chapter 23 the integumentary system 23-2 learning outcomes (cont.) 23.1 describe the functions of...

CHAPTER

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

23The Integumentary

System

23-2


Learning Outcomes (cont.)

23.1 Describe the functions of skin.

23.2 Describe the layers of skin and the characteristics of each layer.

23.3 Explain the factors that affect skin color.

23.4 Summarize types of common skin lesions.

23-3


Learning Outcomes (cont.)

23.5 Describe the accessory organs of skin along with their structures and functions.

23.6 Explain the process of skin healing, including scar production.

23.7 Describe the common diseases and disorders of the skin.

23-4


Introduction

• Integumentary system – Skin

• Body’s outer covering• Largest organ

– Accessory organs:• Hair follicles

• Nails

• Skin glands

23-5


Functions of the Integumentary System

• Protection– First line of defense

• Bacteria• Viruses

– Protects underlying structures • UV radiation • Dehydration

23-6


Functions of the Integumentary System (cont.)

• Body temperature regulation– If too hot

• Dermal blood vessels dilate• More blood to surface so heat escapes

– If too cold• Dermal blood vessels constrict• Prevents heat from escaping

23-7


Functions of the Integumentary System (cont.)

• Vitamin D production– Skin must have sunlight– Needed for calcium absorption

• Sensation – receptors

• Excretion – perspiration

23-8


Apply Your Knowledge

What are the functions of the integumentary system?

ANSWER: The functions of the integumentary system are protection, regulation of body temperature, vitamin D production, sensation, and excretion.

23-9


Skin Structure

• Epidermis

• Dermis

• Hypodermis or subcutaneous layer

23-10


Epidermis

• Superficial layer of the skin

• Major layers – Stratum corneum

• Outermost layer• Mostly dead cells form an impermeable layer

– Stratum basale• Deepest layer• Cells constantly dividing and pushing older cells

outwardTo Figure of Skin

23-11


Epidermis (cont.)

• Cell types– Keratinocyte

• Most common• Makes and accumulates the protein keratin

– Melanocyte ~ makes the pigment melanin

23-12


Dermis

• Deeper, more complex

• Contains all major tissues, plus– Sudoriferous glands

– Sebaceous glands

– Hair follicles and arrector pili muscles

– Collagen, elastin, and nerve fibers

– Blood vesselsTo Figure of Skin

23-13


Subcutaneous Layer

• Hypodermis

• Composed of– Adipose (fat) and loose connective tissue

– Blood vessels and nerves

To Figure of Skin

23-15


Apply Your KnowledgeWhat are the layers of skin and what is their function?

ANSWER: Epidermis – superficial outer layer; cells produce keratin which makes it waterproof and resistant to bacteria and viruses; and melanin which absorbs UV radiation.

Dermis – most complex layer; contains all major tissue types; binds epidermis to subcutaneous tissue

Subcutaneous layer – inner most layer of adipose and loose connective tissue; the adipose cushions and insulates underlying structures and organs.

23-16


Skin Color

• Determined by amount of melanin and activity of melanocytes

• Genetic trait

23-17


Skin Color (cont.)

• Oxygenated blood– Oxygen dissolved in the hemoglobin of the

red blood cells

– Well-oxygenated blood ~ pink skin

– Poorly oxygenated blood ~ pale or bluish skin

23-18



What affects skin color?

ANSWER: The amount of melanin produced by the melanocytes and the oxygenation of the blood.

23-19


Skin Lesions

• Any variation in the skin– As simple as a

freckle

– As serious as a tumor

23-20


Skin Lesions (cont.)

• Primary – originate from disease or body changes

• Secondary – reaction to external trauma

• Vascular – anomalies of blood vessels

23-21



Lesion Name Description

Bulla A large blister or cluster of blisters

Cicatrix A scar, usually inside a wound or tissue

Crust Dried blood or pus on the skin

Ecchymosis A black-and-blue mark or bruise

Erosion A shallow area of skin worn away by friction or pressure

23-22




Excoriation A scratch; may be covered with dried blood

Fissure A crack in the skin’s surface

Keloid An overgrowth of scar tissue

Macule A flat skin discoloration, such as a freckle or a flat mole

Nodule A large pimple or small node

23-23




Papule An elevated mass similar to but smaller than a nodule

Petechiae Pinpoint skin hemorrhages that result from bleeding disorders

Plaque A small, flat, scaly area of skin

Purpura Purple-red bruises usually due to clotting abnormalities

Pustule An elevated (infected) lesion containing pus

23-24




Scale Thin plaques of epithelial tissue on skin’s surface

Tumor A swelling of abnormal tissue growth

Ulcer A wound that results from tissue loss

Vesicle A blister

Wheal Another term for hive

23-25



Match the following:

___ Keloid A. A blister

___ Vesicle B. A crack in the skin’s surface

___ Crust C. An overgrowth of scar tissue

___ Fissure D. A small, flat scaly area of skin

___ Ulcer E. Dried blood or pus on the skin

___ Plaque F. A wound that results from tissue loss

A

E

B

F

D

C

ANSWER:

23-26


Accessory Organs

• Hair follicles– Tube-like depressions in the dermis of skin

– Generate hairs

– Alopecia – follicles die

– Arrector pili ~ muscles that pull on follicles

Diagram

23-27


Accessory Organs (cont.)

• Sudoriferous glands

– Eccrine glands• Watery sweat• Activated by heat

– Apocrine glands• Thicker sweat • Armpit and groin areas• Activated by

nervousness or stress

• Sebaceous glands– Produce sebum to

keep hair soft

– Prevent bacteria from growing on skin

Diagram

23-28


Accessory Organs

• Nails – Protect the ends of

fingers and toes

– Epithelial cells with hard keratin

– Nail body

– Nail root

– Lunula

– Nail bed

23-29


Apply Your KnowledgeMatching:

A.Sudoriferous glands

B.Sebum

C.Apocrine glands

D.Hair follicles

E.Nails

F.Eccrine glands

G.Alopecia

H.Sebaceous glands

I.Arrector pili

tube-like depressions in the skin’s dermis; generate hairs

baldness

produce watery type of sweat

muscles attached to hair follicles; cause “goose bumps”

produce sweat

produce sebum

keeps hair soft and pliable

protect the ends of fingers and toes

become active during puberty

ANSWER:

A

B

C

D

E

FG

H

I

Perfect!

Perfect!

23-30


Skin Healing

• Injury inflammation– Redness due to dilation of

nearby blood vessels

– Swelling because vessels leak fluid into spaces between cells

– Pain because excess fluid activates pain receptors

23-31


Skin Healing (cont.)

• Inflammation promotes healing – Extra blood to area– Extra nutrients– Defensive cells

Injury occursInjury occurs

Blood clot forms

Blood clot forms

Clotted blood and other dried tissue

Scab replaces blood clot

Scab replaces blood clot

Binds the edges of wound; scar may form

Collagen fibers replace

scab

Collagen fibers replace

scab

23-32



How does inflammation promote healing of the skin?

ANSWER: Inflammation promotes healing by bringing extra blood, nutrients for skin repair, and defensive cells to the area of injury.

23-33


Common Diseases and Disorders of the Skin

• Burns – Extent of body surface area and degree of a

burn

– Rule of nines is used to determine extent of burn

• Estimate body surface area

• 11 body areas

23-34


Burns

4½% 4½%

Head and neck9%

Arms, hands, and shoulders

18%

4½% 4½%

Perineum 1%Anterior legs

and feet 18%

Posterior legs and feet

18%

Anterior trunk18%

Posterior trunk and buttocks

18%

Back

23-35


Burns (cont.)

• Superficial – Epidermis only

– Pain, redness, swelling

• Partial-thickness– Epidermis and dermis

– Pain, redness, swelling, blisters

• Full-thickness– All layers of skin and

often underlying structures

– Skin appears charred

– Always requires medical attention

Burns

23-37


Burns (cont.)

• General guidelines for treatment

– Do not remove anything sticking to the burn

– Do not apply butter, lotions, or ointments

– Cool with large amounts of water

23-38


Burns (cont.)

• General guidelines for treatment

– Cover with sterile sheet or plastic bag

– Contact emergency services

– Check airways for swelling

23-39


Skin Cancer and Common Skin Disorders

• Skin – vulnerable due to exposure

• Skin cancer– Epidermis

– Excessive exposure to sunlight

– Types • Basal cell and squamous cell carcinoma

• Malignant melanoma

23-40


Skin Cancer and Common Skin Disorders (cont.)

• Basal Cell – Signs / symptoms

• Growth or sore that will not heal• Waxy, smooth, red, pale, flat, or lumpy

– Treatment

• Curettage and electrodessication

• Mohs surgery

• Cryosurgery

• Laser therapy

23-41



• Squamous Cell – Less common than basal cell

– Flat cells of the epidermis

– Found on face, lips, ears, and backs of hands

– Signs and symptoms and treatments are the same as for basal cell carcinoma

23-42



• Malignant Melanoma– Signs / symptoms

• Mole that itches or bleeds

• ABCDE rule

– Treatment• Surgery

• Determination if cancer has spread

• Chemotherapy and radiation therapy

• Immunotherapy

23-43



Asymmetry – a mole should not become asymmetrical.

Border – a mole should not have irregular borders and edges should not blur into normal tissue.

Color – a mole should not change or become mixture of colors.

23-44



Diameter – a mole should not grow larger than the diameter of a pencil eraser (6 mm.)

Evolving – a mole that has been changing in size, color and appearance, or growing in an area of previously normal skin

23-45



Stage 0 Only found in epidermis

Stage I Spread to epidermis and dermis (1 to 2 mm thick)

Stage II 2 to 4 mm thick and may be ulcerated

Stage III Spread to one or more nearby lymph nodes

Stage IV Spread to other body organs or lymph nodes far from original melanoma

Stages of MelanomaStages of Melanoma

23-46


Common Skin and Hair Disorders

• Alopecia

– Hair loss

– Heredity

• Cellulitis

– Inflammation of connective tissue in skin

– Red, tight, painful skin

• Dermatitis – Inflammation of skin

or a rash– Eczema ~ chronic

dermatitis

• Folliculitis – Swimmer’s rash– Inflammation of hair

follicles

23-47


Common Skin Disorders (cont.)

• Herpes simplex – Type 1

• Cold sores• Spread through saliva

– Type 2 – genital• Genital • Sexually transmitted

– No cure

• Herpes zoster– Shingles

– Chicken pox virus lies dormant

– Symptomatic treatment

– Vaccine

23-48



• Impetigo – Oozing skin lesions

that eventually crust over

– Highly contagious

• Pediculosis– Capitus ~ head lice– Corporis ~ body lice– Pubis ~ pubic lice

• Psoriasis – chronic, inflammatory skin condition

23-49



• Ringworm

– Three types• Tinea corporis• Tinea capitis• Tinea pedis

– Dermatophytes

– Antifungal agents

• Rosacea– Dilation of small

facial blood vessels

– Not curable

23-50



• Scabies – Contagious skin

condition caused by mites

– Redness and itching

– Treat entire family

• Warts – Harmless growths

caused by a virus

– Vary in appearance

– OTC medications

23-51



1. True or False:

___ Basal cell carcinoma is the most aggressive form of skin

cancer and can form anywhere.

___ Squamous cell carcinoma is more likely to spread to surrounding tissues.

___ Lesions of melanoma appear on trunk, head, neck of men and on arms and legs of women.

___ The borders of skin cancers are usually regular.

___ Basal cell carcinoma progresses slowly and rarely spreads to other body parts.

ANSWER:

F

T

T

F

T

Melanomas are more aggressive.

Borders are irregular.

23-52



2. Using Figure for Rule of Nines, determine burn extent for a patient who has burns to his anterior face and both arms.

Click for Rule of Nines

ANSWER:

Face = 4.5%

Both arms, hands, and shoulders = 18%

4.5% + 18% = 22.5%

It all adds up to a right answer!

23-53


In Summary

23.1 The functions of skin include: protection, body temperature regulation, vitamin D production, sensation, and excretion.

23.2 The topmost layer of the skin is the epidermis. The dermis is the complex middle layer. The innermost layer attaching the skin to muscle is the subcutaneous layer.

23.3 The amount of melanin affects and determines skin color. The amount of oxygen-carrying hemoglobin in the blood also affects skin color.

23-54


In Summary (cont.)

23.4 Skin lesions are split among three main types: primary lesions such as macules and vesicles; secondary lesions, which include ulcers and keloids; and vascular lesions, which involve blood vessels and include telangiectasias and ecchymoses.

23.5 The accessory organs of skin include: hair follicles, arrector pili muscles, sebaceous glands,

sudoriferous glands, and keratin-filled nails.

23-55


In Summary (cont.)

23.6 Injured skin becomes inflamed from dilating blood vessels that leak and cause swelling. A blood clot is formed, which is replaced by a scab, which is then replaced by collagen fibers that produce scar tissue.

23.7 Common diseases and disorders of the skin include alopecia, cellulitis, dermatitis, eczema, folliculitis, herpes simplex, herpes zoster, impetigo, pedicuosis, psoriasis, ringworm, rosacea, scabies, and warts.

23-56


We may have different religions, different languages, different colored skin, but we all belong to one human race.

~ Kofi Annan

End of Chapter 23

chapter 23 the integumentary system 23-2 learning outcomes (cont.) 23.1 describe the functions of...

Documents