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16858069
A 20 year old women with an ulcer
Beschreibung
Mindmap am A 20 year old women with an ulcer, erstellt von Moza Almualla am 17/02/2019.
Mindmap von
Moza Almualla
, aktualisiert more than 1 year ago
Mehr
Weniger
Erstellt von
Moza Almualla
vor mehr als 5 Jahre
29
0
0
Zusammenfassung der Ressource
A 20 year old women with an ulcer
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
Medienanhänge
Dermis (binary/octet-stream)
Skin (binary/octet-stream)
Lymph (binary/octet-stream)
Lesion (binary/octet-stream)
Bas (binary/octet-stream)
Bc (binary/octet-stream)
Sc (binary/octet-stream)
Mela (binary/octet-stream)
Mamela (binary/octet-stream)
Scc (binary/octet-stream)
Life Cycle (binary/octet-stream)
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