ANAPHY (Integumentary System)

Integumentary System

Skin and its appendages

-Skin is the biggest organ in the body ; 1.6 to 1.9 m2

Two primary layers

1. Epidermis – outer part of the skin
2. Dermis – deep skin ; inner part of the skin

EPIDERMIS

3 Cell types
1. Keratinocytes – water repellant property ; strength and protection
2. Melanocytes – contains melanin ; skin color
3. Langerhans cells – maintains immunity ; phagocytes, performs phagocytic

6 Cell layers
1. Stratum corneum
- Covers the body ; outermost layer
- Horny layer
- Most superficial layer
- Barrier area
2. Stratum lucidum
- Bright color
- Clear layer ; cells filled with keratin precursor called Eleidin (Eleidin is used in
producing keratin)
3. Stratum granulosum
- Multiple layer ; granular layer
- Cells arranged in two or four layers and filled with Keratohyaline granule
4. Stratum spinosum
- Soft layer ; spiny layer
- Arranged in 8 or 10 layers with prominent dermosomes
- Allows the skin to be flexible
5. Stratum basale
- Only layer that undergoes mitosis
- Single layer column ; deep layer of epidermis
6. Stratum germanitivum
- Growth layer
- Describes the stratum spinosum and stratum basale combined together
Epidermal growth and repair
Dermal and Epidermal Junction
- A definite basement membrane
- Specialized fibrous elements
- Polysaccharide gel serves as “glue”

Dermis
- Gives strength to the skin
- Serves as a reservoir storage area for water and electrolytes
- Contains specialized sensory receptors.
- Plays a critical role in temperature regulation
- This is where the pre-nerve ending located (Pre nerve ending is responsible for us to
feel pain)

Layers of Dermis
1. Papillary Layer
- Collagenous and elastic fibers
2. Reticular layer
- Makes the skin stretchable

Skin Diseases

1. Jaundice
- yellow skin
- people suffering from liver problems
- increase in bilirubin
2. Cyanosis
- Bluish discoloration
- Can develop in the entire body
- Lack of oxygen in the blood
3. Necrosis
- Dark discoloration
- Because of cell death
4. Albinism
- Extremely fair color sking
- Genetic disorder / hereditary
- Doesn’t have melanocytes
***Melanin or melatonin – helps us through in our sleep
5. Vitiligo
- Lack of melanin
- White patches
Function of the skin
 Protection
 Sensation
 Movement without injury
 Excretion
 Vitamin D production – calcium absorption
 Immunity

Homeostasis of body temperature

- To maintain homeostasis of body temperature heat production must be equal to heat
loss.
 Heat production
- Increases body temperature
- By metabolism of foods in skeletal muscles
 Heat loss
- Decreases body temperature
- Approximately 80% of heat loss occurs through the skin
Processes of Heat loss
1. Evaporation – best example is sweating
2. Radiation – heat transfer without contact (Example : camping in cold – need a bonfire to
transfer heat without contact)
3. Conduction – heat transfer with contact (Example : camping in cold – need another
persons hug or cuddle to transfer heat)
4. Convection – heat loss through air current
Homeostatic Regulation of Heat Loss

Burns – thermal injury or chemical injury

***thermal -high temperature
***example of Chemical : muriatic acid
-causes of erotion of the skin
 Major : >25% (greater than)
 Moderate : 15-25%
 Minor : <15% (less than)
TBSA – Total Burn Surface Area

Degrees of Burn

 1st degree burn

- Also known as superficial burn
- Depth – affected part is the epidermis ; dermis is still intact
- Color – reddish, sunburn
- Surface – outer layer
- Painful
 2nd degree burn
- Also known as partial thickness
- Affected part is the dermis ; therefore epidermis is affected
- Dermis is already exposed
- Color – white or blisters, skin lesions: has water inside
- Example : Scald or when drinking coffee
- Very painful ; most painful in fact
 3rd degree burn
- Also known as full thickness
- Affected area including the subcutaneous or fat layer
- Epidermis, dermis and subcutaneous are all damaged.
- Dermis is not intact
- Subcutaneous is under the dermis.
- Non painful – no dermis, no free nerve ending (free nerve ending- pain, touch and
temperature)
- Color : yellow (because of pus or nana)
- Skin is already dead
 4th degree burn
- Also known as deep full thickness
- Deep burn ; affected area is the muscle
- Bones and muscles are already exposed.
 - Color : black, necrosis or cell death
- Deepest surface, innermost layer ; non painful

How we solve: Rule of 9

 Face & neck is 9%
 Abdomen & chest in 18% (9% each front and back)
 Arm is 9% each side
 Legs is 18% each side
 Half for anterior and half for posterior
 Genitals is 1%
 =Total of 100%

Hair
- Widely distributed in the body except palms and soles
- Fine and soft hair coat existing before birth is called Lanugo.
- If newborn baby lacks lanugo it means that the baby is preterm.
- Important for the new born because it helps to maintain the body temperature.
- Coarse pubic and axillary hair that develops at puberty is called Terminal hair.
- Hair follicles and hair develop from epidermis.

Parts of the Hair

1. Papilla – cluster of capillaries germinal matrix
- Small blood vessels
2. Root – part of the hair embedded in follicle in dermis
3. Shaft – visible part of the hair
4. Medulla – inner core of hair, Cortex is the outer portion
5. Growth – hair on head averages 5 inches of growth per year
***Alopecia – minimal growth of hair ; genetic ; sometimes due to medications
***For patients taking chemotherapy, Alopecia is temporary ; sometimes it takes 4-6
weeks
6. Sebaceous Gland – Attach and secrete sebum into follicle

Nails
-consists of epidermal cells converted to hard keratin
-nails doesn’t absorb water ; water resistant

Parts of the nails

1. Nail body – visible part of the nail
2. Root – part of the nail in groove hidden by fold of skin ; the cuticle
 3. Lunula – the white part of the nails
4. Nail bed – layer of epithelium under nail body
5. Growth – average growth about 0.5mm per week or slightly over 1 inch per year.

2 types of skin Glands

1. Eccrine glands – sweat glands ; responsible for producing sweat

2. Apocrine glands – commonly located in the hairy parts of the body
Example: Armpit

Sebaceous glands – secrete sebum (oily)

- Lipid component have antifungal activity
- Simple branched gland
Ceruminous glands – found in ears, produces cerumen
- Modified apocrine sweat glands
- Cerumen is important to prevent the entry of the microorganisms.

Skin for:
Children – skin is smooth, unwrinkled and characterized by elasticity and flexibility
- Ability for rapid healing
Adult – development and activation of sebaceous and sweat glands as well as sebum production.
Old age – decreased sebaceous and sweat gland activity hence; wrinkling and decrease ability to
tolerate to cold occurs.

Skin disorders

1. Dermatosis – inflammatory skin disorder ; characterized by blisters

2. Dermatitis – characterized by reddish black ; lesions begin to show up ; color red
3. Impetigo – bacterial infection ; commonly found in the children around the nose or mouth
4. Tinea – fungal infection ; ringworm ; cause of poor hygiene
***Tinea on the male genital is called jock itch.
5. Warts – due to virus or bacteria
***genital warts is STD. Can get through having sex with someone who is contaminated
with the virus.
6. Boils – contains pus or nana, inflammatory lesions ; skin is elevated.
7. Psoriasis – chronic skin disorder, this is not treatable but manageable ; scaly white
patches
8. Frostbite – characterized necrosis due to prolong exposure to the cold environment.
Blood vessel will constrict. Color: black
***If body parts doesn’t receive enough blood supply, there will be necrosis.
3 types of skin cancer

1. Basal skin cancer – commonly found in the exposed part of the body ; color red
2. Squamous skin cancer – non exposed area ; example the chest and abdomen
3. Melanoma – most serious type of skin cancer. It can grow anywhere in the body. Can be
found in the exposed and non exposed area. Color black.

***10am to 2pm – highest peak of radiation coming from the sun ; prevent from exposure
between this time

ANAPHY (Muscular System)

Muscular System

3 types of Muscle Tissue

1. Cardiac muscle – responsible for heartbeat ; involuntary
2. Skeletal muscle – voluntary movement
3. Smooth muscle – organs

 There are more than 600 skeletal muscles in the body

 40 to 50% of our body is skeletal muscles
 Muscles along with the skeleton, determine the form and contour of our body

Skeletal Muscle structure

Connective tissue component

1. Endomysium – inner cover
2. Perymysium – tough connective tissue ; strength
3. Epimysium – outside cover

Size, shape and fiber arrangement

 Size – small to large masses
 Shape – broad, narrow, long, tapering, short, blunt, triangular, quadrilateral, irregular, flat
sheets, bulky masses
 Arrangement – parallel to long axis, converge to narrow attachment, oblique pennate,
bipennate curved.

Attachment of muscles
 Origin – starting point ; maintain location ; does not move when muscle contracts.
 Insertion – moves when muscle contracts.

Muscle Action
 Prime mover – performs a specific movement
 Antagonist – allows its movement on the other side ; “kontrabida”
 Synergists – stimulates aid or support the movement of the prime mover.
 Fixator muscles – maintains the muscles intact or in place

Lever System
 Rigid bar – immobilized the muscle ; steady
 Fulcrum – balances the movement of the muscle
 Load – stimulates the muscle to move
 Pull – contraction ; movement produced by the muscle
 1. First class lever – fulcrum lies between the pull and the load ; not abundant in the
human body.
2. Second class lever – load lies between fulcrum and the joint at which pull is exerted.
3. Third class lever – pull is exerted between the fulcrum and the load ; movement
against the gravity ; most common type of movement.

How muscles are named?

 Location, function and shape
 Direction of fibers
 Numbers of heads and divisions
 Point of attachment
 Relative size

Important skeletal muscles

 Muscle of facial expression – unique in that at least one point of attachment is two deep
layers of skin.
 Muscle of mastication – responsible for chewing.
 Muscle that moved that head – allows to move the head
 Zygomaticus minor and major – responsible for smiling

Trunk muscles

 Muscles of the thorax – responsible for breathing ; respiratory

 Muscles of the abdominal wall – peristalsis or digestion
 Muscles of the back – stabilizing the back
 Muscles of the pelvic floor – Kegel’s maneuver ; support the structure in the pelvic
cavity
Diaphragm – major muscle use for breathing
External oblique – abs

Upper limb muscles

 Muscles acting on the shoulder girdle – movement of upper extremities ; arms ; located
anteriorly or posteriorly
 Muscles that moves the upper arm – the shoulder is a synovial joint ; extensive
movement in every plane motion.
 Muscles that move the forearm – found on the elbow
 Muscles that move the wrist, hand and fingers – located on the anterior and posterior
surfaces of the forearm.
Deltoid muscles – intramuscular injection
Trapezius – neck to the back ; movement of the neck

Lower limb muscles

 - The pelvic girdle and lower extremity function in locomotion
- Allows us to maintain balance
- Move the thigh and lower leg ; move the ankle and foot

 Extrinsic foot muscles – located in the leg and exert their actions by pulling on tendons.
 Intrinsic foot muscles – located within the foot and responsible for flexion, extension,
abduction and adduction of toes.

***Good posture is important to prevent muscle injury.

- Body alignment that most favors functions
- Body is in one direction
- Minimal muscle movement can produce output ; has a wide base of support ; feet standing
far from each other or wide open
- Structure other than muscle and bones have a role in maintaining posture.

Muscular Physiology
General Functions
 Movement of the body as a whole or of its parts
 Heat production
 Posture

Function of the Skeletal Muscle tissue

Characteristics of the Skeletal muscle cell

 Excitability or irritability – muscle reacts to a stimulus
 Contractility – muscles become short but it allows movement
 Extensibility – muscle becomes long and allows movement

Overview of the muscle cell

 When Myosin attached to the actin that’s the only time muscles move.
 Muscle cells are called fibers.
 Sarcolemma – plasma membrane of muscle fibers
 Sarcoplasmic reticulum – binding site ; the one that binds is the Calcium
***Calcium is an electrolyte needed by the body or muscle

Myofibrils – numerous fine fibers packed close together in sarcoplasm

Sarcomere – a segment of myofibrils between two successive Z lines.
I-band – stripe part ; 2 colors ; arrange in line
H-zone – found in between the A-band
Z-line – located before or after an I-band
C-protein – used to kill bacteria in the body
T Tubules
- Membranes with ion pumps
- Transport calcium ions inward from the sarcoplasm ; deeper into the cells.

Myofilaments
- Each myofibril contains thousands of thick and thin myofilament.
- Kinds (Protein Molecule)
- Myosin – makes up almost all the thick filament.
- Myosin “heads” are chemically attracted to actin molecules.
- Uses ATP – energy that produce by the cell
- Myosin will convert the chemical energy to mechanical energy.
Actin
- Globular protein that firms two fibrous strands ; thin
- Does not initiate movement
Tropomyosin
- Protein that blocks the active sites on the actin molecules.
Troponin
- Protein that holds tropomyosin molecules in place

Characteristics of muscles
 Excitation and contraction
 Neuromuscular junction – space between the muscles
 Acetylcholine – travels and bind through the neuromuscular junction ; very important ;
stimulates the muscle to move

Sliding filament Theory

- How muscle movement occurs
- When active sites on the actin are exposed

Length and tension relationship

 Maximal strength that a muscle can develop bears a direct relationship to the initial
length of its fiber.
 A shortened muscle’s sarcomeres are compressed, therefore the muscle cannot develop
much tension.

Isotonic and Isometric Contractions

 Isometric contraction – length of the muscle is normal ; no changes ; tension increases
 Isotonic contraction – length, size of the muscle will change ; tension remains the same
 ***Concentric – muscle shortens as it contracts
***Eccentric – muscle lengthens while contracting

SKELETAL system and Articulation

Skeletal system – framework protects body and internal organ. Bone produce blood cells

*There are 206 bones in the body

*Periosteum – covers the bone outside
*Endeosteum – internal cover of the bone
*Bone Matrix – Inorganic and organic substances of the bone; non living part of the bone.

BONE ANATOMY
Spongy Bone – soft part of the bones; located at the end of long bones.
It contains red blood cells. (Blood cells came from red bone marrow).
Compact Bone – collagen (collagen is hard)

*red blood cell - carries oxygen in the blood

*white blood cell - fights infection
*platelets – prevents bleeding coagulation (prevents or stops bleeding)
(Note: Artery carries the oxygenated blood while vein the de-oxygenated blood.)

TWO TYPES OF BONE MARROW

Red Bone Marrow - Blood cells
Yellow Bone Marrow – made up of fats (for protection and thermo regulation) Blood vessels run
through on the Yellow Bone Marrow.

LONG BONE
Epiphysis
Diaphysis

DIVISION OF SKELETON
(1) Axial Skeleton – middle part of the body; they belong long axis of the body
(2) Appendicular Skeleton – Side or lateral bones; bone in the lateral extremities (legs and
feet)

(1) AXIAL SKELETON

SKULL

Frontal bone – Frontal lobe of the brain (anterior); contains the frontal sinuses
*Coronal Suture - the one that separates the frontal and Parietal

Temporal – side (near to temporal lobe of the brain) there are 2 temporal lobes
*Lamboidal – Separates the left and right

Parietal – top (flat)

Occipital – back (posterior)

Sphenoid Bone – Between the frontal and temporal bone (bat shaped bones)
(Note that headache is due to Sphenoid sinuses being congested)

Ethmoid Bone – Irregular bone; found inside the orbit which supports the eyeball

Maxilla (Upper Jaw) –mastification; smiling

Mandible (Lower jaw) – largest and strongest bone of the face

*articulate – binded together

Zygomatic Bone – shapes the cheeks and forms the outer margin of the orbit

Nasal Bone – Nasal bones form the upper part of the bridge of the nose; Cartilage forms of the lower
part

Lacrimal Bone – Paper thin bone

Palatine Bone – Two bones combined for hard palate

*Upper part of the mouth (Hard palate)
*Lower part of the mouth (Soft Palate)

Inferior Nasal Conchae (Turbinates) – Lower Edge

Vomer Bone – Posterior Portion (Back)

Hyoid Bone – U shaped bone; located on top of the Larynx; only bone in the body that articulates
with no other bones.

VERTEBRAL COLUMN
(Consists of 24 bones)

Spinal Column – divided into 5 major parts below:

Cervical – protects the cervical spinal nerves
Thoracic
Lumbar
Sacrum
Coccyx

Sternum – is the bone where ribs are connected; flat bone

Made up of the below:
Manubrium - head part; first pair of rib is connected
Body – biggest part, flat part
Xiphoid Process – depressed part; end part of sternum

THREE TYPES OF RIBS (There are 12 pairs of ribs)

*First seven ribs are known as the true ribs because they are connected with the Sternum
* Eight to Twelve known as False Ribs as they are not connected to the sternum
* Ribs 11 and 12 are called Floating ribs; not connected together
(Note that Ribs has spaces called intercoastalspaces. Intercoastal spaces is where
our instercoastel muscles are located which are responsible for breathing)

(2) APPENDICULAR SKELETON (Side of the body)

Upper Extremity:
Clavicle - form the only bony joint with the trunk. The Sternoclavicular Joint
Scapula – Back part of the shoulder
Humerus – Upper Arm
Ulna – Pinky finger (Thinner)
Radius – Near the thumb (thicker)

Shoulder Girdle – Made up of the scapula and clavicle (Sternoclavicular Joint when combined)

Carpal Bones – wrist

Metacarpal Bones – framework of the hand and fingers; made up of 8 small bones
Phalanges – Fingers

Fingers are divided into 3:

Distal - far
Proximal – near
Middle – middle part

LOWER EXTREMITIES (consist of the bones of the hip)

Pelvic Girdle – contraction to support the lower part of the body; important for pregnant women as
this is the passageway for babies. ; made up of sacrum and the 2 coxal bones bound tightly by
strong ligaments.

*Coxal Bone made up of the below:

Ilium - largest and one of the rich source of bone marrow
Ischium - Strongest and lowermost
Pubis – Anteriormost
Note: Android – Male Pelvis (narrowed) / Gynecoid – Female Pelvis (wider)

Femur – longest and strongest bone in the body

Patella – Biggest sesamoid bone in the body (knee)

Tibia – Thick bone of the lower leg

Fibula – Thin part

FOOT

Tarsal – The one that connects the tibia and Fibula to the foot is the Tarsal. (Bigger than carpal)
Talus – Biggest tarsal
Calcaneous – Heel bone
Metatarsal – Framework of foot (Tarsal and Metatarsal is the base of support)

STRUCTURAL CLASSIFICATION
- Joints are named according to type of connective tissue that joins bones together (Fibrous /
Cartilaginous joints)
- Presence of a fluid – filled capsule (Synovial Joint)
- Patients who are suffering arthritis has no or limited Synovial Joint

Three Major Joints in the body:

-Fibrous
-Cartilaginous Joints
- Synovial Joint (made up of Synovial Fluid)

Functional Classification:
Synarthroses – immovable joint (located in the skull)
Amphiarthroses – slightly movable
Diarthroses – freely movable

PARTS OF SYNOVIAL JOINTS:

Joint Capsule – sleeve like casing; cover the end part of the bone (for binding bones)
Synovial Membrane – produces the synovial fluid

Articular Cartilage – covers the external surface of the bone

Joint Cavity – small spaces between bones connected by a joint

Menisci (articular disk) – pads of fibrocartilage located between articulating bones

Ligaments – strong cords of dense white fibrous tissue; holds the joints together

Bursae –space in which synovial fluid allows movement

Uniaxial Joints - Synovial Joints allows one movement around only one axis and in only one plane.
Hinge Joint – allows only flexion and extension
Pivot Joint – Circular movement

Biaxial Joint – Synovial Joints that permit movements around two perpendicular axes
Saddle Joints - miniature saddle
Condyloid joints – condyle fits into an elliptical socket.

Multiaxial Joints – Synovial joints permit movements around three or more axes in three or more
planes.
Ball and socket (Spheroid) joints – most movable joints; ball shaped
Gliding Joints – limited gliding movements

3 Major Representative Synovial Joints:

Humeroscapular – most movable joint in the body
Hip Joint – maintains base of support
Knee Joint – most complex and most frequently injured joint.

VERTEBRAL JOINT
Annulus Fibrous – hard
Nucleus Pulposus – jelly like structure

RANGE OF MOTION
-Assesment used to determine extent of joint injury
-ROM measured by instrument called GONIOMETER

TWO TYPES OF MOVEMENT

Active motion – can move body alone without support
Passive Motion – move with support

ANGULAR MOVEMENTS
Flexion – towards the body
Extension – away the body
Hyperextension
PLANTAR FLEXION/ DORSIFLEXION (feet)
Plantar Flexion – Move the feet lower
Dorsiflexion – Move the feet towards the leg

ABDUCTION / ADDUCTION (arms)

Abduction – away from the body
Adduction – towards the body

ROTATION/ CIRCUMDUCTION
Rotation
Circumduction

PRONATION/SUPINATION (Palm)
Supination – palm facing upward (In bed: Upward)
Pronation - palm facing downward (In bed: Prone position / flat on bed or downwards)

GLIDING MOVEMENT - side to side

INVERSION / EVERSION (FEET)

Inversion – move the feet inside
Eversion – move the feet outside

PROTRACTION/ RETRACTION
Protraction – outside
Retraction – inside

ELEVATION / DEPRESSION
Elevation – close mouth; upward; elevation of mandible
Depression – open mouth; downward; Depression of mandible