Lecture 4 - Continuation of Cells PDF

o Lymph nodes CLEANS/FILTERS the fluids LECTURE 4 - CONTINUATION OF then return the fluid back to the VEINS...

o Lymph nodes CLEANS/FILTERS the fluids LECTURE 4 - CONTINUATION OF then return the fluid back to the VEINS (Refer to Lymphatic Ducts) CELLS o Example: Organsism from the oral cavity may enter the lymphatic system where it is acted upon by the Lymphocytes ▪ This creates EDEMATOUS LYMPH NODES 12/19/24 LYMPHATIC ORGANS o Primary – Bone Marrow and Thymus o Secondary – Spleen, Tonsils, and Lymph Nodes LYMPHATIC SYSTEM o Basically, these organs are the ones that produce LYMPHOCYTES ▪ However, most of these are made in the PRIMARY organs: FUNCTION 1: Absorbs fluids not absorbed by the CAPILLARIES the BONE MARROW and THYMUS o FlLTERS the fluid in the circulatory system IMPORTANT STRUCTURES IN THE LYMPHATIC SYSTEM o Whenever there is accumulation of fluid in the interstitium o Lymphatic Ducts – LARGEST lymphatic vessels in the human body because reabsorption does not happen, the LYMPHATIC SYSTEM ▪ Lymph collected from the different parts of the body absorbs the fluids to prevent accumulation need to be transported into the larger lymphatic vessels, o Basics of Circulation until they reach the LYMPHATIC DUCTS ▪ Starts with the HEART ▪ There are 2 Lymphatic Ducts ▪ Heart contracts and EJECTS blood goes into ARTERIES These ducts carry the fluids to the VEINS (They ▪ From ARTERIES until they reach ARTERIOLES are the junction of the lymphatic system to the Smallest arteries in the body circulatory system) ▪ Go into the CAPILLARIES Left Lymphatic Duct (aka. THORACIC DUCT) Has an ARTERIAL END and VENOUS END o LARGEST ▪ Fluids and nutrients from capillaries move out of o UPPER LEFT, LOWER LEFT, LOWER RIGHT circulation and go into CELLS ¾ OF BODY connects to the Left From the ARTERIAL END to INTERSTITIUM Lymphatic Duct (Hence, largest) The space where the cells are found are the Right Lymphatic Duct INTERSTITIUM o UPPER RIGHT ¼ OF BODY connects to o Hence, why there are found in the Right Lymphatic Duct interstitial space ▪ The LYMPHATIC DUCTS specifically connect to the 2 ▪ Fluids and nutrients that need reoxygenation or to waste, VEINS: go back to the capillaries in the VENOUS END INTERNAL JUGULAR VEIN Known as the REABSORPTION of fluids/nutrients SUBCLAVIAN VEIN o If REABSORPTION does not occur due to o Cisterna Chyli disease or disorder, accumulation of ▪ Dilated sac at the lower end of the THORACIC DUCT (Left fluid occurs and EDEMA results Lymphatic Duct) o Uncontrolled reabsorption occurs often ▪ Drains lymph from INTESTINAL and LUMBAR area Veins will carry the blood back to the HEART ▪ Heart will deliver this deoxygenated blood to the lungs to be reoxygenated BOARD QUESTION: Red pulp of the spleen contains? Answer: RBC and ▪ Cycle repeats Macrohpages FUNCTION 2: Filters the fluid in the circulatory system o Fluids within the lymphatic vessels are called LYMPH Also contains Macrophages o GOAL is to deliver the fluids back to the VEINS SPLEEN – named as GRAVEYARD of RBC ▪ Before this delivery happens, there are CHECKPOINTS in BOARD QUESTION: White pulp of the spleen contains? Answer: WBC (B&T place Lymphocytes specifically) Called LYMPH NODES o Creating LYMPHOCYTES (functional unit) B cells transform into PLASMA CELLS  Arterial End of Capillaries o Has higher pressure OUT of capillaries (blood vessels to CAPILLARY DYNAMICS (IMPORTANT TOPIC) capillaries) Venous End of Capillaries o Has lower pressure OUT of capillaries (capillaries to blood vessel) INTEGUMENTARY SYSTEM Largest SYSTEM of the body (Mainly because it’s about the SKIN) 2 Parts: Epidermis and Dermis Epidermis o Interstitium has proteins o Keratinized Stratified Squamous Epithelium (Keratinized because it is o Blood has its own proteins the OUTSIDE layer) Oncotic Pressure / Colloid Osmotic Pressure o 4 Cell Types o Form of osmotic pressure EXERTED by PROTEINS in the blood ▪ Keratinocytes plasma or interstitial fluid Most numerous in the EPIDERMIS o Interstitium Fluid has Produces KERATIN (hence, Keratinocytes) o INTERSTITIUM ONCOTIC PRESSURE ▪ Melanocytes ▪ PULLS fluid into the interstitium Produces the pigment melanin o BLOOD ONCOTIC PRESSURE Originated from embryonic cells known as NEURAL ▪ PULLS fluid into capillaries CREST CELLS Hydrostatic Pressure Nucleus is located away from UV rays o Actively move nucleus away from the UV rays o Because melanocytes are VERY SUSCEPTIBLE to UV Rays (from the Sun) 2 Types of MELANIN: o Eumelanin ▪ Brown to black pigment o ▪ Creates the dark pigment as an extra o Force generated by the PRESSURE of FLUID inside or outside of a layer to protect against the UV rays CAPILLARY against a CAPILLARY WALL (why the sun tans us) o Hydrostatic pressure of interstitium and hydrostatic pressure of o Pheomelanin the blood moves the fluids in OPPOSITE DIRECTIONS ▪ Yellow to red pigment o Interstitium Hydrostatic Pressure ▪ Langerhans Cells ▪ PUSHES fluid into capillaries As stated in previous lecture, it is just a type of o Blood Hydrostatic Pressure Macrophage but it is found in the Epidermis ▪ PUSHES fluid into interstitium o Specifically, the S. Spinosum ▪ Merkel Cells Least numerous in epidermis Capillary movement is determined by these PRESSURES o In the Stratum Basale o Example: Contains MERKEL (TACTILE) DISCS ▪ BHP: +40mmHG | IHP: 30mmhG Merkel Cells and Merkel Discs detect TOUCH ▪ IOP: 20mmhG | BOP: 10mmHG sensations Results in FLUID OUT o Because the BHP (Push Out) and IOP (Pulls Out) is total higher than BOP (Pull In) and IHP (Push In)  LAYERS OF THE EPIDERMIS LAMELLAR GRANULES – Layer of lipid o Epidermis does not have DIRECT BLOOD AND NERVE SUPPLY o Acts as a water repellant ▪ Unlike the Dermis, which has both abundantly o Retains moist and prevents dehydration The nutrients will diffuse over to the Stratum in the epidermis Basale only o Stratum Lucidum ▪ Aka. CLEAR CELL LAYER or TRANSLUCENT LAYER ▪ Found only in THICK SKIN Fingertips, Palms, and Soles o Stratum Corneum ▪ Aka. HORNY Layer (because it has FLAKES) ▪ NOT THE THICKEST (only S. Spinosum is) ▪ What doc actually meant is that it has SEVERAL STACKS of cells, even though they are FLAT Most number of cells / most numerous o IMPORTANT STUFF: o o Stratum Basale ▪ Callus – Abnormal thickening of S. Corneum ▪ DEEPEST LAYER (as in BASE-ale) Due to constant friction ▪ Responsible for the production of KERATIN ▪ Dandruffs – Excess keratinocytes shedding from the INTERMEDIATE FILAMENTS SCALP Otherwise known as TONOFILAMENTS SCALP is actually an acronym: o Tonofilaments are the precursors of o Skin Keratin o Connective Tissue ▪ Highest mitotic activity of KERATINOCYTES o Aponeuroses Because they receive nutrients from the Dermis o Loose Connective Tissue directly below it o Periosteum ▪ Contains the MELANOCYTES and MERKEL CELLS Seborrheic Dermatitis o Stratum Spinosum o Sebum – Oil of scalp ▪ PRICKLE-CELL layer or SPINY Layer (as in SPINE-osum) ▪ This sebum is acted upon by the ▪ It is the THICKEST LAYER of the epidermis fungus, causing dermatitis and ▪ Production of KERATIN INTERMEDIATE irritation. FILAMENTS/TONOFILAMENTS ▪ Multiplication of keratinocytes ▪ Lower mitotic activity compared to the S. Basale which results in Dandruffs Same principle as above, it is only passed down nutrients from lower layers ▪ Langerhans Cells present o Stratum Granulosum, Lucidum, and Corneum has NO MITOTIC QUESTION: activity ▪ BOARD EXAM: MITOCHONDRIA is the initiator of 1. Combination of Stratum Basale and stratum spinosum is known as? APOPTOSIS Answer: Stratum Germinativum Lysosome enzymes are the ones that kill the cell Also known as the MALPHIGIAN Layer o Stratum Granulosum ▪ Cells undergo APOPTOSIS From the term “Germinativium” as in alive or ▪ NO mitotic activity 2. Disease associated with absence of melanin? Answer: Albinism/Albino ▪ Cessation of Tonofilament Production ▪ 2 Granules: Melanocytes are actually PRESENT, but they CANNOT produce KERATOHYALIN GRANULES – ASSEMBLES MELANIN tonofilaments to Keratin 3. Disease associated with deficiency in melanin? Answer: Vitiligo  Melanin present but in deficiency, resulting in patches of pigment and non-pigmentation 4. Amino acid needed to produce melanin, dopamine, epinephrine, norepinephrine and thyroxine? Answer: Tyrosine Dermis 2nd layer of Integumentary System THICKER than epidermis Made up of COLALGEN and ELASLTIC FIBERS o As stated above, this provides blood supply for Epidermis ▪ Wickham’s Striae is usually found in the BUCCAL Has 2 Layers: MUCOSA o The Dermal Papillae and Rete Pegs/Epidermal Ridges present as more SPIKY or SAW-TOOTHED o o Papillary Layer ▪ Thinner Layer ▪ Dermal Papillae – Rounded/Nipple like projections towards the epidermis o Reticular Layer ▪ Thicker than papillary layer ▪ ▪ Major nutrient supplier of the skin o However, Lichen Planus may also present as an ABSENCE of Rete ▪ Attached to the SUBCUTANEOUS LAYER or Pegs HYPODERMIS Hypodermis is NOT part of the integumentary system QUESTION: What are the extensions of the dermis towards the epidermis? Answer: Dermal Papillae What are the extensions of the epidermis towards the dermis? Answer: Rete Pegs / Epidermal Ridges What is the disease characterized of multiple, bilateral (left and right side of mouth) white dots or lines (wickham’s striae) and histologically ▪ o Lichen Planus has a chance to progress into SCC (Squamous Cell presenting sawtoothing of dermoepidermal junction? Carcinoma) o Answer: Lichen Planus ▪ Must be observed ▪ Usually it is a self-limiting disorder, resolving on its own in about 2 years What is a chronic inflammatory dermatosis of unknown cause in which the lesions appear to have a pink to salmon color covered by loosely adherent silver-white scale? o Answer: Psoriasis o Take note of description: ▪ Pink to Salmon Color  ▪ Silver-white Scales TYPES OF VITAMINS o Unknown cause ▪ Vitamin A (Retinol) o Rapid multiplication of Keratinocytes which do not reach o Carotene (as in Carrots) – Important for the production of maturation Vitamin A ▪ Keratinization is incomplete o Responsible for: General Growth and Health ▪ Reproduction ▪ Growth SUMMARY OF MECHANORECEPTORS AND THEIR FUNCTIONS ▪ Bone and Tooth Development ▪ Skin Health ▪ Vision ▪ Immune System ▪ Antioxidants o Vitamin Deficiency: Nyctalopia ▪ Nyctalopia – Night Blindless ▪ Vitamin B1 (Thiamine) ▪ Merkel and Meissner (M&M) – TOUCH o Responsible for: Nerve Function o Meissner corpuscle (Corpuscles of Touch) is MORE SENSITIVE to o Vitamin B1 Deficiency: Beriberi touch ▪ Vitamin B2 (Riboflavin) ▪ Ruffini/Bulbous Corpuscle – HOT and STRETCH o Responsible for: Growth and RBC Production o Ruffa (HOT) and Luffy (STRETCH) o Deficiencies: ▪ End-Bulb of Krause – COLD ▪ Angular Cheilitis (Perleche) o End-Bulb of CLAUS (Santa Claus) – COLD “Cheilo- “Lips ▪ Pacinian Corpuscles – PRESSURE and PROPRIOCEPTION “-itis” Inflammation o PP (PEEPEE) ▪ Glossitis o Onion-shaped (Penis Onion) ▪ Sore Throat ▪ Proprioceptors – Proprioception ▪ Vitamin B3 (Niacin/Nicotinic Acid) o Proprioception – the sense of body position and movement o Responsible for: Digestion o The ability to perceive the body’s location o Deficiencies: o Found in Joints ▪ Pellagra 4Ds ▪ Nociceptors & Naked Nerve (Free Nerve Endings) – PAIN Diarrhea o NOICE = Pain Dermatitis o No Pain, No Gain Dementia Death ▪ Vitamin B4-B8 Names o B4 – Adenine o B5 – Pantothenic Acid) o B6 – Pyridoxine o B7 – Biotin o B8 – Inositol ▪ Vitamin B9 (Folic Acid) o Responsible for: RBC Production and pregnancy o Deficiency: Megaloblastic Anemia (Folate-Deficiency Anemia) ▪ Deficiency in B9 causes enlargement of RBC ▪ Vitamin B10-B11 o B10 (PABA/Para-Aminobenzoic Acid) o B11 (Salicylic Acid)  ▪ Vitamin B12 (Cyanocobalamin) BASIC TYPES OF SKIN CANCER o Responsible for: RBC Production ▪ Basal Cell Carcinoma (BCC) o Deficiency: Megaloblastic Anemia (Pernicious Anemia) o MOST COMMON SKIN cancer ▪ Orally, we can see this as Beefy Tongue o Cancer of the S. Basale (Hence, BASAL cell carcinoma) ▪ Vitamin C (Ascorbic Acid) o Most common location is MIDFACE o Responsible for: Wound Healing and Maintains Healthy o Common to farmers Tissue o Usually, cancers are usually rapidly growing and ▪ Deficiency cause: Scurvy ▪ However, BCC is SLOW-GROWING Scorbutic Gingivitis – Gingivitis due to Scurvy o Histologically, it travels downward ▪ Vitamin D (Calciferol, aka Sunshine vitamin) ▪ Squamous Cell Carcinoma (SCC) o Responsible for: Calcium Absorption o Second most common SKIN cancer ▪ Vitamin D is responsible for calcium absorption in the ▪ Orally, it is the MOST COMMON in the oral cavity digestive tract, deficiency of it causes calcium o Involves “Squamous Cell” deficiency ▪ BOARD EXAM: Most common site of Oral SCC? o Deficiency: Answer: Lower Lip ▪ Rickets in children ▪ BOARD EXAM: Most common site of INTRAORAL ▪ Osteomalacia in adult SCC? ▪ Vitamin E (Tocopherol) Answer: Posterolateral Corner of Tongue o Responsible for: Antioxidant, scavenger for free radicals in cells, stimulates immune system ▪ Vitamin K (as in Koagulation) o Produced in the SMALL INTESTINE ▪ By INTESTINAL BACTERIA o Functions in Clotting (Coagulation) o Deficiency: Bleeding Tendency o Question from batchmate: o Histologically: Presents with KERATIN PEARLS ▪ BOARD EXAM QUESTION: What type of malignant tumor are KERATIN PEARLS found? Answer: SCC VITAMIN D SYNTHESIS: ▪ Melanoma (Cancer of Melanocytes) ▪ Does not come from the sun, but UV rays help o NO benign melanoma ▪ Starts from a molecule (7-DEHYDROCHOLESTEROL) in our skin ▪ So either Melanoma/Malignant Melanoma o Activated by UV-B (From the Sun) ▪ MOLES are benign tumors of melanocytes o UV rays from the sun converts 7-D into Vitamin D3 o DEADLIEST Skin Cancer o Vitamin D3 goes to liver ▪ Due to HIGH metastatic rate ▪ Is converted into CALCIDIOL o Clinical Features: ABCDE ▪ CALCIDIOL is still inactive form of Vitamin D ▪ Asymmetry (Irregular Shape) ▪ Calcidiol is converted in the Kidney ▪ Border (Irregular Border) Is converted into CALCITRIOL (1,25 ▪ Color (Irregular Color dyhydroxycholecalciferol) ▪ Diameter (Larger than ordinary mole: 6mm or above) o BOARD EXAM QUESTION: active form of ▪ Evolving (Changes in size, shape, and color thru time) Vitamin D o 2 Growth Patterns: Radial Growth and Vertical Growth Active form of Vitamin D ▪ Radial - Horizontal ▪ Vertical – Vertical More dangerous because it goes DOWN to other layers, resulting in METASTASIS o Metastasis goes through our BLOOD and LYMPHATIC VESSELS o Survival rate is less than 30% in 5 years in all cases worldwide  7.) Sudoriferous Glands (aka Sweat Glands) o Produces Sweat (duh) IMPORTANT MEDICAL TERMS TO REMEMBER (Not in notes): o Eccrine Sweat Glands 1.) Cyanosis – bluish color due to INADEQUATE OXYGEN ▪ Found throughout the body o Example: Blue Baby Syndrome ▪ Contains LESS proteins ▪ Born with bluish skin, causes: o Apocrine Sweat Glands (NOT Apocrine Gland) ▪ Erythroblastosis Fetalis (Rh Incompatibility) ▪ Found mainly in: Blood Types have Rhesus Factor (Rh) Axilla (arm pits) o The (+) and the (-) are Rh Areola GENETICS: Have dominant and recessive traits Perianal areas o (+) is a Dominant Trait ▪ This is the BAD ODOR sweat glands o (-) is a Recessive Trait Because of MORE protein and MORE VISCOUS o In a couple with a A+ and A- blood types, the Secretions baby will have an A+ blood type 8.) Ceruminous Glands o The baby will have an A+ blood type, o Secretes Cerumen while the mother will have an A- blood ▪ This is the WAXY material of EAR type 9.) Osteomalacia and Rickets – both are Vitamin D or Calcium Deficiency o The first baby will have NO problems o Osteomalacia – AFTER closure of Epiphyseal Plate because there are NO ANTIBODIES yet o Rickets – BEFORE closure of Epiphyseal Plate o The immune system acts upon this and ▪ Results in: BOW LEGS/SABER SHIN creates antibodies but does not affect Not exclusive to RICKETS the baby Can be found in Congenital Syphilis o The second baby WILL be affected o Caused by Treponema Pallidum because the antibodies are already there o This crosses the placental barrier ▪ Specifically the IgG which 10.) Vitamin D2 aka Ergocalciferol (EGO as in high ego due to eating vegan) crosses the placental barrier o D2 as in 2 letter C in Ergocalciferol ▪ In some cases, there will be o Found in PLANT diets some fatal cases but, in most 11.) Vitamin D3 aka Cholecalciferol (CHOLE as in fat, from animal cells) cases, there is BLUE BABY o D3 as in 3 letter C in Cholecalciferol SYNDROME o Found in animal plants ▪ Something to consider when 12.) Photosensitivity – Light (Photo) Sensitivity creating babies o Sensitive Skin when exposed to light rays, especially UV o However, there is now a cure for this: o BOARD EXAM: Which of the following are drugs most likely to RHOGAM or Rho(D) Immune Globulin cause photosensitivity? ▪ Other causes are Methemoglobinemia Blood disorder that occurs when there is too much methemoglobin in the blood o Does not carry oxygen molecules, resulting in BLUISH discoloration 2.) Arrector pili muscles – smooth muscle for “goosebumps” 3.) Alopecia – Partial OR Complete Loss of hair o Treated with MINOXIDIL 4.) Hirsutism (as in HAIRsutism) (Hair-so-much-tism) o Excess growth in localized, possibly in non-common areas ▪ 5.) Hypertrichosis (Werewolf Syndrome) (HAIRper Trichosis) 13.) Scar aka Cicatrix (CICA = SCAR) o Excess growth of hair in the whole body o Cicatrization – the process of SCAR formation o Generalized hair growth Y-Linked inheritance 14.) Freckles aka Ephelis/Ephelides (Ephey has Freckles) 6.) Sebaceous Glands – secretes SEBUM (CBUM) o Excessive MELANIN o Prevent water from EVAPORATING from skin 15.) Rule of 9 – Assesses the percentage of burn body part o Body has specific percentage in terms of BURNS that relate to how much damage there is ▪ Example: 3rd degree burn requires 30% and above to be considered fatal o 16.) Blister – Fluid-filled lesions (lesion, that’s why they are Blisters) o Bula/Bullae – Large blister with FLUID (5mm and above) o Vesicle - Small blister with FLUID (5mm below) 17.) Cyst – Fluid filled/semifluid-filled/air-filled with DEVELOPED EPITHELIAL WALL o EPITHELIAL WALL is the unique feature 18.) Papule and Nodule o Papule - ELEVATION of Skin less than 10mm in diameter o Nodule – ELEVATION of skin above 10mm in diameter 19.) Hives o Medically known as “URTICARIA” (Think of Doc Soria) o Reddened, Elevated, Itchy Patches of Skin o USUALLY in ALLERGIC reactions 20.) Pruritus o ITCHING (not urticaria) 21.) Common Wart (aka VERRUCA VULGARIS) o Mostly common due to HPV (Human Papillomavirus) ▪ Infects the skin cells and multiplies, creating the structure of the WART o HPV2 and HPV4 are the 2 MOST COMMON causes of Common Warts o ADDITIONAL NOTE: ▪ HPV16 and HPV18 cause Cervical Cancer NOT related to WART Formation ▪ Low Number (HPV2 and HPV4) common warts ▪ High Number (HPV16 and HPV18) cervical cancer Both have +2 difference (2 and 4, 16 and 18)