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Integumentary > Lesson 1 > Flashcards

Lesson 1 Flashcards

1
Q

Ranges in skin thickness

A

0.5 to 6.0mm

weighs 4-5 kg

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2
Q

How much cardiac output does skin receive?

A

1/3 resting cardiac output

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3
Q

Skin function:

A 
Thermoregulation
Sensation
Metabolism of vitamin D
Protection from Shear
Protection from Water Loss
Body image, expression
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4
Q

3 main layers:

A

Epidermis
Dermis
Subcutaneous

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5
Q

How often is epidermal renewal?

A

every 45 to 75 days.

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6
Q

Layers of epidermis:

A 
startum corneum
stratum lucidum
stratum granulosum
statum spinosum
statum basale
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7
Q

How does epidermins receive nutrients?

A

diffusion from dermis

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8
Q

Thickness of epidermis?

A

.06-.6 mm thick

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9
Q

Keratinocytes

A

Are the majority of epithelial cells (90%).

Make up the layers of the epidermis, lining of various body organs, sebaceous glands, hair follicles, and sweat glands

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10
Q

What attracks keratinocytes?

A

Attracted by neutrophils, macrophages, and the current of injury and advance in a sheet to resurface injured area.
Also advance from dermal appendages

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11
Q

What stimulates growth of keratinocytes?

A

Growth stimulated by moist environment and oxygen

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12
Q

Corneocytes

A

Differentiated keratinocyte surrounded by a cornified envelope

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13
Q

Langerhans Cells

A

Dendritic clear cells containing distinctive granules

Probably monocytic in origin

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14
Q

What are Langerhan cells necrosed by?

A

UV rays

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15
Q

Location of Melanocytes:

A

Between or beneath the deepest layer of epithelium (Basal layer).

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16
Q

Function of melanocytes:

A

Synthesize melanin (pigment) from amino acids Tyrosine with enzyme tyrosinase.

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17
Q

How do melanocytes pigment the cell?

A

Have branching processes by which melanosomes (pigment granules) are transferred to epidermal cells, pigmenting epidermis.

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18
Q

Cells involved in hypersensitivity and skin graft rejection?

A

Langerhans Cells

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19
Q

Merkel Cells/Discs

A

Mechanoreceptors attached to keratinocytes by desmasomes that provide sensation of light touch

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20
Q

Epidermal functions

A

Protective layer to the more fragile dermis and its structures
Prevents water loss (90% keratinocytes)/regulates fluid
Synthesizes vitamin D
Provides pigmentation (melanocytes)
Protect from shear, friction and toxins
Important role for body image, expression
Assists with excretion
Light touch sensation
Thermoregulation

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21
Q

Starum Corneum:

A

25- 30 rows of flat dead cells filled with Keratin
Flattened cells, no nuclei
Continuously shed and replaced, barrier to heat, light, bacteria and some chemicals

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22
Q

Stratum Lucidium

A

only present in palms of hands and soles of feet

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23
Q

Appearance of stratum lucidium under microscope:

A

Clear flat dead cells that appear clear under microscope

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24
Q

Stratum Grannulosum (grannular layer)

A

3-5 rows of flattened cells

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25
Q

What does stratum grannulosum contain?

A

Keratohyalin which is precursor to waterproofing protein Keratin which is found in the top layer

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26
Q

Stratum Spinosum

A

Multiple rows of polyhedral cells

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27
Q

What does stratum spinosum contain?

A

More mature rows of keratinocytes appear “spiny” due to keratin filament formation
Langerhan cells

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28
Q

What is the stratum spinosum attached together by?

A

desmosomes

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29
Q

Stratum Basale/Germinativum

A

Cuboidal/Columnar Cells

Site of new cell production

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30
Q

What are keratoncytes connected by in the stratum basale?

A

connected to the basement membrane by hemadesmosomes, and to each other by desmosomes

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31
Q

Which layer doe nails arise from?

A

stratum basale

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32
Q

What else is in stratum basale?

A 
merkel discs (nerve endings/mechanoreceptors)
melanocytes
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33
Q

Basement Membrane

A

Attaches the epidermis to the dermis via rete ridges(rete pegs)
Acts as a scaffold for the epidermis
Filters substances moving from dermis to epidermis

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34
Q

What compromised basement membrane?

A

type IV collagen fibers

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35
Q

What does dermis house?

A

Sensory organs
Vasculature- Provides nourishment to epidermis and thermoregulation
Dermal appendages
Protects against infection

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36
Q

Thickness of dermis:

A

2-4mm

thickest layer of skin

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37
Q

Dermal appendages

A

hair follicles
sebaceous glands
sudoriferous glands
nails

38
Q

Where are sudoriferous glands?

A

everywhere but lips and ears secrete sweat

39
Q

Dermis cell types

A 
Fibroblasts produce collagen and elastin
Macrophages
White blood cells
Mast cells- produce histamines
Sensory receptors
40
Q

Papillary region

A

Top 1/5 is the dermal papillae- which are finger-like projections into concavities of the epidermis and attach to the Rete ridges of the epidermis

41
Q

What does the papillary region allow?

A

capillaries to come close to the epidermis for nutrient and O 2 exchange

42
Q

Reticular Region

A

Dense irregular connective tissue, collagen, elastin
Contains adipose, follicles, nerves, oil glands, ducts of sweat glands
Provides strength and elasticity to skin

43
Q

Subcutaneous/Endodermal Layer/Hypodermis

A

Fibers extend from the dermis into this layer to anchor the skin
Superficial fascia (fibrous in appearance)
Contains deep blood vessels and nerve endings
Adipose or fatty layer

44
Q

What does the adipose or fatty layer do?

A 
White or pale yellow when healthy
Insulates
Energy reserve 
Cushioning 
Storage of vitamin A, D, E, & K
45
Q

Deep Tissue Layer

A

muscle
tendon
ligament/joint capsule
bone

46
Q

Effects of aging on skin:

A 
decreases:
Dermal thickness
Fatty layer
Collagen and elastin
Sensation and metabolism
Sweat glands
Circulation
Epidermal regeneration
47
Q

Superficial Wounds effect:

A

epidermis

48
Q

Examples of superficial wound:

A

abrasion

first degree burn

49
Q

Partial thickness would affects:

A

epidermis

dermis

50
Q

Examples of partial thickness wounds:

A

blister
second degree burn
stage II pressure ulcer
wagner grade I ulcer

51
Q

Full thickness would affects:

A

epidermis
dermis
subcutaneous tissue
may extend deeper

52
Q

Examples of full thickness wounds:

A

3rd degree burns
4th degree burn
stage II pressure ulcer
wagner grade 2-5 ulcer

53
Q

Types of Full Thickness Wound Closure

A

primary intention
secondary intention
delayed primary/tertiary intention

54
Q

Primary intention:

A

wound edges are approximated and closed

55
Q

Secondary intention:

A

allow wound to heal without surgical closure. Heals with scar tissue replacement. Infection risk or unable to approximate edges

56
Q

Delayed primary/ tertiary intention:

A

The wound is allowed to heal secondarily, then primarily closed for final healing. Done to resolve infection, allow contracture of wound or granulation base prior to grafting.
Wound should be closed within 1–2 weeks of suturing

57
Q

How long does primary closure (intention) take?

A

1-14 days

edges are approximated

58
Q

How long does secondary closure (intention) take?

A

follows 3 phases of normal wound healing

59
Q

How long does an acute wound take in secondary closure?

A

within 2 weeks

60
Q

How long does chronic wound take in secondary closure?

A

within 30 days

61
Q

Phases of Wound Healing

A

Hemostasis
Inflammation
Epithelialization/Proliferation
Remodeling

62
Q

Hemostasis

A

Immediate after injury
Vasoconstriction
Platelet aggregation-Platelets adhere to vascular endothelium and each other

63
Q

What is released as platelets adhere?

A

albumin, fibrinogen, fibrinectin, coagulation factors, and growth factors including PDGF, TGF-, FGF-2 (cytokines and chemotactic agents)
Fibrin deposition, clot is end product

64
Q

Cardinal Signs of Inflammation

A 
Swelling
Redness
Warmth
Pain
Decreased function
65
Q

How long does inflammation last?

A

start at time of injury and lasts 3-7 days

66
Q

Margination

A

A phenomenon that occurs during the early inflammatory phase. As a result of capillary dilation and slowed blood flow, Leucocytes tend to occupy the periphery and adhere to the endothelial cells that line the blood vessels

67
Q

Cellular response of inflammation:

A 
Platelets
PMNs
Fibroblasts
Macrophages
Mast cells
68
Q

Polymorphonuclear Leukocytes:

A 
Margination, diapedesis, chemotaxis
First cells to site of injury
Scavengers
Kill bacteria
Clean wound
Secrete inflammatory mediators and MMPs
69
Q

What do Granular (polymorphonuclear leukocytes- PMN’s) neutrophils do?

A

cleanse wound of microorganisms
release lysozyme
migrate to wound space
phagocytotic

70
Q

What is lysozyme?

A

an enzyme that produce free radicals to destroy bacteria

71
Q

Who do PMNs eosinophils do?

A

Larger nucleii than neutrophils.

Motile phagocytes with distinctive anti-parasitic function

72
Q

What do PMNs basophils do?

A

release histamine which cause vascular dilation

stimulates migration of enothelial cells

73
Q

What to basophils promote?

A

fibroblast proliferation and mitosis by release of a mitogen TNF alpha

74
Q

Macrophages:

A

type of monocyte from bone marrow
ingest bacteria
clean up debris after infection

75
Q

What do macrophages excrete?

A

ascorbic acid, Hydrogen peroxide, & Lactic Acid which attract more Macrophages and intensify inflammatory response.

76
Q

Parts of proliferation:

A

angiogenesis
granulation tissue formation
wound contraction

77
Q

Goal of proliferation phase?

A

in wound defect with new tissue, and restore skin integrity

78
Q

When does proliferation phase begin?

A

Overlaps and follows the inflammatory Phase beginning 3-5 days post-injury and continuing for 3 weeks in healing by primary intention

79
Q

Angiogenesis

A

Capillary buds extend into the wound bed.
Endothilial cells fill wound space creating capillaries with loose junctions and gaps in enothelial lining causing edematous look.
Capillary loops look like small granules: Granulation. Granulation tissue is delicate and needs protection.
Collagen synthesis by fibroblasts

80
Q

Chronic wound:

A

Fibronection composition, Chronic wound fluid-inhibiting factors, delayed re-epithelialization due to non-productive wound edges, protracted inflammatory and proliferative responses

81
Q

Goal of epithelization:

A

wound closure

82
Q

When does epithelization begin?

A

Starts immediately after trauma as protection from organisms

Occurs concurrently with other phases

83
Q

Function of angioblast:

A

forms new blood vessels

84
Q

Function of fibroblast:

A

builds granulation tissue

85
Q

Function of myofibroblast:

A

causes wound contraction

86
Q

Function of keratinocyte

A

reepithelialize wound surface

87
Q

Maturation and Remodeling

A

New collagen synthesis
Old collagen is broken down by collagenases
Reorientation of collagen fibers
May continue up to 2 years after wound closure

88
Q

When does remodeling being?

A

Begins as Granulation tissue is formed and continues for 1-2 years post injury until it reaches maturation

89
Q

Strength after remodeling?

A

Will not exceed 70-80% tensile strength of original. At closure tensile strength 15% normal

90
Q

Chronic remodeling:

A

imbalance in collagen synthesis and lysis, dehiscence, keloids

Integumentary (18 decks)

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