Tegument color 2 Flashcards
Redness
Definition
Mechanisms:
Definition: diffuse tegument redness Mechanisms: Cutaneos vessel dilatation Blood alterations: Increase of red cell count and oxyhemoglobin quantity
Redness
Physiological
Pathological
Physiological Emotions Exposure to heat, sun Pathological Generalized Chronic lymphatic leukemia Localized Face: chronic ethylism, DM (diabetic rosacea), Cushing’s disease, LED, CO intoxication, febrile diseases Palms, soles: liver cirrhosis
Jaundice
Definition
Mechanisms:
Definition: Yellow color of the teguments and mucosa due to impregnation with bilirubin.
Mechanisms:
Increased bilirubin production
Poor elimination
Bilirubin physiology
Hemolysis (distruction of red cells, especially in the liver and spleen) => unconjugated (insoluble) bilirubin
Unconjugated bilirubin + albumin (soluble complex) -> in the liver
Liver – conjugation process => conjugated (soluble) bilirubin eliminated in the intestine through the bile.
There are 2 types ofbilirubin in the blood
Conjugated bilirubin
Unconjugated bilirubin
The normal level of bilirubin in the blood is of 1mg%
Jaundice
clinical presentation
classification
Clinic:
Jaundice initially occures inseamna apare, appears inseamna pare/ appears in the sclera (a tissue rich in elastin, with affinity towards bilirubin)
Classification (pathogen)
Pre-hepatic hemolytic jaundice
Mechanism: high production of unconjungated bilirubin – not all the quantity can be taken over and conjugated by the liver
Clinic: flavinic jaundice – the patient is pale, rather than jaundiced
Lab: unconjugated bilirubin rises
Causes: hemolytic anemia
Hepatocellular jaundice
Mechanisms: bilirubin intake, conjugation and/or elimination disorders
Clinic: reddish hue (rubin jaundice)
Lab: the conjugated and the unconjugated bilirubin increase
Causes: liver diseases (acute hepatitis, chronic hepatitis, liver cirrhosis, etc)
Obstructive jaundice
Mechanism: obstruction of intra- and extra-hepatic ways biliary ways/ ducts
Clinic: jaundice with greenish hue (green jaundice)
Lab: the conjugated bilirubin increases
Causes: litiaza coledociana, cancer de cap de pancreas, odite stenozante, colangio-sarcoame
Mixed jaundice – all 3 forms combined
Ex: coledocolithiasis + acute satelite hepatitis
Cyanosis
Definition
Classification
Definition: blue-purple color of teguments and mucosa due to the increase of reduced hemoglobin over 5g% in the capillary blood Classification: Central cyanosis Peripheral cyanosis Mixed cyanosis
Central cyanosis
Mechanisms
Semiological characteristics
Mechanisms:
Insufficient oxygen in the blood after passing through the lungs
Mixed oxygenated with non-oxygenated blood (right-left shunt)
Semiological characteristics
Involves teguments and mucosa
It is warm
In digital pressure we notice the sequence
Cyanosis -> pallor -> cyanosis
Central cyanosis
Causes
Cardiac diseases Mitral stenosis Left ventricular failure Congenital cardiopathies with right-left shunt (ex. DSV) Respiratory diseases Obstructive chronic bronchitis COPD Bronchiolitis Obstruction of the upper airways (foreign objects, laringeal tumors) Hematological diseases Polyglobulia
Peripheral cyanosis
Mechanism:
Semiological characteristics
Mechanism:
Excessive oxygen emanation from capillary veins, due to a slow blood circulation through stasis
Semiological characteristics
Involves only teguments
It is cold
In digital pressure we notice the sequence:
Cyanosis -> pallor -> redness -> cyanosis
cyanosis causes
Generalized cyanosis Physiological Exposure to cold weather Pathological Congestive cardiac failure Tricuspid valvulopathies Localized cyanosis Vein obstructions Thromboflebitis, vein compressions
Mixed cyanosis
Both central and peripheral cyanosis are present
Causes:
Acute and chronic cor pulmonale
Pigmentation disorders
Hyperchromia – skin hyperpigmentation
Constitutional
Race
Ephelides (freckles) – small irregular stains, of yellow-brownish color, appearing on areas with exposure to sun
Physiological
Pregnant women (pregnancy cloasma – brown spots on forehead, temples, cheekbones, upper nose, appearing in the first month of pregnancy)
After sun exposure
Pathological
After radiotherapy
Long time administration of barbiturice, bismuth salts, silver salts
Chronic diseases: Addison’s disease, hemochromatosis, porfiria, pellagra (PP vitamin defficiency), Basedow disease (hyperpigmentation around the orbits and mouth)
Hypochromia/achromia
Congenital
Albinism – the complete absence of melanic pigment from the skin, hair, eyes (the iris is transparent)
Acquired
Vitiligo – white, irregular spots of face, dorsalk side of hands etc.
Could be idiopathic or a consequence of trauma (psychic, cerebral commotions)
Cutaneous lesions
Purpura
Extravasation of blood in the skin and mucous membranes due to capillary bleeding with spontaneous appearance or after trauma
Causes: coagulopathies, vasopathies, thrombopathies
Cutaneous manifestation:
Petechiae – sub-tegument or sub-mucosa blood extravasation, as small round purple spots of 1-3 mm in diameter)
Bruising – more profound, dermo-hypodermic blood extravasation, larger thextravazare sanguina situata mai profundn 1 cm, or reddish-purple color
Sufusions – larger surface, involving wide tegument areas (coagulopathiues)
Vibic – linear blood extravasations, in flexion folds
Purpura
Mucosa hemorrhages:
nasal – epistaxis
gingival – gingivoragia
Upper digestive – manifested through hematemesis or melena
rectal
pulmonary – hemoptisia
Serous hemorrhages
Hemothorax – blood collection in the pleural cavity
Hemoperitoneum – blood collection in the peritoneal cavity
Hemarthrosis – blood collection in joints
Abundant hemorrhages in organs, tissues – hematoma
Trophic disorders
Gangrene
Gangrene – necrosis of a portion of a tissues, consequence of:
Circulatory disorder (chronic acute ischemia)
Trophic nervous disorder
infection (anaerobic germs)
Clinic: black-purple color of the involved teguments
Causes:
Obliterative chronic arteriopathy of the lower limbs
Arterial embolism
Diabetic arteriopathy
Eschar
Eschar – gangrene involving all tissues, all the way to the bone
Appears in patients immobilized in bed for a long time
Clubbing fingers
Clubbing fingers, asa se numesc degetele hipocratice/Hippocratic fingers – the obvious thickening of the soft tissues in the last phalange of fingers and/or toes, with the simultaneous deformation of nails
Clinic: fingers – drumstick appearance
Causes:
Pulmonary diseases: bronchiectasia, lung cancer, tuberculosis
Cardiovascular diseases: cyanogenic congenital cardiopathies, sub-acute bacterial endocarditis (SABE)
Digestive diseases: intestinal polyposis, primitive biliary cirrhosis, ulcero-hemorrhagic rectocolitis/ulcerative colitis
Edema
Definitionv
Mechanisms
Definition: serous infiltration of tissues resulting in the increase of interstitial liquid/volum
Mechanisms:
Increase in hydrostatic pressure
Decrease of coloid-osmotic pressure (lower albumin)
Increase of electrolytes concentration, especially sodium
Higher capillary membrane permeability
Capillary dilatation
Lymphatic circulation disorder
Edema
Phases
Pre-edema (the patients puts weight on) Clinically manifested edema Generalized edema – anasarca, with transudate in the serous cavities: Pleural cavity - hydrothorax Peritoneum – ascites Pericardium – hydropericardium
edema
clinical presentation
Clinic:
It is best noticed in periorbital area/eyelids, face, lips, retromaleolar and genitalia
The teguments are shiny, stretched
When transitory pressure is applied on a hard surface (bones), there appears a gouge (the “well” sign)/pitting edema, asa se numeste semnul godeului
Cardiac edema
Characteristics Cyanotic, cold Initially appears in the declive parts of the body (retromaleolar -> calfs) More accentuated in the evening Causes: Congestive cardiac failure Cor pulmonale
Kidney edema
Characteristics: White, soft, puffy Initially appears in eyelids, face More obvious in the morning Causes: Acute and chronic glomerulonephritis Nephrotic syndrome
Liver edema
Characteristics:
White-yellow color, predominantly in the body’s lower half
Causes:
Liver cirrhosis
Allergic edema
Characteristics: White, soft Appears suddenly Is of transitory nature Appears together with itching
Venous edema
Characteristics:
Appears in the obstruction of a vein trunk (eg profound leg thrombophlebitis; unilaterally)
Appears in the chronic venous failure of the lower limbs, both uni- and bilaterally
Particular types of edema
Edema and cyanosis in cloak – appear in the compression of the upper vena cava
Clinic: edema and cyanosis involve the cephalic extremity the neck, the upper limbs and the thorax
Causes: mediastinal tumors, lung cancer, voluminous retrosternal goiter etc.
