CH 7: Signs and symptoms, aging and the integumentary system Flashcards
What is the largest body organ, constituting 15-20% of body weight with three primary levels?
Skin
What are the two skin levels that the dermis is separated into?
Papillary dermis
Reticular dermis
What is the primary function(s) of the skin?
- Protect underlying structures from external injury and harmful substances
- Insulator
- Holding organs together
- Sensory perception
- Contributing to fluid balance
- Controlling temp
- Absorbing UV radiation
- Metabolizing vitamin D
- Synthesizing epidermal lipids
What is the skin layer?
- Stratum corneum
- Keratinocytes (squamous cells)
- Langerhans cells
- Basal cells
Epidermis
What is the skin layer?
- Collagen, reticulum, elastic
- Fibroblasts
- Macrophages
- Mast cells
- Lymphatic glands
- Blood vessels
- Nerve fibers
Dermis
What is the skin layer?
- Eccrine unit
- Apocrine unit
- Hair follicles
- Nails
- Sebaceous glands
Epidermal appendages
What is the skin layer?
-Adipose (fat)
Subcutaneous tissue
What is the structure based on the function?
- Protection (from trauma, microbes)
- Barrier (prevents fluid, electrolyte, chemical losses)
Epidermis: Stratum corneum
What is the structure based on the function?
-Synthesis of keratin (skin protein)
Epidermis: Keratinocytes (squamous cells)
What is the structure based on the function?
- Antigen presentation
- Immune response
Epidermis: Langerhans cells
What is the structure based on the function?
-Epidermal reproduction
Epidermis: Basal cells
What is the structure based on the function?
- Skin proteins
- Skin texture
Dermis: Collagen, reticulum, elastin
What is the structure based on the function?
-Collagen synthesis for skin strength and wound healing
Dermis: Fibroblasts
What is the structure based on the function?
- Phagocytosis of foreign substances
- Initiates inflammation and repair
Dermis: Macrophages
What is the structure based on the function?
-Provide histamine for vasodilation and chemotactic factors for inflammatory response
Dermis: Mast cells
What is the structure based on the function?
- Removal of microbes and excess interstitial fluids
- Provide lymphatic drainage
Dermis: Lymphatic glands
What is the structure based on the function?
- Provide metabolic skin requirements
- Thermoregulation
Dermis: Blood vessels
What is the structure based on the function?
-Perception of heat and cold, pain, itching
Dermis: Nerve fibers
What is the structure based on the function?
-Thermoregulation by perspiration
Epidermal appendages: Eccrine unit
What is the structure based on the function?
- Production of apocrine sweat
- No significance known
Epidermal appendages: Apocrine unit
What is the structure based on the function?
- Production
- Cavity enclosing hair
Epidermal appendages: Hair follicles
What is the structure based on the function?
- Protection
- Mechanical assistance
Epidermal appendages: Nails
What is the structure based on the function?
-Produce sebum (oil to lubricate skin)
Epidermal appendages: Sebaceous glands
What is the structure based on the function?
- Energy storage and balance
- Trauma absorption
Subcutaneous Tissue: Adipose (fat)
What can occur as a result of a wide variety of etiologic factors?
Skin lesions
What are the causes of skin lesions?
- Contact with injurious agents (chemical toxins)
- Contact with infective organisms
- Reaction to medication
- Physical trauma
- Hereditary factors
- Reaction to allergens
- Reaction to radiotherapy
- Systemic origin (diseases with cutaneous manifestation; arterial insufficiency)
- Burns (thermal, electrical, chemical, inhalation)
- Neoplasm (paraneoplastic syndrome)
What is the first lesion to appear on the skin and has a visually recognizable structure?
Primary lesion
What type of lesion are these examples?
- Macule
- Papule
- Plaque
- Nodule
- Tumor
- Wheal
- Vesicle
- Pustule
Primary lesion
What type of lesion occurs when changes happen to the primary lesion?
Secondary lesion
What type of lesion are these examples?
- Scale
- Crust
- Thickening
- Erosion
- Ulcer
- Scar
- Excoriation
Secondary lesion
How do secondary lesions typically occur?
- Scratching
- Rubbing
- Medication
- Natural disease progression
- Process of healing
What is commonly caused by nevus, may involve an overgrowth of one or more of any normal components of skin (pigment cells, blood vessels, and lymph vessels)?
Birthmarks
What type of birthmark?
- Mongolian spot
- Cafe au lait spot
Pigment cells
What type of birthmark?
- Portwine stain
- Strawberry hemangioma
Vascular
What type of birthmark?
- Epidermal nevus
- Nevus sebaceus
Epidermal
What type of birthmark?
- Juvenile elastoma
- Collagenoma
Connective tissue
What type of birthmarks may be removed by laser therapy for cosmetic reasons?
Vascular birthmark
What are documentation of skin lesion characteristics?
- Size (all dimensions)
- Shape or configuration
- Color
- Temp
- Tenderness, pain, pruritus
- Texture
- Mobility; skin tugor
- Elevation or depression
- Pedunculation (stemlike connections)
What are documentation of skin lesion exudates?
- Color
- Odor
- Amount
- Consistency
What are documentation of skin lesion pattern of arrangements?
- Annular (rings)
- Grouped
- Linear
- Arciform (bow shaped)
- Diffuse
What are documentation of skin lesions location and distribution?
- Generalized, localized, universal
- Region of body (unilateral, bilateral, symmetric, asymmetric)
- Patterns (dermatomal, flexor or extensor, random, related to clothing lines)
- Discrete or confluent (running together)
What is most common manifestation of dermatologic disease?
Pruritus (itching)
What is a symptom of underlying systemic disease in up to 50% of people with generalized itching, especially among the chronically ill and older population?
Pruritus (itching)
What can lead to damage if scratching injures the skin’s protective barrier possibly resulting in increased inflammation, infection, and scarring?
Pruritus (itching)
What are the most common systemic disorders that can cause pruritus (itching)?
- Diabetes mellitus
- Drug hypersensitivity
- Hyperthyroidism
What type of skin lesions, including blisters, are associated with risk of exposure to HIV?
Bullous
What is most commonly known as hives?
Urticaria
What is a vascular reaction of the skin marked by appearance of smooth, slightly elevated patches (wheals)?
Urticaria (hives)
What usually erupts from an allergic reaction to drugs or infection and rarely last longer than 2 days but may exist in a chronic form, lasting more than 3 weeks, rarely months to years?
Urticaria (hives)
What is the approx reduction in number of mast cells responsible for urticaria in intrinsically aged skin?
50%
What are blue-black macules found over the lumbosacral area in 90% of Native American, African American, and Asian infants and can easily be mistake for a large bruise?
Mongolian spots (congenital demal melanocytosis)
What is a generalized term for an eruption on the skin, most often on face, trunk, axilla, groin, and is often accompanied by itching?
Rash
What can manifest on a continuum anywhere from erythema to macular lesions to raised papular appearance?
Rash
What typically occurs as a secondary response to some primary agent such as exposure to sun, allergens, irritants, or medications, or in associated with systemic diseases?
Rash
What are the most common rashes?
- Diaper rash
- Drug rash
- Heat rash
- Butterfly rash
What type of rash is a cutaneous reaction across the nose and adjacent areas of cheek and most often encountered in systemic lupus erythematosus (SLE)?
Butterfly rash
What is a rash appearing on the breast- especially a rash on the areola and nipple with or without accompanying symptoms of itching, soreness, or burning?
Paget disease of nipple (rare form of breast cancer)
What are fluid containing elevated lesions of skin with clear watery or bloody contents?
Blisters (vesicles or bullae)
What can occur as a manifestation of a wide variety of diseases?
Blisters (vesicles or bullae)
What may be primarily associated with diseases of a genetic or autoimmune origin or may be secondary to viral or bacterial infections of skin, local injury to skin, or drug administration?
Blisters (vesicles or bullae)
Which blisters should not be opened and debrided?
- Hemorrhage frostbite blisters
- Stable, noninfected arterial blisters
- Stable, noninfected heel blisters
What skin conditions are blisters commonly associated with?
- Frostbite
- Dermatitis
- Burns
- Pressure
- Malignancy
- A side effect of medications
What type of blisters may be the first sign of underlying malignancy?
Blisters associated with underlying neoplasm (paraneoplastic pemphigus)
What will set into a gelatinous film if debridement is delayed (in a burn, this film is beginning of eschar and an ideal culture medium for bacteria)?
Blister fluid
What impairs normal function of neutrophils and lymphocytes which reduces the effectiveness of local immunity?
Blister fluid
What also contains arachidonic acid metabolities that increase the inflammatory response and retard the fibrinolytic process; delayed the healing of wound?
Blister fluid
What is a mild for of ichthyosis or excessive dryness of skin characterized by dry, rough, discolored skin with the formation of scaly desquamation (shedding of epithelium in small sheets)?
Xeroderma
What problem is accentuated by dry climates and by use of drying skin cleansers, soaps, disinfectants, and solvents
Xeroderma
What do the hormone changes during puberty stimulate?
- Maturation of hair follicles
- Sebaceous glands
- Apocrine and eccrine units
- Mild acne
- Perspiration and body odor
- Freckles (promoted by sun exposure)
- Pigmented nevi (moles)
What are some visible indications of skin changes associated with aging?
- Gray hair
- Balding
- Loss of secondary sexual hair
- Increased facial hair
- Excessive facial hair (upper lip and chin) for women
- Balding after menopause
- Increased facial hair (nares, eyebrows, helix of ear) for men
What may be causing the skin to denote the onset of senescence (process or condition of growing old)?
- Aging process itself (intrinsic aging)
- Cumulative effects of exposure to sunlight (photoaging)
- Environmental factors (extrinsic factors)
What are the structure or functional changes that occur in the skin?
- Diminished pain perception
- Increased vulnerability to injury
- Decreased vascularity
- Weakened inflammatory response
What is known as hormonal abnormalities that may result in excessive facial and body hair in women?
Androgen-related
What is known as hormonal and genetic changes that produce male-pattern baldness?
Alopecia
What is known as the use of birth control pills or pregnancy in adolescence and adulthood that may result in temporary changes in hair growth patterns or hyperpigmentation of cheeks and forehead?
-Melasma or Pregnancy mask
What signifies loss of elastin fibers, weakened collagen, and decreased subcutaneous fat and is accelerated by smoking and excessive sun exposure?
Wrinkling
What are other common age-related integumentary changes?
- Lax skin
- Vascular changes (decreased elasticity of blood vessel walls, angiomas)
- Dermal or epidermal degenerative changes
- Wrinkling
What is the primary factor in the loss of protective functions of the skin?
Diminished barrier function of stratum corneum (outermost layer of epidermis)
What is one of the body’s principal suppliers of vitamin D, which is produced when the hormone 7-dehydrocholesterol is exposed to sunlight?
Epidermis
Vitamin D hormone levels are only about what percentage of what they were in youth?
25%
What plays a vital role in building bone?
Vitamin D
