Pathology 2 : Integument System

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Pathology 2 : Integument System
2013-07-09 03:19:54
pathology massage therapy

pathology for the massage therapist
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  1. What is a NEVUS
    • A birthmark or mole
    • The most common form of congenital skin anomaly (normal elements of the skin are arranged abnormally)
  2. Characteristics of a BLUE NEVUS
    • Blue Tinge
    • Sometimes can be precancerous
  3. What is a HEMANGIOMA
    benign tumor of newly formed blood vessels that develop most commonly in childhood (tumor of a blood vessel)
  4. Characteristics of a PORT-WINED STAINED HEMANGIOMA
    • flat
    • red
    • not a lot of pressure with massage
  5. Characteristics of a STRAWBERRY HEMANGIOMA
    • small
    • sometimes elevated
    • red
    • a precursor to malignant melanoma
    • equal likelihood of occurring on skin that is exposed to the sun as on the skin that is not exposed to the sun
  7. Pigmentation Disorders (4)
    • Vitiligo
    • Lentigo
    • Ephelides (Freckle)
    • Albinism
  8. What is VITILIGO
    • common disorder manifested by LOSS of MELANOCYTES within the EPIDERMIS
    • common to the hands wrists, axilla, perioral, periobital, and anogenital regions
  9. What is LENTiGO
    • small, oval, tan-brown pigmented lesions caused by the benign proliferation (growth) of melanocytes
    • occurs in all ages
    • melanocyte hyperplasia
    • not dangerous, but if it suddenly appears, should be seen
  10. What is EPHELIDES (Freckle)
    • most common pigmented lesion of childhood in light pigmented individuals
    • fade and reappear with the seasons
  11. What is ALBINISM
    • disorder of skin pigmentation caused by the failure of melanocytes to produce melanin
    • lack or defect in enzyme called Tyrosinase
    • without melanin, susceptible to skin cancer & sensitive to UV rays
    • possibly more sensitive to heat
  12. External Injury : What is Mechanical Trama
    Abrasion, contusion, laceration, incised wound, and penetrating wounds
  13. Corn vs Callus
    Corn :: INWARD - thickening of stratum corneum resulting from friction or pressure. Forms a mass that pushes down into the skin

    Callus :: UPWARD - thickening of stratum corneum resulting from friction or pressure
  14. External Injury : Electrical Injury
    • has entry & exit point
    • ex. lightening, electricity
  15. External Injury : Radiation Injury
    • free radicals damage - x-rays, UV rays
    • cumulative
    • not irreversible
  16. First degree burn
    • erythema
    • edema
    • focal necrosis (cell death) or epidermal cells that heals rapidly with no scarring

    1st = epidermis = sunburn
  17. Second degree burn
    • full thickness of epidermis
    • part of the dermis
    • spares the adnexa (hair, follicles, etc.)
    • leads to blisters and erythema
    • healing occurs through adexa [FYI: Adexa: the appendages of the skin]
    • fluid goes between the epidermis & dermis

    2nd = epidermis & dermis = blisters
  18. Third degree burn
    • full thickness burn of the epidermis, dermis, & adnexa
    • results in severe scarring of the dermis
    • risk of shock, infection

    3rd = epidermis, dermis, & adexa (hypodermis) - scarring, skin grafts
  19. Inflammatory & Vesicular Skin Disorders : Eczema or Dermatitis
    • present with red papulo-vesicular pattern
    • localized edema
    • lichenification (thickening of the skin, characterized by accentuated skin markings; often the result of chronic scratching)
    • non-contagious pruritic (itchy) rash
  20. Inflammatory & Vesicular Skin Disorders : Seborrheic Dermatitis
    • red, scaly, itchy skin esp the nasolabial folds, eyebrows, and upper chest
    • accounts for the production of lost of dandruff
    • inflammed
  21. Inflammatory & Vesicular Skin Disorders : Psorasis
    • erhytematous papules & plaques found on extensor surfaces and scalp
    • "beefy-red" plaques with silver scaling skin
    • affects 1-2% of the U.S. population
    • skin is growing too fast
  22. Inflammatory & Vesicular Skin Disorders : Uticaria
    • raised
    • well-delimited
    • pruritic papules & plaques that appear & disappear within a few hrs causing edema to superficial portions of the dermis

    • Clinical Significance:
    • HIVES - lesions develop and fade within hrs. Some episodes may last for days. Typically triggered by pollens, food, drugs and insect venom & stress.
  23. Infectious Diseases :  Impetigo
    • superficial infection of the epidermis
    • caused by Staphylococcus aureus & Streptococcus pyogenes
    • most commonly occurs in children
    • transmission is by direct contact
    • highly contagious
  24. Infectious Diseases : Folliculitis
    • most often caused by Staphylococcus aureus
    • common infection of the hair follicle that may occur on any part of the body
    • where there is hair causing pain, swelling, and erythema (redness)
  25. Infectious Diseases : Cellulitis
    • rapidly spreading acute inflammation of subcutaneous (hypodermis) tissue that often occurs as a complication of wound infection
    • red, hot & swollen
    • cut, scratch, athletes foot, bite
    • can be dangerous if it gets to circulatory system
  26. Infectious Diseases : Necrotizing fasciitis
    • infection of the deep subcutaneous tissue, deep fascia, and underlying skeletal muscle
    • affects the limbs and abdominal wall
    • lesions spread rapidly and require prompt and aggressive surgical debridement
    • not common
  27. Infectious Diseases : Leprosy
    • a common disease in tropical countries caused by Mycobacterium leprae
    • clinical manifestations depend on the immunologic reactivity of the host
    • incubation time anywhere from 9 months to 20 years
    • not super contagious
  28. Infectious Diseases : Syphilis
    • a common sexually transmitted disease
    • caused by Terponema pallidum that causes skin lesions in both the early and late stages of the disease
    • initial lesion is painless
    • initital stage a primary chancre is present that exudes a serous fluid full of the bacteria
    • second stage a large variety of rashes affect the entire body
    • incubation is 10 days to 3 months, 3 weeks is typical
    • most common : affects 20 to 29 year old patients in the U.S.
    • contagious when on skin
  29. Infectious Diseases : Viral Infections :
    • caused by the variola virus
    • need a host to live
  30. Infectious Diseases : Viral Infections : Chickenpox
    • virus enters through the respiratory tract and after an incubation of 13-17 days, the infection manifests itself mainly in the skin
    • 1/100,000 children die from chickenpox in the U.S. each year
  31. Infectious Diseases : Viral Infections : Herpes Zoster (Shingles)
    caused by varicella-zoster virus, the same virus that causes chickenpox
  32. Infectious Diseases : Viral Infections : Herpes Simplex
    • type 1: causes oral lesions
    • type 1: repeated recurrence producing "cold sores or blisters"
    • type 2: causes genital lesions
    • type 2: an epidemic sexually transmitted disease in the U.S. and is HIGHLY contagious, causing recurrent blisters that may be almost symptomless in the cervix
  33. Herpetic whitlow
    a herpes infection of the terminal end of the finger/fingernail
  34. Infectious Diseases : Viral Infections : Measles
    • acute highly contagious viral infection
    • rubeola virus presents as small dots with white or blue centers
    • causes death in children <5 yrs of age
  35. Infectious Diseases : Viral Infections : Molluscum Contagiousum
    • viral lesion transmitted by direct contact
    • characterized by the presence of large dome-shaped "pearly" papules
    • folds in the arm or the groin
    • also found in clusters on the chest, abdomen, and buttocks, face and eyelids
    • commonly transmitted sexually or can be contracted in swimming pools
  36. The Common Wart (Verruca Vulgaris)
    skin growth caused by the human papilloma virus (HPV)
  37. Dermatophytes cause...
    • cause circular, elevated, red and scaly lesions of the skin
  38. Dermatophytes (group of #5)
    • Tinea (or ringworm) capitis - head
    • Tinea corporis - body surface
    • Tinea cruris - inguinal areas / jock itch
    • Tinea pedis - athletes foot
    • Tinea unguium - toenails
  39. Candidiasis
    • Yeast infection
    • usually confined to the superficial layers of the skin and the mucus membranes
    • can affect only skin or become widespread
    • can ultimately cause sepsis in the immune-compromised patients
  40. Scabies
    • contagious skin disease
    • caused by mites that burrow into the stratum corneum, producing serpingious (wandering) burrows from which the mite can be extracted
    • itching resulting from the mite eggs, feces and bites
    • wash sheets in boiling hot water if you had a client that has scabies
  41. Neoplasms of the skin
    The most important carcinogenic agent in most cutaneous cancer is ultraviolet light
  42. Benign Keratocytic Neoplasm: Seborrheic Keratosis
    • Not contagious/benign
    • very common lesion
    • occuring on the trunk, extremities, and face
    • usually in elderly
  43. Benign Keratocytic Neoplasm: Keratoacanthoma
    • Benign
    • usually occurs in middle age
    • commonly on the face or upper extremities
    • characterized by rapid early growth phase, reaching maximum size in a few weeks, followed by a static phase (up to one year) after which lesion spontaneously involutes (collapses on itself) with scarring.
  44. Premalignant Lesions of the skin: Actinic Keratosis
    • represents the effect on the skin of UV radiation
    • dysplasia of the epidermis and degeneration of the dermal collagen
    • can become cancerous
  45. Malignant Neoplasm : Basal Cell Carcinoma
    • common skin neoplasm
    • usually occurring in sun-exposed areas of light-skinned peoples over the age of 40
    • usually does not metastize
  46. Malignant Neoplasm: Squamous Cell Carcinoma
    • very common
    • especially in sun-exposed skin of the elderly, fair skinned individuals
    • presents as a shallow ulcer with a raised, everted, firm border
  47. Malignant Neoplasm: Malignant Melanoma
    • increasing at a faster rate than any cancer
    • prognosis is excellent if caught before the vertical growth phase (growth down in the skin) exceeds 4.0 mm.
    • if the cancer exceeds 4.0 mm of vertical growth 75% of patients die
  48. The intermediate lesions (radial growth phase & vertical growth phase)
    Radial growth phase - superficial spreading melanoma in all directions

    Vertical growth phase - after 1-2 yrs tends to be more vertical, moving deeper into the dermis. As it moves into the dermis, there is an increasing likelihood that cancer will enter the bloodstream and spread to distant sites within the body
  49. ABCD's of Melanoma Recognition
    • Asymmetry : one 1/2 is different from the other
    • Border : irregular border
    • Color : mixture of any colors, even brown & blacks, changing colors
    • Diameter : greater than the diameter of a pencil eraser