeons to be aware of cleavage lines. An incision made across the cleavage lines is likely to gap and produce considerable scar tissue, but an incision made parallel with the lines tends to gap less and produce less scar tissue |
| stretch marks | - If the skin is overstretched for any reason, the dermis can be damaged, leaving lines that are visible through the epidermis. - can develop when a person increases in size quite rapidly. |
| dermal papillae | - upper part of the dermis projections; contain many blood vessels - Blood flow through these vessels supplies the overlying epidermis with nutrients, removes waste products, and helps regulate body temperature. |
| friction ridges | - arranged in parallel, curving ridges that shape the overlying epidermis into patterns called as - impressions left on surfaces are fingerprints and foot - increase friction and improve the grip of the hands and feet |
| intradermal injection | delivers material to the blood slowly and is administered by drawing the skin taut and inserting a small needle at a shallow angle into the dermis; an example is the tuberculin skin test |
| subcutaneous injection | achieved by pinching the skin to form a “tent” and inserting a short needle into the adipose tissue of the subcutaneous tissue; an example is an insulin injection. |
| intramuscular injection | - delivers material to the blood faster than the other two - accomplished by inserting a long needle at a 90-degree angle to the skin into a muscle deep to the subcutaneous tissue. - used for most vaccines and certain antibiotics. |
| Several factors determine skin color | (1) pigments in the skin, (2) blood circulating through the skin, and (3) the thickness of the stratum corneum |
| Melanin | - group of pigments primarily responsible for skin, hair, and eye color - molecules are brown to black pigments, but some are yellowish or reddish. - provides protection against ultraviolet light from the sun. |
| Melanocytes | - produce melanin - irregularly shaped cells located between the stratum basale and the stratum spinosum. |
| Melanin protects a cell’s DNA from UV damage. Based on this information, around which cellular structure would you expect the melanosomes to congregate? | ❶ Within melanocytes, the Golgi apparatuses package melanin into vesicles called melanosomes ❷ Melanosomes move into the cell processes of the melanocytes. ❸ Epithelial cells phagocytize the tips of the melanocyte cell processes, thereby acquiring melan |
| Albinism | recessive genetic trait that causes a deficiency or an absence of melanin, resulting in fair skin, white hair, and unpigmented irises in the eyes. |
| Cyanosis | A decrease in the blood O2 content produces a bluish color of the skin |
| Carotene | - yellow pigment found in plants such as squash and carrots. - Humans normally ingest it and use it as a source of vitamin A. |
| Subcutaneous tissue or hypodermis | - skin rests on it - not part of the skin but instead attaches the skin to underlying bone and muscle and supplies it with blood vessels and nerves - loose connective tissue, including adipose tissue that contains about half the body’s stored lipids |
| accessory skin structures | - are attached to or embedded into the skin - hair, glands, and nails |
| Hair | - found everywhere on the skin, except on the palms, the soles, the lips, the nipples, parts of the genitalia, and the distal segments of the fingers and toes. |
| Hair Follicle | - hair arises from it - an invagination of the epidermis that extends deep into the dermis |
| Hair Shaft | - hair protrudes above the surface of the skin |
| Hair Root | - below the surface |
| Hair Bulb | - the expanded base of the root - hair is produced here - it lies on the hair papilla |
| Cortex (hair) | - it is a hard that surrounds the soft center, the medulla |
| Medulla | - soft center |
| Cuticle | - it covers the cortex - a single layer of overlapping cells that holds the hair in the hair follicle |
| Hair papilla | - an extension of the dermis that protrudes into the hair bulb. |
| Arrector pili | Smooth muscle attached to the hair follicle and dermis that raises the hair when it contracts. - Contraction of it causes the hair to become more perpendicular to the skin's surface or to “stand on end,” and it produces called a “goose bump.” |
| major glands of the skin | Sebaceous glands and sweat glands |
| Sebaceous glands | - are simple, branched acinar glands (see chapter 4). Most are connected by a duct to the superficial part of a hair follicle. They produce sebum |
| Sebum | - an oily, white substance rich in lipids. The sebum is released by holocrine secretion and lubricates the hair and the surface of the skin, which prevents drying and protects against some bacteria. |
| Sweat glands/Sudoriferous glands | - Usually, a secretory organ that produces a watery secretion, called sweat, that is released onto the surface of the skin; some sweat glands, however, produce an organic secretion. |
| 2 kinds of sweat glands | (1) eccrine and (2) apocrine |
| Eccrine sweat glands | - simple, coiled, tubular glands and release sweat by merocrine secretion. - refers to water-producing sweat glands - When the body temperature starts to rise above normal levels, the sweat glands produce sweat, which evaporates and cools the body |
| Apocrine sweat glands | - simple, coiled, tubular glands that produce a thick secretion rich in organic substances. - open into hair follicles, but only in the armpits and genitalia. - become active at puberty because of the influence of reproductive hormones. - body order |
| Nail | - a thin plate, consisting of layers of dead stratum corneum cells that contain a very hard type of keratin. - grow continuously and do not have a resting stage. - Parts: body, root, nail fold, cuticle - Scalelike modification of the epidermis |
| Nail body | - visible part of the nail |
| Nail root | - the part of the nail covered by skin |
| Cuticle (eponychium) | - stratum corneum that extends onto the nail body |
| Nail matrix | - nail root extends distally - epithelial tissue with a stratum basale that gives rise to the cells that form the nail - thicker than the nail bed and produces most of the nail |
| Nail bed | - nail also attaches to the underlying - located distal to the nail matrix |
| Lunula | - can be seen through the nail body as a whitish, crescent-shaped area at the base of the nail - small part of the nail matrix |
| Protection | - The skin provides protection against abrasion and ultraviolet light. It also prevents microorganisms from entering the body and reduces water loss, thus preventing dehydration. |
| Sensation | The integumentary system has sensory receptors that can detect heat, cold, touch, pressure, and pain. |
| Vitamin D production | When exposed to ultraviolet light, the skin produces a molecule that can be transformed into vitamin D, an important regulator of calcium homeostasis. |
| Temperature regulation | The amount of blood flow beneath the skin’s surface and the activity of sweat glands in the skin both help regulate body temperature. |
| Excretion | Small amounts of waste products are lost through the skin and in gland secretions |
| Jaundice | - yellowish skin color - occur when the liver is damaged by a disease, such as viral hepatitis |
| Burn | injury to a tissue caused by heat, cold, friction, chemicals, electricity, or radiation. Burns are classified according to their depth |
| Partial-thickness burns | - part of the stratum basale remains viable, and regeneration of the epidermis occurs from within the burn area, as well as from the edges of the burn. Partial-thickness burns are divided into first- and second-degree burns. |
| Division of partial-thickness burn | first- and second-degree burns |
| First-degree burns | - involve only the epidermis and are red and painful - slight edema, , or swelling, may be present - can be caused by sunburn or brief exposure to very hot or very cold objects, and they heal without scarring in about a week. |
| Second-degree burns | - damage both the epidermis and the dermis. - healing takes about 2 weeks and no scarring result - the epidermis, including the stratum basale where the stem cells are found, is damaged. |
| full-thickness burns, or third-degree burns | - epidermis and the dermis are completely destroyed, and recovery occurs from the edges of the burn wound - painless because sensory receptors in the epidermis and dermis have been destroyed - appear white, tan, brown, black, or deep cherry red. |
| Treatment of burn | - Intravenous fluids - High-protein, high-calorie diet - Antimicrobials - Debridement - Skin grafts |
| Fourth degree burn | - are extremely severe burns that affect tissues deeper than the subcutaneous tissue. These burns often damage muscle, bone, and other tissues associated with them |
| 3 Receptors | Tactile receptors, pain receptors, thermal receptors |
| Types of tactile receptors | 1) Free nerve endings 2) Merkel's Disc 3) Hair end organ 4) Ruffini endings 5) Pacinian corpuscles |
| Free nerve endings | – found in the skin & other tissues; detect touch & pressure |
| Meissner’s corpuscle | – have encapsulated endings; they are rapidly adapting touch receptor; present in the nonhairy parts of the skin (glabrous skin); abundant in lips, fingertips; sensitive to movement of very light objects over the surface of the skin |
| Merkel’s disc | – have expanded endings; they are slowly adapting touch receptors; often grouped together in a single receptor organ called Iggo dome receptor |
| Hair end organ | – detects mainly movement of objects on the surface of the body; slight movement of any hair on the body stimulates the nerve fiber entwining its base |
| Ruffini endings | – have expanded endings; they are slowly adapting touch receptor; found in the deeper layers of the skin & also in deeper tissues; detects heavy & continuous touch signals & pressure signals |
| Pacinian corpuscles | – have encapsulated endings; they are rapidly adapting touch receptors; lie immediately beneath the skin & also deep in the fascial tissues of the body; important for detecting tissue vibration |
| Pain Receptors | - all free nerve endings - They are widespread in the superficial layers of the skin & also in certain internal tissues like periosteum, arterial walls and joint surfaces |
| Thermal Receptors | - free nerve endings - located immediately under the skin at discrete but separated points - 2 types: responding to temperatures slightly above body temperature (warmth) & that respond to temperatures slightly below body temperature (cold) |
| Bacterial Infections | Acne Myonecrosis/Gas Gangrene Leprosy/Hansen’s Disease |
| Acne | - Pores become clogged by sebum, flaked skin and by the bacteria Propionibacterium acnes - Leads to the formation of blackheads, white heads & inflamed infected abscesses |
| Myonecrosis/Gas Gangrene | - Caused by Clostridium perfringens, a bacteria that produce necrotizing enzymes and toxins which rapidly destroy tissue especially muscle tissue |
| Leprosy/Hansen’s Disease | - Caused by Mycobacterium leprae, characterized by numerous nodules in skin, peripheral nerve involvement and loss of sensation |
| Skin Infections caused by Staph. aureus | Sty Folliculitis Furuncle (boil) Carbuncle Scalded Skin Syndrome Impetigo |
| Sty | - Inflammation of a sebaceous gland that opens into a follicle of an eyelash |
| Folliculitis | - Inflammation of a hair follicle |
| Furuncle (boil) | - A localized pyogenic infection of the skin usually resulting from folliculitis |
| Carbuncle | - A deep seated pyogenic infection of the skin usually arising from a coalescence of furuncles |
| Scalded Skin Syndrome | - The superficial layers of the epidermis slough off in response to the presence of exfoliatin |
| Impetigo | - Bullous lesions that rupture & form paper thin, white crusted lesions |
| Skin Infections caused by Streptococcus pyogenes: | Cellulitis Erysipelas Fasciitis Impetigo Scarlet fever |
| Cellulitis | - Warm, painful diffuse induration of the skin surrounded by erythema and edema |
| Erysipelas | - An acute cellulitis with fever & hot, tender red eruptions on the skin |
| Fasciitis | - Inflammation of the fascia (fibrous tissue that envelops the body beneath the skin, also encloses muscles) |
| Impetigo | - Vesicular, pustular lesions which rupture & form thick, honey colored crust |
| Scarlet fever | - Widespread pink/red rash on abdomen, sides of chest & skin folds |
| Viral Infections | Chickenpox/Varicella Shingles/Herpes Zoster Cold sores Rubella/German measles Measles/Rubeola Warts |
| Chickenpox/Varicella | - Caused by Varicella zoster virus; with pruritic vesicular rash found all over the body |
| Shingles/Herpes Zoster | - Caused by Varicella zoster virus; presence of fluid filled blisters accompanied by pain and paresthesia |
| Cold sores | - Caused by Herpes Simplex virus; small fluid-filled blisters that itch; seen around lips and in oral mucosa |
| Rubella/German measles | - Caused by Rubella virus; pink flat rash starting on the face and neck and spreads to the trunk, arms and legs - Clinical course is only 3 days |
| Measles/Rubeola | - Caused by Rubeola virus; red blotchy skin rash begins on the face and then becomes generalized |
| Warts | - Caused by human papilloma viruses |
| Fungal Infections | Dermatophytoses (tinea or ringworm infections) Tinea capitis – scalp Tinea barbae – beard area Tinea cruris – groin area Tinea corporis – trunk of the body Tinea pedis – foot Tinea unguium – nails |
| Arthropod Associated Lesions: | Scabies Pediculosis |
| Scabies | - A pruritic dermatosis caused by the mite Sarcoptes scabiei - Seen on the interdigital skin, palms, wrists, scrotal folds |
| Pediculosis | - A pruritic dermatosis caused by the head, body, or crab louse - The insect or its eggs can usually be seen attached to hair |
| Hereditary/Genetics | Psoriasis – a chronic condition characterized by reddened epidermal lesions covered with dry, silvery scales |
| Allergies | Contact dermatitis – itching, redness, swelling of the skin progressing to blistering; caused by exposure of the skin to chemicals that provoke allergic response |
| Decubitus Ulcer | Seen in bedridden patients who are not turned regularly • Blood supply to the area is restricted resulting to cell death • Permanent damage to superficial blood vessels result in degeneration & ulceration of the skin |
| Consequences of Burns | • Dehydration & electrolyte imbalance leading to kidney shutdown & circulatory shock • Infection = leading cause of death in burn victims |
| Rule of Nines | • Method used to calculate the percentage of body area burned |
| Management of Burns (1) | Immerse the burned part in cold or tap water, people with clothes on fire should not run, flames should be smothered by covering the bun victim w/ blanket or carpet • Maintenance of airway: endotracheal intubation • IV fluids • Tetanus prophylaxis |
| Management of Burns (2) - Wound Care | • Wound care: clean the area with soap & water, debridement, excisions, change the dressings regularly • Infection control: topical application antibacterial cream like silver sulfadiazine • Skin grafts |
| Management of Burns (3) - Environmental Care | Environmental control: isolate in private room or burn unit, proper hand washing before handling the patient, wear gloves, mask, cap, gown • Nutritional support: high calorie intake • Physical therapy: proper positioning, exercise |
| Skin Cancer | • Most important risk factor is over exposure to ultraviolet radiation in sunlight • Other predisposing factors include frequent irritation of the skin by infections, chemicals or physical trauma |
| Common Types of Skin Cancer | Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma |
| Basal Cell Carcinoma | • Least malignant ; most common skin cancer • Cells of the stratum basale proliferate & invade the dermis & subcutaneous tissue • Site: sun exposed areas of the face |
| Squamous Cell Carcinoma | • Arises from the cells of the stratum spinosum • Grows rapidly & metastasizes to adjacent lymph nodes • Site: scalp, ears, dorsum of hands, lower lip |
| Malignant Melanoma | • Cancer of melanocytes • Accounts for 5% of skin cancers • Site: wherever there is pigment; can appear spontaneously |
| Structures Found in Dermis | •Blood and lymph vessels •Nerves •Muscles •Glands •Hair follicles |
| Divisions of the Dermis | •Papillary •Reticular • Subcutaneous (hypodermis) |
| First Degree Burns - What to do | • Immerse in cold water 10 to 45 minutes or use cold, wet cloths. • Cold stops burn progression • NOT ice • May use other liquids • Aloe, moisturizer lotion |
| Second Degree Burns - What to do | • Immerse in cold water / wet pack • Aspirin or ibuprofen • Do not break blisters • May seek medical attention |
| Third Degree Burns - What to do | • Usually not necessary to apply cold to areas of third degree • Do not apply ointments • Apply sterile, non-stick dressings (do not use plastic) • Check ABC’s • Treat for shock • Get medical help |
| Recognition of Melanoma | recognition: • A - Asymmetry • B - Border irregularity • C - Colors • D - Diameter larger than 6 mm |
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