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Ch. 8/9 Pathophysiology

Terms in this set (44)

3 Skin Layers
epidermis, dermis, hypodermis
5 layers of epidermis
1. stratum basale,
2. stratum spinosum
3. stratum granulosum
4. stratum lucidum
5. stratum corneum
Atopic Dermatitis (Eczema)
Atopic—inherited tendency

Common problem in infancy
Rash is erythematous, with serous exudate - occurs on face, chest, and shoulders
- Areas become sensitive to soap, some fabrics, temperature changes
- In adults, rash is dry, scaly, and pruritic, often on flexor surfaces.
- Potential complication—secondary infections
- Treatment - topical glucocorticoids, antihistamines, get rid of aggrevator
Psoriasis
Chronic inflammation skin disorder
- effects 1%-3% of population
- possibly genetic
- onset teen years - varies in severity
Signs: red patches covered in SILVERY SCALES, dry and cracked skin may bleed, thick rigged nails, swollen stiff joints
Treatment: glucocorticoids, exposure to sunlight, anti metabolic methotrexate (severe cases)
Schleroderma
May occur as a skin disorder with no known cause
- Signs: hard, shiny, tight areas of skin, narrowed shortened fingertips, lost facial expression, movement of mouth and eye may be impaired
- cutaneous form might effect microcirculation of organs causing renal failure / respiratory failure
- increased collagen deposition
- inflammation / fibrosis with decreased capillary networks
Treatment: varying medications
Cellulitis (Erysipelas)
Infection of the dermis and subcutaneous layer, usually arising from an injury
- usually Staphylococcus aureus - sometimes Streptococcus
- lower trunk / legs
- people with restricted circulation in extremities / immunocompromised people
- Signs: red area, edematous (swollen), pain, red streaks along close lymph vessels
Impetigo
- Common infection in infants / children (some adults)
- S. aureus (highly contagious)
- Signs: small red vesicles (rapidly enlarge), lesions on face, vesicles rupture forming yellowish brown crusty masses, pruritus (itching)
- Treatment: topical antibiotics in early stages, systematic administration if lesions are extensive (antibiotic resistant strains are becoming common)
Acute Necrotizing Fasciitis
aerobic / anaerobic bacteria at site of infection
- severe inflammation and tissue necrosis - often history of minor trauma / infection of the skin / subq. tissue
- formed by Gram Positive group - A beta - hemolytic Streptococcus
Signs:inflamed, painful area rapidly increasing in size, apparent dermal gangrene
Systematic Manifestations: fever, hypotension, organ failure, achy cardia, mental confusion
Treatment: aggressive microbial therapy, fluid replacement, cut out infected tissue increase oxygen flow, amputation
Herpes Simplex Type 1
(HSV1) Cold sores, blisters
- Primary Injection: asymptomatic - virus remains latent in nerve ganglia
- Flare up triggered by: common cold, stress, sun exposure
- Spread by direct contact with lesion fluid
- Potential complications: virus spread to eye (keratitis), herpetic whitlow (infection to fingers)
Herpes Simplex Type 2
(HSV2) genital herpes
Primary Injection: asymptomatic - virus remains latent in nerve ganglia
- Flare up triggered by: common cold, stress, sun exposure
- Spread by direct contact with lesion fluid
- Potential complications: virus spread to eye (keratitis), herpetic whitlow (infection to fingers)
Tinea Capitis
Infection of scalp
- common in school aged kids
- possible erythema (redness)
- oral anti fungal medication
Tinea Corporis
Infection of the body - Ringworm (typically non-hairy parts)
- round lesion, clear center
- pruritus
- topical anti fungal medication
Tinea Pendis
Athletes Foot (partly toes)
- associated with pools and gyms
secondary bacterial infection may occur
- topical anti fungal meds
Tinea Unguium
Infection of nails and toenails
- nail turns white then brown
- nail thickens then cracks
- infection spreads to other nails
Pediculosis (Lice) 3 Types
Pediculus Humanus - corporis (body) - capitis (head) - pubic (pubic)
- female louse lay eggs on hair shaft
- after hatching louse bites host, sucking blood for ova production
- excoriation (scratch abrasion) occurs
Squamous Cell Carcinoma
Painless malignant tumor of the epidermis
- lesions most often found of exposed skin (sometimes oral) - face / neck - back of tongue
- When lesion is removed quickly great prognosis
- invasive type comes from premalignant condition
Actinic Keratosis
Found on skin exposed to UV Radiation
- common on fair skinned people
lesion appears as pigmented scaly patch
Synarthrosis
immovable joint - cranial sutures
Ampiarthrosis
slightly movable joint - ribs to sternum
Diarthrosis
freely movable joint - shoulder
Closed vs. Open Fractures
open: (compound) skin broken
closed: skin not broken
Factors Effecting Bone Healing
- amount of local damage
- proximity of bone ends
presence of foreign material or infection
- blood supply to fracture site
- systematic factors: age, nutrition, anemia
Compartment SYNDROME
Edema (excess fluid) in one area of compartment of limb between layers of dense connective tissue (fascia)
- ischemia / infraction of tissue may occur because of compression of arterial blood supply
- dead tissue may become gangrenous requiring amputation
- cause can be TIGHT CAST
Osteoporosis
LONG TERM GLUCOCORTICOIDS CAN CAUSE IT!
Decrease in bone mass / density
- 2 forms: primary (idiopathic, 50+ yrs, decrease sex hormone, decrease calcium intake) secondary (as complication of another disorder)
- bone resorption exceeds formation
- loss of compact bone
- diagnosis with bone density scan
- can cause compression fracture of vertebra, hips, wrists
- can cause scoliosis, kyphosis
Osteoporosis (Pre-Disposing Factors / Treatment)
- age 50+ years
- decrease mobility / sedentary lifestyle
- hormonal factors: excess corticosteroids of parathyroid hormone (PTH), deficit of estrogen / testosterone
- deficit of calcium, vitamin D, protein
- cigarette smoking
- small light bone structure (Asian / European ancestry)
- excessive caffeine
Treatment: dietary supplements, fluoride supplement, calcitonin, human parathyroid hormone, weight bearing exercise, roloxifene or tamoxifen
Rickets / Osteomalacia
From vitamin D / phosphate deficit
- causes: dietary deficit, malabsorption, lack of sun exposure
- in kids leads to weak bones / other skeletal deformities
- in adults soft bones, compression fractures
Ewing Sarcoma
someone in adolescents - usually occurs in long bones
Muscular Dystrophy
Group of autosomal recessive disorders
- degeneration of skeletal muscle over time
- Duchennes MD is most common (young boys)
Signs: early motor weakness (pelvic gridle), Gower maneuver (pushing up to erect position), tendon reflex reduced, deformities develop (Kyphoscoliosis), respiratory infections common, cardiac myopathy common
Diagnostic Tests: identify common genetic abnormalities, elevated creatine kinase levels, electromyography, muscle biopsy, blood test (ABNORMAL DYSTROPHIN LEVEL)
Treatment: no curvature treatment, moderate exercise, supportive appliances, massages, ventilators
Treatment: no curative treatment, moderate exercise, supportive appliances, massages, ventilators
Rheumatoid Arthritis
Autoimmune disorder
- causes chronic systemic inflammatory disease
- higher incidence in women
- all ages
- Synovitis: marked inflammation
- Pannus formation: granulation tissue spreads
- cartilage erosion: unstable joints
- fibrosis: calcifies joint space
- ankylosis: joint fixation / deformity
Other changes: occurs around joints, atrophy of muscles - bone alignment shifts - muscle spasm caused by inflammation / pain
Rheumatoid Arthritis (Etiology, Signs, Effects, Treatments)
Etiology: unknown cause, present genetic factor, some links to viral infection
Signs: inflammation first to joints / fingers, joints red / swollen, sensitive to touch, joint stiffness / impaired movement
Effects: fatigue, depression, malaise, anorexia
Treatment: rest / moderate activity, hot / cold compress, NSAIDs, Physical therapy, analgesia for pain
Bursitis
Inflammation associated with Bursae of bones, muscles, tendons, ligaments
- Most common cause: repetitive motion in joint
Diagnosis: physical exam, ultrasound or MRI
Treatment: rest, antiinflammation drugs
Candida
fungal infection on skin or mucous membrane
Contact Dermatitis
Exposure to allergen: metals, soap, cosmetics, chemicals, plants, etc.
- sensitivity on first exposure - rash develops on site
Pustule
elevated, erythematous (redness) lesion, usually contains puruvulant exudate (puss)
Vesicle
elevated, thin walled lesion containing clear fluid (blister)
Papule
small, firm, elevated lesion
Macule
small, flat, circumscribed lesion of a different color than normal skin
RICE
Rest
Immobilization
Compression
Elevation
(For fractures)
Fat Embolism
complication of bone healing (long bone)
Type 1 Reaction
ingestion of substance (nuts, fruits, shellfish, drugs)
Osteogenic Sarcoma
most common type of bone cancer
- occurs in shaft of long bone
common in kids, young adults
- bone pain at rest
Urticaria
(Hives) - Result of type 1 reaction
Signs: eruption of hard, raised, erythematous lesion - highly pruritic
Found: skin ,may be scattered, over body, occasionally pharyngeal mucosa
2 benign tumors
actinic keratoses, seborrheic
pruritus treatment
resting, topical agents
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