Pathology Test 2 Lecture 3

Front 1

1 out of _ people who consult a doctor have a skin disorder

Back 1

4

Front 2

_ is the 1st lesion to appear on the skin & appears as a sign (eg. macule, papule, plaque, nodule, tumor, wheal, vesicle, pustule)
_ becomes _ w/change (eg. scale, crust, thickening, erosion, ulcer, scar, excoriation, fissure, atrophy).
Changes may occur from rubbing, meds, disease progression or process of healing.

Back 2

Primary lesion
Primary lesions become secondary lesions

Front 3

_- hurting yourself

Back 3

Munchousin

Front 4

basic functions of skin:
_ regulation
_
_
_ protection

Back 4

Temperature
Protection
Elasticity
UV light

Front 5

Keratinizing stratified squamous epithelium
4 basic layers:
_—stratum germinativum (constantly dividing)
_—stratum spinosum
_—stratum granulosum
_—Dust in the Wind—dead keratinocytes

Back 5

Basal layer
Spinous layer
Granular layer
Stratum corneum

Front 6

cell types in the epidermis:

1. _—epithelial cells found in all layers of the epidermis that produces keratin, a skin protein.

2. _—forms melanin & found in the basal layer. Protects against sunburn, UV carcinogenesis & determines skin color.

3. _—tissue macrophages that aid in immune response

Back 6

Keratinocytes
Melanocytes
Langerhans cells

Front 7

_: Components—blood vessels, nerve fibers, connective tissue (collagen & elastin), & fibroblasts.
Skin components:
Hair follicle
_ glands—secretes sebum, oil to lubricate skin
_ glands are found in the axillary, genital & anal areas—produce odor
_ glands—thermoregulation by perspiration

Back 7

dermis
Sebaceous
Apocrine
Eccrine

Front 8

_: Aka hypodexmis, fat filled area so acts as an insulator. Elderly lose this layer of fat.

Function of this layer is for energy storage & balance, trauma absorption

Back 8

subcutaneous tissue

Front 9

_:
Chronic inflammatory dz
Most common type of eczema*
Early manifestation of _ that appears before development of allergic rhinitis or asthma. _ refers to a group of 3 associated allergic disorders:
Asthma
Allergic rhinitis (hay fever)
_ dermatitis
Often associated with food allergies, increased levels of IgE

Back 9

aptopic dermatitis
atopy
Atopy
Atopic

Front 10

_ s&s:
Acute form in infants= crusting rash
Chronic form-dry, thickened, brownish-grey colored skin (lichenified)
Xerosis and pruritus (scratching) are the major symptoms, may cause severely excoriated lesions, infection and scarring. Secondary complications may arise due to this change.

Back 10

atopic dertatitis

Front 11

_: Caused by exposure to a chemical, mechanical, physical or biologic agent
Aging may contribute to development of delayed cell-mediated hypersensitivity. Dermatitis of unknown origin more common in elderly.
S&Spruritus, erythema, edema occurs 1-2 days after exposure. Signs begin at site of exposure then extend distally. May progress to vesiculation, oozing, crusting & scaling

Back 11

contact dermatitis

Front 12

_: Superficial inflammatory rxn caused by irritant exposure, allergic sensitization, or genetically determined idiopathic factors
_—extensive erosions w/serous exudate or by pruritic, erythematous papules & vesicles on a background of erythema
_—erythematous excoriated scaling papules that are grouped or scattered over erythematous skin
_—thickened skin & increased skin marking (lichenification) secondary to rubbing & scratching; excoriated papules, fibrotic papules & nodules & areas of hypo & hyperpigmentation

Back 12

eczema
acute
subacute
chronic

Front 13

_—extensive erosions w/serous exudate or by pruritic, erythematous papules & vesicles on a background of erythema

Back 13

acute eczema

Front 14

_—erythematous excoriated scaling papules that are grouped or scattered over erythematous skin

Back 14

subacute eczema

Front 15

_—thickened skin & increased skin marking (lichenification) secondary to rubbing & scratching; excoriated papules, fibrotic papules & nodules & areas of hypo & hyperpigmentation

Back 15

chronic eczema

Front 16

__: Development of very dry, thin skin & shallow ulcers of the LEs primarily from venous insufficiency. Often, pt has a hx of varicose veins or DVT.
Process begins w/edema as result of slowed venous return to the heart. Due to slow return, LE tissue becomes hypoxic from poor blood supplynecrosis may begin.
S&S: itching, feeling of heaviness, hemosiderin staining & open shallow lesions (hard to heal due to lack of oxygenated blood).
Use compression to treat. Apply compression gradually

Back 16

stasis dermatitis

Front 17

_: Acute inflammation w/infection of skin & subcutaneous tissue. S. pyogens or staphylococcus is the usual cause in adults. Infection
Older adults, immunocompromised such as pts w/DM, malnutrition, receiving steroid therapy & presence of ulcers.
Tendency of reoccurring especially at area of lymphatic obstruction.

Back 17

cellulitis

Front 18

_: Usually occurs in loose tissue beneath skin on UE/LEs.
S&S: erythematous, edematous, tender & sometimes nodular.
Erysipelas, surface _ of skin, affects upper dermis & has patches of skin that are red, painful w/sharply defined borders & feel hot to the touch. Red streaks extending from the patches indicate the lymph vessels are infected.
IV antibiotics are the primary Rx.

Back 18

cellulitis x's 2

Front 19

_ aka _: is a local dz brought about by the same virus that causes varicella (chickenpox)
Initial infection w/varicella is common in children
_ may occur & reoccur at any age, peak incidence between 50-70
Pathogenesis: reactivation of varicella virus lying dormant in the cerebral ganglia of the CN. Factors associated w/recurrence are aging, immunosuppression & varicella @ a young age.

Back 19

herpes zoster
Aka shingles
Shingles

Front 20

_: S&S: vesicular eruption occurs unilaterally in distribution of a dermatome supplied by the dorsal root or extramedullary CN sensory ganglion.
Usually seen on the trunk or along 5th CN. Starts w/pain, tingling along the affected spinal or CN dermatome along with fever, chills, malaise, & GI disturbances.
Postherpetic neuralgia is pain in the area of recurrence that persists after the lesions have resolved. Pain varies from constant/intermittent & light/deep visceral sensation.

Back 20

herpes zoster

Front 21

_: Caused by unrelieved pressure & results in damage to underlying tissue.
Usually occur over bony prominences:
Heels, sacrum, ischial tuberosities, greater trochanters, elbows, scapula & are staged


Incidence: 1.8 million—500,000 in SNF & 400,000 w/diabetic foot ulcers

Back 21

pressure ulcers

Front 22

Causative factors for _: External pressure
Friction
Shearing forces
Maceration- prunish effect if it is too wet
Decreased skin resilence
Malnutrition
Decreased circulation

Back 22

pressure ulcers

Front 23

Concern with using arm bikes verses leg bikes- risk for _with pt. with a _ condition.

Back 23

heart attack
CV

Front 24

pathogenesis for _:
_-> _-> _
Pressure reduces_ supply and _ drainage of affected area
If pressure is relieved, a brief period of rebound capillary dilation (_) occurs & no tissue damage develops.
If pressure is not relieved, the endothelial cells lining the capillaries become disrupted by platelet aggregation, forming microthrombi that _ blood flow & cause _ of surrounding tissue.

Back 24

pressure ulcer
pressure
eschemia
tissue necrosis
blood supply & lymph drainage
reactive hyperemia
occlude
anoxic necrosis