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The Integumentary System and Body
           Membranes




 Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Objectives

• Classify, compare the structure of, and give examples of
  each type of body membrane
• Describe the structure and function of the epidermis and
  dermis
• List and briefly describe each accessory organ of the
  skin
• List and discuss the three primary functions of the
  integumentary system
• List and describe major skin disorders and infections
• Classify burns and describe how to estimate the extent
  of a burn injury
      Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Classification of
                    Body Membranes

• Classification of body membranes
  – Epithelial membranes—composed of
    epithelial tissue and an underlying layer of
    connective tissue
  – Connective tissue membranes—composed
    exclusively of various types of connective
    tissue



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Classification of
                    Body Membranes

• Epithelial membranes
  – Cutaneous membrane—the skin
  – Serous membranes—simple squamous
    epithelium on a connective tissue
    basement membrane
    • Parietal—line walls of body cavities
    • Visceral—cover organs found in body cavities



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Classification of
                    Body Membranes

• Examples
  – Pleura—parietal and visceral layers line
    walls of thoracic cavity and cover the lungs
  – Peritoneum—parietal and visceral layers
    line walls of abdominal cavity and cover
    the organs in that cavity




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Classification of
                    Body Membranes

• Diseases
  – Pleurisy—inflammation of the serous
    membranes that line the chest cavity and
    cover the lungs
  – Peritonitis—inflammation of the serous
    membranes in the abdominal cavity that
    line the walls and cover the abdominal
    organs

    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Classification of
                    Body Membranes

• Mucous membranes
  – Line body surfaces that open directly to the
    exterior
  – Produce mucus, a thick secretion that
    keeps the membranes soft and moist




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Classification of
                    Body Membranes

• Connective tissue membranes
  – Do not contain epithelial components
  – Produce a lubricant called synovial fluid
  – Examples
     • The synovial membranes in the spaces
       between joints and in the lining of the bursal
       sacs



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Structure—two primary layers called
  epidermis and dermis
  – Epidermis
    • Outermost and thinnest primary layer of skin
    • Composed of several layers of stratified
      squamous epithelium




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Structure
  – Epidermis
     • Stratum germinativum—innermost (deepest) layer of cells
       that continually reproduce; new cells move toward the
       surface
              – Sometimes called the pigment layer
              – Pigment cells called melanocytes, which produce the brown
                pigment melanin
     • As cells approach the surface, they are filled with a
       tough, waterproof protein called keratin and eventually flake
       off
     • Stratum corneum—outermost layer of keratin-filled cells

     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Structure
  – Epidermis
     • Skin color changes
              – Pink flush indicates increased blood volume or increased
                blood oxygen
              – Cyanosis—bluish gray color indicates decreased blood
                oxygen level
              – Vitiligo—patchy light skin areas resulting from acquired
                loss of epidermal melanocytes (Figure 6-4)
              – Increased skin pigmentation caused by hormonal changes
                in pregnant women
              – Freckles—small, flat macules—common normal skin
                pigment variation


     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Dermal-epidermal junction—specialized
  area of contact between the epidermis
  and dermis; sometimes described as
  ―spot welds‖
  – Provide support for epidermis
  – Weakened or destroyed junctions can
    cause blisters


    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Structure
  – Dermis
     • Deeper and thicker of the two primary skin layers and
       composed largely of connective tissue
     • Upper area of dermis characterized by parallel rows of
       peglike dermal papillae
     • Thick skin has parallel friction ridges and no hairs
     • Thin skin has irregular, shallow grooves and hair
     • Deeper area of dermis is filled with network of tough
       collagenous and stretchable elastic fibers



     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Structure
  – Dermis
     • Number of elastic fibers decreases with age
       and contributes to wrinkle formation
             – Striae—―stretch marks‖; elongated marks caused by
               overstretching of skin




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Structure
  – Dermis
     • Dermis also contains nerve endings, muscle
       fibers, hair follicles, sweat and sebaceous
       glands, and many blood vessels
             – Birthmarks—malformation of dermal blood vessels
                 » Strawberry hemangioma
                 » Port-wine stain
                 » Stork bite



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Appendages of the skin
  – Hair
    • Soft hair of fetus and newborn called lanugo
    • Hair growth requires epidermal tubelike
      structure called hair follicle
    • Hair growth begins from hair papilla




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Appendages of the skin
  – Hair
    • Hair root lies hidden in follicle; visible part of
      hair called shaft
    • Alopecia (Figure 6-8)—hair loss
    • Arrector pili—specialized smooth muscle that
      produces ―goose pimples‖ and causes hair to
      stand up straight



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Appendages of the skin
  – Receptors
    • Specialized nerve endings—make it possible
      for skin to act as a sense organ
             – Meissner (tactile) corpuscle—capable of detecting
               light touch
             – Lamellar (Pacini) corpuscle—capable of detecting
               pressure




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Nails
  – Produced by epidermal cells over terminal ends of
    fingers and toes
  – Visible part called nail body
  – Root lies in a groove and is hidden by cuticle
  – Crescent-shaped area nearest root called lunula
  – Nail bed may change color with change in blood
    flow



     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Nails
  – Normal variations in nail structure
     • Longitudinal ridges in light-skinned individuals
     • Pigmented bands in dark-skinned individuals
  – Abnormal variations in nail structure
     • Onycholysis—separation of nail from nail bed
     • Pitting—common in psoriasis



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Skin glands—two main types
  – Sweat, or sudoriferous
  – Sebaceous




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Skin glands
  – Sweat, or sudoriferous, glands
    • Eccrine sweat gland
             – Most numerous, important, and widespread of the
               sweat glands
             – Produce perspiration or sweat, which flows out
               through pores on skin surface
             – Function throughout life and assist in body heat
               regulation



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Skin glands
  – Sweat or sudoriferous glands
    • Apocrine sweat glands
             – Found primarily in axilla and around genitalia
             – Secrete a thicker, milky secretion quite different from
               eccrine perspiration
             – Breakdown of secretion by skin bacteria produces
               odor




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
The Skin

• Skin glands
  – Sebaceous glands
             – Secrete oil or sebum for hair and skin
             – Secretion increases during adolescence
             – Amount of secretion regulated by sex hormones
             – Sebum in sebaceous gland ducts may darken to
               form a blackhead
             – Acne vulgaris—inflammation of sebaceous gland
               ducts



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Functions of the Skin

• Protection—first line of defense
  – Against infection by microbes
  – Against ultraviolet rays from sun
  – Against harmful chemicals
  – Against cuts and tears
  – Bruising can cause discoloration as blood
    released from damaged vessels breaks down
  – Skin grafts may be needed to replace skin
    destroyed by disease or trauma

      Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Functions of the Skin

• Temperature regulation
  – Skin can release almost 3000 calories of
    body heat per day
  – Mechanisms of temperature regulation
    • Regulation of sweat secretion
    • Regulation of flow of blood close to the body
      surface



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Functions of the Skin

• Sense organ activity
  – Receptors serve as receivers for the
    body, keeping it informed of changes in its
    environment
  – Skin can detect sensations of light
    touch, pressure, pain, heat, and color




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Skin
                  (Dermatoses)

• Skin lesions—any measurable variation from
  the normal structure
  – Elevated lesions—cast a shadow outside their
    edges
     •    Papule—small, firm raised lesion
     •    Plaque—large raised lesion
     •    Vesicle—blister
     •    Pustule—pus-filled lesion
     •    Crust—scab
     •    Wheal (hive)—raised, firm lesion with a light center


     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Disorders of the Skin
               (Dermatoses)

– Flat lesions—do not cast a shadow
  • Macule—flat, discolored region
– Depressed lesions cast a shadow within their
  edges
  • Excoriation—missing epidermis, as in a scratch
  • Ulcer—craterlike lesion
  • Fissure—deep crack or break
– Some lesions are produced by scrapes and
  cuts—the skin can repair itself
  Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Burns

• Treatment and recovery or survival
  depend on total area involved and
  severity or depth of the burn
• Classification of burns
  – First-degree (partial-thickness) burns—only
    surface layers of epidermis involved
  – Second-degree (partial-thickness) burns—
    involve deep epidermal layers; always
    cause injury to upper layers of the dermis

    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Burns

• Classification of burns
  – Third-degree (full-thickness) burns—
    characterized by complete destruction of
    the epidermis and dermis
     • May involve underlying muscle and bone
       (fourth degree)
     • Lesion is insensitive to pain because of
       destruction of nerve endings immediately after
       injury—intense pain is experienced soon
       thereafter

    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Burns

• Estimating body surface area using the
  ―rule of nines‖ in adults
  – Body divided into 11 areas of 9% each
  – Additional 1% of body surface area around
    genitals




    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Skin Infections

• Impetigo—highly contagious staphylococcal
  or streptococcal infection
• Tinea—fungal infection (mycosis) of the skin;
  several forms occur
• Warts—benign neoplasm caused by
  papillomavirus
• Boils—furuncles; staphylococcal infection in
  hair follicles
• Scabies—parasitic infection

     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Vascular and
   Inflammatory Skin Disorders

• Decubitus ulcers (bedsores) develop when
  pressure slows down blood flow to local
  areas of the skin
• Urticaria or hives—red lesions caused by fluid
  loss from blood vessels
• Scleroderma—disorder of vessels and
  connective tissue characterized by hardening
  of the skin; two types: localized and systemic


     Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Vascular and
   Inflammatory Skin Disorders

• Psoriasis—chronic inflammatory
  condition accompanied by scaly
  plaques
• Eczema—common inflammatory
  condition characterized by
  papules, vesicles, and crusts; not a
  disease itself but a symptom of an
  underlying condition
    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Skin Cancer

• Three common types
  – Squamous cell carcinoma—the most
    common type, characterized by
    hard, raised tumors
  – Basal cell carcinoma—characterized by
    papules with a central crater; rarely
    spreads
  – Melanoma—malignancy in a nevus (mole);
    the most serious type

    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Skin Cancer

• The most important causative factor in
  common skin cancers is exposure to
  sunlight
• Kaposi sarcoma, characterized by
  purple lesions, is associated with AIDS
  and other immune deficiencies



    Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.

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M licensure and starting a practice
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K interpersonal communication
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J 2 diverse community of patients
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J 1 patient reception and registration
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I appointment schduleing
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H circulatory system
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H 2 bacteriology, sanitation, and sterilization
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G nervous system
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F endocrine system
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F 2 the endocrine system
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D anatomy and physiology of the hair and skin
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E integumentary system

  • 1. The Integumentary System and Body Membranes Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 2. Objectives • Classify, compare the structure of, and give examples of each type of body membrane • Describe the structure and function of the epidermis and dermis • List and briefly describe each accessory organ of the skin • List and discuss the three primary functions of the integumentary system • List and describe major skin disorders and infections • Classify burns and describe how to estimate the extent of a burn injury Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 3. Classification of Body Membranes • Classification of body membranes – Epithelial membranes—composed of epithelial tissue and an underlying layer of connective tissue – Connective tissue membranes—composed exclusively of various types of connective tissue Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 4. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 5. Classification of Body Membranes • Epithelial membranes – Cutaneous membrane—the skin – Serous membranes—simple squamous epithelium on a connective tissue basement membrane • Parietal—line walls of body cavities • Visceral—cover organs found in body cavities Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 6. Classification of Body Membranes • Examples – Pleura—parietal and visceral layers line walls of thoracic cavity and cover the lungs – Peritoneum—parietal and visceral layers line walls of abdominal cavity and cover the organs in that cavity Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 7. Classification of Body Membranes • Diseases – Pleurisy—inflammation of the serous membranes that line the chest cavity and cover the lungs – Peritonitis—inflammation of the serous membranes in the abdominal cavity that line the walls and cover the abdominal organs Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 8. Classification of Body Membranes • Mucous membranes – Line body surfaces that open directly to the exterior – Produce mucus, a thick secretion that keeps the membranes soft and moist Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 9. Classification of Body Membranes • Connective tissue membranes – Do not contain epithelial components – Produce a lubricant called synovial fluid – Examples • The synovial membranes in the spaces between joints and in the lining of the bursal sacs Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 10. The Skin • Structure—two primary layers called epidermis and dermis – Epidermis • Outermost and thinnest primary layer of skin • Composed of several layers of stratified squamous epithelium Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 11. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 12. The Skin • Structure – Epidermis • Stratum germinativum—innermost (deepest) layer of cells that continually reproduce; new cells move toward the surface – Sometimes called the pigment layer – Pigment cells called melanocytes, which produce the brown pigment melanin • As cells approach the surface, they are filled with a tough, waterproof protein called keratin and eventually flake off • Stratum corneum—outermost layer of keratin-filled cells Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 13. The Skin • Structure – Epidermis • Skin color changes – Pink flush indicates increased blood volume or increased blood oxygen – Cyanosis—bluish gray color indicates decreased blood oxygen level – Vitiligo—patchy light skin areas resulting from acquired loss of epidermal melanocytes (Figure 6-4) – Increased skin pigmentation caused by hormonal changes in pregnant women – Freckles—small, flat macules—common normal skin pigment variation Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 14. The Skin • Dermal-epidermal junction—specialized area of contact between the epidermis and dermis; sometimes described as ―spot welds‖ – Provide support for epidermis – Weakened or destroyed junctions can cause blisters Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 15. The Skin • Structure – Dermis • Deeper and thicker of the two primary skin layers and composed largely of connective tissue • Upper area of dermis characterized by parallel rows of peglike dermal papillae • Thick skin has parallel friction ridges and no hairs • Thin skin has irregular, shallow grooves and hair • Deeper area of dermis is filled with network of tough collagenous and stretchable elastic fibers Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 16. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 17. The Skin • Structure – Dermis • Number of elastic fibers decreases with age and contributes to wrinkle formation – Striae—―stretch marks‖; elongated marks caused by overstretching of skin Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 18. The Skin • Structure – Dermis • Dermis also contains nerve endings, muscle fibers, hair follicles, sweat and sebaceous glands, and many blood vessels – Birthmarks—malformation of dermal blood vessels » Strawberry hemangioma » Port-wine stain » Stork bite Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 19. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 20. The Skin • Appendages of the skin – Hair • Soft hair of fetus and newborn called lanugo • Hair growth requires epidermal tubelike structure called hair follicle • Hair growth begins from hair papilla Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 21. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 22. The Skin • Appendages of the skin – Hair • Hair root lies hidden in follicle; visible part of hair called shaft • Alopecia (Figure 6-8)—hair loss • Arrector pili—specialized smooth muscle that produces ―goose pimples‖ and causes hair to stand up straight Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 23. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 24. The Skin • Appendages of the skin – Receptors • Specialized nerve endings—make it possible for skin to act as a sense organ – Meissner (tactile) corpuscle—capable of detecting light touch – Lamellar (Pacini) corpuscle—capable of detecting pressure Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 25. The Skin • Nails – Produced by epidermal cells over terminal ends of fingers and toes – Visible part called nail body – Root lies in a groove and is hidden by cuticle – Crescent-shaped area nearest root called lunula – Nail bed may change color with change in blood flow Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 26. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 27. The Skin • Nails – Normal variations in nail structure • Longitudinal ridges in light-skinned individuals • Pigmented bands in dark-skinned individuals – Abnormal variations in nail structure • Onycholysis—separation of nail from nail bed • Pitting—common in psoriasis Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 28. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 29. The Skin • Skin glands—two main types – Sweat, or sudoriferous – Sebaceous Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 30. The Skin • Skin glands – Sweat, or sudoriferous, glands • Eccrine sweat gland – Most numerous, important, and widespread of the sweat glands – Produce perspiration or sweat, which flows out through pores on skin surface – Function throughout life and assist in body heat regulation Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 31. The Skin • Skin glands – Sweat or sudoriferous glands • Apocrine sweat glands – Found primarily in axilla and around genitalia – Secrete a thicker, milky secretion quite different from eccrine perspiration – Breakdown of secretion by skin bacteria produces odor Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 32. The Skin • Skin glands – Sebaceous glands – Secrete oil or sebum for hair and skin – Secretion increases during adolescence – Amount of secretion regulated by sex hormones – Sebum in sebaceous gland ducts may darken to form a blackhead – Acne vulgaris—inflammation of sebaceous gland ducts Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 33. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 34. Functions of the Skin • Protection—first line of defense – Against infection by microbes – Against ultraviolet rays from sun – Against harmful chemicals – Against cuts and tears – Bruising can cause discoloration as blood released from damaged vessels breaks down – Skin grafts may be needed to replace skin destroyed by disease or trauma Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 35. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 36. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 37. Functions of the Skin • Temperature regulation – Skin can release almost 3000 calories of body heat per day – Mechanisms of temperature regulation • Regulation of sweat secretion • Regulation of flow of blood close to the body surface Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 38. Functions of the Skin • Sense organ activity – Receptors serve as receivers for the body, keeping it informed of changes in its environment – Skin can detect sensations of light touch, pressure, pain, heat, and color Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 39. Disorders of the Skin (Dermatoses) • Skin lesions—any measurable variation from the normal structure – Elevated lesions—cast a shadow outside their edges • Papule—small, firm raised lesion • Plaque—large raised lesion • Vesicle—blister • Pustule—pus-filled lesion • Crust—scab • Wheal (hive)—raised, firm lesion with a light center Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 40. Disorders of the Skin (Dermatoses) – Flat lesions—do not cast a shadow • Macule—flat, discolored region – Depressed lesions cast a shadow within their edges • Excoriation—missing epidermis, as in a scratch • Ulcer—craterlike lesion • Fissure—deep crack or break – Some lesions are produced by scrapes and cuts—the skin can repair itself Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 41. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 42. Burns • Treatment and recovery or survival depend on total area involved and severity or depth of the burn • Classification of burns – First-degree (partial-thickness) burns—only surface layers of epidermis involved – Second-degree (partial-thickness) burns— involve deep epidermal layers; always cause injury to upper layers of the dermis Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 43. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 44. Burns • Classification of burns – Third-degree (full-thickness) burns— characterized by complete destruction of the epidermis and dermis • May involve underlying muscle and bone (fourth degree) • Lesion is insensitive to pain because of destruction of nerve endings immediately after injury—intense pain is experienced soon thereafter Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 45. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 46. Burns • Estimating body surface area using the ―rule of nines‖ in adults – Body divided into 11 areas of 9% each – Additional 1% of body surface area around genitals Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 47. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 48. Skin Infections • Impetigo—highly contagious staphylococcal or streptococcal infection • Tinea—fungal infection (mycosis) of the skin; several forms occur • Warts—benign neoplasm caused by papillomavirus • Boils—furuncles; staphylococcal infection in hair follicles • Scabies—parasitic infection Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 49. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 50. Vascular and Inflammatory Skin Disorders • Decubitus ulcers (bedsores) develop when pressure slows down blood flow to local areas of the skin • Urticaria or hives—red lesions caused by fluid loss from blood vessels • Scleroderma—disorder of vessels and connective tissue characterized by hardening of the skin; two types: localized and systemic Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 51. Vascular and Inflammatory Skin Disorders • Psoriasis—chronic inflammatory condition accompanied by scaly plaques • Eczema—common inflammatory condition characterized by papules, vesicles, and crusts; not a disease itself but a symptom of an underlying condition Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 52. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 53. Skin Cancer • Three common types – Squamous cell carcinoma—the most common type, characterized by hard, raised tumors – Basal cell carcinoma—characterized by papules with a central crater; rarely spreads – Melanoma—malignancy in a nevus (mole); the most serious type Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 54. Skin Cancer • The most important causative factor in common skin cancers is exposure to sunlight • Kaposi sarcoma, characterized by purple lesions, is associated with AIDS and other immune deficiencies Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.
  • 55. Mosby items and derived items © 2010, 2006, 2002, 1997, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.

Notas do Editor

  1. A membrane is a thin, sheetlike structure that covers and protects the body’s surface, lines body cavities, and covers the inner surfaces of hollow organs, such as the digestive, reproductive, and respiratory passageways.What are some of the other functions performed by membranes? Some membranes anchor organs to each other or to bones, membranes secrete lubricating fluids that reduce friction during organ movements (beating heart or lung expansion and contraction), membrane lubricants also decrease friction between bones in joints.
  2. What are the three types of epithelial membranes? cutaneous, serous, and mucousThe cutaneous membrane is the primary organ of the integumentary system. It has a superficial layer of epithelial cells and an underlying layer of supportive connective tissue.The serous membrane that lines body cavities and covers the surfaces of organs is a single, continuous sheet of tissue.The name of the serous membrane is determined by its location.What are some examples of serous membranes? What are their functions? Serous membranes are found only on surfaces within closed cavities. Parietal membranes line the walls of cavities like wallpaper in a room. Visceral membranes cover the surface of organs within body cavities.
  3. Serous membranes secrete a thin, watery fluid that helps to reduce friction and serves as a lubricant when organs rub against one another and against the walls of the cavities that contain them.
  4. Pleurisy is also known as “pleuritis.”Why might peritonitis sometimes be a serious complication of an infected appendix? An infected appendix that ruptures will allow the contents of the gastrointestinal tract to enter the peritoneal cavity.
  5. What are some examples of mucous membranes in the body? Mucous membranes line body surfaces that open directly to the exterior such as those lining the respiratory, digestive, urinary, and reproductive tracts.What is the mucocutaneous junction? The transitional area that serves as the point of fusion where skin and mucous membranes meetThe epithelial component of a mucous membrane varies depending on location and function.The esophagus has a tough, abrasion-resistant stratified squamous epithelium.The lower segment of the digestive tract has a simple, columnar epithelium.
  6. What are some examples of connective tissue membranes, and what are the functions that they serve? Synovial membranes line the spaces between bones and joints; they also line the cushion-like sacs called bursae.In figure 6-2 the various types of epithelial and connective tissue membranes are shown.What are the functions performed by each of the membranes in figure 6-2?
  7. One square inch of skin contains: 500 sweat glands, 1000 nerve endings, yards of blood vessels, 100 oil (sebaceous) glands, 150 sensors for pressure, 75 sensors for heat, and 10 sensors for cold.What type of membrane is the skin? CutaneousDescribe the process of cell reproduction performed by the stratum germinativum. Mitosis; then they move toward the surface and specialize in ways that increase their ability to provide protection for the body tissues that lie below them.What purposes does this process serve? It enables the skin to repair itself if injured.
  8. What is keratin and what purpose does it serve? Keratin is a tough, waterproof material that provides cells in the outer layer of the skin with a horny, abrasion-resistant, and protective quality.
  9. Pigment—comes from Latin term meaning “paint.”The higher the concentration of melanin, the deeper the color of skin.What is the primary function of melanin? Melanin determines skin color.How is the amount of melanin in the skin determined? Heredity and exposure to sunlight affect amount of melanin.Cyanosis: change in skin color (bluish tinge in light-skinned individuals) if blood oxygen levels or blood flow is reduced.
  10. Cells of the dermis are scattered far apart, with many fibers in between.What types of fibers are in the dermis, and what are their characteristics? Dermis is composed largely of connective tissue with tough, strong fibers (collagen or white fibers) and stretchable and elastic (yellow).
  11. The dermis contains a specialized network of nerves and nerve endings to process sensory information such as pain, pressure, touch, and temperature.What results from the elastic fibers in the dermis decreasing with age? Why would this happen? The number of elastic fibers decreases with age and wrinkles develop as the skin loses elasticity, sags, and becomes less soft and pliant.
  12. Are there any parts of the body that are hairless? If so, which? The lips, palms of the hands, and soles of the feet are hairless.What is lanugo? Lanugo is the downy, soft hair of a newborn.
  13. What is the arrector pili? What function does it perform and why? The arrector pili is a tiny, smooth (involuntary) muscle attached to the base of a dermal papilla above and the side of a hair follicle below. When it contracts, it simultaneously pulls on its two points of attachment to create goose pimples or goose flesh.What parts of the hair are in the dermis? What parts are in the epidermis? See Figure 6-2.
  14. Receptors are widely distributed over the skin.
  15. How are nails formed?What purposes might the nails serve? See Figure 6-9 and Figure 6-10
  16. What might cause the nail bed to change colors? Decrease in blood oxygen level
  17. A single square inch of skin on the palms contains about 3000 eccrine sweat glands.What is the difference between eccrine and apocrine glands? Eccrine sweat glands are more numerous and widespread over the body. They produce a transparent, thin, watery liquid. Apocrine glands are found primarily in the axilla and genital areas. They secrete a thicker, milky secretion that produces odor when skin bacteria decompose the secretion. Apocrine glands become active at puberty.
  18. Apocrine glands enlarge and begin to function at puberty.What causes the odor sometimes associated with secretions of the apocrine glands?
  19. Sebum secretion decreases in late adulthood, contributing to increased wrinkling and cracking of the skin.Why would sebum be referred to as “nature’s skin cream”? It prevents drying and cracking of the skin.
  20. How does the skin protect the body against the potential hazards listed in this slide? Intact skin prevents damage from external forces; waterproof skin products are best treatment for skin maintenance.What are the defensive properties of keratin? Keratin is waterproof, which prevents fluid from entering or leaving through the skinWhat are the defensive properties of melanin? Protects body against ultraviolet rays of the sun
  21. How is heat lost through the skin? By regulation of the blood flow through capillaries in the skin; dilation will cause heat loss.Blood supply to the skin far exceeds the amount needed by the skin.
  22. How do receptors respond to environmental changes? There are receptors for light touch (Meissner corpuscles), pressure (Pacini corpuscles), pain, heat and cold.
  23. Skin lesions can be benign or malignant or might not indicate a disorder at all.What are some examples of benign lesions and malignant lesions? See Table 6-1, Figure 6-15What are some examples of lesions that do not indicate a disorder?
  24. In what ways can the skin be burned? Burns can occur from a fire, contact of the skin with a hot surface, exposure to ultraviolet light. Burns can also occur when skin contacts an electric current or harmful chemical.
  25. The classification system used to describe the severity of burns is based on the number of tissue layers involved.The most severe burns destroy not only layers of skin and subcutaneous tissue but underlying tissues as well.What are some examples of how one might receive first-, second-, and third-degree burns? What are the symptoms, and what tissues are damaged? See Figure 6-16, Figure 6-17, A, Figure 6-17, B
  26. What are the 11 body areas defined by the “rule of nines”? See Figure 6-18What percentage of the body is injured if a person has burns to the face and both arms? 27%
  27. Skin infections are common because the skin is the body’s first line of defense against microbes.Can skin infections be life threatening? Provide an example. Yes, infections with staphylococcal or streptococcal bacteria that begin in the skin and become systemic.Give examples of skin infections that are caused by a virus, a fungus, and an itch mite.
  28. Skin disorders can be caused by a lack of blood flow, allergic reactions, inflammatory reactions, or autoimmune diseases that attack the skin.
  29. What are the warning signs of malignant melanoma? Asymmetrical, irregular, or indistinct in shape, unevenly colored, larger than 6 mmWhat does ABCD stand for in evaluation of a mole? Asymmetry, Border, Color, Diameter
  30. Adults who have had more than two blistering sunburns before the age of 20 years have a much greater risk for development of melanoma than someone who has had no such burns.