Transcript Introduction

Anatomy &
Physiology
for Health Professions:
An Interactive Journey
Bruce J. Colbert
Jeff Ankney
Karen Lee
Chapter 7
The Integumentary System:
The Protective Covering
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Chapter 7
The Integumentary System: The Protective Covering
Multimedia Asset Directory
Slide 30
Slide 71
Slide 72
Slide 73
Slide 74
Slide 75
Slide 76
Wound Repair
Pressure Sores
Eczema
Skin Cancer
Decubitus Ulcers
Emergency Medical Technicians
Nursing
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
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Introduction
• The integumentary system protects the body
from environmental damage.
• The skin forms a protective barrier shielding the
body from the elements and pathogens, as well
as performing several other vital functions.
• Skin is essential to well-being, helps to regulate
body temperature, and contains many accessory
organs such as nail, hair, and glands.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Learning Objectives
• Discuss the functions of the integumentary
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•
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•
•
system
List and describe the layers of the skin
Explain the healing process of skin
Describe the structure and growth of hair and
nails
Explain how the body regulates temperature
through the integumentary system
Discuss various common diseases of the
integumentary system
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
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Pronunciation Guide
Click on the megaphone icon before each item to hear the pronunciation.
Apocrine Glands
Carotene
Corium
Eccrine Glands
Epidermis
Epithelial Tissue
Keratin
Keratinization
Lesion
Lunala
Melanin
Anatomy & Physiology for Health Professions:
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(APP oh crin)
(CARE eh teen)
(CORE ee um)
(EKK rin)
(ep ih DER miss)
(ep ih THEE lee al)
(KAIR ah tin)
(KAIR ah tin eye ZAY shun)
(LEE zhun)
(LOO nyoo lah)
(MELL an in)
Copyright ©2007 by Pearson Education, Inc.
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Pronunciation Guide (cont’d)
Click on the megaphone icon before each item to hear the pronunciation.
Melanocytes
Pustule
Sebaceous gland
Sebum
Squamous cells
Stratum corneum
Subcutaneous fascia
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
(mell AN oh sights)
(PUS tyool)
(see BAY shuss)
(SEE bum)
(SKWAY muss sells)
(STRAY tum core NEE um)
(sub cue TAY nee us FAY she
ah)
Copyright ©2007 by Pearson Education, Inc.
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System Overview
• The integumentary system is comprised of the
skin and its accessory components including
hair, nails, and associated glands.
• The integumentary system performs several vital
functions:
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Protection from pathogens
Balances fluid levels
Stores fatty tissue for energy supply
Produces vitamin D (with help from the sun)
Provides sensory input
Helps to regulate body temperature
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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The Skin
• The skin is the largest organ, weighing
approximately 20 pounds and covering an area
about 20.83 square feet on an adult.
• A cross section of skin reveals three layers:
 Epidermis
 Dermis
 Subcutaneous Fascia
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Figure 7-1
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
The three layers of the skin.
Copyright ©2007 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Epidermis
• The epidermis is the layer of skin that we see on
the outside. It is made up of five or six even
smaller layers of tissue.
• There are no blood vessels or nerve endings in
this layer.
• The cells on the surface of the epidermis are
constantly shedding, being replaced with new
cells that grow and arise from the deeper region
called the stratum basale every 2–4 weeks.
Anatomy & Physiology for Health Professions:
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Outermost Layer
of the Epidermis
• The outermost layer is a layer of dead
cells, called the stratum corneum, which
are flat, scaly, keratinized epithelial cells.
• You slough off 500 million cells every day,
or about 1½ pounds of dead skin a year,
allowing for rapid repair in case of injuries.
Anatomy & Physiology for Health Professions:
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Skin Color
• Specialized cells called melanocytes are located
deep in the epidermis and are responsible for
skin color.
• Melanocytes produce melanin, a substance that
causes skin color.
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Skin Color (cont’d)
• Everyone contains the same amount of
melanocytes, but the variation in skin color is the
result of the amount of melanin produced and
how it is distributed.
• Carotene, another form of pigment, gives a
yellowish hue to skin while a pinkish hue is
derived from the hemoglobin in the blood.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Affects of Disease on Skin
Color
• Color of skin can indicate disease.
• When liver disease occurs, the body can’t
breakdown bilirubin. The buildup of bilirubin
gives the skin a deeper, yellow color.
• A malfunctioning adrenal gland can cause the
skin to turn bronze due to excessive melanin.
Anatomy & Physiology for Health Professions:
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Affects of Disease on Skin
Color (cont’d)
• Excessive bruising could indicate skin,
blood, or circulatory problems.
• Cyanosis, or a blue coloring, results from a
drop in oxygenation.
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Dermis
• The layer below, or inferior, to the epidermis is
the thicker dermis layer.
• This layer contains the following:
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Capillaries
Collagenous/elastic fibers
Involuntary muscles
Nerve endings
Lymph vessels
Hair follicles
Sudoriferous glands (sweat)
Sebaceous glands (oil)
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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The Dermal Layer
• Small “fingers” of tissue project from the surface
of the dermis and anchor this layer to the
epidermal layer.
• Finger and toe prints arise from this layer.
• Nerve fibers allow you to sense what is
happening in your environment.
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
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The Dermal Layer (cont’d)
• Vasodilation of capillaries in this layer cause
blushing.
• Collagen and elastic fibers allow for the elasticity
of skin, preventing the tearing of skin with
movement. They allow skin to return to normal
shape during periods of rest. Older people lose
some of this elasticity, leading to wrinkles.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
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Sudiferous Glands
• There are two main types of sudiferous, or
sweat, glands.
 Apocrine sweat glands secrete at the hair follicles in
the groin and anal region as well as the armpits.
These glands become active around puberty and are
believed to act as sexual attractants.
 Eccrine glands are found in greater numbers on your
palms, feet, forehead, and upper lip and are important
in the regulation of temperature.
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Sudiferous Glands (cont’d)
• The body has 3 million sweat glands.
• Sweat has no odor, but bacteria degrades the
substances in the sweat over time into
chemicals that give off strong smells commonly
known as body odors.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Sebaceous Glands
• Sebaceous glands play an important role by
secreting oil, or sebum.
• Sebum keeps the skin from drying out and (due
to its acidic nature) helps destroy some
pathogens on the skin’s surface.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Figure 7-2
Sweat and sebaceous glands.
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
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More Bothersome Than
Amazing Fact of Life
• When sebaceous glands within the skin become
blocked, sebum stagnates and is exposed to air,
drying out. The sebum turns black creating the
infamous blackhead. If it becomes infected, it
becomes a pimple. Squeezing blackheads can
cause craters at the site. It is best to keep the
area clean and let nature take its course.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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More Bothersome Than
Amazing Fact of Life (cont’d)
• When cleaning your skin, washing too frequently
using water that is too hot, soap that is too
harsh, or aggressive drying can dry out and
damage your skin, as well as removing the antibacterial layer of sebum. Moderation is the key.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Subcutaneous Fascia
• The innermost layer of the skin is the
subcutaneous fascia, or hypodermis.
• The subcutaneous fascia is composed of elastic
and fibrous connective tissue and fatty tissue.
• Lipocytes, or fat cells, produce the fat needed to
provide padding to protect the deeper tissues of
the body and act as insulation for temperature
regulation.
• Fascia attaches to the muscles of the body.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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How Skin Heals
• Everyone has skin injuries from time to time.
• If skin is punctured and the wound damages
blood vessels, the wound fills with blood. Blood
contains substances that cause clotting. The top
part of the clot exposed to air hardens to form a
scab, nature’s band-aid, forming a barrier and
preventing pathogens from entering.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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How Skin Heals (cont’d)
• Next, white blood cells enter and destroy any
pathogens, while fibroblasts come and begin
pulling the edges of the wound together. The
basale layer hyperproduces cells for repair of
the wound.
Anatomy & Physiology for Health Professions:
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Skin Healing
• If the wound is deep, a scar, composed of
collagen fibers, develops. Scars don’t contain
any accessory organs or nerve endings.
Stitches, adhesive strips (butterflies), or special
glue reduce scarring.
• Note, the wound ideally starts to heal from the
inside out. This aids in preventing pathogens
from becoming trapped between a healed
surface and the deeper layer of skin where they
could develop into a pocket of infection.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Figure 7-3
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Wound repair.
Copyright ©2007 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Click here to view an animation on the topic of Wound Repair.
Back to Directory
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
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Burns to the Skin
• Burns can be caused by heat, chemicals,
electricity, or radiation.
• Two factors affect assessments of damage:
 Depth
 Amount of area damaged
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First Degree Burns
• The depth of a burn relates to the layer or layers of skin
•
•
•
•
affected by the burn.
First degree burns damage only the outer layer, or
epidermis.
Symptoms include redness and pain, but no blister.
Pain subsides in 2–3 days and there is no scarring.
Complete healing takes about 1 week.
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Second Degree Burns
• Second degree burns involve the entire depth of the
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•
•
•
•
epidermis and a portion of the dermis.
Symptoms include redness, pain, and blistering.
The extent of blistering is dependent on the depth of the
burn.
Blistering extends after the initial burn.
Blisters heal within 10–14 days if there are no
complications, with deeper second degree burns taking
1–3½ months.
Scarring in second degree burns is common.
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Third Degree Burns
• Third degree burns affect all three layers of the
skin.
• The surface of the burn has a leathery feel and
will range in color from black, brown, tan, red, or
white.
• The victim feels no pain because the pain
receptors are destroyed.
• Also destroyed are sweat and sebaceous
glands, hair follicles, and blood vessels.
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Fourth Degree Burns
• Fourth degree burns are the worst burns.
• These burns penetrate the bone and cause
bone damage.
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Amount of Area Damaged
• The rule of nines is used to estimate extent of area
damaged by burns.
• The body is divided into the following regions, each
given a percentage of body surface area value:
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Head and neck – 9%
Each upper limb – 9% (2 x 9 = 18%)
Front of trunk – 18%
Back of trunk and buttocks – 18%
Front of legs – 18%
Back of legs – 18%
Perineum (including anus and urogenital region) – 1%
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Figure 7-4
Assessing the degree of the burn.
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Clinical Concerns
• The clinical concerns for burn victims relate to
the functions of the skin already discussed,
including:
 Bacterial infections
 Fluid loss
 Heat loss
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Burn Treatment
• Severe burns require healing steps at an
intensity level the body can’t manage on its own.
• Damaged skin must be removed as soon as
possible and skin grafting must be started.
• Autografting is using the patient’s own skin,
while heterografting is required if the patient
suffered a large area of burn and has little
healthy skin to graft.
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Burn Treatment (cont’d)
• Grafting requires many trips to the OR because
large areas can’t be done all at once and often
the grafts don’t “take.”
• It is possible to grow sheets of skin tissue in the
laboratory from patient cells or utilization of
synthetic materials.
Anatomy & Physiology for Health Professions:
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Clinical Application: Medicine
Delivery via the Skin
• A variety of medications can be delivered via the
integumentary system. Medicines can be
applied to adhesive patches that are placed on
the skin where it is slowly absorbed into the
blood stream. These are called transdermal
patches. Nicotine, nitroglycerin, and birth control
are all medications that can be delivered in this
manner. A more rapid absorption method would
be sublingually (under the tongue).
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Clinical Application: Medicine
Delivery via the Skin (cont’d)
• If medications can’t be taken by mouth or the
digestive system destroys the medication, a
hypodermic injection using a syringe and needle
allows medication to be directly delivered
subcutaneously (under the skin) or
intracutaneously (into the skin). Other routes
include intramuscular, intraspinal, and
intravascular.
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Nails
• Specialized epithelial cells originating from the
nail root form your nails.
• As these cells grow out and over the nail bed,
they become keratinized forming a substance
similar to the horns on a bull.
• The cuticle is a fold of tissue that covers the nail
root.
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Nails (cont’d)
• The portion that we see is called the nail body.
• Nails normally grow 1 mm every week.
• The pink color of the nail comes from the
vascularization of the tissue under the nails,
while the white half-moon shaped area, or lunula
is a result of the thicker layer of cells at the base.
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Figure 7-5
Anatomy & Physiology for Health Professions:
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Structure of the fingernail.
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Clinical Application: Assessing
Peripheral Perfusion
• The pink color of the nail is clinically significant
in assessing perfusion (blood flow) to the
extremities and is a determinate of oxygenation.
If you pinch one of your fingers, the pink color
should return within 5 seconds (usually within 3
seconds) if you have good perfusion. Longer
return to normal pink color indicates a problem.
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Clinical Application: Assessing
Peripheral Perfusion (cont’d)
• Diabetes can cause reduced blood flow to the
extremities. This is called peripheral vascular
disease (PVD). Blood clots or vascular spasm
can decrease blood flow, as can hypothermia,
making peripheral refill slower.
• Reduced levels of oxygen can cause a blue
color to nail beds.
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Hair
• Body hair is normal and serves important
purposes.
• Hair helps to regulate body temperature and
functions as a sensor to help detect things on
your skin such as bugs or cobwebs.
• Eyelashes help to protect our eyes from foreign
objects while hair in the nose helps filter out
particulate matter.
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Anatomy of a Hair
• Visible hair is composed of fibrous protein called
keratin.
• The hair you see is called the shaft with the root
extending down into the dermis to the follicle.
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Anatomy of a Hair (cont’d)
• The follicle is formed by epithelial cells with a
rich source of blood provided by the dermal
blood vessels.
• Cells divide and grow in the base of the follicle,
older cells are pushed away and die, so the
shaft of the hair is comprised of dead cells.
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Hair Anatomy
• Shaving or cutting hair doesn’t make it grow
quicker or thicker.
• There is a sebaceous gland associated with
each hair follicle, secreting sebum that coats the
hair follicle and works its way to the skin’s
surface to prevent drying of the hair, acting as an
anti-bacterial, and lubricating the hair shaft.
• Sebum production decreases with age,
explaining why older people have drier skin and
more brittle hair.
Anatomy & Physiology for Health Professions:
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Figure 7-6
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Diagram of a hair follicle.
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Hair Color and Texture
• Your hair color is dependent on the amount and
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•
•
•
•
type of melanin you produce.
The more melanin, the darker your hair.
White hair occurs in the absence of melanin.
Red hair is the result of hair that has melanin with
iron in it.
Flat hair shafts produce curly hair, while round
hair shafts produce straight hair.
The life span of hair is dependent on location, with
eyelashes lasting 3–4 months while the hair on
your head lasts 3–4 years (unless you’re a
teacher – we pull our hair out before then!).
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Applied Science:
Forensics and Hair
• An interesting sidelight concerning hair is its
ability to tell a pathologist if an individual
ingested certain drugs or other substances such
as lead or arsenic! Trace amounts of ingested
substances can become part of the hair’s
composition. As a result, analysis of a hair
sample can reveal what and how long ago
something was ingested. The longer the length
of hair, the longer the record of what was
consumed by that individual.
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Bruce J. Colbert, Jeff Ankney, and Karen Lee
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Temperature Regulation
• The integumentary system plays a major role in
the regulation of the body’s temperature.
• Part of the regulation of temperature is
accomplished by changes in the size of the blood
vessels. Vasodilation exposes heated blood to
external cooling air. Vasoconstriction keeps
cooling of blood to a minimum when it’s cold
outside.
Anatomy & Physiology for Health Professions:
An Interactive Journey, 1e
Bruce J. Colbert, Jeff Ankney, and Karen Lee
Copyright ©2007 by Pearson Education, Inc.
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Temperature Regulation (cont’d)
• Sweat glands excrete water onto the skin’s
surface, allowing cooling through evaporation.
This requires adequate hydration to continue to
produce sweat. By the time you feel thirsty you’re
already dehydrating. You can potentially secrete
12 liters of sweat in a 24 hour period.
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Shivering
• Shivering causes muscle activity that produces
heat to warm you when you’re cold.
• Hairs on your skin stand erect when arrector pili
muscles contract; this is known as goose
bumps. These hairs create a dead space
insulating you from cooler surroundings, like a
goose down jacket.
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Figure 7-7
Integumentary regulation of body temperature.
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Diseases of the Skin
• There are whole sections of medical libraries
dedicated to diseases of the skin.
• A lesion is a single infected patch of skin.
• In addition to lesions there are many common
pathological conditions of the integumentary
system.
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Figure 7-8
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Various types of skin lesions.
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Table 7-1
Common Pathological Conditions of the Integumentary System
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Table 7-1 (continued)
Common Pathological Conditions of the Integumentary System
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Table 7-1 (continued)
Common Pathological Conditions of the Integumentary System
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Figure 7-9
Various types of integumentary conditions. (a) Urticaria (hives). (Courtesy of
Jason L. Smith, MD.)
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Figure 7-9 (continued) Various types of integumentary conditions. (b) Malignant melanoma.
(Source: Biophoto Associates/Photo Researchers, Inc.)
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Figure 7-9 (continued) Various types of integumentary conditions. (c) Erythema infectiosum
(fifth disease). (Courtesy of Jason L. Smith, MD.)
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Figure 7-9 (continued)
Various types of integumentary conditions. (d) Acne. (Courtesy of
Jason L. Smith, MD.)
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Figure 7-9 (continued) Various types of integumentary conditions. (e) Poison ivy
(dermatitis). (Courtesy of Jason L. Smith, MD.)
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Figure 7-9 (continued)
Various types of integumentary conditions. (f) Herpes simplex.
(Courtesy of Jason L. Smith, MD.)
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Figure 7-9 (continued)
Various types of integumentary conditions. (g) Burn, second degree.
(Courtesy of Jason L. Smith, MD.)
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Snapshots from the Journey
• Your skin is your largest organ; it acts as a
barrier to infection and injury; helps to keep you
from drying out; stores fat; synthesizes and
excretes vitamin D; regulates body temperature;
provides a minor excretory function in the
elimination of water, salts, and urea; and
provides sensory input.
• The skin is composed of 3 layers, constantly
recreating itself. Glands secrete oil to moisturize,
waterproof, and control body temperature.
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Snapshots from the Journey
(cont’d)
• Burns are assessed by depth of burn and area
covered.
• Nails are protective devices composed of dead
material.
• Hair (also dead material) aids in controlling body
temperature.
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Case Study
A 27-year-old female presents to her doctor’s office with
complaints of red, itching, and oozing skin for the past 2
days. Physical exam and history reveal a well-nourished,
white female who is otherwise in good health, has no
known allergies, normal vital signs, pupils are normal and
reactive, has good reflexes, normal breath sounds, liquid
filled vesicles, and scabbing on both legs from the top of
her sock lines to the bottom of her shorts, and new vesicles
have formed around her eyes. The patient states that she
returned from a primitive camping and hiking vacation in
Virginia two days ago. Based on the case study
information, what do you think the diagnosis is? What
caused the vesicles to begin to form around her eyes?
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End of Chapter
Review Questions
1. The substance that is mainly responsible for
skin color is:
a.
b.
c.
d.
Melanin
Pigmentin
Carrots
Luna
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End of Chapter
Review Questions
2. Whether you have naturally curly or straight hair
is dependent on the shape of your
a.
b.
c.
d.
Hair follicle
Hair shaft
Sebum
Melanin
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End of Chapter
Review Questions
3. The fibrous protein that makes up your hair and
nails is called and filled your epidermal cells is
called:
a.
b.
c.
d.
Carotene
Myelin
Keratin
Dermasene
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End of Chapter
Review Questions
4. In a cold environment, in order to maintain a
core body temperature, peripheral blood vessels
will:
a.
b.
c.
d.
Vasodilate
Venospasm
Shiver
Vasoconstrict
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End of Chapter
Review Questions
5. The hair on your scalp can last:
a. 3 to 4 months
b. Until your 40s
c. 3 to 4 years
d. Until you have kids
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Review Questions
6. The three main layers of skin are the _______,
7.
8.
9.
10.
________, and ________ .
The two main types of sweat glands are the
______ and the _______ glands.
Sebaceous glands secrete an oily substance
called __________ .
For some individuals, melanin locates in small
patches called _________ .
Yellow jaundice, a condition associated with
liver disease, occurs as a result of the build-up
of _________.
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Review Questions
11. Discuss three functions of the integumentary
system.
12. Discuss the functions of sebum.
13. Why is there an increased production of
melanin when there is an increased sun
exposure?
14. How does the integumentary system assist in
the regulation of body temperature?
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