Integumentary I Study Guide

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Integumentary I Study Guide

• This guide is to assist you in acquiring
  information for the Course
• You may use this guideline and email the
  instructor at any time for assistance
• Please try to come to class prepared to discuss
  the case

• Make sure you have an understanding of all
  materials prior to our examinations.
• Work in groups to problem solve. Utilized the
  resources in the ASU library, internet and
  faculty.

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Week I II The Role of the Integumentary System

• Phases of Wound Healing
• Inflammatory
• Vascular/Cellular Responses
• Lymphatic Response
• Acute Phase of Inflammation

• Subacute Phase of Inflammation
• Chronic Phase of Inflammation

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Vascular Reaction

• Heomstatic Mechanisms
• Coagulation
• Vasoconstriction occurs
• The role of Serotonin, ADP, ETC..
• Platlets are used to stop bleeding
• Margination

• Histamine facilitates the form neutrophilic
  leukocytes
• Plasma Proteins
• Fibroogen and the Fibrin Plug
• Diapedesis and Chemtatic attraction
• Exudate
• Characteristics of Wound Drainage

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Cellular Reaction

• Leukocytes
• Types Granulocytes and mononuclear cells
• Granulocytes neutrophils, eocinophils, basophils
• Review the number of circulatin blood cells per
  milliter of blood

• Phagocytosis during the initial phase
• Neutorphils release proteases/collagenase
• Chemotaxis
• The timing of wound repair is important
• Erythrocytes
• Lymphocytes

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Hemodynamic Activity

• Vasoconstriction
• Vasodilation Bleeding
• Increased Capillary Permeability
• Phagocytic Cells
• Neutrophils
• Macrophages

• Lymphocytes

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Leukocytes

• Polymophonuclear leukocytes (granulocytes)
• -nuetrophils
• -eosinophils
• -basophils

• Mononuclear cells
• -monocytes
• -lymphocytes
• -macrophage cells

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Lymphocytes

• Antigens
• T Lymphocytes
• B Lymphoctyes

• Gamma Globulins
• Antibodies

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Platelets

• Pluging
• PDGF

• Regulation

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Chemical Mediators of Inflammation

• Histamine
• Serotonin
• Kinins

• Prostoglandins

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Chronic Inflammation

• Time Frame
• Necrotic Tissue
• Lysis

• Granuloma

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Connective Tissue Wound Healing

• Cells
• Fibers

• Amorphorus

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Cells

• FIXED CELLS
• Fibroblasts
• Macrophages
• Adipocytes

• FREE CELLS
• Macrophages
• Lymphocytes
• Plasma Cells
• Mast Cells
• Myofibroblasts

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Connective Tissue Matrix

• Collagen
• Elastin

• Reticulin

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Nonfibrous Elements of Connective Tissue

• Water
• Salt
• Glycosaminoglycans

• (GAG)

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Ground Substance Characteristics

• Compliance
• Flexibility
• Integrity
• Strength
• Support
• Density
• Decreases Tissue Friction

• Protection
• Transportation
• Storage

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Collagenous Fiber Characteristics

• 70 Dry Wet Skin
• Strength
• Resist Stretching
• Resists Mechanical Forces
• Resists Deformation
• Structure

• Stiffness to Dermis

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Types of Collagen

• Type I
• -Located in Dermis
• -Tendons
• -Fascia
• -Bone
• -Teeth

• Type III
• -Found in Embryonic connective Tissue
• -Reticular Networks in deep dermis
• -Blood vessels
• -Wounds

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Characteristics of Elastic Fibers

• Long
• Thin
• Refractible

• Elastic
• Extensible

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Types of Microfibrils

• Elastin
• Glucoproteins

• Lipids

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Cardinal Signs of Inflammation

• Rubor
• Tumor

• Color
• Dolor

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Wounding

• Inflammatory Phase

• Fibroblastic Phase

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Factors Affecting Repair

• Blood Supply
• Proteins
• Minerals
• Amino Acids
• Enzymes

• Hormones
• Oxygen
• Infection
• Vitamins

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Steroids

• Decreased metabolic activity

• There is a lack of research regarding the
  specific effect steriods has on wounds

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The Effect of Diabetes Mellitus on Wound Healing

• Decreased Extensibility
• Increased Hydration
• Suppressed Insulin
• Decreased Fibroblastic Activity
• Decreased Tensile Strength

• Diabetic Neuropathies
• Small Vessel Disease
• Decreased Oxygen
• Retraumatization
• Infection

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Collagen Imbalances

• Keloids
• Hydrogen bonding

• Immature Scar formation
• Mature Scar formation

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Granulation Tissue formation

• Macrophage
• Fibroblasts
• Chemotatic factors
• Structural Macromolecules
• Degrative Enzymes
• Tissue Geometry

• Fibrin
• Collagen
• Fibronectin
• Transformation growth factor-beta
• Thrombopondin

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Re-epitheliazation

• Timing-Hours
• Loss of structure
• Development of Pseudopodia
• Epidermal layer is 4-6 cells thick

• Fibronectin

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Fibroplasia

• Phenotypic changes
• Cellular organelles retract
• Proliferationof the myofibroblasts

• Synthesis of fibronectin
• Thombin
• Hyaluronic Acid

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Neovasularization

• Angiogenesis
• Vascular network
• Anastomosis
• Coupling

• Secretions of Collagenase
• Lymphatic vessels
• Neural tissue

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Wound Contraction

• Fibronexus
• Type I/III Collagen

• Cytoplasmic pseudopodia
• Chronic conditions

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Factors Affecting Chronic Wound Epithelialization

• Surgery
• Blood Supply
• Infection
• Medication
• Trauma
• Systemic Medications

• Ulcer type
• Macro environment
• Nutrition
• Age
• Illness

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Factors Affecting Wound Epithelialization and
Contraction

• Poor surgical Technique
• Arteriosclerosis
• Venous insufficiency
• tissue ischemia
• Bacterial
• Fungal
• Yeast infections

• Local anesthetics
• Malnutrition
• Protein deprivation
• Vitamen deficiency
• Corticosteriods
• Nonstriodal anti-inflammatory drugs
• Heparin

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Factors Affcting Wound Epithelializaton and
Contraction

• Endocrine disorders
• System vascular disorders
• Aspirin
• Heparin
• Coumadin
• Penicillamine
• Nicotine

• Phenylbutazone
• Connective tissue disease
• Age

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Saunders Chapter 24

• Introducation Anatomical and Physiological
  Considerations

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Role of Skin

• Protection
• Holds Organs
• Fluid Balance
• Controls Temperature
• An Organ of Sensation
• Absorbs UV

• Metabolizes vitamin D
• Porvides Cosmesis
• Provides delivery for drugs

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Role of Physical Therapy in Skin Conditions

• Facilitate motor control
• Manages pain
• Increases extensibility

• Decreases friction
• Promotes cognitive drive

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Anatomy of Epidermis

• Outer Layer
• Thickest on palms and soles
• Avascular

• Basement membrane
• Nutrition by capillaries

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Straus Corneum

• Keratinocytes
• Prevents desication of underlying tisues
• Excludes noxius substances
• Cell renewal
• Basal layer

• Cornified layer
• Epidermal nuclei disentegrate
• The stratus is neither continuous nor homogenous

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Melaoncytes

• Found in the Basal layer
• Pigement production in the skin
• Chronic light exposure increases the of
  melanocytes

• Melanocytes synthesize the pigment melanin
• Shape is octopuslike
• Purpose is to provide protection from UV

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Langerhans Cells

• Found in Mid Dermis
• Has an immune function
• Not well understood the function

• Important in immunogically mediating inflammatory
  diseases that are rare

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Basement Membrane

• Contains multiple layers
• Is not rigid but impervous to most substances

• Holds the skin together

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Dermis

• Fibroblasts
• Macrophages

• Mast Cells

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Circulation

• Anastomosis

• Lymphatic

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Sensory

• Free nerve endings

• Specialized receptors

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Skin appendages

• Hair follicles
• Sebaceous glands
• Sweat glands

• Nails
• Smooth muscles

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Skin as an Immune System

• Keratinocytes

• Langerhans Cells

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Electrical Properties of the Skin

• Sodium Channels
• Equilibrium Potentials appro.10 mV

• Endogenous Currents
• Applied Currents
• Length of Currents
• Strength of Currents
• Skin Batteries

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Week III Integumentary Pathophysiology
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PATHOLOGY

• IMPLICATIONS FOR THE PHYSICAL THERAPIST

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Concepts of Pathology

• Biological implications
• Psychological implications
• Spiritual implications
• Sociological implication

• Illness
• Disease
• Disablity

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Disease Prevention

• Primary
• Secondary

• Tertiary

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Health Promotion

• Self-Responsibility
• Nutritional Awareness
• Stress Reduction
• Management

• Physical Fitness
• Wellness
• Safety
• Support Groups

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