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Slide 1 ___________________________________ ___________________________________ Chapter 4: Body Membranes and the Integumentary System ___________________________________ ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 2 ___________________________________ Introduction • Skin often reveals our inner workings and general health • In most manual therapies, the skin is primary interface with clients • Therapists may feel many differences in clients’ skin ___________________________________ ___________________________________ • Clients feel status of their tissue and quality of therapist’s touch ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 3 ___________________________________ Membranes • Membrane: broad flat sheet of at least 2 layers of tissue ___________________________________ • Body has 4 primary types of membranes: – 1 of primarily connective tissue – 3 of epithelial tissue ___________________________________ ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 4 ___________________________________ Connective Tissue Membranes • Synovial membranes line fibrous connective tissue capsules in joints • Composed of 2 layers: – Thick fibrous connective tissue layer on outside ___________________________________ ___________________________________ – Thin internal layer of simple epithelium • Synovial fluid secreted by epithelial layer reduces friction and wear to bone ends ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ Epithelial Tissue Membranes • Comprised of layer of epithelial tissue attached to connective tissue layer (basement membrane) • Capable of rapid regeneration • Ideal for protecting organs and lining body cavities and passages ___________________________________ ___________________________________ • 3 types: – Mucous ___________________________________ – Serous – Cutaneous Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 6 ___________________________________ Mucous Membranes • Line cavities open to external environment ___________________________________ • Line respiratory, digestive, urinary, and vaginal tracts • Secrete mucus – Helps protect against invading pathogens ___________________________________ – Helps warm and humidify air on way to lungs • In digestive, urinary, and vaginal tracts, protects against wear or erosion ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 7 ___________________________________ Serous Membranes • Found in cavities without openings to external environment • Folded into 2 distinct layers: – Parietal layer lines cavity ___________________________________ ___________________________________ – Visceral layer covers organs • Space between layers contains serous fluid • Serous fluid provides lubrication to reduce friction between layers, allowing smooth movement ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 8 ___________________________________ Cutaneous Membrane • Body’s outer covering and primary organ of integumentary system • Consists of stratified layer of epithelial tissue attached to thick connective tissue layer ___________________________________ ___________________________________ ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 9 ___________________________________ Integumentary System • Comprised of cutaneous membrane and accessory organs, including: – Hair ___________________________________ ___________________________________ – Nails – Sudoriferous (sweat) glands – Sebaceous (oil) glands – Sensory receptors ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 10 ___________________________________ Functions of Skin • Protection ___________________________________ • Temperature regulation • Excretion and absorption • General sensory organ ___________________________________ • Synthesis of vitamin D ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ Layers of the Skin • External epithelial, deeper dermal, and subcutaneous layers ___________________________________ ___________________________________ ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 12 ___________________________________ Epidermis • Composed of stratified squamous epithelium ___________________________________ • 90% of cells are keratinocytes • 5 strata of epidermis (see Figure 4-5): – Horny layer (stratum corneum) ___________________________________ – Clear or glassy layer (stratum lucidum) – Granular layer (stratum granulosum) – Spiny layer (stratum spinosum) ___________________________________ – Germinating layer (stratum germinativum) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 13 ___________________________________ Epidermis (cont’d) • Continually renews and replaces itself • Melanocytes produce dark pigment that protects skin from UV • Malignant melanoma: serious skin cancer ___________________________________ ___________________________________ – Warning signs (ABCD) for mole: asymmetry, indistinct border, black/brown color, larger diameter • Breaks in skin may allow pathogens to enter ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 14 ___________________________________ Epidermis (cont’d) • Precautions for therapists: ___________________________________ – Minimize risk of allergic response to emollients – Avoid blocking skin pores or glands with emollient – Attend to ingredients and purity of products applied during exfoliations and wraps – Be cautious with hydrotherapy treatments that open pores and enhance skin absorbency and excretion ___________________________________ ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 15 ___________________________________ Dermis • Skin layer housing blood and lymph vessels, nerves, and accessory organs (see Figure 4-6) • Collagen and elastin fibers make skin extensible and elastic • 2 regions: ___________________________________ ___________________________________ – Papillary region – Reticular region ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 16 ___________________________________ Subcutaneous Layer • Also known as hypodermis or superficial fascia ___________________________________ • Attaches skin to underlying tissues and organs • Contains adipose tissue that insulates body and stores energy ___________________________________ • Rich with blood and lymph vessels, nerves, and sensory receptors ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 17 ___________________________________ Accessory Organs: Hair and Nails • Hair and nails serve protective function • Genetics, hormone production, and nutrition influence pattern of hair distribution over body • Shape and color of nails may indicate systemic disorders ___________________________________ ___________________________________ – Nails may be yellow, pitted or ridged, or more concave or convex – Signs caused by blood, respiratory, or thyroid disorder ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 18 ___________________________________ Accessory Organs: Sebaceous Glands • Sebaceous glands secrete oily or waxy fluid (sebum) ___________________________________ – Helps keeps skin soft and pliable – Inhibits growth of certain bacteria • Most sebaceous glands are connected to hair follicles ___________________________________ • Sebaceous gland activity increases in adolescence ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 19 ___________________________________ Accessory Organs: Sudoriferous Glands • Secrete sweat through pores of skin • Support homeostasis by helping regulate body temperature, water balance, and elimination of metabolic byproducts • 2 types: ___________________________________ ___________________________________ – Eccrine glands: primary sweat glands for thermal and water regulatory ability – Apocrine glands: concentrated in axilla, groin, areolar breast tissue, and beard area ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 20 ___________________________________ Accessory Organs: Sensory Receptors • Wide variety of sensory organs sensitive to touch, temperature, pain, vibration, and pressure • Receptors in papillary zone sensitive to superficial stimuli – Free nerve endings, Merkel discs, Meissner corpuscles ___________________________________ ___________________________________ • Receptors in deeper reticular layer more sensitive to deep tactile stimulation – Pacinian corpuscles, Ruffini corpuscles, hair root plexus ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 21 ___________________________________ Links to the Nervous System • Sensory receptors in skin connected to nerve cells or fibers that carry information to spinal cord and brain • Each region of skin (dermatome) correlated to specific nerves and spinal levels (see Figure 4-9) • Connective Tissue Massage (CTM) aims to create systemic changes via dermatome stimulation • Brain and skin are intricately linked and cannot be functionally separated ___________________________________ ___________________________________ ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 22 ___________________________________ Links to the Nervous System (cont’d) • Infants and children deprived of tactile and movement stimulus often fail to thrive • Research shows profound connection between tactile stimulus, emotional well-being, and physiologic function • Infants receiving regular massage: ___________________________________ ___________________________________ – Experienced fewer colds and less diarrhea – Grew faster and gained more weight – Exhibited less agitation and excitability ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 23 ___________________________________ Skin Conditions and Diseases • Therapists should be familiar with skin conditions and diseases • You may see skin areas clients do not see • You can monitor changes in skin tone or appearance in regular clients ___________________________________ ___________________________________ • Avoid direct contact with any broken skin • Refer clients for medical attention when needed ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 24 ___________________________________ Common Contagious Skin Disorders • If contagious disorder is suspected, reschedule after medical diagnosis and treatment • Always use proper hygiene, sanitary practices, and universal precautions • Common contagious disorders (see Figure 4-11): ___________________________________ ___________________________________ – Fungal infections (e.g., tinea or ringworm) – Bacterial infections (e.g., staph) – Viral infections (e.g., herpes simplex or zoster) ___________________________________ – Parasitic infections (e.g., scabies or lice) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 25 ___________________________________ Common Noncontagious Skin Disorders • Direct contact may be contraindicated ___________________________________ • Common noncontagious disorders (see Figure 4-12): – Acne ___________________________________ – Eczema – Hives (urticaria) – Psoriasis ___________________________________ – Vitiligo Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________ Slide 26 ___________________________________ Aging and the Integumentary System • Signs of aging easily recognized in skin and hair • General dehydration and breakdown of collagen and elastin fibers • Dermis begins to stiffen, wrinkle, and thin ___________________________________ ___________________________________ • Decreases in melanin production cause graying hair and changes in skin pigmentation, including brownish age spots • Skin less able to regenerate and repair itself ___________________________________ Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins ___________________________________ ___________________________________ ___________________________________