Mindmap

A 20 year old women with an ulcer

Moza Almualla Englisch

Inhalt der Mindmap

Skin
- Three major regions
  - Epidermis
    - Outermost superficial region
    - Stratified squamous epithelium
    - 4 distinct cell types
      - Keratinocytes
      - Melanocytes
      - Merkel cells
      - Langerhans’ cells
    - 5 Layers/strata
      - Basale or germinativum
        Spinosum
        Granulosum
        Lucidum (thick skin)
        Corneum
  - Dermis (Corium)
    - Cell types
      - Fibroblasts
      - Macrophages
      - Mast cells
    - Middle region
    - 2 layers
      - Papillary
        Areolar connective tissue + Collagen + Elastic fibers
        Superior surface
        Peg like projections (Dermal papillae)
        Capillary loops
        Tactile corpuscles
        Free nerve endings
      - Reticular
        Collagen + Elastin fibers
  - Hypodermis (superficial fascia/tissue)
    - Deepest region
    - Adipose & Areolar connective tissue
- Lymph drainage
  - Part of the vascular system
  - Important part of the immune system
  - Large network of lymphatic vessels
    - Carry a clear fluid (lymph)
      - To the heart
- Lesions
  - Non-Infectious lesions
    - Contact dermatitis
      - Allergic
      - Irritant
    - Acne
    - Drug Rashes
    - Poison Ivy/Poison Oak
    - Toxic Epidermal Necrolysis
    - Eczema
    - Urticaria
    - Actinic keratosis
    - Rosacea
    - Psoriasis
    - Vitiligo
    - Melasma
    - Skin cancer
      - Squamous cell carcinoma
        Squamous atypia extending through basement membrane
        Squamous eddies “keratin pearls”, cell nests
        Most common tumor on sun-exposed skin in older people
      - Malignant melanoma
        Asymmetry
        Border irregularity
        Color change
        Diameter >6mm
        Eelevation
      - Basal cell carcinoma
        Cords and islands of basaloid cells
        Hyperchromatic nuclei
        Peripheral palisading
        Mucinous stroma
        Clefting between tumor and stroma
        Slow growing and rarely metastasize
        Sun-exposed skin (Face, Fair skin,Forty)
    - Unresponsive to Antiseptic
  - Infectious lesions
    - Bacterial
      - Impetigo
      - Boils
      - Leprosy
      - Cellulitis
    - Viral
      - Shingles
      - Chickenpox
      - Molluscum contagiosum
      - Warts
      - Measles
    - Fungal
      - Athlete’s foot
      - Ringworm
      - Nail fungus
      - Oral thrush
      - Diaper rash
    - Parasitic
      - Lice
      - Scabies
  - Ulcers
    - Produced by
      - Necrosis of cells
      - Shedding of necrotic and inflammatory tissue
    - Causes
      - Traumatic
        Mechanical
        Physical (Electrical and radiation)
      - Vascular Insufficiency
        Arterial / Venous
      - Neoplastic Conditions
      - Metabolic Diseases
      - Infective
        Syphilis
        Leishmaniasis
        Vector borne zoonotic disease
        Sandfly
        Lutzomyia (New World)
        Phlebotomus (Old World)
        Types
        Cutaneous
        Skin at the site of a sandfly bite
        Leishmania tropica (Delhi or Baghdad boil)
        Afghanistan / Iran / Saudi Arabia / Syria / Brazil / Peru
        Clinical Presentation
        Localized skin lesions can heal spontaneously or become chronic lesions with disfiguring scars
        Visceral (Kala-azar)
        Liver / Spleen / Bone marrow
        Bangladesh / Brazil / India / Sudan
        Mucocutaneous ((Espundia)
        Mucous membranes of the mouth and nose "very rare" (Brazieliens)
        Bolivia / Brazil / Peru
        Clinical Presentation
        Ulcerative lesions and destruction of the mucosa
        Caused by
        Obligate intracellular parasite
        Invade reticuloendothelial cells
        Two forms
        Amastigote
        In humans
        Promastogotes
        Life cycle
        Pathogenesis
        Due to an immune reaction to the organism
        Cell mediated immunity
        Leukopenia / Monocytosis / Lymphocytosis / Anemia / Thrombocytopenia
        IgM and IgG levels are extremely elevated (Not protective)
        Epidemiology
        350 million people in the world are at risk
        12 million people are infected
        1.6 million people get infected every year
        In 88 tropical, subtropical and temperate countries
        Laboratory diagnosis
        Clinical specimens
        Splenic aspirate
        Bone marrow aspirate
        Lymph node aspirate
        Dermal scrapings
        Liver aspirate
        Microscopy (Giemsa-stained smear)
        Culture (Novy-McNeal-Nicolle)
        Molecular techniques (PCR)
        Serologic testing: (IFA) / (ELISAs)
        Biopsy
        Direct agglutination test (DAT)
        rK39 immunochromatographic test (rK39 RDT
        Treatment
        Pentavalent antimonials
        Sodium stibogluconate & Meglumine antimoniate
        Parenterally
        Adverse effects
        Pain at the injection site
        Pancreatitis
        Elevated liver enzyme
        Arthralgias
        Myalgia
        GI upset
        Cardiac arrhythmias
        Mechanism of action
        Inhibition of glycolysis in the parasite at the phosphofructokinase reaction
        Cutaneous and visceral leishmaniasis
        Miltefosine
        Orally
        Visceral Leishmaniasis
        Mechanism of action
        Interfere with phospholipids in parasitic cell membrane > Apoptosis
        Adverse effects
        Nausea & vomiting
        Amphotericin B
        Paromomycin
        Mechanism of action
        Irreversible inhibitor of protein synthesis / Bind to 30S ribosomal subunit
        Parenterally
        Adverse effects
        GI distress & diarrhea
        Aminoglycoside antibiotic
        Complications
        Cutaneous
        Bleeding
        Other infections
        Disfigurement
        Visceral
        Fatal
        Effects on
        Internal organs & immune system
        Prognosis
        Cure rates > High with the proper medicine
        Death in 2 years > Complications (Other infections)
      - Inflammation
        Cardinal Signs
        Calor (Heat)
        Rubor (Redness)
        Tumor (Swelling)
        Dolor (Pain)
        Functio laesa (Loss of function)
        Due to
        Vascular changes
        Leukocyte recruitment and activation
  - Itching
    - Dry skin
    - Leads to
      - Scratch marks
      - Bleeding
      - Scars
      - Infections
- Role of skin in nonspecific Immunity
  - Keratinized layer
    - Barrier for microorganisms
  - Sweat and sebaceous secretions
    - Bacteriostatic substances (Lactic acid)
  - pH (3-5)
    - Inhibits bacterial growth
  - Lipids in sebum
  - Dermcidin in sweat
    - Toxic to bacteria
- Wound healing
  - Regeneration
    - Replacement of damaged tissue with native
  - Repair
    - Replacement of damaged tissue with fibrous scar

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Beschreibung: Mindmap am A 20 year old women with an ulcer, erstellt von Moza Almualla am 17/02/2019.
Erstellt von: Moza Almualla · Feb 2019
Aktualisiert: 17 Feb 2019
Aufrufe: 36
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A 20 year old women with an ulcer

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