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Integumentary System: Assessment and Intervention > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Normal Skin

A

Fair, smooth, fresh, elastic, even complexion, no apparent wrinkles, and almost invisible pores no obvious peeling, cosmetic defects, or hypersensitivity due to constant maintenance of moisture and lipid balance

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2
Q

Skin Facts

A
  • largest single organ in the body - 16% of body weight - 3000 sq. inches of surface area - 1/3 of the circulating blood in the body is in the skin - 20% of available protein in the body is normally used in epidermis replacement
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3
Q

Layers of the Epidermis

A
  • Stratum Germinativum - Stratum Spinosum - Stratum Granulosum - Stratum Lucidum - Stratum Corneum
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4
Q

Layers of the Dermis

A
  • Stratum Paplare - Stratum Reticulare
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5
Q

Hypodermis

A

the innermost and thickest layer of the skin. It invaginates into the dermis and is attached to the later, immediately above it, by collagen and elastin fibers. It is essentially composed of a type of cells specialized in accumulating and storing fats, known as adipocytes. These cells are grouped together in lobules separated by CT The hypodermis acts as an energy reserve.

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6
Q

Epidermis

A
  • multilayered structure which renews itself (52-75 days) by cell division in its deepest basal layer - the epidermal cell is referred to as a keratinocyte and cells produced by cell division ascend towards the surface and undergo a process of keratinization - the cells on the skin surface forming fully keratinized dead cells layer which are abraded by day to day wear and tear from the environment
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7
Q

Stratum Germinativum

A
  • basal cell layer of the epidermis - single layer of cuboidal keratinocytes with melanocytes interspersed among them - major region of mitotic activity (50% of the basal cells are normally dividing with other 50% becoming active after wounding) - Basal cells are connected by desmosomes which anchor intermediate epithelial cell filaments made of keratin (Type I - Acidic ; Type 2 - Basic)
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8
Q

Stratum Spinosum

A
  • Prickle cell layer of the epidermis - cells arise from migration of basal layer cells detached from the basement membrane - cells are flatter and have more keratin and more obvious desmosomes (silky appearance) - cells have nuclei - some are mitotically active - Langerhans cells - bone marrow generated skin macrophages are interspersed among prickle cells
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9
Q

Stratum Granulosum

A
  • prickle cell layer of the epidermis - flattened cells containing particles known as keratohyaline granules - in the cytoplasm are organelles (Odland bodies) capable of discharging lipids and enzymes into the intercellular spaces which hold cells together
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10
Q

Stratum Lucidum and Stratum Corneum

A
  • the most superficial superficial layers of the skin composed of layers of dead cells - keratin filaments are highly cross linked forming keratohyalin - high lipid content membrane coating granules are excreted into intercellular space forming a water impermeable barrier responsible for 98% of water retention ability of the epidermis
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11
Q

Dermis

A
  • Principal mechanical skin barrier - Dense, irregular, mesodermally derived CT, composed of collagen (mostly type I), elastine, and glycosaminoglycans - comprising 80-90% of the skin with network of elastic fibers function to support the epidermis and bind the skin to the deeper hypodermis - contains extensive vasculature, nerves, smooth muscles, and fibroblasts - has a papillary layer and a reticular layer
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12
Q

Papillary Layer

A
  • layer of the dermis with dermal ridges extending up into the epidermis containing mast cells, macrophages, Meissner’s corpuscless and capillaries (papillary plexus) providing nutrients to the avascular epidermis.
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13
Q

Reticular Layer

A
  • Layer of the dermis consisting of irregular dense CT made of collagen and elastic fibers, few cells, Pacinian corpuscles and capillaries (cutaneous plexus) providing nourishment to the dermis.
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14
Q

Hypodermis

A
  • composed of CT and fat tissue Provides: - insulation - Shock Absorption - Energy storage - Keratinocytes when the epidermis is destroyed - Nourishment because it contains major blood vessels of the skin
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15
Q

Epidermopoesis

A
  • the cell production in the germinative layer of the epidermis must be balanced by the cell loss at the skin surface. - epidermal growth factor binds to specific receptor present on the surface of the epidermal basal cell layer - Following binding EGF is carried into the keratinocytes cytoplasm and nucleus where it promotes cell growth - process of epidermopoesis consists of: stimulatory factors and inhibitory factors
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16
Q

Stimulatory Factors of Epidermopoesis

A
  • EGF (Epidermal Growth Factor) - Keartinoicytes growth - TGF (Transforming Growth Factor) alpha - activates EGF receptor - Interleukin-1 - keratinoicytes proliferation - Immunological cytokines - expression of 2nd messengers for different hormones - Basic Fibroblasts Growth Factor (bFGF) - Androgens - stimulate epidermal mitosis - Vitamin A - stimulation of epidermal mitosis
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17
Q

Inhibitory Factors of Epidermopoesis

A

Transforming Growth Factor Beta: - Inhibits the growth of keratinocytes - Stimulates fibroblasts growth and although it may have an inhibitory effect on epidermal growth it stimulates wound healing Alpha and Gamma Interferons: - Have cytostatic effect on keratinocytes both in vivo and in vitro

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18
Q

Skin as a part of natural resistance

A
  • Constant desquamation of the skin - Fatty acids of the sebum - Lactic Acid of the sweat - Melanin Pigment - protection against UV radiation - Langerhans Cells - Immunosurveillance against viral infections - Keratinocytes - secretion of immunoregulating cytokines - Epidermotropic T-Cells
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19
Q

Skin - Prevention of Loss of Essential Fluids

A
  • Stratum corneum, with its overlapping cells and intracellular lipids, makes diffusion of water very difficult - in the absence of a stratum corneum the body may lose significant amounts of water and become rapidly dehydrated
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20
Q

Thermoregulation (by skin)

A

Specialized vascular structures of the dermis: Extensive Venous Plexus: - Large quantities of blood which can be forced into circulation - Blood Flow - 400 ml/min (40ml/min required for nutrition) - Thick muscular layer innervated by adrenergic fibers Arteriovenous Anastomoses - Closed by vasoconstriction when temperature is normal - Open during hyperthermia - sympathetic inhibition - Closed during hypothermia (15 deg. C) - maximal vasoconstriction - Maximal vasodilation at (0 deg. C) - muscle paralysis which prevents freezing Insulation by fat in subcutaneous tissue Evaporation of Sweat

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21
Q

Calcium Homeostasis (by skin)

A
  • Dehydrocholesterol - UV Rays - Cholecalciferol (Vitamin D3) - Hydroxylation in the liver and kidneys - Parathyroid Hormone - Vitamin D - Calcium Absorption from the GI tract and reabsorption from the kidneys
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22
Q

Skin as a Sensory Organ

A
  • Heat - Cold - Pain - Touch - Tickle - Erogenous Zones
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23
Q

Misc. Skin Functions

A
  • the skin has great psychological importance at all ages - skin is an organ of emotional expression and a site for the discharge of anxiety - the fingers and toes, the palms of the hands and soles of the feet are covered with a system of ridges forming fingerprints which are unique to each individual
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24
Q

Skin Aging - Epidermal Changes

A
  • Moisture content of the stratum corneum decreases in aged skin leading to more brittle skin - Turnover time takes longer in elderly persons - Skin is less cohesive and is prone to ill effects of mechanical forces acting on the skin - contact between dermis and epidermis decreases from 2.70 per square millimeter at the age of 30 to 1.9 mm at the age of 70.
25
Q

Skin Aging - Dermal Changes

A
  • Collagen fibers thicken and become less soluble with decreased production 1%/year - Collagen becomes more resistant to enzyme debridement - Degeneration of elastin; becoming thicker and coiled - the # of cells (fibroblasts, mast cells) decrease by 50% from one year of age to 65 - decreased microvasculature function with diminished inflammatory response
26
Q

Skin Aging - Hypodermal Changes

A
  • Fat content increases in the body until about age 70 serving as a caloric bank, as protection against mechanical forces and against conductive heat loss. - in advanced age, fat is reabsorbed by the body resulting in less protection against pressure which make the person more prone to develop pressure ulcers
27
Q

Consequences of Skin Aging

A

Aging causes Decreased: - Epithelization - Angiogenesis - Biosynthetic Activity - Delayed collagen remodeling - Delayed Wound Contraction - Increased Wound Dehiscence

28
Q

Per Primam Intentionem

A
  • the best possible wound -uncomplicated healing of the injury when continuity of the tissue is reestablished without infection - small, smooth, approximated wounds - surgical incisions
29
Q

Time table for wound healing by first intention

A
  • Minutes - clotting meshwork stops bleeding - 24-48 h - epithelial cells are regenerating from the edges of the wound and cells cover the injury - 3-5 days - granulation tissue fills the wound preventing epithelial migration deep into the wound - 2 weeks - fibroblasts continue to multiply and large amounts of collagen are present - 1-3 months - granulation tissue is de-vascularized changing temporary red to a permanent white scar.
30
Q

Per Secundam Intentionem

A
  • large and irregular or infected - wound contraction and development of granulation tissue from the depth and margins of the wound - slow process resulting in large scars
31
Q

Per Tertiary Intentionem

A
  • skin is minimally healed with restored anatomical but not functional continuity
32
Q

Phases of wound Healing

A
  1. Inflammation 2. Proliferation 3. Remodeling
33
Q

Signs of inflammation

A
  1. Heat - Calor 2. Redness - rubor 3. Swelling/edema - Tumor 4. Pain - Dolor 5. Loss of function
34
Q

Inflammation Days 1-10

A
  • Vasoconstriction - Vasodilation - Infiltration of neutrophils - infiltration of macrophages - platelet release of growth factor - fibroblast production of ground substance and collagen
35
Q

Vasoconstriction

A

the initial transient phase with little importance

36
Q

Vasodilation

A

opening of the arterioles pre-capillary sphincters resulting in active hyperemia

37
Q

Slowing of the Circulation

A

due to increased blood viscosity related to escape of plasma into the tissues

38
Q

other parts of the vascular reaction

A
  • Capillary hydrostatic pressure is increased, followed by escape of plasma proteins into the extravascular space, increasing the colloid osmotic pressure there - Consequently, more fluid leaves the vessels than is returned. This fluid is called exudate, and this process is called exudation
39
Q

Increased permeability of small vessels following tissue damage (non-mediated leakage)

A

toxins or physical agents may cause necrosis of endothelium, leading to leakage.

40
Q

increased permeability of small vessels following tissue damage (mediated leakage)

A

chemical mediators of inflammation cause retraction of endothelial cells, leaving leaking gaps.

41
Q

Patterns of Increased Leakage (vascular reaction to wound healing)

A

Immediate transient response - lasts for 30-60 minutes (mediated by histamine) Delayed response - starts 2 hours after injury and lasts for up to 8 hours (mediated by local factors e.g. bradykinin) Immediate Prolonged Response - result of epithelium necrosis, lasts over 24 hours

42
Q

Cellular response to inflammation in wound healing

A
  • the neutrophil is the main cell to mediate the effect of acute inflammation. - in slight tissue damage, an adequate supply of neutrophils is derived from the normal # in the circulating blood - in extensive tissue damage, neutrophils are released from bone marrow to increase the absolute count of neutrophyls in the blood
43
Q

main cellular events in the inflammation response during wound healing

A

activation of endothelium - to allow adhesion of neutrophils activation of neutrophils - to enhance capacity for phagocytosis and generation of inflammatory mediators neutrophil ability to move - from vessels toward the area of tissue damage

44
Q

critical function of inflammation in order to degrade necrotic tissue

A

the delivery of leukocytes to the site of injury the phases of the leukocyte journey are: - margination and adhesion (pavementing) - migration toward a chemotactic stimulus - phagocitosis

45
Q

Inflammation - cellular responses in wound healing (exudation and neutrophils)

A
  • exudation, increased plasma viscosity, and slowing of the blood flow at the site of tissue damage - neutrophils to flow in plasmatic zone causing their aggregation to the walls in a process termed margination
46
Q

Wound Healing - Inflammation - Cellular Responses (normal vs. inflammed)

A
  • in the normal tissues neutrophils randomly contact the endothelium, but do not adhere to it - at the site of the acute inflammation, specific process of the adhesion of neutrophils to the vascular endothelium occurs - this process is called “pavementing” unknown mechanism
47
Q

Wound Healing - Inflammation - Cellular responses (Leukocytes and migrating cells)

A
  • leukocytes migrate by active ameboid movement through the walls of venules, but do not commonly exit from capillaries - migrating cells insert pseudopodia, and migrate through the gap between the endothelial cells, pass through the vessel wall, and enter extravascular space
48
Q

Wound Healing - Inflammation - Cellular Responses (Red Blood Cells)

A
  • red blood cells may also escape from vessels - this process is passive and depends on hydrostatic pressure forcing the red cells out - this process is called Diapedesis
49
Q

Wound Healing - inflammation - cellular response (leukocytes and chemotaxis)

A
  • leukocytes emigrate in tissues toward the site of injury (chemotaxis) - chemotaxis is mediated by chemotaxic factors: - soluble bacterial components - complement system components (C5a) - arachidonic acid derivates (leukotriene B4)
50
Q

Overall Neutrophil Characteristics

A
  • movement - calcium dependent contraction of cytoplasmic microtubules - phagocytosis - process where neutrophils and macrophages ingest solid particles - oxygen dependent - neutrophils produce hydrogen peroxide which produce a noxious agent - oxygen independent - neutrophil enzyme lactoferrin binds iron required for bacterial growth
51
Q

Healing begins very early in the process of inflammation and involves 2 distinct processes:

A
  • regeneration of injured tissue by parenchymal cells of the same type - replacement of injured tissue by connective tissue
52
Q

Wound Healing - Proliferation days 3-20

A

Fibroplasia - myofibroblasts migrate into wound space - collagen synthesis begins about 5 days after myofibroblasts arrival Granulation (neovascularization) - endothelial budding - red granular appearance re-epithelization wound contraction

53
Q

Wound Healing Proliferation

A
  • wound healing is restoration of integrity to an injured tissue which is accomplished by 3 mechanisms: - wound contraction - wound regeneration - wound repair
54
Q

Proliferation in wound healing (Regeneration)

A
  • the renewal of a lost tissue where missing cells are replaced by identical ones - due to the loss of the cell to cell contact inhibition, cells surrounding injured area start multiplying in order to replace the lost cells - re-epithelization
55
Q

Proliferation in Wound Healing (repair)

A
  • repair is a process by which a wound heals by forming granulation tissue, producing collagen, and eventually scarring - repair is the healing of a large tissue defect that extend through the basement membrane to the connective tissue
56
Q

wound healing - proliferation - contraction

A
  • contraction is a reduction in size of a wound (as much as 70%) mediated principally by myofibroblasts - myofibroblasts have features intermediate between those of fibroblasts and smooth muscle cells and their contraction decreases the size of the injury
57
Q

Wound Healing - Proliferation (Granulation)

A
  • granulation tissue is the specialized type of tissue that is the hallmark of wound healing - the amount of granulation tissue depends on the degree of inflammation Granulation tissue characteristics: - proliferation of new capillaries - angiogenesis - proliferation of fibroblasts (fibroplasia) with proliferation and deposition of collagen
58
Q

Wound Healing Remodeling - day 9 onward

A
  • Collagen Synthesis - Collagen Lysis - Scar Avascularization

Integumentary System: Assessment and Intervention (1 decks)

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