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2nd path test > Integument (Ginn) > Flashcards

Integument (Ginn) Flashcards

1
Q

objectives

A
  • recognize and describe gross lesions
  • diseases common per species
  • form ddx
  • know primary vs secondary lesion: give/recognize example of each
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2
Q

Common presenting complaints

A
  • odor
  • hair loss
  • itchiness
  • pigment change
  • lumps, bumps
  • scales
  • crusts
  • sores
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3
Q

Functions of skin

A
  • Temp and blood pressure regulation
  • flud regulation
  • protection: barrier
  • sensation
  • nutrient metabolism
  • immune functions: SALT
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4
Q

Microscopic anatomy of skin

A
  • Epidermis
    • can involve hair follicles (they are invagination of epidermis)
  • Dermis
  • Adnexa
    • hair follicle
    • apocrine gland
    • sebacious gland
  • Panniculus
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5
Q

basal layer of skin

A

germinal layer

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6
Q

Epidermis

A
  • Stratum corneum
  • Stratum granulosum
  • Stratu spinosum
  • Stratum basale
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7
Q

Diagnostic approach

A
  • Signalment
    • age of patient, breed, sex, color
    • age of lesions
  • History
    • duration, pruritus, other animals
  • Distribution and character of lesions
  • Response or failure to respond to treatment
  • overall health status
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8
Q

Blue dobermans

A

follicular dysplasia

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9
Q

Primary lesions most useful for

A

dx of dz

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10
Q

Secondary lesion

A

evolution

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11
Q

Acanthosis

A
  • Epidermal change: hyperplasia
    • usually affects stratum spinosum
    • regular
    • Irregular: yeast
    • papillated
    • pseudocarcinomatous
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12
Q

Yeast infection

A
  • acanthosis - lichenification
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13
Q

Hyperkeratosis

A
  • inc width of stratum corneum
    • orthokeratotic: too much, or not exfoliated
    • parakeratotic: too much with retained nuclei
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14
Q

Ichthyosis

A
  • congenital dz too much growth stratum corneum
  • good env for microbe growth and infections
  • orthokeratotic

*golden retrievers

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15
Q

Superficial necrolytic dermatitis

A
  • hyperkeratosis of foot pads
  • metabolic dz
  • assoc with liver disease
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16
Q

Dyskeratosis

A
  • premature keratinization of cells in epidermis
  • epidermal change
  • can be precancerous change
  • often see with parakeratosis as well
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17
Q

Necrosis

A
  • Epidermal changes
  • full thickness
  • apoptosis: single cell or clusters of cells
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18
Q

Erythema multiforme

A
  • tissue reaction to something
  • scattered, transepidermal reaction
  • Clinically
    • erosions
    • ulcers
    • crusts
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19
Q

Cutanous atrophy

A
  • fewer cells, smaller cells
  • epidermis
  • dermis
  • follicles
    • alopecia

*associated with cushings

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20
Q

Edema

A
  • Epidermal changes
    • intercellular = spongiosis
    • intracellular
      • hydropic degeneration
      • ballooning degeneration
  • could lead to sub-epidermal vesicle
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21
Q

Full thickness epidermal necrosis

A
  • toxic
  • burn
  • vasculitis
  • painful, life-threatening
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22
Q

Acantholysis

A
  • loss of cohesion between keratinocytes due to breakdown of cell to cell attachments
  • two main mechanisms
    • type II hypersensitivity: pemfigus foleacious
      • diff from infection
    • enzymatic destruction
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23
Q

Pemphigus foliaceus

A
  • primary lesion is pustule
    • secondary lesion is crust
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24
Q

classic distribution of pemfiigus foleaceus

A

across nasal planum

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25
Q

vesicles/bullae

A
  • epidermal changes
  • fluid filled
  • within epidermis or at epidermal/dermal junction
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26
Q

Vesicular or pustular pathogenesis

A
  • Marked spongiosis, hydropic or ballooning degeneration
  • Enzymatic destruction
  • Immune destruction
    • acantholysis
    • other
  • mechanical destruction
    • burn
    • friction
  • Genetic structural defects
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27
Q

Vesicle

A
  • Severe epidermal edema
  • severe contact hypersensitivity
  • sting/bite (type 1)
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28
Q

Epidermal-dermal separation

A
  • immune mediated
  • primary lesion: vesicle
    • secondary lesion: ulcer
29
Q

Pustules

A
  • epidermal changes
    • Pustule
      • neutrophilic: infection
      • eosinophilic: atopy, hypersensitivity
      • pautrier’s microabscesses: malignant leukocytes
    • crust
30
Q

changes in pigmentation

A
  • hyperpigmentation
    • chronic inflammation
    • idiopathic
  • hypopigmentation
    • prob with basal membrane
      • only pigmented part of skin
31
Q

Follicular changes

A
  • Hyperkeratosis
  • Atrophy
  • Folliculitis
  • Furunculosis
  • Dysplasia
32
Q

DDX folliculitis

A
  1. bacterial infection
  2. dermatophytes
  3. demodecosis
33
Q

Folliculitis/furunculosis

A
  • grossly, folliculocentric papules or nodule
  • patcy alopecia
  • ulcerative draning lesions in severe cases
  • inflammation targets hair follicle
    • leukocytes are within the wall or lumen of follicle
    • furunculosis
      • wall of follicle is destroyed by infiltrate and contents of hair follicle are in dermis
34
Q

Dermal changes

A
  • Inflammation
  • Edema
    • urticaria/Angioedema
    • immunologic (Type 1) and nonimmunologic causes
  • Mucinosis: chinese shar pei
  • Collagen
    • fibrosis
    • degeneration
    • mineralization
  • Elastin: elastosis
    • calcinosis cutis
    • hyperadrenocorticism
  • Subcutis
    • panniculitis
    • fat necrosis
35
Q

Vessels

A
  • Vasodilation
    • erythema, edema
  • Vasculitis
    • thrombosis
    • ischemia
    • edema
    • hemorrhage
    • atrophy
36
Q

When bx

A
  • devastating dz
  • neoplasm
  • unsuccessful tx
  • immediate answer
  • primary lesions, leading margins, edges of ulcers, crusts
  • multiple sites
37
Q

Pattern DX of skin and disease

A
  • Based on types of cells present and their distribution in conjuction with types of changes discussed
  • Rarely pathognomonic
    • suggestive of pathogenesis and categories of disease
38
Q

Cellular infiltrates

A
  • Neutrophils
    • active inflammation
  • Eosinophils
    • allergic or ectoparasites
  • Mononuclear phagocytes
    • persistent antigen in tissue
  • Lymphocytes/plasma cells
  • Mast cells
    • resident cells, hypersensitivity
39
Q

Perivascular Dermatitis

A
  • most common type
  • generic response to skin injury
  • suggests hypersensitivity
  • aggregates of inflammatory cells around vessels
  • acute/chronic
40
Q

Interface dermatitis

A
  • hydropic degeneration/apoptosis in basal layer
  • band of lymphs, plasma cells, macs at epidermal/dermal junction
  • pigmentary incontinence
  • +/- vesicles at interface

*almost always immune mediated

41
Q

Interface dermatitis

pathogenesis

A
  • cytotoxic T-cell attack on keratinocytes or melanocytes, or basement membrane components
  • non-immune mediated damage
  • unknown
42
Q

Uveodermatologic syndrome

A
  • akitas
  • attack on melanocytes
  • uveitis is painful
43
Q

Interface Dermatitis

Discoid lupus

A
  • depigmentation around face and nose
44
Q

Whats the target of interface dermatitis?

TQ

A
  • Anything at the basal region, dermal epidermal junction
45
Q

Common pathogenesis in interface dermatitis?

A
  • Immune mediated
  • DKH: melanocytes
  • Discoid lupus
  • systemic lupus

*depigmenting

46
Q

Vasculitis

A
  • Leukocytes within walls of capillaries and venules
  • evidence of vessel damage
    • edema/hemorrhage
    • fibrinoid necrosis/thrombosis
    • leukoclasis
  • Overall skin changes will reflect degree of vascular damage
    • mild-atrophy and alopecia
    • severe-cutaneous infarction and ulceration
  • If multicentric, lesions at
    • tail
    • footpads
    • ears

*vasculitis common in dogs and horse

47
Q

Vasculitis pathogenesis

A
  • Type III hypersensitivity: immune complex deposition in vessels
  • Primary bacterial skin disease
  • bacterial septicemia
  • systemic infection with endotheliotropic organism
    • rickettsia
48
Q

Vasculitis-pigs

A
  • Erysepalothrix rhusiopathiae - septic emboli
49
Q

Nodular to diffuse dermatitis

A
  • dermis +/- panniculus
    • have nodules or diffuse infiltrates of leukocytes
  • Types of leukocytes present help point to a cause
  • Pathogenesis
    • persistence of antigens in tissue stimulate a cell mediated immune response
50
Q

Nodular to diffuse dermatitis

causes

A
  • Fungi - zygomeycetes, others
  • deep pyo
  • higher bacteria - acid fast bacteria
  • parasites
  • protozoans
  • oomycetes
    • pythium, lagenidium
  • Algae
  • idiopathic - sterile
  • foreign material
  • neoplasms
  • histiocytic
  • eosinophilic granulomas
51
Q

Dematiaceus fungi

A
  • fungi pigmented in tissues
  • nodular to diffuse dermatitis
  • ex: horse traumatic implantation
52
Q

Vesicular or pustular

A
  • Vesicles or pustules are within or below the epidermis
    • intraepidermal
      • subcorneal
      • suprabasilar
    • subepidermal: splits epidermis and dermis
53
Q

Vesicular or pustular pathogenesis

A
  • marked spongiosis, hydropic or ballooning degeneration
  • enzymatic destrution
  • immune destruction
  • mechanical destruction
    • burn
    • friction
    • genetic structural defects
54
Q

Vesicular or pustular, determining specific process

A
  • need to know
    • level of vesicle formation
    • degree and type of celular infiltrate
    • signalment
    • distribution of lesions needed to determine specific dz process present
55
Q

Level of vesicle is critical

A

to determine specific disease process present

56
Q

Subcorneal vesicle/pustule

A
  • superficial pyoderma
  • pemphigus foliaceus
57
Q

Suprabasilar vesicle/pustule

A
  • pemphigus vulgaris
58
Q

Subepidermal vesicle/pustule

A
  • bullous pemphigoid
  • SLE (systemic lupoid erythematosus)
  • TEN (Toxic epidermal necrosis)
  • burns
  • EB (epidermal lysis bullosa)
59
Q

TEN vs EB

A
  • TEN: epidermis dead
  • EB: viable epidermis
60
Q

Folliculitis/furunculosis

A
  • grossly, folliculocentric papules or nodule
  • patchy alopecia
  • severe cases may have ulcerative draining lesions
  • Inflammation targets hair follicle
    • leukocytes are within the wall or lumen of the follicle
    • furunculosis: wall of follicle destroyed by infiltrate and contents of hair follicle are in dermis
61
Q

Folliculitis/furunculosis

A
  • colonization of hair follicle by organism most common
    • bacteria, dermatophytes, mites
  • immune mediated
  • idiopathic
62
Q

Folliculitis/furunculosis other causes

A
  • feline acne
  • pelodera
  • arthropod bites (common in fl)
    • eosinophilic folliculitis
63
Q

What are most common causes of folliculitis in dogs?

TQ

A
  1. Bacteria
  2. Dermatophytes
  3. Mites
64
Q

Panniculitis

A
  • Subcutaneous fat focus of inflammation
  • Grossly-papules and nodules that drain
    • may have oily exudate
  • Histologically
    • inflammation of subcutis - nodular to diffuse
  • same list of agents as nodular to diffuse
  • part of systemic dz
    • pancreatitis
  • idiopathic sterile nodular panniculitis
65
Q

Commn DDX for panniculitis in cats

A
  • Atypical mycobacteria
  • Nocardia
66
Q

Atrophic Dermatoses

A
  • symmetric hypotrichosis, thin skin
    • comedones
    • telangiectasia
    • hyperpigmentation
  • focal atrophic dermatotsis - partial ischemia
67
Q

Atrophic dermatoses most common cause

A

Hormonal disturbance

68
Q

Atrophic dermatoses

A
  • epidermal and follicular atrophy with hyperkeratosis
  • sebaceous gland atrophy
  • hyperpigmentation
  • may or may not se inflammation
  • hormonal imbalance
    • hyperadrenocorticism
    • hypothyroidism
    • sex hormone imbalance
  • ischemia if focal
  • need additional clinical and biochemical info for definitive dx in most cases
69
Q

Cats hyperadrenocorticism

A

fragile skin

2nd path test (10 decks)

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