Chapter 4 Integumentary System Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Objectives Identify organs and structures of the integumentary system. Define and spell the word parts related to the integumentary system Define, pronounce and spell disease and disorder terms related to the integumentary system. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-2 Integumentary System Function The skin forms a protective covering that when unbroken prevents entry of bacteria and other invading organisms. The skin also protects the body from water loss and from damaging effects of ultraviolet light. Other functions include regulation of body temperature and synthesis of vitamin D. The integumentary system comprises the skin, nails, and sweat and oil glands. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-3 Structure of the Skin Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-4 Major Structures of the Skin epidermis: outer layer of skin keratin: horny, or cornified, layer composed of protein melanin: color, or pigmentation, of skin dermis (also called “true skin”): the inner layer of skin Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-5 Major Structures of the Skin (cont’d.) sudoriferous glands: tiny, coiled, tubular structures that emerge through pores on skin’s surface sebaceous glands: secrete sebum (oil) into the hair follicles, where the hair shafts pass through the dermis Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-6 Accessory Structures of the Skin hair: compressed, keratinized cells that arise from hair follicles (sacs that enclose the hair fibers) nails: originate in the epidermis; found on the upper surface of the ends of the fingers and toes Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-7 Combining Forms for the Integumentary System cutane/o, derm/o, dermat/o - skin hidr/o - sweat kerat/o – hard, horny tissue onych/o, ungu/o - nail seb/o - sebum trich/o - hair Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-8 Cross Section of the Skin Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-9 Combining Forms Commonly Used with Integumentary System Terms aut/o - self bi/o - life coni/o - dust crypt/o - hidden heter/o - other myc/o - fungus necr/o – death; cells, body pachy/o - thick rhytid/o - wrinkles staphyl/o - grapelike strept/o - twisted xer/o - dry Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-10 Prefixes epi- - on, upon, over intra- - within para- - beside, beyond, around, abnormal per- - through sub- - under, below trans- - through, across, beyond Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-11 Suffixes -a – noun suffix no meaning -coccus – berry shaped -ectomy – excision or surgical removal -ia – diseased or abnormal state, condition of -itis - inflammation -malacia - softening -opsy – view of, viewing -phagia – eating or swallowing -plasty – surgical repair -rrhea – flow, discharge -tome – instrument used to cut Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-12 Clicker Question Which of the following means “eating or swallowing”? pachy/o b) -phagia c) -plasty a) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-13 Disease and Disorder Terms Built From Word Parts Dermatitis – inflammation of the skin Dermatoconiosis – abnormal condition of the skin caused by dust Dermatofibroma – fibrous tumor of the skin Hidradenitis – inflammation of the sweat gland Leiodermia – condition of smooth skin Oncychocryptosis – abnormal condition of hidden or ingrown nail Onychomalacia – softening of the nails Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-14 Onychomycosis – abnormal condition of fungus in the nails Onychophagia – eating of the nails (nail biting) Pachyderma – thickening of the skin Paronychia – diseased state around the nail Seborrhea – discharge of sebum Trichomycosis – abnormal condition of fungus in the hair Xeroderma – dry skin Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-15 The -a Ending The -a ending in the terms “pachyderma,” “xeroderma,” “erythroderma,” “leukoderma,” and “xanthoderma” is a noun suffix and has no meaning Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-16 Analyze and Define WR /CV/ WR / S onych/o/myc/osis CF / dermatoconiosis hydradenitis dermatitis abnormal condition of fungus in the nail Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-17 Disease and Disorder Terms Not Built From Word Parts Abrasion – scraping away of the skin by mechanical process or injury Abscess – localized collection of pus Acne – inflammatory disease of the skin involving sebaceous glands and hair follicles actinic keratosis – precancerous skin condition of horny tissue formation that results excessive exposure to sunlight. May become squamous cell carcinoma Albinism – congenital hereditary condition characterized by partial or total lack of pigment in the skin, hari, and eyes basal cell carcinoma (BCC) – epithelial tumor arising from the epidermis. Seldom metastasizes but invades local tissue. Candidiasis – an infection of the skin, mouth (also called thrush), or vagina cause by yeast. It is normally present in the mucous membranes; overgrowth causes an infection. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-18 Carbuncle – skin infection composed of a cluster of boils caused by staphylococcal bacteria Cellulitis – inflammation of the skin and subcutaneous tissue caused by infection leading redness, swelling and fever Contusion – injury with no break in the skin, characterized by pain, swelling, and discoloration (bruise) Eczema – noninfectious, inflammatory skin disease, characterized by redness, blisters, scabs and itching. Fissure – slit or cracklike sore in the skin Furuncle – painful skin node caused by staphylococcal bacteria in a hair follicle (boil) Gangrene – death of tissue caused by loss of blood supply followed by bacterial invasion (form of necrosis) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-19 Disease and Disorder Terms Not Built From Word Parts (cont’d.) Herpes – inflammatory skin disease caused by herpes virus characterized by small blisters in clusters. Many types (simplex, zoster – causes shingles) Impetigo – superficial skin infection characterized by pustules and caused by either staph or strep. Kaposi sarcoma – cancerous condition starting as purple or brown papules on the lower extremities that spreads through the skin to the lymph nodes and internal organs. Seen a lot with AIDS. Laceration – torn, ragged-edged wound Lesion – any visible change in tissue resulting from injury or disease. Includes sores, wounds, ulcers, and tumors Pediculosis – invasion into the skin and hair by lice Psoriasis – chronic skin condition with red lesions and silvery scales Rosacea – disorder of the skin that produces erythema, papules, pustules, and broken blood vessels, usually occurring on the central area of the face in people older than 30 Scabies – Skin infection caused by the itch mite. Papule eruptions from female burrowing and laying eggs. Severe itching. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-20 Scleroderma – chronic hardening of the connective tissue of the skin and other body organs. Shingles – development of painful, inflamed blisters that follow the nerve routes; cause by the same virus that causes chickenpox squamous cell carcinoma (SqCCA) – a malignant growth that develops from scale-like epithelial tissue. Potential for metastasis. Chronic exposure to sunlight systemic lupus erythematosus (SLE) – inflammatory disease involving the skin, joints, kidneys and nervous system. Autoimmune. Will go into remission. Can affect other organs. Tinea – fungal infection of the skin. Affects keratin of skin, hair, nails. Tinea capitus (scalp), T. corporis (body), T pedis (foot) Urticaria – itching skin eruption composed of sheals of varying size and shape. (Hives) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-21 Common Skin Disorders Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-22 Common Skin Disorders (cont’d.) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-23 Common Skin Disorders (cont’d.) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-24 Cancers of the Skin Squamous cell carcinoma Melanoma Actinic keratosis Basal cell carcinoma Kaposi sarcoma Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-25 Clicker Question Shingles is also called tinea b) herpes zoster c) impetigo a) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-26 Surgical Terms Built from Word Parts Biopsy – Removal of living tissue to be viewed under microscope Dermatoautoplasty – surgical repair using one’s own skin (autograft) Dermatoheteroplasty – surgical repair using skin from others (allograft) Dermatoplasty – surgical repair of the skin Dermatome – instrument used to cut skin Onychectomy – excision of a nail Rhytidectomy – excision of wrinkles (facelift) Rhytidoplasty – surgical repair of wrinkles Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-27 Surgical Terms Not Built from Word Parts Cauterization – destruction of tissue with hot or cold insturments, electrical current or caustic substance (cautery) Cryosurgery – destruction of tissue by using extreme cold (liquid nitrogen) Debridement – removal of contaminated or dead tissue and foreign matter from an open wound Dermabrasion – procedure to remove skin scars with abrasive material, such as sandpaper Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-28 Excision – removal by cutting Incision – surgical cut or wound produced by a sharp instrument incision and drainage (I&D) – cut made to allow free flow or withdrawl of fluids from a lesion, wound or cavity laser surgery – procedure using an instrument that emits a high powered beam of light used to cut, burn, vaporize, or destroy tissue Mohs surgery – technique of microscopically controlled serial excisions of skin cancers Suturing – to stitch edges of a wound surgically. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-29 Complementary Terms Built from Word Parts Dermatologist – physician who studies and treats skin diseases dermatology (derm) – study of the skin; diagnosis and treatment Epidermal – pertaining to upon the skin Erythroderma – red skin (abnormal redness) Hypodermic – pertaining to under the skin intradermal (ID) = pertaining to within the skin Keratogenic – originating in horny tissue Leukoderma – white skin (less color than normal) Necrosis – abnormal condition of death (cells and tissues die) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-30 Percutaneous – pertaining to through the skin staphylococcus (staph) – berry shaped bacteria in grapelike clusters (pl. staphylococci) streptococcus (strep) – berry shaped bacteria in twisted chains (pl. streptococci) subcutaneous (subcut) – pertaining to under the skin transdermal (TD) – pertaining to through the skin Ungual – pertaining to the nail Xanthoderma – yellow skin (jaundice) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-31 Routes of Administration 1. Intradermal 3. Transdermal 2. Subcutaneous, hypodermic Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-32 Complementary Terms Not Built from Word Parts Adipose – fat, fatty Allergy – hypersensitivity to a substance Alopecia – loss of hair Bacteria – single-celled microorganisms that reporduce by cell division and may cause infection by invading body tissue Cicatrix - scar Cyst – a closed sac containing fluid or semisolid material cytomegalovirus (CMV) – a herpes-type virus that usually causes disease when the immune system is compromised Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-33 Diaphoresis – profuse sweating Ecchymosis – escape of blood into the tissues, causing superficial discoloration (bruise) Edema – puffy swelling of tissue from the accumulation of fluid Emollient – agent that softens or soothes the skin Erythema - redness Fungus – organism that feeds by absorbing organic molecules from its surroundings and my cause infection by invading body tissue; reproduces by budding (yeast); or spore formation (mold) Induration – abnormal hard spots Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-34 Complementary Terms Not Built from Word Parts (cont’d.) Jaundice – condition characterized by yellow tinge to the skin (xanthoderma) Keloid – overgrowth of scar tissue Leukoplakia – condition characterized by white spots or patches on the mucous membrane (precancerous?) Macule – flat, colored spot on the skin nevus (pL nevi) – circumscribed malformation of the skin, usually brown, black or flesh colored. Congenital is a birthmark, otherwise also called a mole. Nodule – small knotlike mass that can be felt by touch Pallor - paleness Papule – small, solid skin elevation (pimple) petechia (pl. petechiae) – a pinpoint skin hemorrhage Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-35 pressure ulcer (decub) – eroded sore on the skin caused by prolonged pressure, often occurring in bedridden patients. (decubitus ulcer or bed sore) Pruritus – severe itching Purpura – disorder characterized by hemorrhages into the tissue, giving the skin a purple-red discoloration Pustule – elevation of the skin containing pus Ulcer – eroded sore on the skin or mucous membrane Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-36 Verruca – circumscribed cutaneous elevation caused by a virus (wart) Vesicle – small elevation of the epidermis containing liquid (blister) Virus – minute microorganism, much smaller than bacterium, characterized by a lack of independent metabolism and the ability to replicate only within living host cells; may cause infection by invading body tissue Wheal = transitory, itchy elevation of the skin with a white center and a red surrounding area; a wheal is an individual urticaria (hive) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-37 Burn Keloid Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-38 Stage 2 Pressure Ulcer Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-39 Clicker Question The term which means profuse sweating is ecchymosis b) emollient c) diaphoresis a) Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-40 Abbreviations BCC – basal cell carcinoma Bx - biopsy CMV = cytomegalovirus Decub – pressure ulcer Derm - dermatology I & D – incision and drainage I D - intradermal SLE – systemic lupus erythematosus SqCCA – squamous cell carcinoma Staph - staphylococcus Strep - streptococcus Subcut - subcutaneous TD - transdermal Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-41 Read Medical Terms In Use Emily visited the dermatology clinic because of pruritus secondary to dermatitis involving her scalp, arms, and legs. A diagnosis of psoriasis was made. Eczema, scabies, and tinea were considered in the differential diagnosis. An emollient cream was prescribed. In addition the patient showed the dermatologist the tender, discolored, thickened nall of her right great toe. Emily learned she had onychomycosis, for which she was given an additional prescription for an oral antifungal drug. Copyright © 2009, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4-42