Integumentary System The integumentary system, from the word integument, derived from the Latin word integumentum,

meaning a covering, is composed mainly of the body surfaces or known as the skin. This is the external covering of the body comprising of the skin, its pigments, and various exocrine glands that produce sweat, tears, and other oils, mucous, waxes, scents, and milk. It also includes all derived structures such as hair, feathers, scales, teeth, nails, claws, horns, and beaks. This system also contains specialized nerve receptors for stimuli. As an organ system, the integumentary system is the largest. In human beings, it amounts to about 16 percent of the body weight. It is composed of many types of tissue, including epithelial, connective, neural, and muscular. This organ system, composed of many diverse cells and tissues, provides a wall of defense between the body and the environment.

7 Chief Functions: 1. Regulation of body temperature 2. Protection 3. Sensation 4. Excretion 5. Immunity 6. Blood reservoir 7. Synthesis of Vit. D

Layers of the Skin:

Stratum Basale: the deepest epidermal layer, attached to dermis along a wavy borderline. Stratum Spinosum: several cell layers thick, contains web-like cells called intermediate filaments Stratum Granulosum: consists of three to five cell layers in which drastic change in keratinocyte appear Stratum Lucidum: consists of few rows of clear, flat, and dead keratinocytes, appear as a translucent band above the Stratum Granulosum

Stratum Corneum: a broad zone of 20-30 layers thick which accounts for of the epidermal skin

Cells in Epidermis:

Melanocytes: the spider shaped epithelial cells that synthesize the pigment, melanin Langerhans: arise from bone marrow and migrate to epidermis Merkel Cells: present in the dermal-epidermal junctions, shaped like a spiky hemisphere

Thick vs. Thin Skin:

Thick skin: covers the palms, fingertips, and soles of the feet, consisting of five layers Thin skin: covers the rest of body, the stratum lucidum is absent and other strata are thinner

Epidermis: Is a keratinized stratifies squamous epithelium consisting of four distinct cell types(Merkel, Langerhans, Melanocytes, and epidermal dendritic cells) and four to five layers(Stratum Basale, Stratum Spinosum, Stratum Granulosum, Stratum Lucidum, and Stratum Corneum)

Dermis: Second major skin region, is strong, flexible connective tissue. It cells are usually those found in any connective tissue: fibroblasts, macrophages, and occasional mast cells. Its semi-fluid matrix is heavily embedded with collagen, elastin and reticular fibers.

Skin Color: There are three factors that contribute to skin color: Melanin, Carotene, and Hemoglobin, but only Melanin is made in the skin.

Melanin, a polymer made of tyrosine amino acids, ranges in color from yellow to reddishbrown to black. Its synthesis depends on an enzyme in melanocytes called tyrosinase, which passes from melanocytes to basal keratinocytes

Glands in Skin:

Eccrine Glands: are far more abundant on the palms, soles and forehead. Each is a tubular, coiled tubular gland. Apocrine Glands: are largely confined to axillary and anogenital areas. Larger than Eccrine glands and their ducts empty into hair follicles. Ceruminous Glands: are modified apocrine glands found in the lining of the external ear canal. Sebaceous Glands (Oil glands): are simple alveolar glands with little or no visible lumen that are found all over the body except on the palms and soles. Secrete an oily secretion called, sebum

Skin Cancers: Most Common

Basal Cell Carcinoma: is the least malignant and most common skin cancer. Occurs most often on sun-exposed areas of the face and appear as shiny, dome-shaped nodules Squamous Cell Carcinoma: arises from the keratinocytes of the Stratum Spinosum. Appears as a scaly reddened papule that appears on the head and hands Melanoma: cancer of melanocytes, the most dangerous type of skin cancer. Appear spontaneously

Types of Burns:

First-degree burn: only the epidermis is damaged. Symptoms are localized redness, pain and swelling. Second-degree burn: injure the epidermis and the upper region of dermis. Symptoms same as first-degree but blisters may appear Third-degree burn: involve the entire thickness of the skin. Burned area appears graywhite, cherry red, or blackened and with little or no edema.

Rule of Nines: A method of estimating the extent of body surface that has been burned in an adult, dividing the body into sections of 9 per cent or multiples of 9 per cent.

Diseases and Disorders

1) Acne- problem of swelling and Inflammation-skin disease marked by pimples on the face,

chest, and back .

2) Athletes Foot- an infection of the feet caused by fungus-contagious

Skin culture -is a laboratory test to look for and identify disease-causing substances in a sample of skin3)Burn- type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction and scalding3 degrees of burn
3) Dermatitis- inflammation of the skin- The rash of dermatitis is itchy& red

4) Psoriasis - is a common skin condition that causes skin redness and irritation. -Most people with psoriasis have thick, red skin with flaky, silver-white patches called scales. 5.) Seborrhoeic dermatitis -an inflammatory skin disorder affecting the scalp , face and torso. -The cause is still unknown -Psychological stress and fatigue may aggravate dermatitis-Symptoms show flakes of the skin called dandruff. -Shampoos and other creams that contain antifungal is recommended by dermatologist 6.) Paronychia - a nail disease commonly misidentified as a synonym for whitelow or felon. -Usually cause by bacteria. -Topical anti-biotic can be used to treat the ailment. 7.) Acute Paronychia- It may follow any break in the skin, characterized by an infection that starts in the paronychia at the side of the nail, with local redness, swelling and pain

8.)Chronic Paronychia- It is a nail disorder prevalent in individuals whose hands or feet are subject to moist local environments and is often due to contact dermatitis.

CARDIOVASCULAR SYSTEM

The cardiovascular system or sometimes that have also been known a as the blood vascular system or the simply circulatory is composed by : 1. Heart 2. Blood Vessels @ Vasculature 3. Cells and Plasma that make up the blood for our body.

The blood vessels of the body represents a closed delivery system that have functions to : 1. Transports blood around the body. 2. Circulating substances such as oxygen, carbon dioxide, nutrients, hormones and waste products.

There are 3 mains types of blood vessels such as veins, arteries, and capillaries. The principles function of the heart is to continuously pump blood around the cardiovascular system and body. It receives the both of sympathetic and parasympathetic nerve fiber which alter the rate of the beat.

The vital sign of the cardiovascular system is to maintaining homeostasis which depends on the continuous and controlled movement of blood through the thousands of miles capillaries that penetrate every tissue and reach every cell in the body. Rough descriptive image of human heart 1. The human heart is shaped like an upside-down pear and is located slightly to the left of center inside the chest cavity. 2. About the size of a closed fist, the heart is made primarily of muscle tissue that contracts rhythmically to propel blood to all parts of the body. 3. It typically weighs about 32575g in men and 275 75 g in women. 4. The heart can be described as having three surfaces and an apex. 5. About two thirds of the heart is to the left of the mid-line. 6. The anterior surface of the heart is formed mainly by the right ventricle and is in contact with the ribs and sternum. 7. The inferior surface of the heart is formed mainly by the left ventricle and is in contact with the diaphragm. 8. The posterior surface of the heart is formed mainly by the left atrium.

9. This surface is also known as the base of the heart. 10. The apex which is anterior to the rest of the heart consists only of the left ventricle and forms an important clinical landmark when assessing the size of the heart. 11. The aorta and the pulmonary trunk arise from the left and right ventricles respectively at the superior pole of the heart 12. The superior and inferior vena cavae open into the upper and lower parts of the right atrium. 13. There are four pulmonary veins which open into the back of the left atrium. 14. The junction between the atria and the ventricles is marked by the atrioventricular groove and the junction between the ventricles both posteriorly and anteriorly is marked by the interventricular grooves.

Base of the Heart

1. Base of the heart, directed upward, backward, and to the right, is separated from the fifth,

sixth, seventh, and eighth thoracic vertebra by the esophagus, aorta, and thoracic duct. 2. It is formed mainly by the left atrium, and, to a small extent, by the back part of the right atrium. 3. Somewhat quadrilateral in form, it is in relation above with the bifurcation of the pulmonary artery, and is bounded below by the posterior part of the coronary sulcus (groove or fissure), containing the coronary sinus. 4. On the right it is limited by the sulcus terminalis of the right atrium, and on the left by the ligament of the left vena cava and the oblique (pertaining to muscles running obliquely in the body as opposed to those running transversely or longitudinally) vein of the left atrium. 5. The four pulmonary veins, two on either side, open into the left atrium, while the superior vena cava opens into the upper, and the anterior vena cava into the lower, part of the right atrium.

Apex of the heart

1. Apex of the heart is the lowest superficial part of the heart. 2. It is directed downward, forward, and to the left, and is overlapped by the left lung and

pleura.
3. It lies behind the fifth left intercostals space, 8 to 9 cm. from the mid-sternal line, slightly

medial to the midclavicular line.

4. Alternately, it can be found about 4 cm. below and 2 mm. to the medial side of the left

mammary papilla.
5. Its function is to pump blood to left atrium.

Vessels that supply blood to cardiac muscle

1. The heart is nourished not by the blood passing through its chambers but by a specialized

network of blood vessels. Known as the coronary arteries, these blood vessels encircle the heart like a crown. 2. About 5 percent of the blood pumped to the body enters the coronary arteries, which branch from the aorta just above where it emerges from the left ventricle. 3. Three main coronary arteriesthe right, the left circumflex, and the left anterior descending nourish different regions of the heart muscle. 4. From these three arteries arise smaller branches that enter the muscular walls of the heart to provide a constant supply of oxygen and nutrients.
5. Veins running through the heart muscle converge to form a large channel called the coronary

sinus, which returns blood to the right atrium.

Heart Valves Heart valves are valves in the heart that maintain the unidirectional flow of blood by opening and closing depending on the difference in pressure on each side.

Mitral Valve
1. The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a

dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV).
2. In Latin, the term mitral means shaped like a miter, or bishop's cap. 3. The mitral valve and the tricuspid valve are known collectively as the atrioventricular

valves because they lie between the atria and the ventricles of the heart and control flow. Tricuspid Valve
1. The tricuspid valve is on the right side of the heart, between the right atrium and the right

ventricle.
2. The normal tricuspid valve usually has three leaflets and three papillary muscles. 3. Tricuspid valves may also occur with two or four leaflets, and the number may change

during life. Aortic Valve

1. The aortic valve is one of the valves of the heart.

2. It lies between the left ventricle and the aorta. 3. The aortic valve has three cusps. 4. These cusps are half moon shaped hence also called aortic semi lunar valve. 5. Each cusp has a small swelling in the center called the nodule. 6. Dilatation of the wall of the aorta behind these cusps is called aortic sinus. 7. When the aortic valve is open, the normal size of the orifice is 3-4 cm in adults. 8. During ventricular systole, pressure rises in the left ventricle. 9. When the pressure in the left ventricle rises above the pressure in the aorta, the aortic valve opens, allowing blood to exit the left ventricle into the aorta. 10. When ventricular systole ends, pressure in the left ventricle rapidly drops. 11. When the pressure in the left ventricle decreases, the aortic pressure forces the aortic valve to close. 12. The closure of the aortic valve contributes the component of the second heart sound (S2).

Pulmonic Valve
1. Pulmonic valve is the semi lunar valve of the heart that lies between the right ventricle and

the pulmonary artery and has three cusps.

2. Similar to the aortic valve, the pulmonic valve opens in ventricular systole, when the

pressure in the right ventricle rises above the pressure in the pulmonary artery. 3. At the end of ventricular systole, when the pressure in the right ventricle falls rapidly, the pressure in the pulmonary artery will close the pulmonic valve. 4. The closure of the pulmonic valve contributes the component of the second heart sound (S2). 5. The right heart is a low-pressure system, so the component of the second heart sound is usually softer than the component of the second heart sound. 6. However, it is physiologically normal in some young people to hear both components separated during inhalation.

Generation of the Heartbeat 1. Unlike most muscles, which rely on nerve impulses to cause them to contract, heart muscle can contract of its own accord. 2. Certain heart muscle cells have the ability to contract spontaneously, and these cells generate electrical signals that spread to the rest of the heart and cause it to contract with a regular, steady beat. 3. The heartbeat begins with a small group of specialized muscle cells located in the upper right-hand corner of the right atrium. 4. This area is known as the sinoatrial (SA) node. 5. Cells in the SA node generate their electrical signals more frequently than cells elsewhere in the heart, so the electrical signals generated by the SA node synchronize the electrical signals traveling to the rest of the heart. 6. For this reason, the SA node is also known as the hearts pacemaker.

7. Impulses generated by the SA node spread rapidly throughout the atria, so that all the muscle cells of the atria contract virtually in unison. 8. Electrical impulses cannot be conducted through the partition between the atria and ventricles, which is primarily made of fibrous connective tissue rather than muscle cells. 9. The impulses from the SA node are carried across this connective tissue partition by a small bridge of muscle called the atrioventricular conduction system. 10. The first part of this system is a group of cells at the lower margin of the right atrium, known as the atrioventricular (AV) node. 11. Cells in the AV node conduct impulses relatively slowly, introducing a delay of about twotenths of a second before an impulse reaches the ventricles. 12. This delay allows time for the blood in the atria to empty into the ventricles before the ventricles begin contracting. 13. After making its way through the AV node, an impulse passes along a group of muscle fibers called the bundle of His, which span the connective tissue wall separating the atria from the ventricles. 14. Once on the other side of that wall, the impulse spreads rapidly among the muscle cells that make up the ventricles. 15. The impulse travels to all parts of the ventricles with the help of a network of fastconducting fibers called Purkinje fibers. 16. These fibers are necessary because the ventricular walls are so thick and massive. 17. If the impulse had to spread directly from one muscle cell to another, different parts of the ventricles would not contract together, and the heart would not pump blood efficiently. 18. Although this complicated circuit has many steps, an electrical impulse spreads from the SA node throughout the heart in less than one second. 19. The journey of an electrical impulse around the heart can be traced by a machine called an electrocardiograph. 20. This instrument consists of a recording device attached to electrodes that are placed at various points on a persons skin. 21. The recording device measures different phases of the heartbeat and traces these patterns as peaks and valleys in a graphic image known as an electrocardiogram (ECG, sometimes known as EKG).

22. Changes or abnormalities in the heartbeat or in the hearts rate of contraction register on the ECG, helping doctors diagnose heart problems or identify damage from a heart attack.

PICTURES & DIAGRAM

Difference between Adult and Fetal Circulation Criteria Artery Adult Circulation Carries oxygenated blood away from the heart Fetal Circulation Carries Non-oxygenated blood away from the fetal heart

Veins

Carries non-oxygenated bloodCarries oxygenated blood towards the heart back to the heart

Exchange of Gases Pressure

Takes places in the lungs

Takes place in the placenta

Increase pressure on the left Increase pressure on the right side of the heart side of the heart

Adult circulation sequence

1. Non-oxygenated blood enters the right atrium via the inferior and superior vena cava. 2. Increase level of blood in the right atrium causes the tricuspid valve to open and drain the blood to the right ventricle. 3. Pressure of blood in the right ventricle causes the pulmonic valve to open and nonoxygenated blood is directed to the pulmonary artery then to the lungs. 4. Exchange of gases occurs in the lungs. Highly oxygenated blood is returned to the heart via the pulmonary vein to the left atrium. 5. From the left atrium the pressure of the oxygenated blood causes the mitral valve to open and drain the oxygenated blood to the left ventricle. 6. Left ventricle then pumps the oxygenated blood that opens the aortic valve. Blood is then directed to the ascending and descending aorta to be distributed in the systemic circulation.

Fetal Circulation Sequence

1. Exchange of gases occurs in the placenta. Oxygenated blood is carried by the umbilical vein towards the fetal heart. 2. The ductus venosus directs part of the blood flow from the umbilical vein away from the fetal liver (filtration of the blood by the liver is unnecessary during the fetal life) and directly to the inferior vena cava. 3. Blood from the ductus venosus enters to the inferior vena cava. Increase levels of oxygenated blood flows into the right atrium. 4. In adults, the increase pressure of the right atrium causes the tricuspid valve to open thus, draining the blood into the right ventricle. However, in fetal circulation most of the blood in the right atrium is directed by the foramen ovale (opening between the two atria) to the left atrium. 5. The blood then flows to the left atrium to the left ventricle going to the aorta. Majority of the blood in the ascending aorta goes to the brain, heart, head and upper body. 6. The portion of the blood that drained into the right ventricle passes to the pulmonary artery. 7. As blood enters the pulmonary artery (carries blood to the lungs), an opening called ductus arteriosus connects the pulmonary artery and the descending aorta. Hence, most of the blood will bypass the non-functioning fetal lungs and will be distributed to the different parts of the body. A small portion of the oxygenated blood that enters the lungs remains there for fetal lung maturity.

8. The umbilical arteries then carry the non-oxygenated blood away from the heart to the placenta for oxygenation.