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Lecture 1
Lecture 1
178
Medical
Graduate
09/09/2015

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Term
Function of the Skin: ______ input
Definition
sensory
Term
Function of the Skin: ______ regulation
Definition
temperature
Term
Function of the Skin: ______ regulation/excretion _______
Definition
sweating/fluid regulation/excretion of waste
Term
Function of the Skin: production of
Definition
vitamin d
Term
vitamin d is critical for the absorption of what mineral
Definition
calcium
Term
Function of the Skin: barrier to
Definition
infection, harmful chemicals, and UV radiation
Term
Function of the Skin: protection
Definition
physical protection to underlying structures
Term
4 layers of the skin from surface to deep
Definition
epidermis, dermis, subcutaneous fat, deep tissues
Term
how thick is the epidermis
Definition
.06-.6 mm thick
Term
where are the thickest portions of the epidermis
Definition
plantar surface of foot/palms
Term
is the epidermis vascular or avascular
Definition
avascular
Term
what is the epidermis primarily made up of
Definition
keratinocytes
Term
how many layers does the epidermis ahve
Definition
5
Term
what gives rise to nails
Definition
hard keratin
Term
a thin layer of epidermis lines what (3)
Definition
hair follicles, sweat, and sebacous glands
Term
5 layers of the epidermis from deep to surface
Definition
basal layer, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum
Term
the basal layer of the eipdermis is held to the dermis by the thin basement membrane by cells called what (2)
Definition
desmosomes, hemidesmosomes
Term
layer responsible for the mitotic activity of keratinocites
Definition
basal layer
Term
layer of epidermis with spiney apperance and houses a more mature layer of keratinocytes
Definition
stratum spinosum
Term
how many cells thick is the stratum granulosum
Definition
3-5 cells thick
Term
first layer where dead keratinocytes appear
Definition
stratum lucidum
Term
how many cells thick is the stratum corneum
Definition
20-30 cells
Term
layer which makes up 75% of teh epidermis
Definition
stratum corneum
Term
which -mosome attaches cells to each other
Definition
desmosomes
Term
which -momsome attaches the cells ot the basement membrane
Definition
hemidesmosomes
Term
how long does it take for a cell to migrate from the basal layer to the stratum cornium
Definition
14-21 days
Term
types of cells in teh epidermis
Definition
langerhan's cells, merkel cells, melanocytes
Term
langerhan's cells are derived from what?
Definition
bone marrow
Term
langerhans cells are located where in the epidermis
Definition
deeper layers
Term
eipdermal cell that may help to fight infections
Definition
langerhan's cells
Term
which epidermal cell may play a part in graft rejections
Definition
langerhan's cells
Term
epidermal cell that functions as a mechnaoreceptors
Definition
merkel cells
Term
merkel cells attach to what in the epidermis
Definition
keratinocytes
Term
merkel cells attach to keratinocytes in the epidermis by what
Definition
desmosomes
Term
merkel cells provide what feed back
Definition
light touch
Term
cell in the epidermis that gives individual skin tone
Definition
melanocytes
Term
what is the thickest layer of the skin
Definition
dermis
Term
what is the dermis primarily made up of
Definition
collagen and elastin
Term
what are the senses that the nerve end sensory organs contained within the dermis (5)
Definition
touch, pain, vibration, temperature, pressure
Term
is the dermis vascular or avascular
Definition
highly vascularized
Term
what are the 2 layers of the demris
Definition
papillary, reticular
Term
layer of dermis directly below basement membrane
Definition
papillary dermis
Term
which layer of the dermis is made up of morem dense collagen
Definition
reticular dermis
Term
why is the reticular dermis made up of more dense collagen
Definition
provide structural support to the skin
Term
which layer of skin are hair follicles located in
Definition
dermis
Term
hair is made up of what type of keratin
Definition
soft
Term
each hair follice has what at its base
Definition
sebaceous gland
Term
the sebaceous gland secretes an oily substance called what
Definition
sebum
Term
what is the purpose of sebum
Definition
lubricate the hair and skin
Term
where skin layer do nails arise from
Definition
stratum basal (stratum germinativum)
Term
what cells do nails arise from
Definition
epidermal and dermal cells
Term
sweat glands aka
Definition
sudoriferous glands
Term
where are sweat glands housed
Definition
dermis
Term
what does the stratum basal extend down through the basement membrane into the papillary dermis to serve as an additional anchor
Definition
rete ridges
Term
what area do blisters form
Definition
layer between epidermis and dermal layer, basement membrane
Term
2 types of subcutaneous tissue
Definition
adipose, fascia
Term
is adipose tissue vascular
Definition
highly vascular
Term
how does epidermis recieve its nutrients
Definition
diffusion from capillary beds/dermal appendages of dermis
Term
role of adipose tissue (4)
Definition
insulation, protection, energy storage, fat soluble storage
Term
what are the fat soluble vitamins
Definition
ADEK
Term
fibrous connective tissue, separates and surrounds almost all structures and is intimately involved in movement
Definition
fascia
Term
what are the deep tissues (5)
Definition
muscle, ligament, joint capsule, cartilage bone
Term
this healing model occurs in wounds such as 1st degree burns, scrapes, contusions, shear/friction injuries and should normally heal themselves with proper interventions
Definition
superficial wound healing
Term
wound healing models: healing of a surgical incision who's edges are clean and approximated with sutures. These wounds should close within 7 days with minimal to no scarring
Definition
primary intention
Term
wound healing models: how can delayed primary intention occur (4)
Definition
wound is contaminated, has large amount of tissue loss, abnormal amount of tissue tension, at a high risk of infection
Term
wound healing models: treatment protocol for delayed primary intention wounds
Definition
wound is left open then sutured closed in 407 days after risk of infection has diminished
Term
wound healing models: delayed primary intention wound care is most often used with what type of wounds?
Definition
traumatic
Term
wound healing models: what do partial thickness wound refer to?
Definition
wounds who have lost the dermal layer
Term
wound healing models: examples of partial thickness wounds (4)
Definition
abrasion, skin tears, 2nd degree burns, stage 2 pressure ulcers
Term
wound healing models: for partial thickness wounds, what does the body immediately begin to do
Definition
inflammation process leading to epithelizalization
Term
wound healing models: wound healing by contraction is which healing model
Definition
secondary intention
Term
wound healing models: what are the most frequent wounds PT's see
Definition
secondary intention wounds
Term
wound healing models: what is a contraction
Definition
myofibroblasts (containing myosin and actin) act on the wound to cause the edges to contract. They influence both the rate and the amount of closure
Term
What are the 3 phases of secondary wound closure
Definition
inflammation, remodeling, proliferation
Term
What is important to note about the 3 phases of secondary wound closure
Definition
all phases occur together with 1 phase predominant
Term
All wounds heal in a predictable pattern of events: 1/5
Definition
hemostasis/coagulation
Term
All wounds heal in a predictable pattern of events: 2/5
Definition
inflammation
Term
All wounds heal in a predictable pattern of events: 3/5
Definition
proliferation
Term
All wounds heal in a predictable pattern of events: 4/5
Definition
maturation/epithelilization
Term
All wounds heal in a predictable pattern of events: 5/5
Definition
remodeling
Term
3 parts of hemostasis
Definition
vasoconstriction, platelet aggregation, fibrin deposition
Term
what is the end result of hemostasis
Definition
clot formation
Term
what is the purpose of clot formation (3)
Definition
prevent further fluid loss, lessen contamination, provide a fibrin mesh for other cells to migrate and attach to
Term
4 key cells in inflammatory phase
Definition
platelets, PMN, macromhages, mast cells
Term
what is the role of platelets (2)
Definition
initiate clot formation, release growth factors which are chemotactic
Term
what is the role of PMN (2)
Definition
1st responders to wound, clean wound, kill bactteria, secrete's MMPs (matrix metalloproteinases)
Term
role of macrophages
Definition
secrete NO and enzymes to kill bacteria, growth factors and MMPs
Term
role of mast cells
Definition
release histamine, enzymes
Term
inflammation functions to rally (2) to the wound site to phagocytes bacteria
Definition
macrophages and neutrophils
Term
inflammation recruits ___ to assist in the breakdown of debris
Definition
MMP's (matrixmetaloproteases)
Term
Inflammation recruits these MMP's to assist in the breakdown of debris
Definition
collagenase, elastase
Term
inflammation is characterized by what S/S (4)
Definition
erythema, edema, heat, and pain
Term
why is inflammatio ncharacterized by erythema, edema, heat, and pain?
Definition
the wound transitions rom vasoconstiction to vasodilation
Term
what is the purpose of mast cells releasing histamine during the inflammation stage
Definition
histamine increases capillary permeability and allows a flood of proteins, WBCs to enter the area
Term
proliferation aka (2)
Definition
repair, epithelialization
Term
the process of repalcing lost dermal tissue with granulation
Definition
proliferation
Term
in the proliferation stage, what is not reproduced
Definition
lost dermis
Term
what produces scar tissue to fill in the gap during the proliferation stage?
Definition
granulation
Term
tensile strength of scar tissue compared to the original dermis
Definition
less tensile
Term
when the wound first closes how strong is the scar tissue compared to the original dermis
Definition
15%
Term
at 2 years post healing how strong is the scar tissue compared to the original dermis
Definition
70-80% as strong
Term
3 key cells in proliferation
Definition
fibroblasts, endothelial cells, myofibroblasts
Term
proliferation: what are fibroblasts responsible for
Definition
protein synthesis
Term
proliferation: fibroblasts are responsible for protein synthesis and the formation of what?
Definition
collagen matrix
Term
proliferation: what is the purpose of the collagen matrix produced by the fibroblasts
Definition
repllaces the original fibrin mesh (clot)
Term
proliferation: what is the process of protein synthesis, formation of collagen matrix, and replacement of the original fibrin mesh stimualted by?
Definition
release of growth factor (TGF-B, PDGF, EGF)
Term
epithelialization aka
Definition
resurfacing the wound
Term
describe epithelialization
Definition
epithelial cells begin to migrate in a single layer across a GRANULATED wound surface towards the middle and begin to proliferate
Term
what stops the process of epithelialization
Definition
contact inhibition
Term
eipthelialization: how do rolled or curled edges occur
Definition
frequently occurs in wounds that have no granular tissue to cross
Term
eipthelialization: when is a wound considered closed
Definition
when the epithelial integrity is restored
Term
eipthelialization: when is a wound considered healed
Definition
until tissue strength approaches normal
Term
eipthelialization: what does the epithilialization look like?
Definition
delicate, pearly pink islands
Term
#1 causes of hypergranulation
Definition
repeated trauma to wound bed
Term
second most common cause for hypergranulation
Definition
bacterial burden
Term
third cause of hypergranulation, inconclusive studies
Definition
too much moisture, hydrocolloid dressings
Term
remodeling aka
Definition
the process of re-establishing the tensile strength of tissue
Term
what key cells from proliferation disappear in remodeling
Definition
fibroblasts
Term
remodeling: what happens to collagen
Definition
reorganizes and scar matures
Term
remodeling: what is the role of collagenase
Definition
regulates the balance between syntehsis and lysis of collagen (fibroplasia)
Term
remodeling: how do keloids form?
Definition
when the abnormal inhibitio of lysis causes an imbalance in fibroplasia, usually genetic in origin
Term
what can cause hypertrophy of granular tissue (hypergranulation)
Definition
too much O2
Term
What is santyl based on?
Definition
collagenase enzyme
Term
what are rolled wound edges called?
Definition
epibole
Term
tricks of the trade to stop hypergranulation (4)
Definition
e stim, silver nitrate sticks, compression wraps, massage
Term
tricks of the trade to stop hypergranulation: e stime
Definition
(+) pole to repel mast cells and decrease hypergranulation
Term
tricks of the trade to stop hypergranulation: silver nitrate sticks
Definition
knock down hypergranulation
Term
tricks of the trade to stop hypergranulation: compression wraps
Definition
decrease perfusion and therefore O2, suppress collagen synthesis and increase lysis
Term
tricks of the trade to stop hypergranulation: massage
Definition
remodeling phse is appropriate time to being soft tissue work to prevent adhesion formation
Term
time frame of healing phases: inflammatory phase
Definition
1-10 days
Term
time frame of healing phases: proliferation phase
Definition
3-28 days
Term
time frame of healing phases: remodeling phase
Definition
9 days-2 years
Term
a wound that fails to prgoress in a timely manner through the normal phases of hlealing
Definition
chronic wound
Term
9 things that can make a wound chronic
Definition
repeated trauma, poor nutrition, co morbidity, poor perfusion, bioburden, chronic inflammatory response, improper treatment/diagnosis, compliance, old age
Term
age related healing: decrease in (3)
Definition
dermal vascularity, collagen density, number of mast cells
Term
age related heailng: fragmentation of what
Definition
elastin
Term
age related healing: flattening of
Definition
basement membrane
Term
an absence of inflammation will be seen in pt's (5)
Definition
taking steroids, with malnutrition, immmune disorders (HIV/AIDS), leukemia, anti-inflammatory drugs
Term
what are potential reasons for chronic inflammation? (5)
Definition
foreign body in wound bed, gauze fibers, stitch, repeated trauma (as in wet to dry), use of cytotoxic agents (dakins, peroxide, betadine)
Term
how long can chronic inflammation continue for?
Definition
months, years
Term
chronic wound fluid compared to acuite wound has: decreased (2)
Definition
metabolic activity level, growth factors (which stimulate chemotaxis, angiogenesiss, proliferation)
Term
chronic wound fluid compared to acuite wound has: excessive
Definition
MMP's compared to TIMPS (need a good balance of MMPs and GF's for normal wound healing)
Term
chronic wound fluid compared to acuite wound has: a large number of
Definition
senescent cells
Term
what are the inhibitors of mmps?
Definition
TIMPS (tissue inhibitor of metalloproteins)
Term
chronic wound fluid is metabollicaly active but
Definition
unable to proliferate well
Term
protein is essential to healing as it is a critical component of what? (3)
Definition
fibroblast formation, collagen synthesis, wound contraction, and scar formation
Term
protein is also important for the formation of (2) needed to prevent infection
Definition
antibodies and leukocytes
Term
a depletion of muscle, visceral protein stores and body fat
Definition
protein calorie malnutrition
Term
signifcant wt loss: 6 months
Definition
10%
Term
signifcant wt loss: 3 months
Definition
7.5%
Term
signifcant wt loss: 1 month
Definition
5%
Term
signifcant wt loss: 1 week
Definition
2%
Term
severe wt loss: 6 months
Definition
>10%
Term
severe wt loss: 3 months
Definition
>7.5%
Term
severe wt loss: 1 month
Definition
>5%
Term
severe wt loss: 1 week
Definition
>2%
Term
Acronym: TLC
Definition
total lymphocyte coute
Term
visceral proteins measured (3)
Definition
albumin, transferrin, TLP
Term
carbohydrate and lipd recommendations for adults
Definition
25-30 kilocalories/kg/day
Term
protein recommendations for adults
Definition
1.5 gm/kg/day
Term
protein recommendation for adults with burns, or extensive ulcerations
Definition
2-3 gm/kg/day
Term
why should overfeeding be avoided
Definition
causes hypoglycemia, fatty liver change, hyperlipidemia, immune suppression, diarrhea
Term
6 vitamins and minerals for wound healing
Definition
vitamin C, vitamin A, Zinc, Vitamin E, Iron, L-arginine
Term
what is vitamin C necessary for?
Definition
fibroblasts to synthesize collagen
Term
vitamin c enhances...
Definition
immune function
Term
if vitamin c deficient, won't see what tissue?
Definition
granulation
Term
vitamin a is essential for what?
Definition
inflammatory response
Term
Vitamin A intake should be boosted d/t what? How high?
Definition
autoimmune disease or chronic steroid use. 25K IU/day orally, 200K IU to wound
Term
zinc is extremely important for what (3)
Definition
collagen synthesis, RNA formation, protein synthesis
Term
zinc can be easily depleted by what (4)
Definition
diarrhea, stress, open wound, chronic illness
Term
if this mineral is depleted, it can be a major reason for wound not heailng
Definition
zinc
Term
vitamin essential for cell wall stability and enhancing immune response
Definition
vitamin e
Term
too uch witamin e will do what?
Definition
decrease collagen production and decrease inflammatory response
Term
vitamin e is necessary for ____ maturatino and ___ transport
Definition
collagen maturation, O2 transport
Term
only amino acid that generates significant amount of nitric oxide
Definition
L-arginine
Term
L-arigine also stimulates (3)
Definition
protein synthesis, angiogenesis, collagen remodeling
Term
L-arginine has also been studied for prevention of wasting in which pt population
Definition
people with critical illness
Term
L-arginine has been studied for these 3 other purposes
Definition
wound healing, body building, spermatogensis
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