BMED 66 HUMAN ANATOMY AND PHYSIOLOGY and PATHOPHYSIOLOGY LECTURE

Lecture Notes: From Marrieb Essentials of Human Anatomy and physiology Global edition
And Hole’s Essentials of Human Anatomy and Physiology
Objectives at the end of the discussion the students will be able to;
1. Explain the parts and functions of the Integumentary system
2. Differentiate the layers of the skin
3. Describe the layers of the skin and Give each function
4. Describe the different appendages of the skin
5. Explain the function of the different appendages of the skin
6. Describe the different imbalances that will effect the normal function of the skin
7. Discuss the different skin pathology infection, burns and skin cancer
8. Explain the Normal effect of development to the skin and integumentary system
Skin and Integumentary System
Introduction:

A. Organs are body structures composed of two or more different tissues.

B. The skin and its accessory organs make up the integumentary system.
 Functions of body membranes
 Cover body surfaces
 Line body cavities
 Form protective sheets around organs
 Classified according to tissue types
Epithelial membranes
Cutaneous membranes
Mucous membranes
Serous membranes
Connective tissue membranes
Synovial membranes

Types of Membranes
A. Serous membranes line body cavities that lack openings to the outside.
1. They line the thorax and abdomen and cover the organs within these cavities.
2. Serous membranes are made up of epithelium and loose connective tissue and secrete
serous fluid that acts as a lubricant.
 Epithelial membranes are simple organs
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 Also called covering and lining membranes

 These membranes contain:
 Epithelial tissue layer
 Connective tissue layer
Serous membranes (serosae)
Line open body cavities that are closed to the exterior of the body
Occur in pairs, separated by serous fluid, with a visceral and parietal layer
Construction
Simple squamous epithelium
Areolar connective tissue

Specific serous membranes

Peritoneum
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Abdominal cavity
Pleura
Around the lungs
Pericardium
Around the heart

B. Mucous membranes line the cavities and openings that lead to the outside of the body,
including the oral and nasal cavities, and openings of the digestive, reproductive, respiratory, and urinary
systems.
1. They consist of epithelium and connective tissue with specialized cells that secrete mucus.
Mucous membranes (mucosae)
Moist membranes
Line all body cavities that open to the exterior body surface
Adapted for absorption or secretion
Construction
Epithelium type depends on site
Loose connective tissue (lamina propria)

C. Synovial membranes line the joint cavities.

1. These membranes consist of only connective tissues and they secrete
lubricating synovial fluid.
Synovial membranes
Loose areolar connective tissue only (no epithelial tissue)
Line fibrous capsules surrounding joints
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Line bursae
Line tendon sheaths
Secrete a lubricating fluid to cushion organs moving against each other during muscle activity

D. The cutaneous membrane consists of the skin,

Cutaneous membrane = skin
Dry membrane
Outermost protective boundary
Construction
Epidermis is composed of keratinized stratified squamous epithelium
Dermis is mostly dense (fibrous) connective tissue
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 Integumentary system consists of the:

 Skin (cutaneous membrane)
 Skin appendages
 Sweat glands
 Oil glands
 Hair
 Nails
 Functions of the Integumentary System
 Insulates and cushion deeper body organs
 Protects the entire body from:
 Mechanical damage (bumps and cuts)
 Chemical damage (acids and bases)
 Thermal damage (heat or cold)
 Ultraviolet (UV) radiation (sunlight)
 Microbes (bacteria)
 Desiccation (drying out)
 Aids in loss or retention of body heat as controlled by the nervous system
 Aids in excretion of urea and uric acid
 Synthesizes vitamin D
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Skin and Its Tissues

A. The skin is a large organ responsible for maintaining homeostasis through temperature
regulation, protection of underlying tissues, retardation of water loss, housing sensory
receptors, synthesizing certain chemicals, and excreting wastes.
B. The skin consists of an outer epidermis and a dermis, connected to underlying tissue by the
subcutaneous layer (hypodermis)

Structure of the Skin

 Two kinds of tissue compose the skin
 Epidermis
 Dermis
 Hypodermis (subcutaneous layer)
 Anchors the skin to underlying organs
 Not technically part of the integumentary system
 Composed mostly of adipose tissue
Serves as a shock absorber and insulates deeper tissues
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C. Epidermis
1. The epidermis is made up of stratified squamous epithelium and lack blood
vessels.
2. The layer of reproducing cells (the stratum basale), which lies at the base of the epidermis, is
well-nourished by dermal blood vessels.
 Epidermis—outer layer
 Capable of being hard and tough
 Stratified squamous epithelium
 Keratinocytes (the most common cell) produce a fibrous protein called keratin
 Avascular
Composed of five layers (strata)
 Summary of layers of the epidermis from deepest to most superficial
 Stratum basale
 Stratum spinosum
 Stratum granulosum
 Stratum lucidum (thick, hairless skin only)
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 Stratum corneum
 Stratum basale (stratum germinativum)
 Deepest layer of epidermis
 Lies next to dermis
 Wavy borderline with the dermis anchors the two together
 Cells undergoing mitosis
 Daughter cells are pushed upward to become the more superficial layers
 Stratum spinosum
 Cells become increasingly flatter and more keratinized
 Stratum granulosum
 Stratum lucidum
 Formed from dead cells of the deeper strata
 Occurs only in thick, hairless skin of the palms of hands and soles of feet
 Stratum corneum
 Outermost layer of epidermis
 Shingle-like dead cells are filled with keratin (protective protein prevents water loss from skin)
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3. Cells are pushed outward as new cells are formed, and become keratinized as they die. Four or five
layers may be seen: stratum basale, stratum spinosum, stratum granulosum, and stratum corneum are always
present and the stratum lucidum is found in the thicker palms and soles.
4. The epidermis is important because it protects against water loss, mechanical injury, chemicals, and
microorganisms.
 Epidermal dendritic cells
 Alert and activate immune cells to a threat (bacterial or viral invasion)

 Merkel cells
 Associated with sensory nerve endings
 Serve as touch receptors called Merkel discs
5. Melanocytes, which lie deep in the epidermis and underlying dermis, produce a pigment called melanin
that protects deeper cells from the sun's ultraviolet rays.
 Melanin
 Melanin is a pigment produced by melanocytes
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 Melanocytes are mostly in the stratum basale of the epidermis

 Color is yellow to brown to black
 Melanin accumulates in membrane-bound granules called melanosomes
 Amount of melanin produced depends upon genetics and exposure to sunlight

6. Melanocytes pass melanin to nearby cells through cytocrine secretion

D. Skin Color
1. Skin color results from a combination of genetic, environmental, and physiological factors.
2. Genetic differences in skin color result from differing amounts of melanin and in the size of melanin
granules.
3. Exposure to sunlight causes darkening of skin as melanin production increases.
4. Circulation within dermal blood vessels affects skin color.
 Three pigments contribute to skin color
1. Melanin
 Yellow, reddish brown, or black pigments
2. Carotene
 Orange-yellow pigment from some vegetables
3. Hemoglobin
 Red coloring from blood cells in dermal capillaries
 Oxygen content determines the extent of red coloring
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 Redness (erythema)—due to embarrassment, inflammation, hypertension, fever, or allergy

 Pallor (blanching)—due to emotional stress (such as fear), anemia, low blood pressure, impaired blood
flow to an area

 Jaundice (yellow cast)—indicates a liver disorder

 Bruises (black and blue marks)—hematomas

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E. Dermis
 Dermis
 Connective tissue
 Underlies the epidermis

1. The dermis binds the epidermis to underlying tissues. Epidermal ridges and dermal papillae cause
the border to be uneven.
2. The dermis consists of connective tissue with collagen and elastic fibers within a gel-like ground
substance
3. Dermal blood vessels carry nutrients to upper layers of skin and help to regulate temperature.
4. The dermis also contains nerve fibers, sensory fibers, hair follicles, sebaceous glands, and sweat
glands.
 Two layers of the dermis
 Papillary layer (upper dermal region) contain projections called dermal papillae
 Indent the epidermis above
 Many projections contain capillary loops, and others house pain and touch receptors
 On palm and sole surfaces, papillae increase friction and gripping ability
 Fingerprints are identifying films of sweat
 Reticular layer (deepest skin layer)
 Blood vessels
 Sweat and oil glands
 Deep pressure receptors (lamellar corpuscles)
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 Other dermal features

 Cutaneous sensory receptors
 Phagocytes
 Collagen and elastic fibers
 Blood vessels

F. Subcutaneous Layer
1. The subcutaneous layer (hypodermis) is composed of loose connective tissue and insulating adipose
tissue.
2. It binds the skin to underlying organs and contains the blood vessels that supply the skin.
3. No sharp boundary exists between the dermis and subcutaneous layer.

Accessory Organs of the Skin

 Cutaneous glands are all exocrine glands
 Sebaceous glands
 Sweat glands
 Hair
 Hair follicles
Nails
A. Nails
1. Nails are protective coverings over the ends of fingers and toes.
2. Nails consist of stratified squamous epithelial cells overlying the nail bed, with the lunula as the most
actively growing region of the nail root.
3. As new cells are produced, older ones are pushed outward and become keratinized.
 Nails
 Heavily keratinized, scalelike modifications of the epidermis
 Stratum basale extends beneath the nail bed, which is responsible for growth
 Lack of pigment makes nails colorless
 Parts of a nail
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 Free edge
 Body is the visible attached portion
 Nail folds are skin folds that overlap the edges of the nail; the cuticle is the proximal edge
 Root of nail is embedded in skin
 Growth of the nail occurs from nail matrix

B. Hair Follicles
1. Hair can be found in nearly all regions of the skin.
2. Individual hairs develop from cells at the base of the hair follicle, an invagination of the lower
epidermis that dips down into the dermis.
3. As new cells are formed, old cells are pushed outward and become keratinized, and die forming
the hair shaft.
 Hair
 Produced by hair follicle
 Root is enclosed in the follicle
 Shaft projects from the surface of the scalp or skin
 Consists of hard keratinized epithelial cells
 Melanocytes provide pigment for hair color
 Hair grows in the matrix of the hair bulb in stratum basale
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 Hair anatomy
 Central medulla
 Cortex surrounds medulla
 Cuticle on outside of cortex
 Most heavily keratinized region of the hair
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 Associated hair structures

 Hair follicle
 Composed of an epithelial root sheath and fibrous sheath
 Dermal region provides a blood supply to the hair bulb (deepest part of the follicle)
 Arrector pili muscle connects to the hair follicle to pull hairs upright when we are cold or
frightened

4. A bundle of smooth muscle cells, called the arrector pili muscle, attaches to each hair follicle. These
muscles cause goose bumps when cold or frightened.
5. Hair color is determined by genetics; melanin from melanocytes is responsible for most hair colors.
Dark hair has eumelanin while blonde and red hair have pheomelanin.
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C. Sebaceous Glands
1. Sebaceous glands (holocrine glands) are associated with hair follicles and secrete sebum that
waterproofs and moisturizes the hair shafts.
 Sebaceous (oil) glands
 Located all over the skin except for palms and soles
 Produce sebum (oil)
 Makes skin soft and moist
 Prevents hair from becoming brittle
 Kills bacteria
 Most have ducts that empty into hair follicles; others open directly onto skin surface
 Glands are activated at puberty
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D. Sweat Glands
1. Sweat glands (sudoriferous glands) are either eccrine, which respond to body temperature, or
apocrine, which respond to body temperature, stress, and sexual arousal.
2. Modified sweat glands, called ceruminous glands, secrete wax in the ear canal.
3. Mammary glands, another modified type of sweat glands, secrete milk.
 Sweat (sudoriferous) glands
 Produce sweat
 Widely distributed in skin
 Two types of sudoriferous glands
 Eccrine glands
 Apocrine glands
 Eccrine glands
 Open via duct to sweat pores on the skin’s surface
 Produce acidic sweat
 Water, salts, vitamin C, traces of metabolic waste
 Function in body temperature regulation

 Apocrine glands
 Ducts empty into hair follicles in the armpit and genitals
 Begin to function at puberty
 Release sweat that also contains fatty acids and proteins (milky or yellowish color)
 Play a minimal role in body temperature regulation
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Regulation of Body Temperature

A. Proper temperature regulation is vital to maintaining metabolic reactions.
B. The skin plays a major role in temperature regulation with the hypothalamus controlling it.
C. Active cells, such as those of the heart and skeletal muscle, produce heat.
D. Heat may be lost to the surroundings from the skin through radiation.
E. The body responds to excessive heat by dilation of dermal blood vessels and sweating.
F. The body responds to excessive cooling by constricting dermal blood vessels, inactivating sweat
glands, and shivering.
Healing of Wounds and Burns
A. Inflammation, in which blood vessels dilate and become more permeable, causing tissues to become
red and swollen, is the body's normal response to injury.
B. Superficial cuts are filled in by reproducing epithelial cells.
C. Deeper cuts are closed off by clots, covered by scabs, and eventually filled in by fibroblasts, making
connective tissue. Blood vessels extend into the area, injured tissues are replaced, and the scab falls
off.
D. Large wounds leave scars and healing may be accompanied by the formation of granulations.

Homeostatic Imbalances of Skin

 Infections and allergies
 Athlete’s foot
 Caused by fungal infection (Tinea pedis)
 Itchy, red peeling skin between the toes
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 Boils (furuncles) and carbuncles

 Caused by inflammation of hair follicles
 Carbuncles are clusters of boils caused by bacteria

 Cold sores (fever blisters)

 Caused by human herpesvirus 1
 Blisters itch and sting

 Contact dermatitis
 Caused by exposure to chemicals that provoke allergic responses
 Itching, redness, and swelling of the skin
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 Impetigo
 Caused by bacterial infection
 Pink, fluid-filled raised lesions around mouth/nose

 Psoriasis
 Triggered by trauma, infection, hormonal changes, or stress
 Red, epidermal lesions covered with dry, silvery scales that itch, burn, crack, or
sometimes bleed
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 Burns
 Tissue damage and cell death caused by heat, electricity, UV radiation, or chemicals
 Associated dangers
 Protein denaturation and cell death
 Dehydration and electrolyte imbalance
 Circulatory shock
 Result in loss of body fluids and infection from the invasion of bacteria
 Extent of a burn is estimated using the rule of nines
 Body is divided into 11 areas for quick estimation
 Each area represents about 9 percent of total body surface area
 The area surrounding the genitals (the perineum) represents 1 percent of body surface
area

 First-degree burn (superficial burn)

 Only epidermis is damaged
 Skin is red and swollen
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 Second-degree burn (partial-thickness burn)

 Epidermis and superficial part of dermis are damaged
 Skin is red, painful, and blistered
 Regrowth of the epithelium can occur

 Third-degree burn (full-thickness burn)

 Destroys epidermis and dermis; burned area is painless
 Requires skin grafts, as regeneration is not possible
 Burned area is blanched (gray-white) or black

 Fourth-degree burn (full-thickness burn)

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 Extends into deeper tissues (bone, muscle, tendons)

 Appears dry and leathery
 Requires surgery and grafting
 May require amputation

 Criteria for deeming burns critical (if any one is met):

 Over 30 percent of body has second-degree burns
 Over 10 percent of the body has third- or fourth-degree burns
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 Third- or fourth-degree burns of the face, hands, or feet, or genitals

 Burns affect the airways
 Circumferential (around the body or limb) burns have occurred
 Skin cancer
 Most common form of cancer in humans
 Most important risk factor is overexposure to ultraviolet (UV) radiation in sunlight and tanning
beds
 Cancer can be classified two ways
 Benign means the neoplasm (tumor) has not spread
 Malignant means the neoplasm has invaded other body areas
 Most common types of skin cancer
 Basal cell carcinoma
 Squamous cell carcinoma
 Malignant melanoma
 Basal cell carcinoma
 Least malignant and most common type of skin cancer
 Arises from cells in stratum basale that are altered so that they can no longer make keratin
 Lesions appear as shiny, dome-shaped nodules that develop a central ulcer

 Squamous cell carcinoma

 Believed to be induced by UV exposure
 Arises from cells of stratum spinosum
 Lesions appear as scaly, reddened papules that gradually form shallow ulcers
 Early removal allows a good chance of cure
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 Metastasizes to lymph nodes if not removed

 Malignant melanoma
 Most deadly of skin cancers, but accounts for only 5 percent of skin cancers
 Arises from melanocytes
 Metastasizes rapidly to lymph and blood vessels
 Detection uses ABCDE rule for recognizing melanoma
 Malignant melanoma (continued)
 A = Asymmetry
 Two sides of pigmented mole do not match
 B = Border irregularity
 Borders of mole are not smooth
 C = Color
 Different colors in pigmented area
 D = Diameter
 Spot is larger than 6 mm in diameter
 E = Evolution
 One or more of the ABCD characteristics is evolving
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Developmental Aspects of Skin and Body Membranes

 Lanugo, a downy hair, covers the body by the fifth or sixth month of fetal development but disappears
by birth

 Vernix caseosa, an oily covering, is apparent at birth

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 Milia, small white spots, are common at birth and disappear by the third week

 Acne may appear during adolescence

 In youth, skin is thick, resilient, and well hydrated

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 With aging, skin loses elasticity and thins

 Skin cancer is a major threat to skin exposed to excessive sunlight

 Balding and/or graying occurs with aging; both are genetically determined; other factors that may
contribute include drugs and emotional stress
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