Lecture 3 Skin hair and nails Physical examinationهيلث3.pdf

I- Skin Structure and function The skin is the largest organ system in the body. It protects the body from environmental stresses (e.g., trauma, pathogens, dirt) and adapts it to other environmental influences (e.g., heat, cold). ‫ ﯾﺣﻣﻲ اﻟﺟﺳم ﻣن‬.‫ اﻟﺟﻠد ھو أﻛﺑر ﺟﮭﺎز ﻓﻲ اﻟﺟﺳم‬ ‫اﻟﺿﻐوط...

I- Skin Structure and function The skin is the largest organ system in the body. It protects the body from environmental stresses (e.g., trauma, pathogens, dirt) and adapts it to other environmental influences (e.g., heat, cold). ‫ ﯾﺣﻣﻲ اﻟﺟﺳم ﻣن‬.‫ اﻟﺟﻠد ھو أﻛﺑر ﺟﮭﺎز ﻓﻲ اﻟﺟﺳم‬ ‫اﻟﺿﻐوط اﻟﺑﯾﺋﯾﺔ )ﻣﺛل اﻟﺻدﻣﺎت وﻣﺳﺑﺑﺎت اﻷﻣراض‬ ‫واﻷوﺳﺎخ( وﯾﺗﻛﯾف ﻣﻊ اﻟﺗﺄﺛﯾرات اﻟﺑﯾﺋﯾﺔ اﻷﺧرى )ﻣﺛل‬.(‫اﻟﺣرارة واﻟﺑرودة‬  The skin has three layers‫ﻳﺘﻜﻮن اﻟﺠﻠﺪ ﻣﻦ ﺛﻼث ﻃ ﻘﺎت‬ 1. The called The skin has three layers outer layer, is the epidermis. inner ‫ ھو‬، ‫ ﯾﺳﻣﻰ اﻟﺟﻠد ﻟدﯾﮫ ﺛﻼث طﺑﻘﺎت اﻟطﺑﻘﺔ اﻟﺧﺎرﺟﯾﺔ‬.١ ‫ ﺑﺎطن‬.‫اﻟﺑﺷرة‬ 2. The supportive layer, is called the dermis..‫ ﺗﺳﻣﻰ اﻷدﻣﺔ‬، ‫ اﻟطﺑﻘﺔ اﻟداﻋﻣﺔ‬.٢ 3. The bottom layer, is called the subcutaneous tissue ‫ ﺗﺳﻣﻰ اﻷﻧﺳﺟﺔ ﺗﺣت اﻟﺟﻠد‬، ‫ اﻟطﺑﻘﺔ اﻟﺳﻔﻠﯾﺔ‬.٣  Epidermis‫ة‬ The epidermis is thin but tough. Its cells are bound tightly together into sheets that form a rugged protective barrier..‫ ﺗﺮﺗ ﻂ ﺧﻼ ﺎﻫﺎ ﺑ ﺣ ﺎم ﻣﻌﺎ ﺻﻔﺎﺋﺢ ﺸ ﻞ ﺣﺎﺟﺰا وﻗﺎﺋ ﺎ وﻋﺮا‬.‫اﻟ ة رﻗ ﻘﺔ وﻟ ﻨﻬﺎ ﺻﻠ ﺔ‬ The inner basal cell layer forms new skin cells. Their major ingredient is the tough, fibrous protein keratin. The melanocytes interspersed along this layer produce the pigment melanin, which gives brown tones to the skin and hair. the amount of melanin they produce varies with genetic, hormonal, and environmental influences. ‫ ﺗ ﺘﺞ اﻟﺨﻼ ﺎ اﻟﺼ ﺎﻏ ﺔ اﻟﻤﺘﻨﺎﺛﺮة ﻋ ﻃﻮل ﻫﺬە‬. ‫ﻫﻮ ﺑﺮوﺗ اﻟ اﺗ اﻟﻠ اﻟﻘﺎ‬ ‫ اﻟﻤﻜﻮن اﻟﺮﺋ‬.‫ﺸ ﻞ ﻃ ﻘﺔ اﻟﺨﻼ ﺎ اﻟﻘﺎﻋﺪ ﺔ اﻟﺪاﺧﻠ ﺔ ﺧﻼ ﺎ ﺟﻠﺪ ﺟﺪ ﺪة‬.‫ ﺗﺨﺘﻠﻒ ﻤ ﺔ اﻟﻤ ﻼﻧ اﻟ ﺗ ﺘﺠﻬﺎ ﺎﺧﺘﻼف اﻟﺘﺄﺛ ات اﻟﺠﻴ ﺔ واﻟﻬﺮﻣﻮﻧ ﺔ واﻟﺒ ﺌ ﺔ‬.‫ واﻟ ﺗﻌ ﻧﻐﻤﺎت ﺑ ﺔ ﻟﻠﺠﻠﺪ واﻟﺸﻌﺮ‬، ‫اﻟﻄ ﻘﺔ ﺻ ﻐﺔ اﻟﻤ ﻼﻧ‬ The outer horny cell layer consists of dead keratinized cells that are interwoven and closely packed. The cells are constantly being shed, or desquamated, and are replaced with new cells from below. The epidermis is completely replaced every 4 weeks. ‫ و ﺘﻢ اﺳ ﺪاﻟﻬﺎ ﺨﻼ ﺎ‬، ‫ أو ﺗﻘ ﻫﺎ‬، ‫ ﻳﺘﻢ إﻟﻘﺎء اﻟﺨﻼ ﺎ ﺎﺳﺘﻤﺮار‬.‫ﺗﺘﻜﻮن ﻃ ﻘﺔ اﻟﺨﻼ ﺎ اﻟﻘﺮﻧ ﺔ اﻟﺨﺎرﺟ ﺔ ﻣﻦ ﺧﻼ ﺎ ﻛ اﺗ ﻨ ﺔ ﻣﻴﺘﺔ ﻣ ﺸﺎ ﻜﺔ وﻣﻌ ﺄة ﺸ ﻞ وﺛﻴﻖ‬.‫ أﺳﺎﺑﻴﻊ‬٤ ‫ ﻳﺘﻢ اﺳ ﺪال اﻟ ة ﺎﻟ ﺎﻣﻞ ﻞ‬.‫ﺟﺪ ﺪة ﻣﻦ اﻷﺳﻔﻞ‬ On the palms and soles skin is thicker because of work and weight bearing. ‫ﻋ اﻟﻨﺨ ﻞ و ﺎﻃﻦ اﻟﺠﻠﺪ أ ﺳﻤ ﺎ ﺴ ﺐ اﻟﻌﻤﻞ وﺗﺤﻤﻞ‬.‫اﻟﻮزن‬ The epidermis is avascular; it is nourished by blood vessels in the dermis below ‫ ﻳﺘﻐﺬى ﻣﻦ اﻷوﻋ ﺔ‬.‫اﻟ ة اﻷوﻋ ﺔ اﻟﺪﻣ ﺔ‬ ‫اﻟﺪﻣ ﺔ اﻷدﻣﺔ أدﻧﺎە‬ Skin color is derived from three sources: (1) mainly from the brown pigment melanin, (2) from the yellow-orange tones of the pigment carotene, and (3) from the red-purple tones in the underlying vascular bed. ‫( ﻣﻦ‬٣) ‫ و‬، ‫( ﻣﻦ درﺟﺎت اﻟﻠﻮن اﻷﺻﻔﺮ اﻟ ﺗﻘﺎ ﻟﺼ ﻐﺔ اﻟ ﺎروﺗ‬٢) ، ‫ﻣﻦ ﺻ ﻐﺔ اﻟﻤ ﻼﻧ اﻟﺒ ﺔ‬ ‫( ﺸ ﻞ رﺋ‬١) :‫ﺸﺘﻖ ﻟﻮن اﻟ ة ﻣﻦ ﺛﻼﺛﺔ ﻣﺼﺎدر‬. ‫اﻟ ﺮ اﻟﻮﻋﺎ اﻷﺳﺎ‬ ‫درﺟﺎت اﻟﻠﻮن اﻷﺣﻤﺮ اﻷرﺟﻮا‬ Skin color is further modified by the thickness of the skin and the presence of edema. ‫ﻣﻦ ﺧﻼل‬ ‫ة ﺸ ﻞأ‬ ‫ﻳﺘﻢ ﺗﻌﺪ ﻞ ﻟﻮن اﻟ‬.‫ﺳﻤﻚ اﻟﺠﻠﺪ ووﺟﻮد وذﻣﺔ‬  Dermis ‫اﻻدﻣﺔ‬ The dermis is the inner supportive layer consisting mostly of connective tissue, or collagen. This is the tough, fibrous protein that enables the skin to resist tearing. The dermis also has resilient elastic tissue that allows the skin to stretch with body movements. The nerves, sensory receptors, blood vessels, and lymphatics lie in the dermis. In addition, appendages from the epidermis such as the hair follicles, sebaceous glands, and sweat glands are embedded in the dermis. ‫ ﻫﺬا‬. ‫اﻟﻄ ﻘﺔ اﻟﺪاﻋﻤﺔ اﻟﺪاﺧﻠ ﺔ اﻟ ﺗﺘﻜﻮن اﻟﻐﺎﻟﺐ ﻣﻦ اﻟ ﺴﻴﺞ اﻟﻀﺎم أو اﻟ ﻮﻻﺟ‬ ‫ اﻷدﻣﺔ‬ ‫ ﺗﺤﺘﻮي اﻷدﻣﺔ أ ﻀﺎ ﻋ أ ﺴﺠﺔ‬.‫ﻫﻮ اﻟ وﺗ اﻟﻠ اﻟﻘﺎ اﻟﺬي ﻤﻜﻦ اﻟﺠﻠﺪ ﻣﻦ ﻣﻘﺎوﻣﺔ اﻟﺘﻤﺰق‬ ‫ ﺗﻘﻊ اﻷﻋﺼﺎب واﻟﻤﺴﺘﻘ ﻼت اﻟﺤﺴ ﺔ‬.‫ﻣﺮﻧﺔ ﻣﺮﻧﺔ ﺴﻤﺢ ﻟﻠﺠﻠﺪ ﺎﻟﺘﻤﺪد ﻣﻊ ﺣﺮ ﺎت اﻟﺠﺴﻢ‬ ‫ ﻳﺘﻢ ﺗﻀﻤ اﻟﺰواﺋﺪ ﻣﻦ اﻟ ة ﻣﺜﻞ‬، ‫ ﺎﻹﺿﺎﻓﺔ إ ذﻟﻚ‬.‫واﻷوﻋ ﺔ اﻟﺪﻣ ﺔ واﻟﻠ ﻤﻔﺎو ﺔ اﻷدﻣﺔ‬.‫ﺼ ﻼت اﻟﺸﻌﺮ واﻟﻐﺪد اﻟﺪﻫﻨ ﺔ واﻟﻐﺪد اﻟﻌﺮﻗ ﺔ اﻷدﻣﺔ‬  Subcutaneous Layer ‫ﻃ ﻘﺔ ﺗﺤﺖ اﻟﺠﻠﺪ‬ The subcutaneous layer is adipose tissue, which is lobules of fat cells. The subcutaneous tissue stores fat for energy, provides insulation for temperature control, and aids in protection by its soft cushioning effect. The loose subcutaneous layer also gives skin its increased mobility over structures underneath. ‫ ﺗﺨﺰن‬.‫ و ﻓﺼ ﺼﺎت اﻟﺨﻼ ﺎ اﻟﺪﻫﻨ ﺔ‬، ‫ اﻟﻄ ﻘﺔ ﺗﺤﺖ اﻟﺠﻠﺪ اﻷ ﺴﺠﺔ اﻟﺪﻫﻨ ﺔ‬ ‫ وﺗﻮﻓﺮ ﻋﺰﻻ ﻟﻠﺘﺤ ﻢ درﺟﺔ‬، ‫اﻷ ﺴﺠﺔ ﺗﺤﺖ اﻟﺠﻠﺪ اﻟﺪﻫﻮن ﻟﻠﺤﺼﻮل ﻋ اﻟﻄﺎﻗﺔ‬ ‫ ﻤﺎ ﺗﻤﻨﺢ اﻟﻄ ﻘﺔ ﺗﺤﺖ‬.‫ و ﺴﺎﻋﺪ اﻟﺤﻤﺎ ﺔ ﻣﻦ ﺧﻼل ﺗﺄﺛ ﺗﻮﺳ ﺪﻫﺎ اﻟﻨﺎﻋﻢ‬، ‫اﻟﺤﺮارة‬.‫اﻟﺠﻠﺪ اﻟﺮﺧﻮة اﻟ ة ﺣﺮﻛﺘﻬﺎ اﻟﻤ ا ﺪة ﻋ اﻟﻬ ﺎ ﻞ اﻟﻤﻮﺟﻮدة ﺗﺤﺘﻬﺎ‬  FUNCTION OF THE SKIN‫وظﯾﻔﺔ اﻟﺟﻠد‬ 1.Protection from physical, chemical, thermal, and light-wave sources..‫ اﻟﺣﻣﺎﯾﺔ ﻣن اﻟﻣﺻﺎدر اﻟﻔﯾزﯾﺎﺋﯾﺔ واﻟﻛﯾﻣﯾﺎﺋﯾﺔ واﻟﺣرارﯾﺔ واﻟﻣوﺟﺎت اﻟﺿوﺋﯾﺔ‬.١ 2. Prevents penetration or invasion of microorganisms and loss of water and electrolytes from within the body..‫ ﯾﻣﻧﻊ اﺧﺗراق أو ﻏزو اﻟﻛﺎﺋﻧﺎت اﻟﺣﯾﺔ اﻟدﻗﯾﻘﺔ وﻓﻘدان اﻟﻣﺎء واﻟﻛﮭﺎرل ﻣن داﺧل اﻟﺟﺳم‬.٢ 3. Perception: Skin is a substantial sensory surface holding the neurosensory end-organs for touch, pain, temperature, and pressure..‫ اﻟﺟﻠد ﻋﺑﺎرة ﻋن ﺳطﺢ ﺣﺳﻲ ﻛﺑﯾر ﯾﺣﻣل اﻷﻋﺿﺎء اﻟطرﻓﯾﺔ اﻟﺣﺳﯾﺔ اﻟﻌﺻﺑﯾﺔ ﻟﻠﻣس واﻷﻟم ودرﺟﺔ اﻟﺣرارة واﻟﺿﻐط‬:‫ اﻹدراك‬.٣ 4. Temperature regulation through sweat glands and heat storage through subcutaneous insulation..‫ ﺗﻧظﯾم درﺟﺔ اﻟﺣرارة ﻣن ﺧﻼل اﻟﻐدد اﻟﻌرﻗﯾﺔ وﺗﺧزﯾن اﻟﺣرارة ﻣن ﺧﻼل اﻟﻌزل ﺗﺣت اﻟﺟﻠد‬.٤ 5. Identification: of People by single combinations of facial characteristics, hair, skin color, and even fingerprints. ‫ ﻣﻦ اﻟﻨﺎس ﻣﻦ ﺧﻼل ﻣﺠﻤﻮﻋﺎت واﺣﺪة ﻣﻦ ﺧﺼﺎﺋﺺ اﻟﻮﺟﻪ واﻟﺸﻌﺮ وﻟﻮن اﻟ ة وﺣ ﺼﻤﺎت‬:‫ ﺗﺤﺪ ﺪ اﻟﻬ ﺔ‬.٥.‫اﻷﺻﺎﺑﻊ‬3 6. Communication by Emotion expression in the sign language of the face and body posture, blanching, etc..‫ إﻟﺦ‬، ‫ اﺑﯾﺿﺎض‬، ‫ اﻟﺗواﺻل ﻋن طرﯾﻖ اﻟﺗﻌﺑﯾر اﻟﻌﺎطﻔﻲ ﺑﻠﻐﺔ اﻹﺷﺎرة ﻟﻠوﺟﮫ ووﺿﻌﯾﺔ اﻟﺟﺳم‬.٦ 7. Wound repair by cell replacement of surface ‫ إﺻﻼح اﻟﺟرح ﻋن طرﯾﻖ اﺳﺗﺑدال اﻟﺧﻼﯾﺎ ﻣن اﻟﺳطﺢ‬.٧ 8. Absorption and excretion of some metabolic blushing or wounds. wastes, products of cellular decomposition such as minerals, sugars, amino acids, cholesterol, uric acid, and urea. ‫ اﻟﻧﻔﺎﯾﺎت وﻣﻧﺗﺟﺎت اﻟﺗﺣﻠل اﻟﺧﻠوي ﻣﺛل‬.‫ اﻣﺗﺻﺎص وإﻓراز ﺑﻌض اﺣﻣرار اﻟوﺟﮫ اﻷﯾﺿﻲ أو اﻟﺟروح‬.٨.‫اﻟﻣﻌﺎدن واﻟﺳﻛرﯾﺎت واﻷﺣﻣﺎض اﻷﻣﯾﻧﯾﺔ واﻟﻛوﻟﯾﺳﺗرول وﺣﻣض اﻟﯾورﯾك واﻟﯾورﯾﺎ‬ 9. Production of vitamin D ultraviolet (UV) light converts cholesterol into vitamin D..(‫( ﯾﺣول اﻟﻛوﻟﯾﺳﺗرول إﻟﻰ ﻓﯾﺗﺎﻣﯾن )د‬UV) ‫ إﻧﺗﺎج ﻓﯾﺗﺎﻣﯾن )د( اﻷﺷﻌﺔ ﻓوق اﻟﺑﻧﻔﺳﺟﯾﺔ‬.٩  Developmental Competence‫اﻟ ﻔﺎءة اﻟﺘﻨﻤ ﺔ‬ Infants and Children: The hair follicles develop in the fetus at 3 months' gestation; by midgestation most of the skin is covered with lanugo, the fine downy hair of the newborn infant. ‫ ﻳﺘﻢ‬، ‫ ﺤﻠﻮل ﻣﻨﺘﺼﻒ اﻟﺤﻤﻞ‬.‫ أﺷﻬﺮ ﻣﻦ اﻟﺤﻤﻞ‬٣ ‫ ﺗﺘﻄﻮر ﺼ ﻼت اﻟﺸﻌﺮ اﻟﺠﻨ ﻋﻨﺪ‬:‫اﻟﺮﺿﻊ واﻷﻃﻔﺎل‬.‫ وﻫﻮ اﻟﺸﻌﺮ اﻟﻨﺎﻋﻢ اﻟﻨﺎﻋﻢ ﻟﻠﺮﺿﻴﻊ ﺣﺪ ﺚ اﻟﻮﻻدة‬، ‫ﺗﻐﻄ ﺔ ﻣﻌﻈﻢ اﻟﺠﻠﺪ ﺎﻟﺰﻏﺐ‬ In the first few months after birth, this is replaced by fine vellus hair. If terminal hair on the scalp is present at birth, it tends to be soft and suffer a patchy loss. ‫ إذا ﺎن اﻟﺸﻌﺮ اﻟﻨﻬﺎ ﻋ ﻓﺮوة اﻟﺮأس‬.‫ ﻳﺘﻢ اﺳ ﺪال ﻫﺬا ﺸﻌﺮ زﻏ ﻧﺎﻋﻢ‬، ‫ﻌﺪ اﻟﻮﻻدة‬ ‫اﻷﺷﻬﺮ اﻟﻘﻠ ﻠﺔ اﻷو‬.‫ ﻓﺈﻧﻪ ﻤ ﻞ إ أن ﻜﻮن ﻧﺎﻋﻤﺎ و ﻌﺎ ﻣﻦ ﻓﻘﺪان ﻏ ﻣﻜﺘﻤﻞ‬، ‫ﻣﻮﺟﻮدا ﻋﻨﺪ اﻟﻮﻻدة‬ The newborn's skin is similar in structure to the adult's, but many of its functions are not fully developed. The newborn's skin is thin, smooth, and elastic and is relatively more permeable than that of the adult; thus the infant is at greater risk for fluid loss.‫ ﻟ ﻦ اﻟﻌﺪ ﺪ ﻣﻦ وﻇﺎﺋﻔﻪ ﻟﻢ ﻳﺘﻢ ﺗﻄ ﺮﻫﺎ ﺎﻟ ﺎﻣﻞ‬، ‫ﺸ ﻪ ﺟﻠﺪ اﻟﻤﻮﻟﻮد اﻟﺠﺪ ﺪ ﻫ ﻠﻪ ﺟﻠﺪ اﻟﺸﺨﺺ اﻟ ﺎﻟﻎ‬ ‫ و ﺎﻟﺘﺎ ﻓﺈن اﻟﺮﺿﻴﻊ أ‬.‫ﺟﻠﺪ اﻟﻤﻮﻟﻮد اﻟﺠﺪ ﺪ رﻗﻴﻖ وﻧﺎﻋﻢ وﻣﺮن وأ ﻧﻔﺎذ ﺔ ﺴ ﺎ ﻣﻦ ﺟﻠﺪ اﻟﺸﺨﺺ اﻟ ﺎﻟﻎ‬ ‫ﻋﺮﺿﺔ ﻟﻔﻘﺪان اﻟﺴﻮاﺋﻞ‬  The Pregnant Woman‫اﻟﻤﺮأة اﻟﺤﺎﻣﻞ‬ Metabolism is increased in pregnancy; as a way to dissipate heat, the peripheral vasculature dilates, and the sweat and sebaceous glands increase secretion. Fat deposits are laid down, particularly in the buttocks and hips, as maternal reserves for the nursing baby. Skin color changes due to increased hormone levels. ‫ ﺗﺘﻤﺪد اﻷوﻋ ﺔ اﻟﺪﻣ ﺔ‬، ‫ ﻛﻄ ﻘﺔ ﻟﺘ ﺪ ﺪ اﻟﺤﺮارة‬.‫اﻟﺤﻤﻞ‬ ‫ ﻳﺘﻢ ز ﺎدة اﻟﺘﻤﺜ ﻞ اﻟﻐﺬا‬ ، ‫ ﻳﺘﻢ وﺿﻊ رواﺳﺐ اﻟﺪﻫﻮن‬.‫ و ﺪ اﻟﻌﺮق واﻟﻐﺪد اﻟﺪﻫﻨ ﺔ ﻣﻦ اﻹﻓﺮاز‬، ‫اﻟﻤﺤ ﻄ ﺔ‬ ‫ ﻳﺘﻐ ﻟﻮن اﻟ ة‬.‫ ﺎﺣﺘ ﺎﻃ ﺎت ﻟﻸم ﻟﻠﻄﻔﻞ اﻟﺮﺿﻴﻊ‬، ‫ﺧﺎﺻﺔ اﻷرداف واﻟﻮرﻛ‬.‫ﺴ ﺐ ز ﺎدة ﻣﺴﺘ ﺎت اﻟﻬﺮﻣﻮن‬  The Aging Adult‫ﺷ ﺨﻮﺧﺔ اﻟ ﺎر‬ The skin is a mirror that reflects aging changes that proceed in all our organ systems; it just happens to be the one organ that we can view directly. The aging process carries a slow atrophy of skin structures. The aging skin loses its elasticity; it folds and sags. By the 70s to 80s, it looks parchment thin, lax, dry, and wrinkled..‫ إﻧﻪ اﻟﻌﻀﻮ اﻟﻮﺣ ﺪ اﻟﺬي ﻤﻜﻨﻨﺎ رؤ ﺘﻪ ﻣ ﺎ ة‬.‫اﻟﺠﻠﺪ ﻫﻮ ﻣﺮآة ﺗﻌﻜﺲ ﺗﻐ ات اﻟﺸ ﺨﻮﺧﺔ اﻟ ﺴﺘﻤﺮ ﺟﻤﻴﻊ أﻧﻈﻤﺘﻨﺎ اﻟﻌﻀ ﺔ‬ ٧٠ ‫ ﺤﻠﻮل‬. ‫ ﻄﻮي و ﺘﺪ‬.‫ ﺷ ﺨﻮﺧﺔ اﻟﺠﻠﺪ ﻔﻘﺪ ﻣﺮوﻧﺘﻪ‬.‫ﺗﺤﻤﻞ ﻋﻤﻠ ﺔ اﻟﺸ ﺨﻮﺧﺔ ﺿﻤﻮرا ﻄﻴﺌﺎ ﻫ ﺎ ﻞ اﻟﺠﻠﺪ‬s ٨٠ ‫إ‬s ،.‫ واﻟﺘﺠﺎﻋ ﺪ‬، ‫ ﺟﺎف‬، ‫ ﻣ ا‬، ‫ﻳ ﺪو اﻟﺮق رﻗ ﻘﺔ‬ Sweat and sebaceous glands decrease in number and function, leaving dry skin. Decreased response of the sweat glands to thermoregulatory demand also puts the aging person at greater risk for heat stroke. ‫ ﻤﺎ أن اﻧﺨﻔﺎض اﺳﺘﺠﺎ ﺔ اﻟﻐﺪد اﻟﻌﺮﻗ ﺔ ﻟﻠﻄﻠﺐ‬.‫ ﻣﻤﺎ ﻳ ك اﻟﺠﻠﺪ ﺟﺎﻓﺎ‬، ‫اﻟﻌﺪد واﻟﻮﻇ ﻔﺔ‬ ‫ﻳﻨﺨﻔﺾ ﻋﺪد اﻟﻐﺪد اﻟﻌﺮﻗ ﺔ واﻟﺪﻫﻨ ﺔ‬.‫ﺔ اﻟﺸﻤﺲ‬ ‫اﻟﻤﻨﻈﻢ اﻟﺤﺮاري ﻌﺮض اﻟﺸﺨﺺ اﻟﻤﺴﻦ ﻟﺨﻄﺮ أ ﻟﻺﺻﺎ ﺔ‬ In the aging hair matrix, the number of functioning melanocytes decreases; there fore the hair looks gray or white and feels thin and fine. ‫ ﻫﻨﺎك ﻳ ﺪو اﻟﺸﻌﺮ رﻣﺎد ﺎ أو أﺑ ﺾ و ﺸﻌﺮ ﺎﻟﻨﺤﺎﻓﺔ‬.‫ ﻳ ﻨﺎﻗﺺ ﻋﺪد اﻟﺨﻼ ﺎ اﻟﺼ ﺎﻏ ﺔ اﻟﻌﺎﻣﻠﺔ‬، ‫ﻣﺼﻔﻮﻓﺔ اﻟﺸﻌﺮ اﻟﺸ ﺨﻮﺧﺔ‬.‫واﻟﻨﻌﻮﻣﺔ‬ Aa testosterone decreases with aging, axillary and pubic hair decrease ‫ و ﻨﺨﻔﺾ ﺷﻌﺮ اﻹ ﻂ واﻟﻌﺎﻧﺔ‬، ‫أﻳﻨﺨﻔﺾ ﻫﺮﻣﻮن اﻟ ﺴﺘﻮﺳﺘ ون ﻣﻊ ﺗﻘﺪم اﻟﻌﻤﺮ‬  Culture and Genetics‫اﻟﺜﻘﺎﻓﺔ وﻋﻠﻢ اﻟﻮراﺛﺔ‬ Melanin protects the skin against harmful UV rays, a genetic advantage accounting for the lower incidence of skin cancer among darkly pigmented African Americans and American Indians. ‫ و ﻣ ة وراﺛ ﺔ ﻣﺴﺆوﻟﺔ ﻋﻦ اﻧﺨﻔﺎض ﻣﻌﺪل‬، ‫ﺤ اﻟﻤ ﻼﻧ اﻟ ة ﻣﻦ اﻷﺷﻌﺔ ﻓﻮق اﻟﺒﻨﻔﺴﺠ ﺔ اﻟﻀﺎرة‬. ‫اﻟﻤﺼﻄ ﻐ واﻟﻬﻨﻮد اﻷﻣ ﻜﻴ‬ ‫اﻹﺻﺎ ﺔ ﻃﺎن اﻟﺠﻠﺪ ﺑ اﻷﻣ ﻜﻴ ﻣﻦ أﺻﻞ أﻓ‬ Melasma, or the “mask of pregnancy,” is a patchy tan-to–dark brown discoloration of the face ‫ ﻫﻮ ﺗﻠﻮن ﻏ ﻣﻜﺘﻤﻞ ﻣﻦ اﻟﻠﻮن اﻟﺒ إ اﻟﺒ اﻟﺪا ﻦ ﻟﻠﻮﺟﻪ‬، "‫ أو "ﻗﻨﺎع اﻟﺤﻤﻞ‬، ‫اﻟ ﻠﻒ‬ The incidence of melanoma is higher in whites than in Hispanics and blacks. Women outnumber men in melanoma cases before age 50. ‫ ﻔﻮق ﻋﺪد اﻟ ﺴﺎء ﻋﺪد اﻟﺮﺟﺎل ﺣﺎﻻت‬.‫واﻟﺴﻮد‬ ‫اﻟﻼﺗ ﻨﻴ‬ ‫اﻟﺒ ﺾ ﻣﻨﻪ‬ ‫ﻃﺎن اﻟﺠﻠﺪ أﻋ‬ ‫ﻣﻌﺪل اﻹﺻﺎ ﺔ‬.٥٠ ‫ﻃﺎن اﻟﺠﻠﺪ ﻗ ﻞ ﺳﻦ‬ by age 65 years men have double the rates of women and by age 80 years they are triple ‫ ﺳﻨﺔ ﻜﻮﻧﻮن ﺛﻼﺛﺔ أﺿﻌﺎف‬٨٠ ‫ ﺳﻨﺔ ﻜﻮن ﻟﺪى اﻟﺮﺟﺎل ﺿﻌﻒ ﻣﻌﺪﻻت اﻟ ﺴﺎء و ﺤﻠﻮل ﺳﻦ‬٦٥ ‫ﺳﻦ‬ Subjective Data of skin, hair, and nails ‫اﻟﺒ ﺎﻧﺎت اﻟﺬاﺗ ﺔ ﻟﻠﺠﻠﺪ واﻟﺸﻌﺮ واﻷﻇﺎﻓﺮ‬ 1. Past history of skin disease (allergies, hives, psoriasis, eczema) (‫ اﻷﻛزﯾﻣﺎ‬، ‫ اﻟﺻدﻓﯾﺔ‬، ‫ ﺧﻼﯾﺎ اﻟﻧﺣل‬، ‫ اﻟﺗﺎرﯾﺦ اﻟﺳﺎﺑﻖ ﻟﻸﻣراض اﻟﺟﻠدﯾﺔ )اﻟﺣﺳﺎﺳﯾﺔ‬.١ 2. Change in pigmentation‫ ﺗﻐﯾر ﻓﻲ ﺗﺻﺑﻎ‬.٢ 3. Change in mole (size or color)(‫ ﺗﻐﯾﯾر ﻓﻲ اﻟﺷﺎﻣﺔ )اﻟﺣﺟم أو اﻟﻠون‬.٣ 4. Excessive dryness or moisture‫ اﻟﺟﻔﺎف اﻟﻣﻔرط أو اﻟرطوﺑﺔ‬.٤ 5. Pruritus‫اﻟﺣﻛﺔ‬ 6. Excessive bruising‫ ﻛدﻣﺎت ﻣﻔرطﺔ‬.٦ 7. Rash or lesion‫ طﻔﺢ ﺟﻠدي أو آﻓﺔ‬.٧ 8. Medications‫ اﻷدوﯾﺔ‬.٨ 9. Hair loss‫ ﺗﺳﺎﻗط اﻟﺷﻌر‬.٩ 10. Change in nails‫ ﺗﻐﯾﯾر ﻓﻲ اﻷظﺎﻓر‬.١٠ 11. Environmental or occupational hazards‫ اﻟﻣﺧﺎطر اﻟﺑﯾﺋﯾﺔ أو اﻟﻣﮭﻧﯾﺔ‬.١١ 12. Patient-centered care‫ اﻟرﻋﺎﯾﺔ اﻟﺗﻲ ﺗرﻛز ﻋﻠﻰ اﻟﻣرﯾض‬.١٢  Taking history when examining the Skin (subjective data) (‫أﺧﺬ اﻟﺘﺎر ــﺦ ﻋﻨﺪ ﻓﺤﺺ اﻟﺠﻠﺪ )ﺑ ﺎﻧﺎت ذاﺗ ﺔ‬ Ask patients‫اﺳﺄل اﻟﻣرﺿﻰ‬ Rational and indication‫ﻋﻘﻼﻧﻲ ودﻻﻟﺔ‬  Past history of skin disease Significant familial predisposition: allergies, psoriasis, atopic dermatitis (eczema), acne.  ‫اﻟﺗﺎرﯾﺦ اﻟﺳﺎﺑﻖ ﻟﻸﻣراض اﻟﺟﻠدﯾﺔ‬.‫ ﺣب اﻟﺷﺑﺎب‬، (‫ اﻟﺗﮭﺎب اﻟﺟﻠد اﻟﺗﺄﺗﺑﻲ )اﻷﻛزﯾﻣﺎ‬، ‫ اﻟﺻدﻓﯾﺔ‬، ‫ اﻟﺣﺳﺎﺳﯾﺔ‬:‫اﻻﺳﺗﻌداد اﻟﻌﺎﺋﻠﻲ اﻟﻛﺑﯾر‬  Any change in skin color or pigmentation: Generalized change suggests systemic illness: pallor, Hypopigmentation (loss of color); jaundice, cyanosis.، ‫ ﺷﺣوب‬:‫اﻟﺗﻐﯾﯾر اﻟﻣﻌﻣم ﯾﺷﯾر إﻟﻰ ﻣرض ﺟﮭﺎزي‬ Hyperpigmentation (increase in color)..‫ زرﻗﺔ‬، ‫اﻟﯾرﻗﺎن‬  ‫ ﻧﻘص ﺗﺻﺑﻎ )ﻓﻘدان اﻟﻠون(؛ ﻓرط ﺗﺻﺑﻎ‬:‫أي ﺗﻐﯾﯾر ﻓﻲ ﻟون اﻟﺟﻠد أو ﺗﺻﺑﻎ‬.(‫)زﯾﺎدة ﻓﻲ اﻟﻠون‬  Any Change in mole (size or color) Signs suggest neoplasm in pigmented nevus..‫ﺗﺷﯾر اﻟﻌﻼﻣﺎت إﻟﻰ وﺟود ورم ﻓﻲ وﺣﻣﺔ ﻣﺻطﺑﻐﺔ‬  (‫أي ﺗﻐﯾﯾر ﻓﻲ اﻟﺷﺎﻣﺔ )اﻟﺣﺟم أو اﻟﻠون‬  Excessive dryness or moisture‫ﺟﻔﺎف ﻣﻔرط أو رطوﺑﺔ‬ Seborrhea—Oily skin Xerosis—Dry skin - ‫اﻟزھم‬ ‫ ﺟﻔﺎف اﻟﺟﻠد‬- ‫ﺟﻔﺎف اﻟﺟﻠد اﻟدھﻧﻲ‬  Pruritus (Any skin itching?)(‫اﻟﺣﻛﺔ )أي ﺣﻛﺔ ﺟﻠدﯾﺔ؟‬ Occurs with dry skin, aging, drug reactions, allergy, obstructive jaundice, uremia, lice. ، ‫ ﯾورﯾﻣﯾﺔ‬، ‫ واﻟﯾرﻗﺎن اﻻﻧﺳدادي‬، ‫ واﻟﺣﺳﺎﺳﯾﺔ‬، ‫ واﻟﺗﻔﺎﻋﻼت اﻟدواﺋﯾﺔ‬، ‫ واﻟﺷﯾﺧوﺧﺔ‬، ‫ﯾﺣدث ﻣﻊ اﻟﺟﻠد اﻟﺟﺎف‬.‫واﻟﻘﻣل‬  Excessive bruising (Tint)(‫ﻛدﻣﺎت ﻣﻔرطﺔ )ﺻﺑﻐﺔ‬ Maybe caused by physical abuse, or frequent falls because of dizziness or drug abuse. ‫ أو اﻟﺳﻘوط اﻟﻣﺗﻛرر ﺑﺳﺑب اﻟدوﺧﺔ أو ﺗﻌﺎطﻲ‬، ‫رﺑﻣﺎ ﺑﺳﺑب اﻻﻋﺗداء اﻟﺟﺳدي‬.‫اﻟﻣﺧدرات‬  Medications‫اﻻدوﯾﮫ‬ Drugs may cause allergic skin eruption: such as aspirin, antibiotics. Drugs may increase sunlight sensitivity and give burn response ‫ ﻗد ﺗزﯾد اﻷدوﯾﺔ ﻣن ﺣﺳﺎﺳﯾﺔ أﺷﻌﺔ اﻟﺷﻣس‬.‫ ﻣﺛل اﻷﺳﺑرﯾن واﻟﻣﺿﺎدات اﻟﺣﯾوﯾﺔ‬:‫ﻗد ﺗﺳﺑب اﻷدوﯾﺔ ﺛوران ﺣﺳﺎﺳﯾﺔ اﻟﺟﻠد‬ ‫وﺗﻌطﻲ اﺳﺗﺟﺎﺑﺔ ﻟﻠﺣروق‬  Hair loss (Any recent hair loss?)(‫ﺗﺳﺎﻗط اﻟﺷﻌر )أي ﺗﺳﺎﻗط ﺷﻌر ﺣدﯾث؟‬ Alopecia is a condition that causes hair to fall out in small patches. Hirsutism is shaggy or excessive hair..‫ اﻟﺷﻌراﻧﯾﺔ ھﻲ ﺷﻌر أﺷﻌث أو ﻣﻔرط‬.‫اﻟﺛﻌﻠﺑﺔ ھﻲ ﺣﺎﻟﺔ ﺗﺗﺳﺑب ﻓﻲ ﺗﺳﺎﻗط اﻟﺷﻌر ﻓﻲ ﺑﻘﻊ ﺻﻐﯾرة‬  Any change in nails?‫أي ﺗﻐﯾﯾر ﻓﻲ اﻷظﺎﻓر؟‬ Indicates nutrient deficiency or acute illness that disturbs nail growth ‫ﯾﺷﯾر إﻟﻰ ﻧﻘص اﻟﻣﻐذﯾﺎت أو اﻟﻣرض اﻟﺣﺎد اﻟذي ﯾزﻋﺞ ﻧﻣو اﻷظﺎﻓر‬  How to Inspect and Palpate the Skin‫ﻛﯾﻔﯾﺔ ﻓﺣص وﺟس اﻟﺟﻠد‬ (objective data)(‫)ﺑﯾﺎﻧﺎت ﻣوﺿوﻋﯾﺔ‬ 1. skin color‫ ﻟون اﻟﺑﺷرة‬.١ Color of skin‫ة‬ ‫ﻟﻮن اﻟ‬ Indicated (Causes)(‫اﻟﻤﺸﺎر إﻟﻴﻬﺎ )اﻷﺳ ﺎب‬ Pallor (no color) When the red-pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the color of connective tissue (collagen), which is mostly (‫ﺷﺤﻮب ) ﺪون ﻟﻮن‬ white. Pallor is common in acute high-stress states such as anxiety or fear because of the powerful peripheral vasoconstriction from sympathetic nervous system stimulation. The skin also looks pale with vasoconstriction from exposure to cold and from cigarette smoking and in the presence of edema ‫ اﻟﺸﺤﻮب ﺷﺎﺋﻊ ﺣﺎﻻت اﻟﺘﻮﺗﺮ اﻟﺸﺪ ﺪ‬.‫ واﻟﺬي ﻜﻮن اﻟﻐﺎﻟﺐ أﺑ ﺾ‬، ( ‫ ﺄﺧﺬ اﻟﺠﻠﺪ ﻟﻮن اﻟ ﺴﻴﺞ اﻟﻀﺎم )اﻟ ﻮﻻﺟ‬، ‫اﻟﻤﺆﻛﺴﺞ اﻟﺪم‬ ‫ﻋﻨﺪﻣﺎ ﺗﻀﻴﻊ ﻧﻐﻤﺎت اﻟﻠﻮن اﻷﺣﻤﺮ اﻟﻮردي ﻣﻦ اﻟﻬ ﻤﻮﻏﻠ‬ ‫ ﻳ ﺪو اﻟﺠﻠﺪ ﺷﺎﺣ ﺎ أ ﻀﺎ ﻣﻊ ﺗﻀﻴﻖ اﻷوﻋ ﺔ ﻣﻦ اﻟﺘﻌﺮض ﻟﻠ د وﻣﻦ ﺗﺪﺧ اﻟﺴﺠﺎﺋﺮ و‬.‫اﻟﺤﺎدة ﻣﺜﻞ اﻟﻘﻠﻖ أو اﻟﺨﻮف ﺴ ﺐ ﺗﻀﻴﻖ اﻷوﻋ ﺔ اﻟﻤﺤ ﻄ ﺔ اﻟﻘﻮي اﻟﻨﺎﺗﺞ ﻋﻦ ﺗﺤﻔ اﻟﺠﻬﺎز اﻟﻌﺼ اﻟﻮدي‬ ‫وﺟﻮد اﻟﻮذﻣﺔ‬ Erythema (redness) Intense redness of the skin is from excess blood (hyperemia) in the dilated superficial capillaries. This sign is expected with fever, local inflammation, or emotional (‫ﺣﻤﺎ )اﺣﻤﺮار‬ reactions such as blushing in vascular flush areas (cheeks, neck, and upper chest). The erythema with fever or localized inflammation has an increased skin temperature from the increased rate of blood flow. ‫ ﻣﻦ اﻟﻤﺘﻮﻗﻊ ﺣﺪوث ﻫﺬە اﻟﻌﻼﻣﺔ ﻣﻊ اﻟﺤ أو اﻻﻟﺘﻬﺎب اﻟﻤﻮﺿ أو ردود اﻟﻔﻌﻞ اﻟﻌﺎﻃﻔ ﺔ ﻣﺜﻞ‬.‫اﻻﺣﻤﺮار اﻟﺸﺪ ﺪ ﻟﻠﺠﻠﺪ ﻧﺎﺗﺞ ﻋﻦ اﻟﺪم اﻟﺰاﺋﺪ )اﺣﺘﻘﺎن اﻟﺪم( اﻟﺸﻌ ات اﻟﺪﻣ ﺔ اﻟﺴﻄﺤ ﺔ اﻟﻤﺘﻮﺳﻌﺔ‬.‫ اﻟﺤﻤﺎ ﻣﻊ اﻟﺤ أو اﻻﻟﺘﻬﺎب اﻟﻤﻮﺿ ﻟﺪ ﻪ ز ﺎدة درﺟﺔ ﺣﺮارة اﻟﺠﻠﺪ ﻣﻦ ز ﺎدة ﻣﻌﺪل ﺗﺪﻓﻖ اﻟﺪم‬.(‫اﺣﻤﺮار اﻟﻮﺟﻪ ﻣﻨﺎﻃﻖ ﺗﺪﻓﻖ اﻷوﻋ ﺔ اﻟﺪﻣ ﺔ )اﻟﺨﺪﻳﻦ واﻟﺮﻗ ﺔ وأﻋ اﻟﺼﺪر‬ Cyanosis (bluish) This is a bluish mottled color from decreased perfusion. the tissues have high levels of deoxygenated blood. This is best seen in the lips, nose, cheeks, ears, (‫زرﻗﺔ )ﻣﺰرق‬ and oral mucous membranes and in artificial fluorescent light. Do not confuse cyanosis with the common and normal bluish tone on the lips of dark- skinned persons of Mediterranean origin Cyanosis is difficult to observe in darkly pigmented people ‫ ﻣﻦ اﻷﻓﻀﻞ رؤ ﺔ ذﻟﻚ اﻟﺸﻔﺎە واﻷﻧﻒ واﻟﺨﺪﻳﻦ واﻷذﻧ واﻷﻏﺸ ﺔ اﻟﻤﺨﺎﻃ ﺔ اﻟﻔﻤ ﺔ و‬.‫ ﺗﺤﺘﻮي اﻷ ﺴﺠﺔ ﻋ ﻣﺴﺘ ﺎت ﻋﺎﻟ ﺔ ﻣﻦ اﻟﺪم ﻏ اﻟﻤﺆﻛﺴﺞ‬.‫ﻫﺬا ﻟﻮن ﻣﺮﻗﺶ ﻣﺰرق ﻣﻦ اﻧﺨﻔﺎض اﻟ و ﺔ‬ ‫ ﻻ ﺗﺨﻠﻂ ﺑ زرﻗﺔ ﻣﻊ ﻟﻬﺠﺔ ﻣﺰرﻗﺔ ﺷﺎﺋﻌﺔ وﻃﺒ ﻌ ﺔ ﻋ ﺷﻔﺎە اﻷﺷﺨﺎص ذوي اﻟ ة اﻟﺪا ﻨﺔ ﻣﻦ أﺻﻞ اﻟ ﺤﺮ اﻷﺑ ﺾ اﻟﻤﺘﻮﺳﻂ ﺼﻌﺐ ﻣﻼﺣﻈﺔ زرﻗﺔ اﻷﺷﺨﺎص‬. ‫ﺿﻮء اﻟﻔﻠﻮرﺳ ﺖ اﻻﺻﻄﻨﺎ‬ ‫اﻟﻤﺼﻄ ﻐ اﻟﺪا ﻨ‬ Jaundice (yellowish) A yellowish skin color indicates rising amounts of bilirubin in the blood. Except for physiologic jaundice in the newborn (p. 215), jaundice does not occur (‫اﻟ ﻗﺎن )ﻣﺼﻔﺮ‬ normally. It is first noted in the junction of the hard and soft palate in the mouth and in the sclera. Then the eyes appear yellow, but do not confuse scleral jaundice with the normal yellow subconjunctival fatty deposits that are common in the outer sclera of dark-skinned persons. The scleral yellow of jaundice extends up to the edge of the iris As levels of serum bilirubin rise, jaundice is evident in the skin over the rest of the body. This is best assessed in direct natural daylight. Common calluses on palms and soles often look yellow; do not interpret these as jaundice. ‫ ﻟﻮﺣﻆ ﻷول ﻣﺮة ﺗﻘﺎﻃﻊ اﻟﺤﻨﻚ اﻟﺼﻠﺐ‬. ‫ ﻻ ﺤﺪث اﻟ ﻗﺎن ﺸ ﻞ ﻃﺒ‬، (٢١٥ ‫ﺣﺪﻳ اﻟﻮﻻدة )ص‬ ‫ ﺎﺳ ﺜﻨﺎء اﻟ ﻗﺎن اﻟﻔﺴﻴﻮﻟﻮ‬.‫اﻟﺪم‬ ‫ﺸ ﻟﻮن اﻟﺠﻠﺪ اﻟﻤﺼﻔﺮ إ ارﺗﻔﺎع ﻤ ﺎت اﻟﺒ ﻠ و‬ ‫ ﻟ ﻦ ﻻ ﺗﺨﻠﻂ ﺑ اﻟ ﻗﺎن اﻟﺼﻠ ﺔ واﻟﺮواﺳﺐ اﻟﺪﻫﻨ ﺔ ﺗﺤﺖ اﻟﻤﻠﺘﺤﻤﺔ اﻟﺼﻔﺮاء اﻟﻄﺒ ﻌ ﺔ اﻟﺸﺎﺋﻌﺔ اﻟﺼﻠ ﺔ اﻟﺨﺎرﺟ ﺔ ﻟﻸﺷﺨﺎص ذوي اﻟ ة‬، ‫ ﺛﻢ ﺗﻈﻬﺮ اﻟﻌﻴﻮن ﺻﻔﺮاء‬.‫اﻟﻔﻢ و اﻟﺼﻠ ﺔ‬ ‫واﻟﻠ‬ ‫ ﻤﺘﺪ اﻷﺻﻔﺮ اﻟﺼﻠﺐ ﻣﻦ اﻟ ﻗﺎن ﺣ ﺣﺎﻓﺔ اﻟﻘﺰﺣ ﺔ‬.‫اﻟﺪا ﻨﺔ‬ ‫ ﻣﻦ اﻷﻓﻀﻞ ﺗﻘﻴ ﻢ ﻫﺬا ﺸ ﻞ ﻣ ﺎ‬.‫ ﻜﻮن اﻟ ﻗﺎن واﺿﺤﺎ اﻟﺠﻠﺪ ﻋ ﻘ ﺔ اﻟﺠﺴﻢ‬، ‫اﻟﺪم‬ ‫ﻣﻊ ارﺗﻔﺎع ﻣﺴﺘ ﺎت اﻟﺒ ﻠ و‬.‫ ﻻ ﺗﻔ ﻫﺬە ﻋ أﻧﻬﺎ اﻟ ﻗﺎن‬.‫ ﻏﺎﻟ ﺎ ﻣﺎ ﺗ ﺪو اﻟ ﺴﻴﺞ اﻟﺸﺎﺋﻌﺔ ﻋ اﻟﻨﺨ ﻞ واﻷﺧﻤﺼ ﺻﻔﺮاء‬. ‫ﺿﻮء اﻟﻨﻬﺎر اﻟﻄﺒ‬  2. Skin Temperature‫ درﺟﺔ ﺣرارة اﻟﺟﻠد‬.٢ Palpate the skin; it should be warm, and the temperature should be equal bilaterally; warmth suggests normal circulatory status..‫ وﯾﺟب أن ﺗﻛون درﺟﺔ اﻟﺣرارة ﻣﺗﺳﺎوﯾﺔ ﺛﻧﺎﺋﯾﺎ ؛ اﻟدفء ﯾﺷﯾر إﻟﻰ ﺣﺎﻟﺔ اﻟدورة اﻟدﻣوﯾﺔ اﻟطﺑﯾﻌﯾﺔ‬، ‫ ﯾﺟب أن ﺗﻛون داﻓﺋﺔ‬.‫ ﺟس اﻟﺟﻠد‬ and feet may be slightly cooler in a cool environment..‫وﻗد ﺗﻛون اﻟﻘدﻣﯾن أﻛﺛر ﺑرودة ﻗﻠﯾﻼ ﻓﻲ ﺑﯾﺋﺔ ﺑﺎردة‬ Abnormal findings‫ ﻧﺘﺎﺋﺞ ﻏ ﻃﺒ ﻌ ﺔ‬definition‫ﺗﻌ ﻒ‬ Hypothermia‫ اﻧﺨﻔﺎض ﺣﺮارة اﻟﺠﺴﻢ‬Generalized coolness may be induced such as in hypothermia used for surgery or high fever. Localized coolness is expected with an immobilized extremity, as when a limb is in a cast or with an intravenous infusion ‫ﻗﺪ ﺤﺪث اﻟ ودة اﻟﻌﺎﻣﺔ ﻤﺎ‬ ‫ ﻣﻦ اﻟﻤﺘﻮﻗﻊ‬.‫ﻫﻮ اﻟﺤﺎل اﻧﺨﻔﺎض ﺣﺮارة اﻟﺠﺴﻢ اﻟﻤﺴﺘﺨﺪم اﻟﺠﺮاﺣﺔ أو ارﺗﻔﺎع درﺟﺔ اﻟﺤﺮارة‬ ‫ ﻤﺎ ﻫﻮ اﻟﺤﺎل ﻋﻨﺪﻣﺎ ﻜﻮن أﺣﺪ اﻷﻃﺮاف ﻗﺎﻟﺐ أو ﻣﻊ‬، ‫ﺣﺪوث ﺑﺮودة ﻣﻮﺿﻌ ﺔ ﻣﻊ ﻃﺮف ﺛﺎ ﺖ‬ ‫ﺐ اﻟﻮر ﺪ‬ Hyperthermia‫ارﺗﻔﺎع اﻟﺤﺮارة‬ Generalized hyperthermia occurs with an increased metabolic rate such as in fever or after heavy exercise. A localized area feels hyperthermic with trauma, infection, or sunburn ‫ﺤﺪث ارﺗﻔﺎع اﻟﺤﺮارة اﻟﻤﻌﻤﻢ ﻣﻊ ز ﺎدة ﻣﻌﺪل اﻷ ﺾ ﻤﺎ ﻫﻮ‬ ‫ ﺸﻌﺮ اﻟﻤﻨﻄﻘﺔ اﻟﻤﻮﺿﻌ ﺔ ﺎرﺗﻔﺎع اﻟﺤﺮارة‬.‫اﻟﺤﺎل اﻟﺤ أو ﻌﺪ ﻣﻤﺎرﺳﺔ اﻟﺘﻤﺎر ﻦ اﻟ ﺎﺿ ﺔ اﻟﺜﻘ ﻠﺔ‬ ‫ﻣﻊ اﻟﺼﺪﻣﺔ أو اﻟﻌﺪوى أو ﺣﺮوق اﻟﺸﻤﺲ‬  3. Skin Moisture ‫ رطوﺑﺔ اﻟﺟﻠد‬.٣ Abnormal ‫ ﻏ ﻃﺒ‬Meaning ‫ﻣﻌ‬ How to assess‫ﻛ ﻔ ﺔ اﻟﺘﻘﻴ ﻢ‬ indication (Causes) ‫اﻻﺳﺘﻌﻤﺎل‬ ‫دوا‬ findings‫اﻟﻨﺘﺎﺋﺞ‬ (‫)اﻷﺳ ﺎب‬ Diaphoresis profuse perspiration By inspection as Perspiration Thyrotoxicosis, ‫اﻟ ﺴﻤﻢ اﻟﺪر‬ ‫اﻟﺘﻌﺮق‬ (Excessive sweat) appears normally on the face, Heart attack,‫ﻗﻠﺒ ﻪ‬ ‫ﻋﺮق ﻏ ﺮ‬ hands, axillae, and skinfolds. Anxiety, or pain‫اﻟﻘﻠﻖ أو اﻷﻟﻢ‬ (‫)اﻟﻌﺮق اﻟﻤﻔﺮط‬ ‫ﻋﻦ ﻃ ﻖ اﻟﻔﺤﺺ ﺣ ﺚ ﻈﻬﺮ اﻟﻌﺮق‬ ‫ﺸ ﻞ ﻃﺒ ﻋ اﻟﻮﺟﻪ واﻟ ﺪﻳﻦ‬.‫واﻹ ﻄ وﻃ ﺎت اﻟﺠﻠﺪ‬ Dehydration Reduction in the Look for dehydration in the oral Severe Vomiting And Diarrhea ‫ﺗﺠﻔﺎف‬ amount of fluids in mucous membranes. with ‫اﻟ ء اﻟﺸﺪ ﺪ واﻹﺳﻬﺎل‬ the body dehydration, mucous membranes Increase Urine Excretion (Diuretics), ‫اﻧﺨﻔﺎض ﻤ ﺔ اﻟﺴﻮاﺋﻞ‬ are dry, and lips look parched and Profuse Sweating (For Example, ‫اﻟﺠﺴﻢ‬ cracked. During Heat Waves, Particularly ‫ا ﺤﺚ ﻋﻦ اﻟﺠﻔﺎف اﻷﻏﺸ ﺔ اﻟﻤﺨﺎﻃ ﺔ‬ With Prolonged Exertion) ‫ ﺗﻜﻮن اﻷﻏﺸ ﺔ‬، ‫ ﻣﻊ اﻟﺠﻔﺎف‬.‫اﻟﻔﻤ ﺔ‬ ‫ اﻟﺘﻌﺮق‬، (‫ز ﺎدة إﻓﺮاز اﻟﺒﻮل )ﻣﺪرات اﻟﺒﻮل‬ ‫ وﺗ ﺪو اﻟﺸﻔﺎە ﺟﺎﻓﺔ‬، ‫اﻟﻤﺨﺎﻃ ﺔ ﺟﺎﻓﺔ‬ ‫ أﺛﻨﺎء ﻣﻮﺟﺎت‬، ‫اﻟﻐ ﺮ )ﻋ ﺳ ﻞ اﻟﻤﺜﺎل‬.‫وﻣ ﺸﻘﻘﺔ‬ (‫ ﺧﺎﺻﺔ ﻣﻊ اﻟﻤﺠﻬﻮد اﻟﻤﻄﻮل‬، ‫اﻟﺤﺮارة‬ Decreasing Water Intake Can Lead To Dehydration..‫ﻤﻜﻦ أن ﻳﺆدي ﺗﻘﻠ ﻞ ﺗﻨﺎول اﻟﻤﺎء إ اﻟﺠﻔﺎف‬  4. Skin Texture and Thickness‫ ﻧﺳﯾﺞ اﻟﺟﻠد وﺳﻣﻛﮫ‬.٤ Normal Findings‫اﻟﻨﺘﺎﺋﺞ اﻟﻌﺎد ﺔ‬ Abnormal findings Skin Texture: Normally smooth and skin feels smoother and softer in Hyperthyroidism firm, with an even surface. skin feels rough, dry, and flaky in Hypothyroidism ، ‫ ﻋﺎدة ﻣﺎ ﻜﻮن ﻧﺎﻋﻤﺎ وﺛﺎﺑﺘﺎ‬:‫ﺴﻴﺞ اﻟﺠﻠﺪ‬ ‫ﺗ ﺪو اﻟ ة أ ﻧﻌﻮﻣﺔ وﻧﻌﻮﻣﺔ ﻓﺮط ﺸﺎط اﻟﻐﺪة اﻟﺪرﻗ ﺔ‬.‫ﻣﻊ ﺳﻄﺢ ﻣﺴﺘﻮ‬ ‫ﻗﺼﻮر اﻟﻐﺪة اﻟﺪرﻗ ﺔ‬ ‫ﺸﻌﺮ اﻟﺠﻠﺪ ﺎﻟﺨﺸﻮﻧﺔ واﻟﺠﻔﺎف واﻟﺘﻘ‬ Skin Thickness: The epidermis is Very thin, shiny skin (atrophic) occurs with arterial uniformly thin over most of the body. insufficiency. ‫ اﻟ ة رﻗ ﻘﺔ ﺸ ﻞ ﻣﻮﺣﺪ ﻋ‬:‫ﺳﻤﻚ اﻟﺠﻠﺪ‬. ‫ﺤﺪث اﻟﺠﻠﺪ اﻟﺮﻗﻴﻖ ﺟﺪا اﻟﻼﻣﻊ )اﻟﻀﻤﻮري( ﻣﻊ ﻗﺼﻮر اﻟ اﻳ‬.‫ﻣﻌﻈﻢ اﻟﺠﺴﻢ‬ A callus is a circumscribed overgrowth of epidermis and is an adaptation to excessive pressure from the friction of work and weight bearing. ‫اﻟ ﺎﻟﺲ ﻫﻮ ﻓﺮط ﻧﻤﻮ ﻣﺤﺪود ﻟﻠ ة وﻫﻮ ﺗﻜ ﻒ ﻣﻊ اﻟﻀﻐﻂ‬.‫اﻟﻤﻔﺮط اﻟﻨﺎﺗﺞ ﻋﻦ اﺣﺘ ﺎك اﻟﻌﻤﻞ وﺗﺤﻤﻞ اﻟﻮزن‬  5. Skin Edema‫ وذﻣﺔ اﻟﺟﻠد‬.٥ Edema is fluid accumulating in the interstitial spaces; usually affects lower body parts such as (feet, ankles, and legs), where the skin looks puffy and tight. ‫ ﻋﺎدة ﻣﺎ ﺼ ﺐ أﺟﺰاء اﻟﺠﺰء اﻟﺴﻔ ﻣﻦ اﻟﺠﺴﻢ ﻣﺜﻞ )اﻟﻘﺪﻣ واﻟ ﺎﺣﻠ‬.‫اﻟﻮذﻣﺔ اﻟﺴﻮاﺋﻞ اﻟﻤ ا ﻤﺔ اﻟﻤﺴﺎﺣﺎت اﻟﺨﻼﻟ ﺔ‬.‫ ﺣ ﺚ ﻳ ﺪو اﻟﺠﻠﺪ ﻣﻨﺘﻔﺨﺎ وﻣﺸﺪودا‬، ( ‫واﻟﺴﺎﻗ‬ Causes of edema: high blood pressure, diabetes, heart failure, kidney failure, and deep vein thrombosis, blood clots..‫ ارﺗﻔﺎع ﺿﻐﻂ اﻟﺪم واﻟﺴﻜﺮي وﻓﺸﻞ اﻟﻘﻠﺐ واﻟﻔﺸﻞ اﻟ ﻠﻮي وﺗﺠﻠﻂ اﻷوردة اﻟﻌﻤ ﻘﺔ واﻟﺠﻠﻄﺎت اﻟﺪﻣ ﺔ‬:‫أﺳ ﺎب اﻟﻮذﻣﺔ‬ How to assess edema? To check for edema, press your finger firmly for 3 to 4 seconds against the swollen area If your pressure leaves a dent in the skin we call it “pitting edema” ‫ ﺛﻮان ﻋ اﻟﻤﻨﻄﻘﺔ اﻟﻤﺘﻮرﻣﺔ إذا ﺗﺮك ﺿﻐﻄﻚ‬٤ ‫ إ‬٣ ‫ اﺿﻐﻂ ﺑ ﺻ ﻌﻚ ﻘﻮة ﻟﻤﺪة‬، ‫ﻛ ﻔ ﺔ ﺗﻘﻴ ﻢ وذﻣﺔ؟ ﻟﻠﺘﺤﻘﻖ ﻣﻦ اﻟﻮذﻣﺔ‬ "‫اﻧ ﻌﺎﺟﺎ اﻟﺠﻠﺪ ﺴﻤ ﻪ "وذﻣﺔ اﻟﺘﻨﻘﺮ‬  6. Skin Vascularity or Bruising‫ اﻷوﻋ ﺔ اﻟﺪﻣ ﺔ اﻟﺠﻠﺪ ﺔ أوﻛﺪﻣﺎت‬.٦ Cherry (senile) angiomas are small (1 to 5 mm), smooth, slightly raised bright red dots commonly appear on the trunk in all adults older than 30 years. They normally increase in size and number with aging. ‫ وﻋﺎدة ﻣﺎ ﺗﻈﻬﺮ ﻧﻘﺎط ﺣﻤﺮاء زاﻫ ﺔ ﻧﺎﻋﻤﺔ‬، (‫ ﻣﻢ‬٥ ‫ إ‬١ ‫أورام وﻋﺎﺋ ﺔ اﻟ ﺮز )اﻟﺸ ﺨﻮﺧﺔ( ﺻﻐ ة )ﻣﻦ‬ ‫ ﻋﺎدة ﻣﺎ ﺗﺰداد اﻟﺤﺠﻢ‬.‫ ﻋﺎﻣﺎ‬٣٠ ‫وﻣﺮﺗﻔﻌﺔ ﻗﻠ ﻼ ﻋ اﻟﺠﺬع ﺟﻤﻴﻊ اﻟ ﺎﻟﻐ اﻟﺬﻳﻦ ﺗ ﺪ أﻋﻤﺎرﻫﻢ ﻋﻦ‬.‫واﻟﻌﺪد ﻣﻊ ﺗﻘﺪم اﻟﻌﻤﺮ‬ If any lesions are present, note the::‫ ﻻﺣﻆ‬، ‫ﺣﺎﻟﺔ وﺟﻮد أي آﻓﺎت‬ 1. Color.‫ﻟﻮن‬ 2. Elevation: flat, raised, or pedunculated..‫ ﻣﺴﻄﺢ أو ﻣﺮﺗﻔﻊ أو ﻣﺴﻨﻮق‬:‫اﻻرﺗﻔﺎع‬ 3. Pattern or shape may be characteristic of a certain disease. ‫ﻗﺪ ﻜﻮن اﻟﻨﻤﻂ أو اﻟﺸ ﻞ ﺳﻤﺔ ﻣﻤ ة‬. ‫ﻟﻤﺮض ﻣﻌ‬ 4. Size, in centimeters ‫اﻟﺤﺠﻢ ﺎﻟﺴ ﺘ ﻤ‬ 5. Location and distribution of the body..‫ﻣﻮﻗﻊ وﺗﻮز ــﻊ اﻟﺠﺴﻢ‬ 6.is it generalized or localized to the area of a specific irritant; around jewelry, watchband, or eyes?‫ﻫﻞ ﻫﻮ ﻣﻌﻤﻢ أو ﻣﻮﺿ ﻟﻤﻨﻄﻘﺔ ﻣﻬﻴﺞ ﻣﻌ ؛ ﺣﻮل اﻟﻤﺠﻮﻫﺮات أو ﺣﺰام اﻟﺴﺎﻋﺔ أو اﻟﻌﻴﻮن؟‬ 7. Any exudate. Note its color and any odor..‫ ﻻﺣﻆ ﻟﻮﻧﻪ وأي راﺋﺤﺔ‬.‫أي اﻹﻓﺮازات‬  II- Hair Assessment‫ﺗﻘﻴ ﻢ اﻟﺸﻌﺮ‬ Hairs are threads of keratin. The hair shaft is the visible projecting part, and the root is below the surface embedded in the follicle. ‫ واﻟﺟذر ﺗﺣت‬، ‫ ﺟذع اﻟﺷﻌرة ھو اﻟﺟزء اﻟﺑﺎرز اﻟﻣرﺋﻲ‬.‫اﻟﺷﻌر ﻋﺑﺎرة ﻋن ﺧﯾوط ﻣن اﻟﻛﯾراﺗﯾن‬.‫اﻟﺳطﺢ اﻟﻣﺿﻣن ﻓﻲ اﻟﻣﺳﺎم‬ :‫ ھﻧﺎك ﻧوﻋﺎن ﻣن اﻟﺷﻌر‬There are two types of hair: 1. Vellus hair is short, fine, slight-colored and covers most of the.١ body..‫ ﺷﻌر اﻟزﻏب ﻗﺻﯾر وﻧﺎﻋم وﺧﻔﯾف اﻟﻠون وﯾﻐطﻲ ﻣﻌظم اﻟﺟﺳم‬.١ 2. Terminal hair, the darker, thicker hair that grows on the scalp and eyebrows and, after puberty, on the axillae, the pubic area, and the face and chest in the male. ‫ وﺑﻌد‬، ‫ اﻟﺷﻌر اﻟداﻛن واﻷﻛﺛر ﺳﻣﻛﺎ اﻟذي ﯾﻧﻣو ﻋﻠﻰ ﻓروة اﻟرأس واﻟﺣواﺟب‬، ‫ اﻟﺷﻌر اﻟﻧﮭﺎﺋﻲ‬.٢.‫ ﻋﻠﻰ اﻹﺑطﯾن وﻣﻧطﻘﺔ اﻟﻌﺎﻧﺔ واﻟوﺟﮫ واﻟﺻدر ﻋﻧد اﻟذﻛر‬، ‫اﻟﺑﻠوغ‬  How to Inspect and Palpate the Hair‫ﻛﯾﻔﯾﺔ ﻓﺣص وﺟس اﻟﺷﻌر‬ (objective data)‫اﻟﺑﯾﺎﻧﺎت اﻟﻣوﺿوﻋﯾﺔ‬ ١. Color: Hair color comes from melanin production. pale blonde, total black, or Graying begins as early as the 30s because of reduced melanin production in the follicles. Genetic factors affect the onset of graying. Alopecia Alopecia ٢. ‫ أو رﻣﺎدي‬، ‫ أﺳود ﻛﻠﻲ‬، ‫ أﺷﻘر ﺷﺎﺣب‬.‫ ﻟون اﻟﺷﻌر ﯾﺄﺗﻲ ﻣن إﻧﺗﺎج اﻟﻣﯾﻼﻧﯾن‬:‫اﻟﻠون‬ ٣٠ ‫ﯾﺑدأ ﻓﻲ وﻗت ﻣﺑﻛر ﻣن‬s ‫ اﻟﻌواﻣل‬.‫ﺑﺳﺑب اﻧﺧﻔﺎض إﻧﺗﺎج اﻟﻣﯾﻼﻧﯾن ﻓﻲ اﻟﺑﺻﯾﻼت‬ ‫ اﻟﺣﺎﺻﮫ‬.‫اﻟوراﺛﯾﺔ ﺗؤﺛر ﻋﻠﻰ ﺑداﯾﺔ اﻟﺷﯾب‬ ٣. 2. Distribution: Hirsutism—excess body hair. In females, this forms a male pattern on the face and chest and indicates endocrine abnormalities. Alopecia is a significant hair loss caused by an abnormality in the immune system that damages hair follicles. ٤. ‫ ﯾﺷﻛل ھذا ﻧﻣطﺎ ذﻛرﯾﺎ ﻋﻠﻰ‬، ‫ ﻓﻲ اﻹﻧﺎث‬.‫ ﺷﻌر اﻟﺟﺳم اﻟزاﺋد‬- ‫ اﻟﺷﻌراﻧﯾﺔ‬:‫ اﻟﺗوزﯾﻊ‬.٢ ‫ اﻟﺛﻌﻠﺑﺔ ھﻲ ﺗﺳﺎﻗط ﻛﺑﯾر ﻟﻠﺷﻌر‬.‫اﻟوﺟﮫ واﻟﺻدر وﯾﺷﯾر إﻟﻰ ﺗﺷوھﺎت اﻟﻐدد اﻟﺻﻣﺎء‬.‫ﻧﺎﺗﺞ ﻋن ﺧﻠل ﻓﻲ اﻟﺟﮭﺎز اﻟﻣﻧﺎﻋﻲ ﯾدﻣر ﺑﺻﯾﻼت اﻟﺷﻌر‬  III- Assessment of Nails‫ﺗﻘﻴ ﻢ اﻷﻇﺎﻓﺮ‬ Nails The nails are hard plates of keratin on the dorsal edges of the fingers and toes. Nails take their pink color from the underlying nail bed of highly vascular epithelial cells. ‫ ﺗﺄﺧذ اﻷظﺎﻓر‬.‫ اﻷظﺎﻓر ﻋﺑﺎرة ﻋن ﺻﻔﺎﺋﺢ ﺻﻠﺑﺔ ﻣن اﻟﻛﯾراﺗﯾن ﻋﻠﻰ اﻟﺣواف اﻟظﮭرﯾﺔ ﻟﻸﺻﺎﺑﻊ وأﺻﺎﺑﻊ اﻟﻘدم‬: ‫اﻷظﺎﻓر‬ ‫ﻟوﻧﮭﺎ اﻟوردي ﻣن‬.‫اﻟظﻔر اﻷﺳﺎﺳﻲ ﻟﻠﺧﻼﯾﺎ اﻟظﮭﺎرﯾﺔ اﻟوﻋﺎﺋﯾﺔ ﻟﻠﻐﺎﯾﺔ‬ How to Inspect and Palpate the Nails? ‫ ﻛﯾﻔﯾﺔ ﻓﺣص وﺟس اﻷظﺎﻓر؟‬ BY 1.Assess the nail Shape and Contour ‫ ﺗﻘﯾﯾم ﺷﻛل اﻟظﻔر وﻣﺣﯾطﮫ‬.١ 2. Assess the nail Consistency ‫ ﺗﻘﯾﯾم اﺗﺳﺎق اﻷظﺎﻓر‬.٢ 3. Assess the nail color ‫ ﺗﻘﯾﯾم ﻟون اﻷظﺎﻓر‬.٣  1) Nail Shape:‫ﺷﻛل اﻟظﻔر‬ he nail surface is normally slightly curved or flat, and the posterior and lateral nail folds are smooth and rounded. Nail edges are smooth, rounded, and clean, suggesting adequate self-care. ‫ ﺣواف اﻷظﺎﻓر ﻧﺎﻋﻣﺔ‬.‫ وطﯾﺎت اﻟظﻔر اﻟﺧﻠﻔﯾﺔ واﻟﺟﺎﻧﺑﯾﺔ ﻧﺎﻋﻣﺔ وﻣﺳﺗدﯾرة‬، ‫ﻋﺎدة ﻣﺎ ﯾﻛون ﺳطﺢ اﻟظﻔر ﻣﻧﺣﻧﯾﺎ أو ﻣﺳطﺣﺎ ﻗﻠﯾﻼ‬.‫ ﻣﻣﺎ ﯾﺷﯾر إﻟﻰ اﻟرﻋﺎﯾﺔ اﻟذاﺗﯾﺔ اﻟﻛﺎﻓﯾﺔ‬، ‫وﻣﺳﺗدﯾرة وﻧظﯾﻔﺔ‬ Note: That the angle of the nail base should be about 160 degree (normal) (‫ درﺟﺔ )طﺑﯾﻌﯾﺔ‬١٦٠ ‫ أن زاوﯾﺔ ﻗﺎﻋدة اﻟظﻔر ﯾﺟب أن ﺗﻛون ﺣواﻟﻲ‬:‫ﻣﻼﺣظﺔ‬  Clubbing nails: it abnormal condition of nails. In early clubbing the angle straightens out to 180 degrees, and the nail base feels spongy to palpation. Then the nail becomes convex as the nail grows ‫ ﺗﺳﺗﻘﯾم‬، ‫ ﻓﻲ اﻟﮭراوات اﻟﻣﺑﻛرة‬.‫ إﻧﮭﺎ ﺣﺎﻟﺔ ﻏﯾر طﺑﯾﻌﯾﺔ ﻟﻸظﺎﻓر‬:‫ھراوات اﻷظﺎﻓر‬ ‫ ﺛم ﯾﺻﺑﺢ اﻟظﻔر‬.‫ وﺗﺷﻌر ﻗﺎﻋدة اﻟظﻔر ﺑﺎﻹﺳﻔﻧﺞ ﻋﻧد اﻟﺟس‬، ‫ درﺟﺔ‬١٨٠ ‫اﻟزاوﯾﺔ إﻟﻰ‬ ‫ﻣﺣدﺑﺎ ﻣﻊ ﻧﻣو اﻟظﻔر‬ Clubbing of nails occurs with congenital cyanotic heart disease, lung cancer, and pulmonary diseases. ‫ﯾﺣدث ھراوات اﻷظﺎﻓر ﻣﻊ أﻣراض اﻟﻘﻠب اﻟﻣزرﻗﺔ اﻟﺧﻠﻘﯾﺔ وﺳرطﺎن اﻟرﺋﺔ وأﻣراض‬.‫اﻟرﺋﺔ‬ Clubbing nail test: place fingernails of same finger on opposite hands against each other, nail to nail. small diamond- shaped "window" is Diamond normally apparent between the nailbeds. If shaped gap this window is obliterated, the test is ‫ﻓﺠﻮة ﻋ‬ positive and clubbing is present. ‫ﺷ ﻞ ﻣﺎس‬ ‫ ﺿﻊ أظﺎﻓر ﻣن ﻧﻔس اﻹﺻﺑﻊ ﻋﻠﻰ أﯾدي‬:‫اﺧﺗﺑﺎر اﻷظﺎﻓر اﻟﮭراوات‬ ‫ ﻋﺎدة ﻣﺎ ﺗظﮭر‬.‫ ﻣن اﻟظﻔر إﻟﻰ اﻟظﻔر‬، ‫ﻣﺗﻘﺎﺑﻠﺔ ﺿد ﺑﻌﺿﮭﺎ اﻟﺑﻌض‬ ‫ إذا ﺗم‬.‫"ﻧﺎﻓذة" ﺻﻐﯾرة ﻋﻠﻰ ﺷﻛل اﻟﻣﺎس ﺑﯾن أﺣواض اﻷظﺎﻓر‬ Clubbing nail test.‫ ﯾﻛون اﻻﺧﺗﺑﺎر إﯾﺟﺎﺑﯾﺎ واﻟﮭراوات ﻣوﺟودة‬، ‫طﻣس ھذه اﻟﻧﺎﻓذة‬ ‫اﺧﺘ ﺎر اﻷﻇﺎﻓﺮ اﻟﻬﺮاوات‬ 2) Nail Consistency‫( اﺗﺳﺎق اﻷظﺎﻓر‬٢ The surface is smooth and regular, not brittle or splitting. Nail thickness is uniform. ‫ ﺳﻤﻚ اﻷﻇﺎﻓﺮ‬.‫ وﻟ ﺲ ﻫﺸﺎ أو ﻣﻨﻘﺴﻤﺎ‬، ‫اﻟﺴﻄﺢ أﻣﻠﺲ وﻣﻨﺘﻈﻢ‬.‫ﻣﻮﺣﺪ‬ Pits, transverse grooves, or lines may indicate a nutrient deficiency or accompany acute illness that disturbs nail growth ‫ﻗﺪ ﺸ اﻟﺤﻔﺮ أو اﻷﺧﺎد ﺪ اﻟﻤﺴﺘﻌﺮﺿﺔ أو اﻟﺨﻄﻮط إ‬ ‫ﻧﻘﺺ اﻟﻤﻐﺬ ﺎت أو ﺗﺼﺎﺣﺐ ﻣﺮﺿﺎ ﺣﺎدا ﻳﺰﻋﺞ ﻧﻤﻮ‬ ‫اﻷﻇﺎﻓﺮ‬  3) Nail Color‫( ﻟون اﻷظﺎﻓر‬٣ Cyanotic nail beds or sluggish Capillary Refill: Depress the nail edge to color return: consider blanch and then release, noting the return cardiovascular or respiratory of color. Normally color return is instant or dysfunction. at least within a few seconds in a cold environment (less than 2 seconds). This ‫أﺳرة اﻷظﺎﻓر اﻟﻣزرﻗﺔ أو ﻋودة اﻟﻠون‬ indicates the status of the peripheral ‫ ﺿﻊ ﻓﻲ اﻋﺗﺑﺎرك ﺿﻌف اﻟﻘﻠب‬:‫اﻟﺑطﻲء‬ circulation. A sluggish color return takes.‫واﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ أو اﻟﺟﮭﺎز اﻟﺗﻧﻔﺳﻲ‬ longer than 2 seconds indicate inadequate peripheral circulation ‫ اﺿﻐط ﻋﻠﻰ ﺣﺎﻓﺔ اﻟظﻔر ﻟﺳﻠﻖ‬:‫إﻋﺎدة ﻣلء اﻟﺷﻌﯾرات اﻟدﻣوﯾﺔ‬ ‫ ﻋﺎدة ﻣﺎ ﯾﻛون إرﺟﺎع‬.‫ ﻣﻊ ﻣﻼﺣظﺔ ﻋودة اﻟﻠون‬، ‫ﺛم ﺣررھﺎ‬ ‫اﻟﻠون ﻓورﯾﺎ أو ﻋﻠﻰ اﻷﻗل ﻓﻲ ﻏﺿون ﺛوان ﻗﻠﯾﻠﺔ ﻓﻲ ﺑﯾﺋﺔ‬ ‫ ھذا ﯾﺷﯾر إﻟﻰ ﺣﺎﻟﺔ اﻟدورة اﻟدﻣوﯾﺔ‬.(‫ ﺛﺎﻧﯾﺔ‬٢ ‫ﺑﺎردة )أﻗل ﻣن‬ ‫ ﺛﺎﻧﯾﺔ‬٢ ‫ ﻋودة اﻟﻠون اﻟﺑطﻲء ﯾﺳﺗﻐرق وﻗﺗﺎ أطول ﻣن‬.‫اﻟطرﻓﯾﺔ‬ ‫ﺗﺷﯾر إﻟﻰ ﻋدم ﻛﻔﺎﯾﺔ اﻟدورة اﻟدﻣوﯾﺔ اﻟطرﻓﯾﺔ‬  IV- Sebaceous Glands ‫اﻟﻐﺪد اﻟﺪﻫﻨ ﺔ‬ produce a protective lipid substance, sebum, which is secreted through the hair follicles..‫ واﻟ ﺗﻔﺮز ﻣﻦ ﺧﻼل ﺼ ﻼت اﻟﺸﻌﺮ‬، ‫ اﻟﺰﻫﻢ‬، ‫إﻧﺘﺎج ﻣﺎدة دﻫﻨ ﺔ واﻗ ﺔ‬ Sebum oils and lubricates the skin and hair and forms an emulsion with water that retards ‫ﻳ ﺖ اﻟﺰﻫﻢ و ﻐ اﻟ ة واﻟﺸﻌﺮ و ﺸ ﻞ ﻣﺴﺘﺤﻠ ﺎ ﺎﻟﻤﺎء ﻳﺆﺧﺮ‬ Sebaceous glands are everywhere except on the palms and soles. They are most abundant in the scalp, forehead, face, and chin. ‫ ﻫﻢ اﻷ وﻓﺮة ﻓﺮوة‬. ‫اﻟﻐﺪد اﻟﺪﻫﻨ ﺔ ﻣﻮﺟﻮدة ﻞ ﻣ ﺎن ﺎﺳ ﺜﻨﺎء اﻟﺮاﺣﺘ واﻷﺧﻤﺼ‬.‫اﻟﺮأس واﻟﺠﺒﻬﺔ واﻟﻮﺟﻪ واﻟﺬﻗﻦ‬  V- Sweat Glands‫اﻟﻐﺪد‬ Two types of sweat glands..‫ﻧﻮﻋﺎن ﻣﻦ اﻟﻐﺪد اﻟﻌﺮﻗ ﺔ‬ 1. The eccrine glands are coiled tubules that open directly onto the skin surface and produce a dilute saline solution called sweat..‫اﻟﻌﺮق‬ ‫ اﻟﻐﺪد اﻟﻤﻔﺮزة ﻋ ﺎرة ﻋﻦ أﻧﺎﺑ ﺐ ﻣﻠﻔﻮﻓﺔ ﺗﻔﺘﺢ ﻣ ﺎ ة ﻋ ﺳﻄﺢ اﻟﺠﻠﺪ وﺗ ﺘﺞ ﻣﺤﻠﻮﻻ ﻣﻠﺤ ﺎ ﻣﺨﻔﻔﺎ ﺴ‬.١ Eccrine glands are widely distributed through the body and are mature in the 2- month-old infant..‫ ﺷﻬﺮ‬٢ ‫اﻟﺮﺿﻴﻊ اﻟ ﺎﻟﻎ ﻣﻦ اﻟﻌﻤﺮ‬ ‫ﻳﺘﻢ ﺗﻮز ــﻊ اﻟﻐﺪد اﻟﻤﻔﺮزة ﻋ ﻧﻄﺎق واﺳﻊ ﻣﻦ ﺧﻼل اﻟﺠﺴﻢ وﺗﻨﻀﺞ‬ 2. The apocrine glands produce a thick, milky secretion and open into the hair follicles. They are located mainly in the axillae, anogenital area, nipples, and navel and are vestigial in humans. ‫ واﻟﻤﻨﻄﻘﺔ‬، ‫اﻹ ﻄ‬ ‫ و ﺗﻘﻊ ﺸ ﻞ رﺋ‬.‫ﺼ ﻼت اﻟﺸﻌﺮ‬ ‫ ﺗ ﺘﺞ اﻟﻐﺪد اﻟﻤﻔﺮزة إﻓﺮازا ﺳﻤ ﺎ ﺣﻠﻴ وﺗﻔﺘﺢ‬.٢. ‫ واﻟ ة و أﺛ ﺔ اﻟ‬، ‫ واﻟﺤﻠﻤﺎت‬، ‫اﻟﺘﻨﺎﺳﻠ ﺔ‬ They become active during puberty, and secretion occurs with emotional and sexual stimulation.. ‫واﻟﺠ‬ ‫ و ﺤﺪث إﻓﺮاز ﻣﻊ اﻟﺘﺤﻔ اﻟﻌﺎﻃ‬، ‫ﺗﺼﺒﺢ ﺸﻄﺔ ﺧﻼل ﻓ ة اﻟ ﻠ غ‬