Integumentary system

I.Body Membranes Cover surfaces Line cavities Form protective ( and often lubricating ) sheets around organs 2 Major Groups of Body Membranes 1. Epithelial membranes - cutaneous, mucous and serous membranes 2. Connective tissue membranes -synovial membrane and cutaneous membrane ( skin or integumentary system ) Classification of Body Membranes A. Epithelial membranes - epithelial is not only misleading but also inaccurate - always combined with an underlying layer of connective tissue, although they all do contain an epithelial sheet ( thus, membranes are actually simple organs ) Types of Epithelial Membranes A. Cutaneous membranes ( skin ) Parts : 1. Epidermis superficial layer composed of keratinizing stratified squamous epithelium 2. Dermis deep layer mostly composed of dense fibrous connective tissue B. Mucous membrane ( mucosa ) - composed of epithelium resting in a loose connective tissue ( lamina propia )

- lines all body cavities that open to the exterior ( hollow organs of respiratory, digestive , urinary and reproductive tracts ) - usually wet or moist membranes that are almost continually bathed in secretions

C. Serous Membranes ( Serosa ) - composed of simple squamous epithelium resting on a thin layer of areolar connective tissue - lines body cavities that are closed to the exterior ( except for the dorsal body cavity and joint cavities ) Layers of Serosa : 1. Parietal layer lines a specific portion of the wall of the vertebral body cavity 2. Visceral layer covers the outside of the organs in that cavity - serous layers are separated by a serous fluid, secreted by both visceral and parietal membranes Serous fluid allows the organs to slide easily across the cavity walls and one another without friction as they carry out their functions - extremely important in mobile organs ( pumping heart and churning stomach ) - specific names of serous membranes depend on their locations

Types of Serous Membranes 1. Peritoneum serosa lining the abdominal cavity 2. Pleura serosa lining the lungs 3. Pericardium serosa around the heart B. Connective Tissue Membranes - synovial membrane - composed of connective tissue without epithelial cells at all Locations : 1. Joint capsule 2. Bursa 3. Tendon sheath

III. Integumentary System ( Skin )

A. Basic Skin Functions 1. Protection ( major function ) - insulates and cushions the deeper organs and protects the entire body from mechanical damage ( cuts and bumps ), chemical damage ( acids and bases ), thermal damage ( heat and cold ), ultraviolet radiation ( sunlight ), and bacteria 2. Prevention of water loss from the body surface - uppermost layer of the skin is full of keratin and cornified ( hardened ), to prevent water loss from the body surface 3. Regulation of Heat Loss - skins rich capillary network and sweat glands ( both controlled by the nervous system ) - play an important role in regulation of heat loss from the body surface 4. Excretion of urea, uric acid, salt and water ( sweating )

5. Vitamin D synthesis - modified cholesterol molecules are located in the skin are converted to vitamin D by sunlight 6. Sensation - cutaneous sensory receptors ( touch, temperature, pressure, and pain receptors ) located in the skin Skin Receptors 1. free nerve endings pain 2. ruffinis corpuscle warmth / heat 3. krauses corpuscle cold 4. paccinian corpuscle deep pressure 5. meisners corpuscle light touch 6. merkels disc light touch Structure of the Skin 1. Epidermis outer layer made up of stratified squamous epithelium - capable of becoming hard and tough ( keratinizing ) - avascular ( this explains why a man can shave daily and not bleed even though he is cutting many cell layers each time he shaves ) Keratinocytes ( keratin cells )

- comprises most cells of the epidermis that produces keratin Layers of Epidermis

stratum corneum thickest layer of epidermis - outermost layer about 20-30 cell layers thick - accounts about three-quarters of the epidermal thickness - cornified / horny cells- shingle-like dead cells remnants completely filled with keratin - rubs and flakes off slowly and steadily and is replaced by cells produced by the division of the deeper stratum basale cells 2. stratum lucidum ( lucidus = clear ) - more apparent in the hairless thick skin of the palms and soles - consists of 3-5 layers of clear, flat, dead cells - contains intermediate substance eleidin that is transformed into keratin - combination of accumulating water-repellant keratin inside them and its increasing distance from the blood supply ( in the dermis ) effectively dooms the stratum lucidum cells due to inability to get adequate nutrients and oxygen 3. stratum granulosum consists of 3-5 layers of flattened cells that develop darkly staining granules called keratohyaline ( precursor of keratin ) - keratin molecules assemble into intermediate filaments that form a barrier to protect deep layers from injury and microbial invasion and make the skin waterproof 4. stratum spinosum contains 8-10 layers of polyhedral ( many sided ) cells that fit closely together - cells are covered with prickly spines - filaments of the cytoskeleton are inserted into desmosomes, located at each spine-like projection, tightly joining the cells to another 5. stratum basale ( stratum germinativum ) - deepest layer of epidermis - lie closest to the dermis - the only epidermal cells that receive adequate nourishment via diffusion of nutrients from the dermis - cells are undergoing cell division

Melanin
Yellow brown pigment produced by melanocytes, found in stratum basale Exposure of skin to sunlight activation of melanocytes melanocytes produces melanin Tanning stratum basale eats melanin accumulation of melanin within the stratum basale cells melanin forms a protective pigment umbrella over the

superficial or sunny side of their nuclei melanin shields their genetic material (DNA) - freckles and moles are seen where melanin is concentrated in one spot Effects of excessive sun exposure 1. skin damage despite melanins protective effect 2. clumping of elastin fibers loading to leathery skin 3. depression of of the immune system 4. alteration of DNA of skin cells leading to skin cancer Dermis Strong, stretchy envelope made up of dense fibrous connective tissue that helps to hold the body together E.g. leather goods ( bags, belts , shoes ) Thickness varies in regions (e.g. thick on the palm of the hands and soles of the feet but quite thin on the eyelids ) Two Major Regions of Dermis 1. papillary regions 2. reticular layer

Epidermis and dermis of (a) thick skin and (b) thin skin (which one makes the difference?)

Papillary layer Upper dermal region area for capillaries Dermal papillae- uneven fingerlike projections from the superior surface of the papillary layer - contains capillary loops, which furnish nutrients to the dermis - houses pain receptors ( free nerve endings ) and touch receptors ( meissners corpuscle ) - arranged in genetically determined patterns on palms and soles, forming ridges on the epidermal surface that enhances gripping ability of the hands and feet - ridges of the finger tips are well provided with sweat pores and leave unique, identifying finger tips Reticular layer Deepest skin layer Contents of reticular layer: 1. phagocytes prevents bacteria from penetrating any deeper into the body 2. collagen and elastin these are found throughout the epidermis collagen responsible for the toughness of the dermis elastin responsible for the elasticity, especially in the young age Aging - reduces the number of collagen and elastin fibers and fat loss of the subcutaneous tissue leading to less elasticity of the skin and begins to sag and wrinkle 3. blood vessels abundant and plays a role in maintaining body temperature homeostasis temperature engorgement of the dermal capillaries blood T warmth and reddening of the skin radiation of heat from the skin T Temporary bypass of blood in the dermal capillaries internal body T

Pressure ulcer Any severe restriction of the normal blood supply to the skin resulting in cell death ( necrosis ) Common in bedridden patients who are not turned regularly or who are dragged or pulled across the bed repeatedly Occurs especially over bony prominences due to the pressure of the body weight on the skin The skin becomes pale or blanched at pressure points due to restriction of blood supply Permanent damage to the superficial blood vessels and tissues eventually results in degeneration and ulceration of the skin Skin Color 3 pigments contributing to skin color: 1. melanin yellow, reddish brown or black - people who produced a lot of melanin have browned-toned skin - light skinned ( caucasian ) people have less melanin 2. carotene amount of carotene deposited in the stratum corneum and subcutaneous tissue - orange-yellow pigment abundant in carrots, orange, deep yellow or leafy green vegetables

3. oxygen amount of oxygen bound to hemoglobin ( pigment in RBC ) in the dermal blood vessels - the crimson color of oxygen rich hemoglobin in the dermal blood supply flushes through the transparent cell layers above and gives the skin a rosy glow Cyanosis bluish discoloration of the skin due to poor oxygenation of the hemoglobin - common during heart failure and severe breathing disorders - skin does not appear cyanotic in black people because of the masking effects of melanin, but cyanosis is apparent in mucous membranes and nail beds

Influence of Emotional stimuli and Diseases in Skin Color 1. Redness or erythema indicates embarrasment ( blushing ), fever, hypertension, inflammation, or allergy 2. Pallor or blanching under certain types of emotional stress ( fear, anger ) some people become pale - pale skin also signifies anemia or hypotension 1. Redness or erythema indicates embarrasment ( blushing ), fever, hypertension, inflammation, or allergy 2. Pallor or blanching under certain types of emotional stress ( fear, anger ) some people become pale - pale skin also signifies anemia or hypotension deficiency in the diet of hemophilia (( bleeders disease )

Skin Appendages Arises from the epidermis and plays a unique role in maintaining body homeostasis 1. cutaneous glands 2. hairs and hair follicles 3. nails Nails:

Scale-like modification of the epidermis that corresponds to the hoof or claw of animals Parts : 1. Free edge 2. body 3. root 4. nail folds 5. cuticle 6. nail bed 7. nail matrix 8. lunula

Body of the nails Visible attached portion Root Embedded in the skin Nail Folds Skin folds covering the borders of the nail Cuticle Thick proximal nail fold Nail Bed Extension of the stratum basale beneath the nail Nail Matrix Thickened proximal area responsible for nail growth Nails become heavily keratinized and die as produced by the matrix ( thus, nails are mostly dead materials ) Lunula White crescent nail matrix at the nail bed Nails are transparent and nearly colorless, but they look pink because of the rich blood supply in the underlying dermis Nails take on a cyanotic ( blue cast ) when the oxygen supply in the blood is low Homeostatic Imbalance of the Skin 1. infections and allergies 2. burns 3. skin cancer Infections and Allergies 1. athletes foot 2. boils and carbuncles 3. cold sores 4. contact dermatitis 5. impetigo 6. psoriasis

Athletes Foot Tinea pedis Itchy, red peeling condition of the skin between the toes due to fungal infection Boils and Carbuncles Inflammation of hair follicles and sebaceous glands, found on the dorsal neck Typically caused by bacterial infection ( Staphylococcus aureus ) Cold sores Fever blisters Small-fluid filled blisters that itch and sting, caused by herpes simplex infection The virus localizes in a cutaneous nerves, where it remains dormant until activated by emotional upset, fever, or UVR Commonly occurs around the lips and in the oral mucosa of the mouth Contact Dermatitis Itching, redness, and swelling of the skin , progressing to blisters Caused by exposure of the skin to chemicals ( poison ivy ) that provoke allergic responses in sensitive individuals Impetigo Pink water-filled, raised lesions that develop a yellow crust and eventually rupture Caused by a highly contagious staphylococcal infection Commonly affects elementary school-aged children Commonly occurs around the mouth and nose Psoriais Chronic condition characterized by reddened epidermal lesions covered with dry, silvery scales Triggering Factors: 1. trauma 2. infection 3. hormonal changes 4. stress Burns Causes: 1. thermal 2. chemical 3. electrical 4. radiation Rule of Nines in Burns Estimation of the burned body surface Divides the body into 11 areas, each accounting for 9% of the total body surface area ( TBSA ), plus an additional surrounding the genital region ( perineum ) representing 1% of TBSA

Burn Classification According to Severity: 1. first degree burns 2. second degree burns 3. third degree burns First Degree Burns Partial thickness burn Epidermis is damaged Generally heal in 2-3 days without any special attention The area becomes red and swollen ( sunburn ) Second Degree Burn Partial thickness burn Involves the dermis and upper region of the dermis Skin is red and painful and blisters appear Regeneration of the epithelium ( healing ) can still occur because of sufficient number of epithelial cells still present Third Degree Burn Full thickness burn Destroys the entire thickness of the skin Burned area appears blanched ( gray white ) or blackened Painless because the nerve endings in the area are destroyed Regeneration ( healing ) is no longer possible Skin grafting must be done to cover the underlying exposed tissue ( due to absence of regeneration ) Critical Burns: 1. over 25% TBSA has 2ndary degree burns 2. over 10% TBSA has 3rd degree burn 3. 3rd degree burns of the face, hands or feet Facial burns are dangerous because of the possibility of the burned respiratory passageways to swell and cause suffocation Joint burns are troublesome because scar tissue formation can severely limit joint mobility Complications of Burns 1. circulator shock 2. renal failure 3. infection 4. depression of the immune system Circulatory shock Due to extravassation of fluids containing proteins and electrolytes from the burned surface dehydration & electrolyte imbalance decrease volume circulatory shock Depression of immune system

Occurs in severe burn cases

Skin Cancer Single most common type of cancer in humans Most skin cancers are idiopathic Risk factors: 1. over exposure to UVR 2. infection 3. chemical 4. physical trauma Types of Skin Cancer: 1. basal cell carcinoma 2. squamous cell carcinoma 3. malignant melanoma Basal cell carcinoma Most common and least malignant cancer Alteration of the cells of stratum basale inablity to distinguish the boundary between the dermis and epidermis invasion of the cancer cells in the dermis and subcutaneous tissues Most commonly occurs on exposed areas of the skin Appears as shiny dome-shaped nodules that later developed a central ulcer with pearly beaded edge Slow growing and metastasis seldom occurs before it is noticed Squamous cell carcinoma Arises from the cells of the stratum spinosum Scaly reddened papule ( small rounded elevation ) that gradually forms a shallow ulcer with a firm, raised border Common sites: 1. scalp 2. ears 3. dorsum of the hands 4. lower lip Grows rapidly and metastasizes to adjacent lymph nodes if not removed Believed to be sun-induced Good prognosticating factors: 1. early detection 2. early removal through surgery 3. early chemotherapy

Malignant Melanoma Cancer of melanocytes Accounts for 5% of skin cancers Occurs spontaneously in pigmented areas but some develop from pigmented moles Usually appears as a spreading brown to black patch that metastasize rapidly to surrounding lymph and blood vessels

50% chances of survival with early detectio

ABCD classification for malignant melanoma: A assymetry two sides of the pigmented spot or mole does not match B border irregularity borders of the lesion are not smooth but exhibit indentations C color pigmented spot contains areas of different colors ( black, brown, tan and sometimes blue, red ) D diameter spot is larger than 6 mm in diameter ( size of a pencil eraser ) Wide surgical excision along with immunotherapy is the usual management for malignant melanoma

Developmental Aspects of Skin and Body Membranes Lanugo down type of hair covering the soon-to born infant during 5th -6th months of fetal development ( shed by birth ) Vermix caseosa accumulations of small white spots in the sebaceous glands on the babys nose and forehead - normally disappear by the 3rd week after birth Skin Development Fetal ( + ) lanugo Neonatal vermis caseosa and millia - very thin and blood vessels can easily be seen through it Infancy thicker and moist, and more deposition of subcutaneous fats Adolescence skin and hair become oilier due to activation of sebaceous glands, causing acne - acne subsides in early adulthood Adulthood 20-30 - skin reaches its optimal appearance Geriatric Period : 1. reduction of subcutaneous fats 2. dry skin 3. thinning of the skin 4. decrease skin elasticity 5. baldness 6. ( + ) vellus hair

Reduction of subcutaneous fats Causes cold intolerance Dry skin Due to decrease oil production and reduction of collagen fibers Causes itchiness and discomfort

Thinning of the Skin Increases the risk for bruising and other types of injuries Decrease skin elasticity Along with the loss of subcutaneous fat causes eyebags and sagging of jowls Baldness Alopecia Occurs in 5th decade of life Due to reduced number of degeneration of hair follicles male pattern baldness = obvious balding / hair loss with aging Vellus hairs Very tiny and colorless hairs ion the bald area due to degeneration of the hair follicles Premature graying of Hair Causes : 1. emotional crisis ( problems ) 2. anxiety 3. protein deficient diets 4. chemotherapy 5. radiation 6. excessive vitamin A 7. fungal diseases ( ringworm ) These conditions are not genetically determined

Hair and Hair Follicles

Functions : 1. minor protection 2. filtration 3. thermoregulation Minor protection guarding the head against bumps, shielding the eyes ( eyelashes ) Filtration keeps foreign particles out of the respiratory tract ( nose hairs or vibrissae ) Thermoregulation provides insulation in cold weather

Parts of a Hair 1. root 2. shaft 3. hair bulb matrix Root Enclosed by hair follicle Shaft Projects from the surface of the skin or scalp Parts : 1. medulla central core 2. cortex covers the medulla 3. cuticle outermost part formed by a single layer of cells that overlap one another like shingles on a roof - roof-like arrangement helps to keep the hairs apart and keeps them from mating - most heavily keratinized region, where it provides strenght and helps keep the inner hair layers tightly compacted

Split Ends Occurs due to susceptibility of the cuticle to abrasion Abrasion wearing away of cuticle at the tip of the shaft frizzing out the keratin fibrils in the inner hair regions split ends Hair Follicles Flexible epithelial structure producing hair Parts : 1. epidermal sheath 2. dermal sheath 3. arrector pilli 4. hair bulb matrix Epidermal Sheath Inner layer composed of epithelial tissue and forms the hair Dermal Sheath Outer layer composed of dermal connective tissue Supplies blood vessels to the epidermal portion and reinforces it Its nipple like papilla provides the blood supply to the matrix in the hair bulb Arrector Pilli Small bonds of smooth muscles that connect each side of the hair follicle to the dermal tissue Contraction ( cold or frightened ) pulls the hair upright, dimpling the skin surface with goose bumps ( piloerection ) Helps keeps animals warm in winter by adding a layer of insulating air to the fur Hair-raising phenomenon is not very useful to human beings Hair Bulb Matrix Growth zone Division of stratum basale cells located at the inferior end of the follicle Daughter cells migrate from the hair bulb matrix where they become keratinized and die Thus, the bulk of the hair shaft ( like the bulb of epidermis ) is dead material Hair pigment is made by melanocytes in the hair bulb with varying amounts of different types of melanin ( yellow, brown, and black ) combine to produce all varieties of hair color from pale to pitch black Cutaneous glands All are exocrine glands that release their secretions to the skin surface via ducts Formed by the cells of the stratum basale, pushing into the deeper skin regions and reside almost entirely in the dermis Types: 1. sebaceous ( oil glands )

- found all over the skin except on the palms of the hands and the soles of the feet - ducts usually empties into a hair follicle, but some open directly onto the skins surface All are exocrine glands that release their secretions to the skin surface via ducts Formed by the cells of the stratum basale, pushing into the deeper skin regions and reside almost entirely in the dermis Types: 1. sebaceous ( oil glands ) - found all over the skin except on the palms of the hands and the soles of the feet - ducts usually empties into a hair follicle, but some open directly onto the skins surface Skin diseases due to affection of sebaceous glands: 1. white head due to blockage of sebum on the duct of sebaceous glands 2. black head due to oxidation and drying of the accumulated sebum on the duct of sebaceous glands 3. acne an active infection of the sebaceous glands accompanied by pimples on the skin 4. seborrhea severe type of sebaceous gland infection due to overactivity of the sebaceous glands - begins on the scalp as pink, raised lesions that gradually form a yellow to brown crust that sloughs off Sweat glands ( sudoriferous ) - widely distributed in the skin, about more than 2.5 million per person Types of Sweat Glands: 1. Eccrine sweat glands 2. Apocrine sweat glands Eccrine Sweat Glands More numerous and found all over the body Sweat clear secretion primarily water plus some salts ( sodium chloride ), vitamin C, metabolic wastes ( urea, ammonia, and uric acid ), and lactic acid ( chemical that attracts mosquitoes ) - acidic ( pH from 4-6 ) inhibiting bacterial growth, which are always present on the skin surface Pores funnel-shaped duct that opens externally where sweat pass to reach the skins surface Sweat Glands Important and highly efficient part of the bodys heat-regulating equipment Supplied with nerve endings that cause them to secrete when the external temperature or body temperature is high Sweat carries large amounts of body heat when it evaporates off the skin surface Secretes upt 7 liters of body water on a hot day

Apocrine Sweat Glands Largely confined to the axillary and genital areas Larger than eccrine glands and their ducts empty into hair follicles Its secretion contains fatty acids and proteins, as well as the substances of eccrine secretion The secretion is odorless, but it causes unpleasant odor when bacteria that live on the skin use its proteins and fats as source of nutrients for their growth Begins to function during puberty under the influence of androgens The precise function is not yet known, but it is activated by nerve fibers during pain and stress and during sexual foreplay