The Skin in podiatry Flashcards
Describe what the Integumentary system is and what it is comprised of
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
Describe the structure and function of the skin
The skin consists of 3 main components, these being:
- The Epidermis
- The Dermis
- The Dermoepidermal junction
Detail the charecteristics of the Epidermis
- 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
What are Keratinocytes
2 answers
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
What are Melanynocytes
- Melonynocytes produce the protein kown as melanin which is responsible for the skins pigment.
- Melanin protects against UV radiation
What are Lagerhan Cells
- 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
What is acute inflammation
- Acute inflammation is an immediate to infection or tissue damage
- It is short in duration lasting from minutes to several days depending on severity
What are the clinical features of inflammation
- Redness (Rubor)
- Heat (Calor)
- Swelling (Tumor)
- Pain (Dolor)
What are the main affects of Chemical/Inflammitory Mediators associated with inflammation
Main features of inflammtion there are 2
PP IG
- 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)
What is the mainsaty treatment for acute inflammation
- R - Rest
- I - Ice
- C- Compression
- E - Elevation
- (This should be adapted for different patients and situations)
Define Chronic Wound
- Wounds that fail to procceed through normal stages of wound healing in an orderly and timely manner
- Normal Stages - Haemostasis, Inflammation, proliferation and remodelling)
Define Aetiology
The cause of a disease or condition
Detail the numerous steps to the assessment of a chronic wound
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.
What is Osteomyelitis
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.
Define Pathogenesis
Development of a disease or condition (the process by which a disease or condition develops)
Describe the pathogenesis of Chronic wounds (The proccess by which an infection lead to a disease)
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
Describe Atrophy of the skin and its characteristics
- 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
What is systematic bacterial infection
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
What is Staphylococcus Aures its features and the resulting conditions
- 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)
*
What is Beta Haemolytic streptococci its features and resultant conditions
Erysipelas
- 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
What is Corynebacterium minutissium
- Bacteria causing erythrasma (moist interdigital fissuring) particularly associated with sweating therefore is treated by primarily controlling sweat
What is Pseudomonas aeruginosa
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
Detail the numerous management stratagies for dealing with a bacterial skin infection
……..diazine and flucloxacillin
- 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
Describe what Veruccae/Warts are
What do they cause
4 answers
- 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
What are Caustics
Caustics are hydroxides of light metals/acids used to remove dead tissue and destroy warts.
Describe the clinical features of warts (single Plantar wart/ Verrucae)
6 answers
- 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
What are the five layers of the epidermis In order (Deepest layer first)
Stratum Basal
Stratum Spinosum (Squamus Layer)
Startum Granulosum
Stratum Lucidium
Stratum Corneum
What is the Stratum Basal Layer Detail its properties
3 answers
clue = germinate
what cells are present = M M
- 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)
What is the strartum spinosum detail its properties
Basal cells - keratinocytes
5 answers
- 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)
What is the Stratum Granulosum, detail its charecteristics
clue = kerathylin granules
3 answers
- 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
What is the Stratum Lucidium
clue = lucid/clear
3 answers
- 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)
What is the stratum Corneum detail its charecteristcis
clue = corneocytes
4 answers
- 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
What is the bodies biological response to acute inflammation, list the steps
5 steps
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
List the Topical treatments available for plantar warts
4 answers MTS acid S N
- 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
What is Electrosurgery in regards to warts
- 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
What is vitaligo
Abnormal pigmentation of the skin
What is Hemostasis
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
What is the inflammation phase of wound healing
- 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
What is the Proliferation stage of wound healing
- 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
What is the remodeling phase of wound healing
- 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)
What is Hyperkaratosis
Increased thickening of the skin (The Stratum Corneum layer of the epidermis)
What are Corns and Callus
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.
What is the pathogenesis of corns and callus
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)
What is Burstitis
Bursitis is basically inflammation of the bursa (fluid filled sac the cushions and lubricates bones and joints)
