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my podiatry notes > The Skin in podiatry > Flashcards

The Skin in podiatry Flashcards

1
Q

Describe what the Integumentary system is and what it is comprised of

A

The Integumentary system in simple terms is a set of organs which form the outermost layer of the human body. It comprises the following:

  • Skin
  • Hair
  • Nails
  • Glands
  • Nerves
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2
Q

Describe the structure and function of the skin

A

The skin consists of 3 main components, these being:

  • The Epidermis
  • The Dermis
  • The Dermoepidermal junction
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3
Q

Detail the charecteristics of the Epidermis

A
  • Epidermis is Avascular (Has no blood vessels)
  • Outermost layer of the skin which forms primary Protective layer for the body (waterproof barrier)
  • Made up of three types of cells Keratinocytes, Melaninocytes and Lagerhans
  • Produces new skin cells via the Stratum Basale Layer
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4
Q

What are Keratinocytes

2 answers

A

Keratinocytes - Highly specialized cells which produce the protein keratin in order to form a protective barrier and stop foreign substances form entering the body. They also play a structural role in the skin forming tight bonds with other cells in order to maintain them in place

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5
Q

What are Melanynocytes

A
  • Melonynocytes produce the protein kown as melanin which is responsible for the skins pigment.
  • Melanin protects against UV radiation
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6
Q

What are Lagerhan Cells

A
  • Lagerhan cells are a form of dendretic cells (Antigen presenting cells) which perform phagocytoses (ingest and eliminate foreign substances) protecting against microorganisms and foreign substances.
  • They are most common in the Stratum spinosum layer
  • After performing phagocytoses the transport portions of the microbe they ingested to the cell membrane presenting it to other immune cells helpin to stimulate immune reactions
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7
Q

What is acute inflammation

A
  • Acute inflammation is an immediate to infection or tissue damage
  • It is short in duration lasting from minutes to several days depending on severity
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8
Q

What are the clinical features of inflammation

A
  • Redness (Rubor)
  • Heat (Calor)
  • Swelling (Tumor)
  • Pain (Dolor)
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9
Q

What are the main affects of Chemical/Inflammitory Mediators associated with inflammation

Main features of inflammtion there are 2

PP IG

A
  • Vasodialation - widening of blood cells to enhance blood flow to areas lacking oxeygen and/or other nuetrient (Redness and Heat)
  • Increased blood vessel permiability that allow plasma proteins and immunogloblins to pass easily through tissue (increased fluid causes swelling)
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10
Q

What is the mainsaty treatment for acute inflammation

A
  • R - Rest
  • I - Ice
  • C- Compression
  • E - Elevation
  • (This should be adapted for different patients and situations)
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11
Q

Define Chronic Wound

A
  • Wounds that fail to procceed through normal stages of wound healing in an orderly and timely manner
  • Normal Stages - Haemostasis, Inflammation, proliferation and remodelling)
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12
Q

Define Aetiology

A

The cause of a disease or condition

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13
Q

Detail the numerous steps to the assessment of a chronic wound

A

Patient History - General assesment of the patients current health status and an in depth look at patient history to determine any medical comorbidities (having 2 or more medical conditions at the same time) and contributing factors

Nuerological and vascular assessments - In order to help identify wound aeitology (Cause of a disease/condition)

Tissue Viability Assesment - to identify presence of any infection e.g. necrosis (Death of tissue), Erythema (Red skin rash), Gangrene (loss of blood supply causing tissue to die)

General Skin Viability - Depth, Size, Site, Odour and apperance of peri wound (tissue around the wound . Nature of the wound margins, base of the wound and the amount and type of exudate should all be assessed.

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14
Q

What is Osteomyelitis

A

Osteomyelitis is an infection in the bone causing pain and discomfort.

Infection reach the bone by travelling through the bloodstream or spreading from nearby tissue.

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15
Q

Define Pathogenesis

A

Development of a disease or condition (the process by which a disease or condition develops)

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16
Q

Describe the pathogenesis of Chronic wounds (The proccess by which an infection lead to a disease)

A

The normal inflamatory proccess is distrupted and a particular set of physiological traits occur:

  • Increased levels of Pro Inflamatory cytokines (Cytokines that favour inflammation) (Cytokines are secreted proteins which aid cell to cell communication in immune response)
  • High levels of reactive oxeygen species (Unstable molecule which contains oxeygen and easily reacts with other molecules in a cell causing damage to dna rna and cell death)
  • High levels of bacteria colonization
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17
Q

Describe Atrophy of the skin and its characteristics

A
  • Degradation of and thinning of the Dermis/Epidermis
  • Thin mechanically weak with poor viability (will struggle to heal when damaged)
  • Atrophic skin lacks nutrition due to poor blood supply
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18
Q

What is systematic bacterial infection

A

SEPTICEMIA CAUSES EPC

  • Septicemia is a bacterial infection which has spread to the bloodstream
  • It can cause Erythemea (REDNESS) and Scaling in the skin
  • Prutitus (Itching)
  • Cellulitis (Deep localised spreading infection)
  • Rapidly result in organ faliure
19
Q

What is Staphylococcus Aures its features and the resulting conditions

A
  • Bacterial infection often affecting the skin
  • Results in demarcated (line/boundary seperating infected and healthy skin) yellowish skin pustules caused by formation of a fibrin wall in the outer edges of the area containing pus (wall of fiborous non globular protein involved in clotting)
    *
20
Q

What is Beta Haemolytic streptococci its features and resultant conditions

Erysipelas

A
  • A form of bacteria which can cause skin infections
  • Causes Erysipelas (infection of the upper layers of skin, Red rash with raised edges)
  • Wounds infected with Beta Haemolytic Streptococci show an eroded margin and straw to yellow coloured exudate due to bacterial production of enzymes such as hyraluronidase
21
Q

What is Corynebacterium minutissium

A
  • Bacteria causing erythrasma (moist interdigital fissuring) particularly associated with sweating therefore is treated by primarily controlling sweat
22
Q

What is Pseudomonas aeruginosa

A

Gram Negative (Gram Test is used to check for bacteria and consists of applying a stain to bacteria to identify specifc bacterium) aerobic rod shaped bacterium which cause skin damage.

Causes greenish pigment that discolours the skin and dressings

23
Q

Detail the numerous management stratagies for dealing with a bacterial skin infection

……..diazine and flucloxacillin

A
  • Topical antimicrobial - This may be used for mild infection e.g. silver sulfadiazine cream/dressing, polyhexamethylene biguanide/PHMB, Iodine dressing.
  • Moderate to severe infection - First line braod spectrum antibiotics e.g. flucloxacillin (cellulitus/wounds) co amoxiclav for diabetic wounds
24
Q

Describe what Veruccae/Warts are

What do they cause

4 answers

A
  • Caused by HPV Human Papilloma Virus
  • Virus causes hyperplasia (enlargement of tissue caused by Increase in cell reproduction rate) of the stratum spinosuum.
  • Verrucae are often asymtematic in non immune compromised individuals

HPV’s causing warts in the foot include:

  • HPV1 -Single, deep plantar warts
  • HPV2 - Mosaic Warts
  • HPV2, 4, 60 - Raised Warts
25
Q

What are Caustics

A

Caustics are hydroxides of light metals/acids used to remove dead tissue and destroy warts.

26
Q

Describe the clinical features of warts (single Plantar wart/ Verrucae)

6 answers

A
  • New Warts can be mistaken for seed corns or foreign body under the skin
  • Established verrucae are rough (cauliflower like surface) sometimes with black dots
  • Black dots (thrombosed Papillae)
  • Verrucae appear encapsulated and when pinched cause a sharp pain
  • Pain can appear in plantar warts as a throbbing when standing
  • Regressing warts show black dots
27
Q

What are the five layers of the epidermis In order (Deepest layer first)

A

Stratum Basal

Stratum Spinosum (Squamus Layer)

Startum Granulosum

Stratum Lucidium

Stratum Corneum

28
Q

What is the Stratum Basal Layer Detail its properties

3 answers

clue = germinate

what cells are present = M M

A
  • Innermost (deepest) layer of the epidermis
  • Also called Stratum Germinativum (as constantly germinating producing new cells)
  • Contains Melaninocytes (skin pigment melanin producing) and Merkel Cells (mechanorecptors associated with touch)
29
Q

What is the strartum spinosum detail its properties

Basal cells - keratinocytes

5 answers

A
  • Squamous layer “spiny layer” due to the fact that cells are held together by spiny like projections
  • Responsible for cytokin synthesis (protien that helps regulate immune response
  • Thickest layer of the epidermis
  • Contains Lagerhans (antigen presenting cells) and Keratinocytes
  • Made up of basal cells which have matured into squamus cells known as keratinocytes (keratin producing cells)
30
Q

What is the Stratum Granulosum, detail its charecteristics

clue = kerathylin granules

3 answers

A
  • Contains Keratinocytes which have moved up from the spinosum layer
  • Keratinocytes contain kerathylin granules which promote cell dehydration
  • As the cells move further toward the surface of the skin they begin to flatten out and dehydrate adheing to one another making them more tough and durable
31
Q

What is the Stratum Lucidium

clue = lucid/clear

3 answers

A
  • Keratinocytes from the granulosum migrate to the lucidium layer dying and in the process forming the stratum lucidium
  • Lucidium is clear transparent layer when viewed under microscope
  • This layer is mainly found on hariless parts of the body where skin is the thickest (palms of hands, soles of feet)
32
Q

What is the stratum Corneum detail its charecteristcis

clue = corneocytes

4 answers

A
  • Uppermost layer of the epidermis
  • Contains Dead Keratinocytes known as corneocytes (cornified cells)
  • Corneocytes are deviod of most water and have no nucleus
  • Cornoecytes serve as hard protective layer against trauma and are eventually shed into the enviroment as dandruff or dust
33
Q

What is the bodies biological response to acute inflammation, list the steps

5 steps

A

Neutrophils,Microphages,Lymphocytes,Fibroblasts,Ephthelial cells

  • Initially Neutrophils arrive (White blood cells,immune system first line of defense)
  • Followed by Macrophages (engulf foreign materials and initiate immune response)
  • Lymphocytes (white blood cell that produce antibodies to attack bacteria, virus, toxins) and fibroblasts (secrete collagen and help with wound healing)
  • Epithelial cells migrate on from wound edges over newly laid dermis and healing is complete
34
Q

List the Topical treatments available for plantar warts

4 answers MTS acid S N

A
  • Monochloroacetic acid - corrosive acid based solution
  • Trichloroacetic acid - same as mcaa but more commonly used as 10% solution
  • Salicylic Acid - solution applied on a daily bases to peel off the upper layer of warts tissue
  • Silver nitrate - paint on solution, file down or etch the wart with scalpal first
35
Q

What is Electrosurgery in regards to warts

A
  • Local anaesthetic is applied to the foot
  • An electric current delivering a lot of heat cauterises the wart burning it off and essentially killing unwanted growth
36
Q

What is vitaligo

A

Abnormal pigmentation of the skin

37
Q

What is Hemostasis

A

Hemostasis is the proccess of a wound being closed by clotting

  • Blood vessels constrict limiting blood flow (Vascular Spasm)
  • Platlets stick together in order to seal the damaged blood vessel (Platelet Plug)
  • Coagulation occurs reinforcing the platelet plug with threads of fibrin which a binding molecules
38
Q

What is the inflammation phase of wound healing

A
  • 2nd stage of wound healing after hemostasis and controls bleeding and prevents infection
  • The fluid engorgement allows healing and repair cells to move to the site of the wound
  • Damaged cells, pathogens, and bacteria are removed from the wound area
39
Q

What is the Proliferation stage of wound healing

A
  • Wound is rebuilt with new tissue made up of collagen and extracellular matrix
  • Miyofibroblasts cause the wound to contract and new blood vessels are constructed so that granulation tissue (red bumpy tissue showing the wound is progressing from inflammatory phase) can be healthy
  • Finally epithelial cells resurface the wound (epithelial cells line the surface of the body
40
Q

What is the remodeling phase of wound healing

A
  • Also called maturation phase
  • Cells used to repair the wound that are no longer needed are removed by apoptosis (programmed cell death
  • Collagen is remodelled so the fibres lie closer together and cross link (reduces scar thickness and makes skin stronger)
41
Q

What is Hyperkaratosis

A

Increased thickening of the skin (The Stratum Corneum layer of the epidermis)

42
Q

What are Corns and Callus

A

Corn - inverted cone of hyperkeratinised tissue that is pushe into the skin

Callus - Yellowish plaque of hard skin

Both are associated with excessive mechanical stress e.g. friction, pressure torsion tension.

43
Q

What is the pathogenesis of corns and callus

A

Both corns and callus develop as a response to mechanical stress

In response to repetitive friction and pressure thickening (keratinisation) takes place as well as a reduced rate of desqumation (peeling of the skin)

44
Q

What is Burstitis

A

Bursitis is basically inflammation of the bursa (fluid filled sac the cushions and lubricates bones and joints)

my podiatry notes (8 decks)

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