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Integumentary System

Integumentary System. An Introduction to the Anatomy, Physiology, Pathology, Diagnostics, Theraputics, and Pharmacology. Integumentary System: Some Definitions:.

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Integumentary System

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  1. Integumentary System An Introduction to the Anatomy, Physiology, Pathology, Diagnostics, Theraputics, and Pharmacology

  2. Integumentary System: Some Definitions: • Integument = the covering layer of the body, consists of epidermis and dermis and structures contained in them. Largest organ system in the body. • Functions of the Integumentary System: • Protects against infectious and environmental hazards • Provides sensation (temperature, pain, pressure)

  3. Basic Layers of the Skin: • Epidermis • Outermost layer/ most superficial layer • Thicker (5 layers) in plantar and palmar areas • Has 4-5 sublayers or strata • Stratum corneum • Stratum germinativum (basal layer)

  4. Epidermal Strata: Some facts • Stratum Corneum: • More superficial layer • Made of dead flat cells • Cells filled with keratin • Hard protein that waterproofs body & retains fluids

  5. Epidermal Strata: Some facts • Stratum germinativum • Deeper strata of the epidermis • Living cells • Basal layer forms new cells to take the place of the keratinized cells above • Basal layer contains melanocytes • Contain melanin (a dark pigment) • Filter light, so protective • Account for skin color

  6. Additional terms: • Albinism—lack of melanin • Albino—a person with albinism

  7. Skin Layer: Dermis (corium) • Dermis • Deeper than the epidermis • Contains living tissue • Capillaries, lymphatic vessels • Nerve endings • Hair follicles • Sebaceous (oil) glands, sweat glands

  8. Hypodermis: the Subcutaneous Layer • Contains: • Loose connective tissue • Blood vessels • Adipose tissue (fat) • Functions: • Binds dermis to the underlying structures • Stores fats • Insulates and cushions the body • Regulates temperature

  9. Accessory Organs of the Skin • Glands, Hair, and Nails • Glands: • Sudoriferous glands • Make sweat, secretes it onto surface • Cools via evaporation, gets rid of waste, moistens the skin • Sebaceous glands • Make sebum, an acidic oily secretion • Helps protect skin against infection

  10. Additional Terms: • Ductules—small tubes or ducts connecting the sebaceous glands to surface • Acne—condition that may occur when the sebaceous ductules become obstructed. • Androgen—a sex hormone that regulates sebum production and secretion

  11. Hair: it’s almost everywhere • Histological parts of hair: • Shaft • Root—embedded in the dermis • Follicle—root + its covering layers • Melanocytes at the base of the follicle • Various amounts account for hair color • Vary with heredity and age • Papilla—capillaries’ covering layer at bottom of the follicle

  12. Additional terms: • Alopecia • Hair loss/baldness • Occurs when papillae die • May be due to • Illnesses • Age • Hormonal effects • Drug or radiation effects

  13. Accessory Organs of the Skin: Nails • Function: protects of distal ends of fingers and toes • Histological parts: • Root-keratinized cells at base of nail • Bed-epithelium layer under the nail to which the nail is attached • Body—the pink exposed part of the nail • Lunula-white semilunar shaped area near base • Nail growth occurs here

  14. Dermatological Combining Forms: • Fat = adipo-, lipo-, or steato- • Liposuction, steatorrhea, adipocere • Skin = cutaneo-, dermato-, dermo- • Cutaneous, dermatologist • Sweat = hidro-, sudoro- • hidroadenitis • Dry, scaly = ichthyo- • ichthyodermal

  15. More Combining Forms • Kerato- = hard tissues • Keratinization • Melano- = black, pigmented • Malignant melanoma • Myco- = fungal • dermatomycosis • Onycho- or ungu/ o- = nail • Onychomycosis, subungual hematoma

  16. Dermatological Combining Forms--continued • Pilo- or tricho- = hair • piloerection • Sclero- = hardening • scleroderma • Sebo- = sebaceous, sebum • Squamo- = scaly, flat cells (squamous) • Xero- = dry (xerodermia)

  17. Dermatology--Suffixes • -cyte • -derma = skin • Pyodermia, xerodermia, scleroderma • -therapy = treatment • Hydrotherapy, cryotherapy (liquid N2)

  18. Dermatology--Prefixes • An- = without • Anhydrous, anhidrosis • Dia- = through, across • diaphoresis • Epi- = above • epidermis

  19. Dermatology--Pathology • Primary lesions • Initial manifestation of the abnormal or altered tissue • Secondary lesions • Alterations that take place in the primary lesion due to infection, trauma, scratching, or progress of the disease

  20. Primary Lesions: • Macule • Flat, pigmented, less than 1 cm diameter • Papule • Elevated solid, less than 1 cm diameter • Nodule • Elevated solid, deeper than papule • Up to 2 cm diameter

  21. Primary Lesions: continued • Tumor • Elevated, solid lesion • Extends into subcutaneous and dermal layers • Over 2 cm diameter • Wheal • Elevated lesion • Skin edema

  22. Primary Lesions: Fluid-filled • Vesicle • Elevated, clear fluid-filled • Less than 0.5 cm diameter • Pustule • Elevated, pus-filled • Less than 1 cm. diameter • Bulla • Elevated, clear fluid-filled, over 1 cm diameter

  23. Secondary Skin Lesions: • Excoriation • Linear scratches, abraisions • Fissure • Crack or slit • Extends into dermis • Ulcer • Open wound • Extends into dermis

  24. Pathology: Burns • Sources of burn injury: • Thermal, chemical, electrical, radioactive • Local effects: • Skin and soft tissue destruction • Systemic effects: • May affect GI and pulmonary tracts, airway • Fluid loss, shock, dehydration • Secondary infection

  25. Burns: Depth of Injury • First Degree • Most superficial burn • Epidermis involved only • No blisters • Heal without scarring • S/S: pain, hyperesthesia, erythema, swelling

  26. Burns: Depth of Injury • Second Degree: • Deeper • dermis and epidermis involved • Vesicles or bullae form • painful • Usually no scar formation • slower healing

  27. Burns: Depth of Injury • Third Degree Burns: • Dermis and epidermis are destroyed • Damage to deeper tissues • Waxy, thickened surface • Painless • Heal with extensive scarring • Often require surgical procedures

  28. Burns: The Rule of Nines • Mathematical calculation for total body surface area (TBSA) involved in burn • Different formula for adult vs. child • Most of body parts are 9% TBSA or multiples of nine.

  29. Oncology • Neoplasm • Abnormal growths of new tissue • May be a nodule, macule, tumor, etc. • Malignancy • Cancerous growth • Cells are unlike the normal cells around them • Invades normal tissue • Metastasis • Spread of the primary tumor cells to other places in the body

  30. Cancer Treatment Modalities • Surgery • Full or partial resection, radical dissection • Chemotherapy • Immunotherapy • Biotherapy • Stimulation of patient’s own immune system • Radiation

  31. Tumor Grading & Staging: • Systems to describe the depth, maturity, severity of tumor and its spread • Grading • Stages I through IV • Microscopic appearance of tumor cells • Staging • TNM system • According to degree of metastasis

  32. Tumor Grading • Grade I • Well-differentiated cells • Best Prognosis • Grade II • Grade III • Grade IV • Most poorly-differentiated cells • Worst Prognosis

  33. TNM Staging System: • T • Presence or absence of tumor • Size and depth of local tissue invasion • Carcinoma in situ • N • Degree of regional lymph node involvement • M • Presence or absence of metastasis

  34. Neoplasms of the Skin • Basal Cell Carcinoma • Most common skin cancer • Structures involved • Hair follicles, basal cell layer • Slow growing • Develop crusting surfaces • Most common tumor in Caucasians • Metastases uncommon

  35. Squamous Cell Carcinoma • Arises from keratinizing epidermal cells • Caucasian males over 60 YOA • More invasive than BCC • In situ or invasive • Predispositions: • Radiation therapy, chronic skin irritation, topical carcinogen exposure, hereditary diseases, Bowen’s disease

  36. Malignant Melanoma: • Arises from abnormal melanocytes in a dark pigmented mole • Rarest of the skin cancers • Incidence is increasing • Most lethal of the skin cancers • Metastases common to liver, lungs, brain • Exposure to sunlight in childhood is a factor

  37. Dermatologic Terms: Diagnostic and Symptomatic • Abscess = walled-in area of purulence • Acne=disease of sebaceous glands and hair follicles • Bowen’s Disease=intraepidermal CA • Carbuncle= skin infection with multiple areas of drainage • Cellulitis • Comedo=acne skin lesion, whitehead

  38. Pathology Terms: continued • Decubitus Ulcer • Pressure sore or bed sore • Dermatomycosis • Fungal skin infection • Ecchymosis • Eczema • Acute or chronic skin inflammation • Erythema

  39. Pathological Terms: continued • Eschar • Damaged, hardened tissue • Furuncle • Infection of follicle that produces a boil • Hirsutism • Excessive hair growth • Impetigo • Skin infection with honey-colored crusting lesions • Keratosis • Hardened area/growth on skin (e.g. callus)

  40. Pathological Terms: • Lentigo • Brown macules, sun-exposed areas • Pallor • Pediculosis • lice infestation • Petechia • Pruritis

  41. Pathological Terms: • Psoriasis • Chronic skin disease • Red patches with dry, silvery scales on surface • Purpura • Bleeding disorder • Scabies = mite infestation, usually STD • Tinea = fungal skin disease • Urticaria = hives, allergic skin disorder

  42. Pathological Terms: • Vitiligo • Localized areas of pigment loss • Verruca • Viral etiology • Epidermal growths • Plantar, juvenile, or veneral warts

  43. Diagnostic Terms: • Skin Tests • Intradermal tests • Often to test for diseases • Diptheria or TB • Patch tests • Usually allergy testing • Scratch tests • Usually allergy testing

  44. Diagnostic Terms: • Surgical • Biopsy • Needle • Punch • Shave • Frozen section

  45. Therapeutic Terms: • Debridement • Dermabraision • Use of sandpaper, wire brushes • Used on scne scars, tatoos, wrinkles, etc. • Fulguration • Electrodesiccation • Use of high frequency electric sparks

  46. Theraputic Terms: • Chemical peel • Chemabraision • Use of chemicals to remove outermost skin layers • For scar tissue, keratoses • Cryosurgery • Use of subfreezing temps (liquid nitrogen) • Incision and Drainage (I & D)

  47. Pharmacological Terms: • Anesthetics • Lidocaine or bupivacaine • Antifungals • Clotrimazole or nystatin • Antihistamines • Diphenhydramine or hydroxyzine • Antiseptics • Chlorhexidine, hydrogen peroxide • Isopropyl alcohol

  48. Pharmacological Terms: • Corticosteroid anti-inflammatories • Hydrocortisone, triamcinolone • Keratolytics • EES, TCN, tretinoin (Retin-A) • Parasiticides • Lindane or permethrin • Protectives: • Various lotions, ointments, creams

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