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Semester 4 > (A&P 400) Integumentary System > Flashcards

(A&P 400) Integumentary System Flashcards

1
Q

what is integumentary system

A

The integumentary system consists of the skin and various accessory structures

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2
Q

integument

A

Can be referred to as skin or integument

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3
Q

Integumentary system overview

A

.

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4
Q

what percetnage of body weight

A

12-16 % of total body weight

Largest organ in the body by weight

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5
Q

skin is

A

Body’s first line of defense against environment

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6
Q

TWO major components of integ system

A

​Cutaneous membrane

​Accessory structures

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7
Q

CUTANEOUS MEMBRANE

A

epidermis

dermis
–> papillary layer
–> reticular layer

(subcutaneous layer)
—> hypodermis
–> not part of cutaneous membrane?

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8
Q

ACCESSORY STRUCTURES

A

hair shaft

pore of sweat gland duct

tactile (Meissner’s) corpuscle

sebaceous glands

arrector pili muscle

sweat gland duct

hair follicle

Lamellar (Pacinian) corpuscle

Nerve fibres

sweat glands

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9
Q

functions of integumentary system

A

Protect underlying tissues and organs against impact, abrasion, fluid loss, chemical attack

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10
Q

function vs BLOOD

A

Acts as a blood reservoir (dermis)

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11
Q

epidermis not vascular, DERMIS VASCULAR

epidermis and cornea

A

At least four types of tissue. Don’t have a blood supply. One is in your cartilage. Another’s in your eye.

The third’s between your backbones. Between each vertebra. The nucleus pulposus. Is quite avascular.

The last is found all over. The outer part of skin. The epidermis layer. Does not have vessels in.

Fascia is a fifth

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12
Q

function vs temp

A

Maintain normal body temperature through either vasodilation, vasoconstriction, insulation or evaporative cooling, as needed

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13
Q

function vs excrete

A

Excrete salts, water, and organic wastes through integumentary glands

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14
Q

sensory function

A

Detect touch, pressure, pain, and temperature stimuli, and relay the information to the nervous system

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15
Q

functions overview

A

protect

blood reservoire

temperature hom

excretion

sensory

**

vitamin D

melanin

keratin

Store lipids

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16
Q

skin produce

A

Synthesizes vitamin D3

Produce melanin, which protects underlying tissue from UV radiation

Produce keratin, which protects against abrasion and serves as water repellent

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17
Q

integumentary system stores

A

Stores lipids in adipocytes in the dermis

and adipose tissue in the subcutaneous layer (HYPODERMIS)

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18
Q

​1) Cutaneous membrane

A

Epidermis (epi, above)
Composed of stratified squamous epithelium

Dermis
—> Papillary layer ((LOOSE) areolar connective tissue)
—> Reticular layer (dense irregular connective tissue)

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19
Q

Subcutaneous Layer

A

Subcutaneous Layer

Not technically a layer of the skin

Aka HYPODERMIS or SUPERFICIAL FASCIA

Separates integument from deep fascia

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20
Q

2) Accessory structures

A

Hairs

Nails

Exocrine glands

Sebaceous glands

Sweat glands

Sensory receptors and
nerve fibers

Arrector pili muscles

Cutaneous plexus (network of blood vessels)

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21
Q

EPIDERMIS

A

..

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22
Q

Basic Structure of the Epidermis

A

Superficial, thinner layer of the cutaneous membrane

Epithelial tissue

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23
Q

epidermis structure

A

Multiple layers (strata) of tightly packed squamous cells

Stratified squamous epithelium

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24
Q

epidermis is

A

Avascular

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25
Q

There are 4 major cell types in the epidermis:

A

Keratinocytes
—> The primary cell type in the epidermis

Melanocytes

Langerhans cells
(type of macrophage (WBC))
—> aka INTRAEPIDERMAL MACROPHAGE

Tactile epithelial cells
—> aka MERKEL cells

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26
Q

what does melanin do

A

Produce melanin, which protects underlying tissue from UV radiation

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27
Q

what does keratinocyte do

A

Produce keratin, which protects against abrasion and serves as water repellent

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28
Q

KERATINOCYTES

A

90-95% of epidermal cells

Produce and accumulate keratin (a tough, fibrous protein)

—> protects skin and underlying tissue from mechanical stress, heat, microbes, and chemicals

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29
Q

WHAT ELSE DO KERATINOCYTES PRODUCE

A

also produce LAMELLAR GRANULES

—> waterproof sealant

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30
Q

MELANOCYTES

A

produce melanin (pigment)

absorbs damaging ultraviolet (UV) light & contributes to skin colour

transfer melanin to keratinocytes via slender projections that extend between cells (dendrites)

inside keratinocytes, melanin covers & protects nuclear material

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31
Q

WHAT DOES MELANIN DO INSIDE KERATINOCYTES

A

inside keratinocytes, melanin covers & protects nuclear material

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32
Q

Langerhans Cells (AKA INTRAEPIDERMAL MACROPHAGES)

A

tissue-resident dendritic cell of the skin

small fraction of epidermal cells

derived from BONE MARROW STEM CELLS (WBC precursor/progenitor)

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33
Q

Tactile Epithelial Cells (aka Merkel cells)

A

least numerous of epidermal cells

contact a tactile disc (sensory structure)

function in the sensation of touch

EPITHELIAL CELLS THAT TRANSMIT TOUCH TO NERVOUS SYSTEM CELLS (??)

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34
Q

Epidermal layers overview

A

Entire epidermis lacks blood vessels

…

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35
Q

where do cells get O2/nutrient / recycle waste

A

Cells get oxygen and nutrients from capillaries in the dermis

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36
Q

how is epidermis structurally organized as a result of lack of BV

A

Cells with highest metabolic demand are closest to the dermis

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37
Q

how long does it take for new cells to move from deepest stratum layer to most superficial layer of epidermis (skin) ?

A

Takes about 7–10 days for cells to move from the deepest stratum to the most superficial layer

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38
Q

what happens to cells at superficial layer of epidermis?

A

Cells in surface layer (STRATUM CORNEUM) remain about 2 weeks before being shed or washed away

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39
Q

stratum corneum

A

The stratum corneum is the outermost layer of the epidermis and marks the final stage of keratinocyte maturation and development.

Keratinocytes at the basal layer of the epidermis are proliferative, and as the cells mature up the epidermis, they slowly lose proliferative potential and undergo programmed destruction.

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40
Q

epidermal layers – DEEP TO SUPERFICIAL (5 layers)

A

Stratum basale

Stratum spinosum

Stratum granulosum

Stratum lucidum (only in thick skin)

Stratum corneum

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41
Q

lucidum etymology

A

Etymology. From Latin tapetum (“tapestry”) and lūcidum (“bright, shining, clear”) the neuter of lūcidum, literally “bright tapestry”.

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42
Q

thin skin

A

Covers most of body surface

Contains four strata (layers) (NOT LUCIDUM)

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43
Q

Thick skin

A

Found on palms of hands and soles of feet

Contains five strata (layers)
—> including stratum lucidum

No hair

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44
Q

​Stratum basale

A

1 layer of cuboidal or columnar basal cells (basal keratinocytes)

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45
Q

stratum basale – how attach to basement membrane?

A

Attached to basement membrane by hemidesmosomes & to other cells via desmosomes

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46
Q

stratum basale – most cells are

A

Most cells here are basal cells, stem cells that divide to replace more superficial keratinocytes

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47
Q

which other cells present @ Stratum basale?

A

Also contains Merkel cells and melanocytes

MERKEL CELLS
–> closer to base = closer to nerve cell + plate that it attaches to and sends tactile signals toward

melanocytes?
—> possibly so melanocytes can receive O2/nutrients quicker to produce melanin more effectively

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48
Q

what happens if stratum basale is damaged?

A

If this layer is damaged, new skin cannot be generated (skin graft necessary)

—> (minor) damage = scars (?)

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49
Q

Stratum spinosum (“spiny layer” or “prickle layer”)

A

Composed of 8–10 layers of keratinocytes bound together by desmosomes

Provides strength and flexibility

Only looks spiny when on a prepared slide

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50
Q

spinosum etymlogy

A

The name spinosum is Latin for prickly, spiny,

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51
Q

what does Statum spinosum contain?

A

Contains Langerhans cells

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52
Q

why spinosum contain langerhans cells?

A

Langerhans cells are dendritic cells derived from the bone marrow in the stratum spinosum that have an immunologic function. They are identical to tissue macrophages and present antigens to lymphocytes.

CHATGPT
“Location and Function: The stratum spinosum is positioned just above the stratum basale (the deepest layer of the epidermis) and below the stratum granulosum. It’s a good location for Langerhans cells to carry out their function of detecting and processing antigens that penetrate the skin. Langerhans cells are crucial for initiating immune responses by capturing and presenting antigens to T cells.”

CHATGPT
“the stratum spinosum offers a strategic location for Langerhans cells to perform their role in immune defense while maintaining important interactions with other skin cells.”

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53
Q

note keratinocytes of Stratum Spinosum and MELANIN

A

melanin taken in by keratinocytes (endocytosis) from nearby melanocytes

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54
Q

​Stratum granulosum (“grainy layer”)

A

Composed of 3–5 layers of keratinocytes

Most cells have stopped dividing and started producing KERATIN and KERATOHYALIN

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55
Q

keratohyalin

A

Keratohyalin is a protein structure found in cytoplasmic granules of the keratinocytes in the stratum granulosum of the epidermis.

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56
Q

keratinocytes in stratum granulosum

A

Cells grow thinner and flatter

Cell membranes thicken and become less permeable

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57
Q

how is stratum granolosum significant (what does it mark?)

A

Marks the transition between the deeper, metabolically active strata and dead cells of superficial strata

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58
Q

stratum granulosum and LAMELLAR GRANULES

A

Contain LAMELLAR GRANULES that release water repellant lipid into cell spaces (of stratums granulosum, lucidum & corneum)

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59
Q

​Stratum lucidum (“clear layer”)

A

Found only in thick skin

3-5 layers of flat, dead cells that appear clear

Flattened, densely packed dead cells filled with KERATIN AND KERATOHYALIN

Adds additional layer of toughness to thick skin

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60
Q

Stratum corneum (cornu, horn)

A

Outermost, protective region with 15–30 layers of keratinized cells (filled with KERATIN)

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61
Q

what are cells of stratum corneum connected via?

A

Dead cells still tightly connected by desmosomes

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62
Q

are cells of stratum corneum waterproof? Or water-resistant?

A

Water resistant, not waterproof

Lose water through insensible perspiration (unable to see or feel) and sensible perspiration (sweat)

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63
Q

SENSIBLE VS INSENSIBLE PERSPIRATION

A

insensible perspiration (unable to see or feel) and sensible perspiration (sweat)

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64
Q

Epidermal Keratinization

A

stem cells divide to produce keratinocytes

As keratinocytes are pushed up towards the surface they accumulate keratin

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65
Q

Keratinization ?

A

replacement of cell contents with keratin

occurs as cells move to the skin surface over 4-6 weeks

they move further away from blood (O2) supply of dermis

gradually they die, are sloughed off, and replaced by cells moving up

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66
Q

NOTE EPIDERMAL GROWTH FACTOR (EGF)

A

epidermal growth factor (EGF) and other hormone-like proteins play a role in epidermal growth

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67
Q

Epidermal Ridges

A

Deeper layers of epidermis form epidermal ridges

Adjacent to dermal papillae (papilla, nipple-shaped mound)

Increase surface area for better attachment

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68
Q

Fingerprints vs Epidermal ridges

A

Pattern of epidermal ridges on surface of fingertips

Unique pattern that does not change during lifetime

Prints of these patterns (fingerprints) used to identify individual

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69
Q

Disorders of the Epidermis

A

..

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70
Q

Dandruff

A

excessive amount of keratinized cells shed from scalp

double the normal amount in larger clusters, becomes more visible

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71
Q

Dandruff – causes/ risk factors

A

Dry skin

Irritated, oily skin

Infections

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72
Q

Psoriasis

A

chronic skin disorder with genetic link

Cause poorly understood

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73
Q

psoriasis pathophysiology

A

Rapidly dividing keratinocytes

cells shed in 3 to 5 days as flaky silvery scales

immature keratinocytes produce abnormal keratin

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74
Q

psoriasis, distinctive feature

A

well-circumscribed (confined?) erythematous plaques with silvery-white scales

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75
Q

psoriasis, commonly found @

A

commonly found at extensor surfaces (knees, elbows), trunk, and scalp

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76
Q

psoriasis types

A

Plaque psoriasis

Nail psoriasis

Guttate psoriasis

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77
Q

Plaque psoriasis

A

Most common type

Described on previous slide

well-circumscribed erythematous plaques with silvery-white scales

commonly found at extensor surfaces (knees, elbows), trunk, and scalp

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78
Q

Nail psoriasis

A

Psoriasis affecting finger or toenails

causes pitting, abnormal nail growth and discoloration

Nail loss may occur

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79
Q

Guttate psoriasis

A

usually triggered by a bacterial infection such as strep throat

primarily affects young adults and children

Characterized by small, drop-shaped, scaling spots on the trunk, arms or legs

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80
Q

guttate define

A

resembling drops or characterized by markings that resemble drops.

gutta = drop
guttatus = speckled

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81
Q

Calluses and Corns

A

Increased pressure or irritation of the skin leads to HYPERKERATOSIS

Increased keratinocytes in the stratum corneum leads to thickened skin

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82
Q

hyperkeratosis define

A

abnormal thickening of the outer layer of the skin.

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83
Q

Corns

A

Smaller, deeper than calluses

have a hard center surrounded by swollen skin

May be painful when pressed

form on the top of the toes or the outer edge of the small toe

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84
Q

calluses are…

where do they develop?

A

rarely painful

develop on pressure spots, such as the heels, the balls of the feet, the palms and the knees

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85
Q

Dermis overview

A

Layer between the epidermis and subcutaneous tissue (hypodermis)

Connective tissue layer

Highly vascular

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86
Q

Dermis components

A

FIBRES:
collagen fibres
elastic fibers

CELLS:
fibroblasts
macrophages
fat cells
hair follicles

Glands

Nerves

Blood vessels

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87
Q

Dermis – fibres

A

collagen fibres
—> provide tensile strength (resist pushing and pulling)

elastic fibers
—> provide extensibility (ability to stretch) & elasticity (return to original shape)

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88
Q

Dermis – Cells

A

Fibroblasts
—> secrete ground substance & extracellular matrix

Macrophages
—> phagocytize bacteria & cellular debris

Adipocytes
—> store triglycerides

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89
Q

two distinct layers of the dermis:

A
  1. Papillary Region
    —> superficial 20% of dermis
  2. Reticular Region
    —> deep 80% of dermis
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90
Q

1) Papillary layer of dermis

A

Named for dermal papillae in this region
—> anchor to epidermis

Composed of areolar tissue
—> thin collagen
—> elastic fibers

Provides cushioning

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91
Q

note way to remember papillary region being compose of AREOLAR CT

A

areolar etymology
—> “areola (n.)​​ ‘colored circle around a nipple’ (areola papillaris), 1706, from Latin areola, literally “small area,” diminutive of area”

papillary etymology
—> “‘of, pertaining to, or resembling a nipple,’ 1660s, from Latin papilla “nipple” (see papilla) + -ary.”

Note again –> papillary region is like a “cushion” (like breasts)

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92
Q

Note the vasculature in PAPILLARY REGION

A

Contains:

—> capillary loops that feed epidermis

—> corpuscles of touch

—> free nerve endings for sensations of heat, cold, pain, tickle, and itch

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93
Q

do corpuscles of touch & other nerve endings connect to TACTILE EPITHELIAL CELLS?

A

presumably yes (?)

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94
Q

2) ​Reticular layer of dermis

A

Interwoven meshwork of dense irregular
connective tissue

—> with thick COLLAGEN and ELASTIC FIBRES

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95
Q

why dense irregular

A

force from various directions

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96
Q

reticular layer contains

A

blood and lymphatic vessels

nerve fibers

accessory organs (hair follicles, sebaceous and sudoriferous glands)

adipocytes
(note that fat is in dermis (cutaneous) as well as hypodermis (subcutaneous)

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97
Q

compare CONTENTS of papillary vs reticular layer

A

PAPILLARY
= capillary loops,
corpuscles of touch,
free nerve endings

RETICULAR
= BV, LV,
nn fibres (not just ends)
= accessory organs,
adipocytes

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98
Q

IMPORTANT NOTE ABOUT RETICULAR LAYER OF DERMIS

A

even though RETICULAR is in the name, it is NOT composed of reticular (LOOSE) CT

It is composed of DENSE IRREGULAR CT

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99
Q

biggest difference of contents between papillary and reticular layers of dermis

A

reticular layer contains ACCESSORY ORGANS and ADIPOCYTES

reticular layer contains the BV/nn FIBRES – NOT JUST THE loop/ends

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100
Q

disorders of DERMIS

A

..

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101
Q

Striae (Stretch Marks)

A

Excessive or quick stretching of the skin leads to dermal scarring

Dermis is torn, replaced with scar tissue

Most fade with time although may always be there

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102
Q

Striae causes, risk factors

A

Weight gain, muscle gain, or rapid growth

Pregnancy

Excess cortisol (Cushing syndrome)

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103
Q

SUBCUTANEOUS LAYER (aka HYPODERMIS or SUPERFICIAL FASCIA)

A

Fascia = sheet

In the body, fascia attaches, wraps, and/or separates deep structures

There is superficial and deep fascia

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104
Q

Subcutaneous layer (not part of skin)

A

Connective tissue that separates skin from deeper structures

Dominated by adipose tissue
—> Protect and support
—> Important energy storage site

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105
Q

Adipose accumulation pattern (men)

A

Neck, arms, lower back, buttocks

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106
Q

Adipose accumulation pattern (women)

A

Breasts, buttocks, hips, thighs

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107
Q

where does fat not generally accumulate regardless of gender?

where does it tend to accumulate regardless of gender?

A

Few cells on back of hands and surfaces of feet

More in abdominal region

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108
Q

the myth of the superficial fascia…

A

Fascial adhesions
Fascial stretching
Myofascial release

See —>
https://yogainternational.com/article/view/fascia-myths-and-fascia-facts/

summary:
Myth #1: Rolling on foam rollers and other massage tools breaks down fascial adhesions, knots, and scar tissue.

Myth #2: We feel pain in our bodies because our fascia is full of knots, adhesions, and scar tissue.

Myth #3: Our fascia can become dehydrated and rolling on massage tools helps to rehydrate it.

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109
Q

Burns

A

Burns are significant injuries

Can damage large areas of skin compromising many essential functions

also…
—> Dehydration and electrolyte imbalance can lead to:
—> Kidney impairment and circulatory shock (hypovolemic)

110
Q

severity of burn depends on

A

Depth of penetration

Total area affected

111
Q

severity rated as

A

Severity is rated as 1st Degree – 3rd Degree burns

112
Q

First-degree burns

A

Partial-thickness burns are either first or second degree burns

Only the surface of the
epidermis affected

E.g.
most sunburns

113
Q

Second-degree burn

A

Entire epidermis and maybe some of dermis damaged

Accessory structures not affected

Blistering, pain, and swelling occur
—> Infection can develop from ruptured blisters

Healing takes 1–2 weeks

114
Q

Third-degree burns

A

Full-thickness burns are considered third degree burns

Destroys epidermis, dermis, and damage extends into subcutaneous layer

Less painful than second-degree burns (*)
—> Burns nervous structures/nociceptors

Extensive burns of this type cannot repair themselves
—> SKIN GRAFTING usually necessary

115
Q

Evaluating burns in a clinical setting

A

Depth of burns
—> Assessed with a pin
—> Absence of reaction to pin prick indicates third-degree burn (loss of sensation)

Percentage of skin that has been burned
—> RULE OF NINES
= Method of estimating percentage of surface area affected by burns
= Modified for children (different body proportions)

116
Q

Emergency treatment of burns

A

Replacing lost fluids and electrolytes

Providing sufficient nutrients
—> Increased metabolic demands for thermoregulation and healing

Preventing infection
—> Cleaning and covering burn
—> Administering antibiotics

Assisting tissue repair with skin grafts
—> Areas of intact skin are transplanted to cover the burn site

117
Q

Skin grafts

A

SPLIT-THICKNESS GRAFT
(transfer of epidermis and superficial portions of dermis)

FULL-THICKNESS GRAFT
(transfer of epidermis and both layers of dermis)

118
Q

sources of graft

A

Autograft—patient’s own undamaged skin
—> Best choice if possible; no rejection by immune system

Allograft—frozen skin from a cadaver

Xenograft—animal skin

119
Q

Factors influencing skin color

A

Presence of 3 pigments

120
Q

3 pigments

A

Melanin

Carotene

Hemoglobin

121
Q

other factors that determie skin tone

A

Degree of dermal blood circulation

Thickness and degree of keratinization in the epidermis

Amount of exposure to ultraviolet (UV) radiation

122
Q

Amount of exposure to ultraviolet (UV) radiation

A

Can increase pigmentation even though skin color genetically determined

123
Q

Melanin

A

Produced by melanocytes in stratum basale

Differences in skin pigmentation are from amount of melanin produced, not from NUMBER/TYPE of melanocytes

124
Q

melanin is

A

Packaged into melanosomes (vesicles)

125
Q

melanosomes go

A

Melanosomes transferred to keratinocytes

126
Q

melanosome – VARY how DEPENDING ON SKIN COLOUR ???

A

Size of melanosomes and point of transfer varies with skin color

127
Q

2 types of melanin

A

Eumelanin

Pheomelanin

128
Q

Eu =

A

good

129
Q

pheo =

A

grey

130
Q

Eumelanin

A

Brown, yellow-brown, or black pigment

131
Q

Pheomelanin

A

Pink, red or yellow pigment

Hair, freckles, lips, nipples

132
Q

Melanin made from (structure)

A

Made from tyrosine

(non-essential amino acid)

133
Q

phenylketonuria, tyrosine, and skin tone

A

“Symptoms of untreated PKU include: Eczema. Skin and/or hair discoloration (LIGHTER compared to other members of their family). Small head size (microcephaly).”

“Because tyrosine is made from phenylalanine, people with PKU can be deficient in tyrosine.”

134
Q

melanin function

A

Protect genetic material from UV radiation

135
Q

2) Carotene

A

orange-yellow pigment

from food

Beta carotene is a precursor of vitamin A

also helps protect the skin

136
Q

Effects of blood supply on skin color

A

Hemoglobin is red pigment found in red blood cells

Blood flows to dermis through SUBPAPILLARY PLEXUS

More blood flow to region results in redder color (erythema)

137
Q

Less blood flow to region initially results in pale color

A

Sustained reduction of blood flow decreases available oxygen

From surface view, skin has bluish color (cyanosis)

Most apparent in very thin skin (lips, beneath nails)

138
Q

SUBPAPILLARY PLEXUS

A

lead to capillary loops of papillary dermis

139
Q

Erythema

A

redness of skin due to enlargement of capillaries in dermis

during inflammation, infection, allergy or burns

140
Q

Cyanosis

A

bluish color to nail beds and skin

hemoglobin depleted of oxygen looks purple-blue

141
Q

Pallor

A

paleness may be due to shock or anemia

142
Q

Jaundice

A

Yellowing of the skin due to increased bilirubin

Due to prehepatic, hepatic, or extrahepatic causes

(See notes from 200FT AP/300PT AP)

143
Q

Albinism

A

inherited inability to produce melanin d/t mutation in one of the genes involved with melanin production
E.g.
—> melanocytes inability to produce tyrosinase

melanin not present in hair, eyes or skin

affects vision and sunburn easily

144
Q

Vitiligo

A

A chronic, usually progressive disorder causing depigmentation

complete or partial loss of melanocytes causing light colored patches

autoimmune condition in which antibodies attack melanocytes

145
Q

Freckles (ephelides)

A

Local increase in concentration of melanin (no extra melanocytes)

Genetic component

Darken due to sun exposure

Lighten in the winter

146
Q

ephelides etymology

A

Borrowed from Ancient Greek ἔφηλῐς (éphēlis, “a freckle”),

from ἐπ- (ep-, “upon, over, epi-”) +‎ ἥλῐος (hḗlios, “the sun”) +‎ -ῐς (-is, nominal suffix).

147
Q

Age Spots (liver spots or solar lentigo)

A

liver spots is misnomer –> nothing to do with liver

accumulations of melanin over time due to long term sunlight exposure

flat blemishes, light brown to black (darker than freckles)

don’t fade in winter, common in adults over 40

148
Q

lentigo etymology

A

late Middle English (denoting a freckle or pimple): from Latin, from lens, lent- ‘lentil’.

149
Q

Moles (melanocytic nevi)

A

benign over-growth of melanocytes

can be congenital or acquired

Acquired moles are due to a combination of genetics and exposure to UV radiation, but it is poorly understood

may be flat or raised

150
Q

nevi (nevus) etymology

A

Nevus (plural: nevi) is the medical term for a mole

“The term originates from nævus, which is Latin for ‘birthmark’”

151
Q

How to know if a mole is concerning?

A

atypical or dysplastic nevi may indicate melanoma

The ABCDEs of moles
A = asymmetry
B = borders
C = color
D = diameter
E = evolving

152
Q

Malignant melanoma

A

Main cause is UV light exposure

Extremely dangerous

Cancerous melanocytes grow rapidly and metastasize through lymphatic system

153
Q

malignant melanoma – survival rate depending on detection

A

If detected early and removed surgically, the 5-year survival rate is 99 percent

If not detected until after metastasis, the 5-year survival rate drops to 14 percent

154
Q

Basal cell carcinoma (BCC)

A

Most common form of skin cancer

Originates in stratum basale due to mutations caused by overexposure to UV radiation

155
Q

basal cell carcinoma appearance

A

Appears as transparent or pearly white nodule

(Although there is a variety of appearance)

156
Q

Basal cell carcinoma survival rate

A

Virtually no metastasis and most people survive

100% 5-year survival rate

157
Q

Squamous cell carcinoma (SCC)

A

Second most common form of skin cancer

Originates in squamous cells of the surface layers of the skin

Caused by overexposure to UV radiation

158
Q

stratum corneum and stratified squamous cells

A

In the epidermis of skin in mammals, reptiles, and birds, the layer of keratin in the outer layer of the stratified squamous epithelial surface is named the stratum corneum.

Stratum corneum is made up of squamous cells which are keratinized and dead. These are shed periodically.

159
Q

stratum corneum (cornu = horn)

A

outer most layer as protection

“horns” protect

160
Q

squamous cell carcinoma metastasis?

A

More likely to metastasize than BCC, but still very rare

5-year survival rate is 99%, especially if detected early

161
Q

Accessory Structures of the Skin

A

Hair, Sebaceous Glands, Sweat Glands, Nails

162
Q

Hair follicles

A

Produce hairs that protect skull

Produce hairs that provide delicate touch sensations

163
Q

Exocrine glands

A

Sweat glands

Sebaceous glands

164
Q

Sweat glands

A

assist in thermoregulation and excrete wastes

165
Q

Sebaceous glands

A

lubricate epidermis

166
Q

Nails

A

Protect and support tips of fingers and toes

167
Q

Hair overview

A

Hair is composed of dead, keratinized cells produced in a specialized hair follicle

Found almost everywhere on the body

Each hair produced by a HAIR FOLLICLE

168
Q

where is hair not found

A

Except palms of hands, sides and soles of feet, sides of fingers and toes, lips, parts of external genitalia

169
Q

a hair follicle

A

Complex structure composed of epithelial and connective tissue that forms a single hair

170
Q

Functions of hair

A

senses light touch
= hair root plexus

PROTECTION
= head hair: protects scalp from injury & UV light
= eyelashes & eyebrows: protect eyes from foreign particles
= body: prevents abrasions

prevents heat loss

171
Q

Hair regions

A

Hair shaft
—> begins deep within hair follicle, but can be seen on the surface

Hair root
—> anchors the hair into the skin
—> Extends from base of follicle to point where hair shaft loses connection with follicle walls

(???)

172
Q

The hair shaft and root have 3 layers of cells:

A

Medulla

Cortex

Cuticle

173
Q

medulla (hair)

A

maybe absent in thin hair

where pigment cells are

174
Q

Cortex (hair)

A

major part of hair shaft

175
Q

Cuticle (hair)

A

single layer of thin, flat, heavily keratinized cells

176
Q

cuticle etymology

A

from Latin cuticula, diminutive of cutis ‘skin’.

177
Q

Medulla or core of hair contains ?

A

Contains flexible, SOFT KERATIN

178
Q

Cortex contains

A

Contains thick layers of HARD KERATIN

Gives hair stiffness

179
Q

Cuticle contains

A

Contains HARD KERATIN

Thin, but very tough

180
Q

what about HAIR FOLLICLE

A

Found in the dermis

Site of hair growth

The hair follicle regulates hair growth

181
Q

hair follicles are extensions of…

A

“The hair follicles are downgrowths of the epidermis in which an ordered array of keratinized cells is gradually pushed upward in the form of hair shafts”

“extend into the first and second layer of your skin and sometimes into the third layer (subcutaneous tissue)”

182
Q

Hair follicle structure

A

Internal root sheath

External root sheath

Glassy membrane

Connective tissue sheath

hair bulb

hair papilla

Hair matrix

183
Q

Internal root sheath

A

Surrounds hair root and deeper portion of shaft

Produced from hair matrix

184
Q

External root sheath

A

Extends from skin surface to hair matrix

185
Q

Glassy membrane

A

Thickened, clear basement membrane

186
Q

Connective tissue sheath

A

Surrounds the epithelial cells of the hair follicle

187
Q

hair papilla

A

(connective tissue papilla)

continuous with CONNECTIVE TISSUE SHEATH

188
Q

hair bulb

A

expanded base of hair follicle

(contains hair papilla –> AKA connective tissue papilla)

189
Q

Hair matrix

A

actively dividing basal cells in contact with hair papilla

(in diagram, arrow basically points towards very base of the hair root (within the medulla))

190
Q

Associated structures (hair)

A

..

191
Q

Root hair plexus

A

collection of sensory nerves surrounding the base of the follicle

192
Q

Arrector pili

A

smooth muscle attached to hair follicle; contraction pulls hair erect

193
Q

Sebaceous gland

A

produces secretions to coat hair and skin surface

194
Q

Hair growth

A

..

195
Q

Hairs grow and shed in hair growth cycle in 4 stages

A

1) Anagen Phase (Active or Growth Phase)

2) Catagen Phase (Regression Phase)

3) Telogen Phase (Resting Phase)

4) Exogen Phase

196
Q

different lengths of uncut hairs?

A

(Variations in growth rate and duration of cycle result in different lengths of uncut hair)

(Shed about 50-100 hairs per day)

197
Q

hair growth phases, etymology

A

ana = to grow or change in place; functionally similar

cata = reverse, backward, degenerative

telo = complete; completion; finished
= end

exo = outside; external

198
Q

1) Anagen Phase (Active Phase)

A

hair matrix cells actively dividing to produce length

lasts 2–6 years

Hair grows at rate of 0.33 mm/day (0.5 inches per month)

199
Q

2) Catagen Phase (Regression Phase)

A

hair matrix cells stop dividing

hair follicle atrophies

2-3 weeks in head hair

200
Q

3) Telogen Phase (Resting Phase)

A

Lasts 3-4 months

Hair loses attachment to follicle

Becomes club hair

Club hair is shed when follicle is reactivated and new hair formation begins

201
Q

4) Exogen Phase

A

Club hair falls out of follicle

202
Q

Rate of growth & replacement cycle dependent on:

A

Genetics

Nutrition

Gender (hormones)

203
Q

hair growth can be affected by

A

Illness

radiation/chemo, surgery, medicaitons

blood loss

severe emotional stress

hormones (DHT)

203
Q

Two types of hair

A

Terminal hairs

Vellus hairs

204
Q

Terminal hairs

A

Large, coarse, darkly pigmented

hairs found on scalp, armpit, eyebrows, eyelashes, facial hair, chest, pubic regions

205
Q

Vellus hairs

A

Smaller, shorter, delicate

Found on general body surface

206
Q

what happens to vellus hairs at puberty? (males)

A

at puberty vellus hair replaced by terminal hair in response to androgens produced in testes & adrenal cortex

207
Q

terminal vs vellus hair ratio – men vs women

A

Adult males
95% terminal hair
5% vellus hair

Adult females
35% terminal hair
65% vellus hair

208
Q

Hair color?

A

Due to melanin produced by melanocytes

Melanocytes scattered into matrix of hair bulb

Melanin passed into keratinized cortex & medulla cells of hair

209
Q

melanin type, hair

A

dark hair: eumelanin

blond/red hair: pheomelanin

gray hair: decreased melanin production d/t progressive decline in tyrosinase

210
Q

Hair Conditions

A

..

211
Q

Alopecia

A

partial or complete loss of hair

may be caused by genes, aging, endocrine disorders, chemotherapy, skin disease

212
Q

chemotherapy and hair loss

A

drugs kill rapidly dividing cells such as hair matrix cells

the 15% of hairs in resting stage are not affected

213
Q

WHICH HAIRS NOT AFFECTED BY CHEMOTHERAPY

A

the 15% of hairs in resting stage are not affected

(TELOGEN PHASE – STAGE 3)

214
Q

Androgenic Alopecia

A

Male Pattern Baldness

genetically predetermined disorder due to an excessive response to androgens (DHT)

215
Q

Hirsutism

A

excessive body hair or body hair in uncommon areas in females or prepubertal males

216
Q

Hirsutism causes

A

Poly Cystic Ovarian Syndrome

Cushing syndrome (excess cortisol)
–> note also listed as risk factor for striae (stretch marks)

Congenital adrenal hyperplasia

Functional tumors of the ovaries or adrenal glands (androgen secreting)

Medications

217
Q

hirsutism etymology

A

The word is from early 17th century: from Latin hirsutus meaning “hairy”.

218
Q

Sebaceous glands

A

Holocrine exocrine glands that discharge an oily lipid secretion onto skin

Located in the dermis

Associated with hair (so absent on palms, soles of feet)

219
Q

sebaceous glands vs arrector pili muscles

A

Contractions of arrector pili muscle cause release of SEBUM onto follicle and skin surface

220
Q

sebum (from sebaceous glands)

A

Mixture of triglycerides, cholesterol, proteins, and electrolytes

Lubricates and moisten hair shaft and is antimicrobial

221
Q

Sudoriferous or Sweat glands

A

Located in dermis

Produce watery secretion

222
Q

which muscles squeeze sudoriferous (sweat) glands?

A

Myoepithelial cells (myo-, muscle)

Squeeze gland to discharge secretion

223
Q

Two types of sudoriferous glands

A

​Eccrine sweat glands

​Apocrine sweat glands

224
Q

sudoriferous etymology

A

late 16th century (in the sense ‘sudorific’): from late Latin sudorifer (from Latin sudor ‘sweat’) + -ous.

225
Q

Eccrine sweat glands

A

Secrete directly onto surface of the skin

Highest number found on palms (~500 glands/cm2 [~3000/in.2]) and soles

Present at birth

Produce watery secretions with electrolytes

Important in thermoregulation and excretion of wastes

Stimulated during emotional stress (cold sweat)

226
Q

Apocrine sweat glands

A

Found in axillae, groin, around nipples, and in pubic region

Ducts open into hair follicle

Active after puberty
—> play a role in “body odour”

Produce sticky, cloudy, odorous secretion with complex composition

Strongly influenced by hormones
—> Stimulated during emotional stress & sexual excitement

Include CERUMINOUS glands and mammary glands

227
Q

ducts open where?

A

apocrine:
Ducts open into hair follicle

eccrine:
directly onto surface of the skin

228
Q

secretion quality?

A

apocrine:
sticky, cloudy, odorous secretion with complex composition

eccrine:
watery secretions with electrolytes

229
Q

why apocrine has disctinct smell?

A

due to interaction with bacteria on skin, not secretion itself

230
Q

Ceruminous Glands

A

modified sudoriferous glands in external auditory meatus (EAM)

duct opens into external auditory meatus or into ducts of sebaceous glands there

secretory portion in subcutaneous layer

begins to function soon after birth

231
Q

what does ceruminous gland do?

A

Produces CERUMEN:

waxy/lubricating
waterproofs canal
barrier to foreign bodies

232
Q

Conditions of Glands of the Skin

A

..

233
Q

Pimples (comedones)

A

Increased sebum blocks sebaceous duct and hair follicle

234
Q

Acne

A

Numerous pimples caused by excessive sebum production or bacterial inflammation of sebaceous glands

Hormonal connection

235
Q

Impacted Cerumen

A

abnormal amount of cerumen in EAM can prevent sound from reaching ear drum

May be structural

236
Q

Accessory Structures: Nails

A

Thick sheets of tightly packed keratinized epidermal cells

237
Q

nails function

A

Protect exposed dorsal surfaces of tips of fingers and toes

Help limit distortion of digits under physical stress

counter-pressure to palmar surfaces of fingers
—> enhance touch perception and manipulations

allow grasping & manipulation of small objects

scratch & groom the body

238
Q

fingernail parts

A

Nail body

Nail bed

Lunula

Free Edge

Nail Root

239
Q

Nail body

A

Bulk of the visual part of the nail

pink underneath due to capillaries in dermis

240
Q

Nail bed

A

Skin underneath the nail

241
Q

Lunula

A

white crescent shaped area at proximal end of nail body

capillaries don’t show through the thickened epithelium in this area

242
Q

Free Edge

A

may extend past the distal end of the digit

white because absence of capillaries underneath

243
Q

Nail Root

A

portion of nail buried in a fold of skin

244
Q

Eponychium (epi-, over; onyx, nail)

A

Portion of stratum corneum of nail root extending over exposed nail

Also known as CUTICLE

245
Q

Hyponychium

A

Area of thickened stratum corneum under free edge

246
Q

Nail matrix

A

proximal portion of the epithelium deep to the nail root

cells divide mitotically to produce new nail cells

growth influenced by age, health, nutritional status, season, time of day and environmental temperature

247
Q

AGE-RELATED CHANGES TO THE INTEGUMENTARY SYSTEM

A

Fewer melanocytes
—> In light-skinned people, skin becomes very pale
—> Increased sensitivity to sun exposure, more likely to sunburn

Drier epidermis (decreased sebaceous gland activity)

248
Q

Thinning epidermis (declining basal cell activity)

A

Connections between epidermis and dermis weaken

More prone to injury, skin tears, and skin infection

249
Q

Reduced vitamin D3 production

A

Causes muscle weakness and brittle bones

250
Q

Diminished immune response

A

Declining numbers of dendritic (langerhans?) cells (to about half of levels at age 21)

Increased chance of skin damage and infection

251
Q

Thinning dermis

A

Fewer elastic fibers

Sagging and wrinkling are the results

252
Q

Decreased perspiration

A

Sweat glands are less active

Greater risk of overheating

253
Q

Reduced blood supply

A

Cools skin and stimulates thermoreceptors

Makes person feel cold even in warm room

254
Q

Slower skin repair

A

Example: blister repair 3–4 weeks in young adult takes 6–8 weeks in 65- to 75-year-old

255
Q

Fewer active follicles

A

Thinner, finer hairs (gray or white from decreased melanocyte activity)

256
Q

Altered hair and fat distribution

A

(decreased sex hormone levels)

257
Q

Vitamin D3 production

A

UV radiation causes epidermal cells of stratum spinosum and stratum basale to convert steroid to CHOLECALCIFEROL (vitamin D3)

Liver creates intermediate product; then converted to calcitriol by kidneys

Calcitriol allows calcium and phosphate absorption in small intestine

258
Q

Diet and vitamin D3 production

A

Naturally from fish, fish oils, and shellfish

Egg yolks

From fortified food products

259
Q

Inadequate supply of calcitriol leads to impaired bone growth and maintenance

A

In children, leads to rickets

In adults, leads to decreased bone density

260
Q

rickets

A

Flexible, poorly mineralized bones

From not enough sunlight or not enough dietary cholecalciferol (vitamin D3)

Bone matrix has insufficient calcium and phosphate

Uncommon in United States

261
Q

In adults, leads to decreased bone density

A

Partially from insufficient dietary intake

Additionally, skin production of cholecalciferol decreases by 75 percent

Increases risk for fractures

Slows healing process

262
Q

Wound Healing

A

..

263
Q

1) Epidermal Wound Healing

A

abrasion or minor burn

basal cells migrate across the wound

contact inhibition with other cells stops migration

epidermal growth factor (EGF) stimulates basal cells to divide

full thickness of epidermis results from further cell divisions

264
Q

2) Deep Wound Healing

A

injury extends to dermis

complex repair process & scar formation

PHASES:
Inflammatory phase
Migratory phase
Proliferative phase
Maturation phase
(Scar tissue formation)

265
Q

Inflammatory phase

A

blood clot unites the wound edge

vasodilatation and increased permeability of blood vessels deliver:

—> neutrophils (phagocytic WBC), macrophages (to clean up debris & microbes) and fibroblasts (to produce scar)

266
Q

Migratory phase

A

clot becomes scab

epithelial cells migrate beneath scab to bridge wound

fibroblasts begin forming scar tissue

damaged blood vessels begin to regrow

tissue filling wound here is called GRANULATION TISSUE

267
Q

Proliferative phase

A

growth of epithelial cells beneath scab

fibroblasts lay down collagen randomly

blood vessel growth

268
Q

Maturation phase

A

scab sloughs off when epidermis is restored to normal thickness

collagen fibers become more organized

fibroblasts begin to disappear

blood vessels restored to normal

269
Q

Scar Tissue Formation = Fibrosis

A

scar tissue is different from normal tissue (in this case skin):

collagen fibres more densely arranged

decreased elasticity

fewer blood vessels  pale

fewer hairs, glands and/or sensory structures

270
Q

excess scar tissue is raised above epidermal surface

A

hypertrophic scar: stays within boundaries of original wound

keloid scar: extends beyond wound boundaries into normal tissue

271
Q
A

Semester 4 (10 decks)

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