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A 20 year old women with an ulcer

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Mind Map on A 20 year old women with an ulcer, created by Moza Almualla on 17/02/2019.
Moza Almualla
Mind Map by Moza Almualla, updated more than 1 year ago
Moza Almualla
Created by Moza Almualla almost 6 years ago
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Resource summary

A 20 year old women with an ulcer
  1. Skin
    1. Three major regions
      1. Epidermis
        1. Outermost superficial region
          1. Stratified squamous epithelium
            1. 4 distinct cell types
              1. Keratinocytes
                1. Melanocytes
                  1. Merkel cells
                    1. Langerhans’ cells
                    2. 5 Layers/strata
                      1. Basale or germinativum
                        1. Spinosum
                          1. Granulosum
                            1. Lucidum (thick skin)
                              1. Corneum
                    3. Dermis (Corium)
                      1. Cell types
                        1. Fibroblasts
                          1. Macrophages
                            1. Mast cells
                            2. Middle region
                              1. 2 layers
                                1. Papillary
                                  1. Areolar connective tissue + Collagen + Elastic fibers
                                    1. Superior surface
                                      1. Peg like projections (Dermal papillae)
                                        1. Capillary loops
                                          1. Tactile corpuscles
                                            1. Free nerve endings
                                        2. Reticular
                                          1. Collagen + Elastin fibers
                                        3. Hypodermis (superficial fascia/tissue)
                                          1. Deepest region
                                            1. Adipose & Areolar connective tissue
                                            3. Lymph drainage
                                              1. Part of the vascular system
                                                1. Important part of the immune system
                                                  1. Large network of lymphatic vessels
                                                    1. Carry a clear fluid (lymph)
                                                      1. To the heart
                                                    3. Lesions
                                                        1. Non-Infectious lesions
                                                          1. Contact dermatitis
                                                            1. Allergic
                                                              1. Irritant
                                                              2. Acne
                                                                1. Drug Rashes
                                                                  1. Poison Ivy/Poison Oak
                                                                    1. Toxic Epidermal Necrolysis
                                                                      1. Eczema
                                                                        1. Urticaria
                                                                          1. Actinic keratosis
                                                                            1. Rosacea
                                                                              1. Psoriasis
                                                                                1. Vitiligo
                                                                                  1. Melasma
                                                                                    1. Skin cancer
                                                                                      1. Squamous cell carcinoma
                                                                                            1. Squamous atypia extending through basement membrane
                                                                                              1. Squamous eddies “keratin pearls”, cell nests
                                                                                              2. Most common tumor on sun-exposed skin in older people
                                                                                              3. Malignant melanoma
                                                                                                  1. Asymmetry
                                                                                                    1. Border irregularity
                                                                                                      1. Color change
                                                                                                        1. Diameter >6mm
                                                                                                          1. Eelevation
                                                                                                          3. Basal cell carcinoma
                                                                                                                1. Cords and islands of basaloid cells
                                                                                                                  1. Hyperchromatic nuclei
                                                                                                                    1. Peripheral palisading
                                                                                                                      1. Mucinous stroma
                                                                                                                        1. Clefting between tumor and stroma
                                                                                                                        2. Slow growing and rarely metastasize
                                                                                                                          1. Sun-exposed skin (Face, Fair skin,Forty)
                                                                                                                        3. Unresponsive to Antiseptic
                                                                                                                        4. Infectious lesions
                                                                                                                          1. Bacterial
                                                                                                                            1. Impetigo
                                                                                                                              1. Boils
                                                                                                                                1. Leprosy
                                                                                                                                  1. Cellulitis
                                                                                                                                  2. Viral
                                                                                                                                    1. Shingles
                                                                                                                                      1. Chickenpox
                                                                                                                                        1. Molluscum contagiosum
                                                                                                                                          1. Warts
                                                                                                                                            1. Measles
                                                                                                                                            2. Fungal
                                                                                                                                              1. Athlete’s foot
                                                                                                                                                1. Ringworm
                                                                                                                                                  1. Nail fungus
                                                                                                                                                    1. Oral thrush
                                                                                                                                                      1. Diaper rash
                                                                                                                                                      2. Parasitic
                                                                                                                                                        1. Lice
                                                                                                                                                          1. Scabies
                                                                                                                                                          2. Ulcers
                                                                                                                                                            1. Produced by
                                                                                                                                                              1. Necrosis of cells
                                                                                                                                                                1. Shedding of necrotic and inflammatory tissue
                                                                                                                                                                2. Causes
                                                                                                                                                                  1. Traumatic
                                                                                                                                                                    1. Mechanical
                                                                                                                                                                      1. Physical (Electrical and radiation)
                                                                                                                                                                      2. Vascular Insufficiency
                                                                                                                                                                        1. Arterial / Venous
                                                                                                                                                                        2. Neoplastic Conditions
                                                                                                                                                                          1. Metabolic Diseases
                                                                                                                                                                            1. Infective
                                                                                                                                                                              1. Syphilis
                                                                                                                                                                                1. Leishmaniasis
                                                                                                                                                                                  1. Vector borne zoonotic disease
                                                                                                                                                                                    1. Sandfly
                                                                                                                                                                                      1. Lutzomyia (New World)
                                                                                                                                                                                        1. Phlebotomus (Old World)
                                                                                                                                                                                      2. Types
                                                                                                                                                                                        1. Cutaneous
                                                                                                                                                                                          1. Skin at the site of a sandfly bite
                                                                                                                                                                                            1. Leishmania tropica (Delhi or Baghdad boil)
                                                                                                                                                                                              1. Afghanistan / Iran / Saudi Arabia / Syria / Brazil / Peru
                                                                                                                                                                                                1. Clinical Presentation
                                                                                                                                                                                                  1. Localized skin lesions can heal spontaneously or become chronic lesions with disfiguring scars
                                                                                                                                                                                            2. Visceral (Kala-azar)
                                                                                                                                                                                              1. Liver / Spleen / Bone marrow
                                                                                                                                                                                                1. Bangladesh / Brazil / India / Sudan
                                                                                                                                                                                              2. Mucocutaneous ((Espundia)
                                                                                                                                                                                                1. Mucous membranes of the mouth and nose "very rare" (Brazieliens)
                                                                                                                                                                                                  1. Bolivia / Brazil / Peru
                                                                                                                                                                                                    1. Clinical Presentation
                                                                                                                                                                                                      1. Ulcerative lesions and destruction of the mucosa
                                                                                                                                                                                                2. Caused by
                                                                                                                                                                                                  1. Obligate intracellular parasite
                                                                                                                                                                                                    1. Invade reticuloendothelial cells
                                                                                                                                                                                                      1. Two forms
                                                                                                                                                                                                        1. Amastigote
                                                                                                                                                                                                          1. In humans
                                                                                                                                                                                                          2. Promastogotes
                                                                                                                                                                                                      2. Life cycle
                                                                                                                                                                                                        2. Pathogenesis
                                                                                                                                                                                                          1. Due to an immune reaction to the organism
                                                                                                                                                                                                            1. Cell mediated immunity
                                                                                                                                                                                                              1. Leukopenia / Monocytosis / Lymphocytosis / Anemia / Thrombocytopenia
                                                                                                                                                                                                                1. IgM and IgG levels are extremely elevated (Not protective)
                                                                                                                                                                                                            2. Epidemiology
                                                                                                                                                                                                              1. 350 million people in the world are at risk
                                                                                                                                                                                                                1. 12 million people are infected
                                                                                                                                                                                                                  1. 1.6 million people get infected every year
                                                                                                                                                                                                                    1. In 88 tropical, subtropical and temperate countries
                                                                                                                                                                                                                    2. Laboratory diagnosis
                                                                                                                                                                                                                      1. Clinical specimens
                                                                                                                                                                                                                        1. Splenic aspirate
                                                                                                                                                                                                                          1. Bone marrow aspirate
                                                                                                                                                                                                                            1. Lymph node aspirate
                                                                                                                                                                                                                              1. Dermal scrapings
                                                                                                                                                                                                                                1. Liver aspirate
                                                                                                                                                                                                                                2. Microscopy (Giemsa-stained smear)
                                                                                                                                                                                                                                  1. Culture (Novy-McNeal-Nicolle)
                                                                                                                                                                                                                                    1. Molecular techniques (PCR)
                                                                                                                                                                                                                                      1. Serologic testing: (IFA) / (ELISAs)
                                                                                                                                                                                                                                        1. Biopsy
                                                                                                                                                                                                                                          1. Direct agglutination test (DAT)
                                                                                                                                                                                                                                            1. rK39 immunochromatographic test (rK39 RDT
                                                                                                                                                                                                                                            2. Treatment
                                                                                                                                                                                                                                              1. Pentavalent antimonials
                                                                                                                                                                                                                                                1. Sodium stibogluconate & Meglumine antimoniate
                                                                                                                                                                                                                                                  1. Parenterally
                                                                                                                                                                                                                                                    1. Adverse effects
                                                                                                                                                                                                                                                      1. Pain at the injection site
                                                                                                                                                                                                                                                        1. Pancreatitis
                                                                                                                                                                                                                                                          1. Elevated liver enzyme
                                                                                                                                                                                                                                                            1. Arthralgias
                                                                                                                                                                                                                                                              1. Myalgia
                                                                                                                                                                                                                                                                1. GI upset
                                                                                                                                                                                                                                                                  1. Cardiac arrhythmias
                                                                                                                                                                                                                                                                  2. Mechanism of action
                                                                                                                                                                                                                                                                    1. Inhibition of glycolysis in the parasite at the phosphofructokinase reaction
                                                                                                                                                                                                                                                                  3. Cutaneous and visceral leishmaniasis
                                                                                                                                                                                                                                                                  4. Miltefosine
                                                                                                                                                                                                                                                                    1. Orally
                                                                                                                                                                                                                                                                      1. Visceral Leishmaniasis
                                                                                                                                                                                                                                                                        1. Mechanism of action
                                                                                                                                                                                                                                                                          1. Interfere with phospholipids in parasitic cell membrane > Apoptosis
                                                                                                                                                                                                                                                                          2. Adverse effects
                                                                                                                                                                                                                                                                            1. Nausea & vomiting
                                                                                                                                                                                                                                                                          3. Amphotericin B
                                                                                                                                                                                                                                                                            1. Paromomycin
                                                                                                                                                                                                                                                                              1. Mechanism of action
                                                                                                                                                                                                                                                                                1. Irreversible inhibitor of protein synthesis / Bind to 30S ribosomal subunit
                                                                                                                                                                                                                                                                                2. Parenterally
                                                                                                                                                                                                                                                                                  1. Adverse effects
                                                                                                                                                                                                                                                                                    1. GI distress & diarrhea
                                                                                                                                                                                                                                                                                    2. Aminoglycoside antibiotic
                                                                                                                                                                                                                                                                                  2. Complications
                                                                                                                                                                                                                                                                                    1. Cutaneous
                                                                                                                                                                                                                                                                                      1. Bleeding
                                                                                                                                                                                                                                                                                        1. Other infections
                                                                                                                                                                                                                                                                                          1. Disfigurement
                                                                                                                                                                                                                                                                                          2. Visceral
                                                                                                                                                                                                                                                                                            1. Fatal
                                                                                                                                                                                                                                                                                              1. Effects on
                                                                                                                                                                                                                                                                                                1. Internal organs & immune system
                                                                                                                                                                                                                                                                                          3. Prognosis
                                                                                                                                                                                                                                                                                            1. Cure rates > High with the proper medicine
                                                                                                                                                                                                                                                                                              1. Death in 2 years > Complications (Other infections)
                                                                                                                                                                                                                                                                                          4. Inflammation
                                                                                                                                                                                                                                                                                            1. Cardinal Signs
                                                                                                                                                                                                                                                                                              1. Calor (Heat)
                                                                                                                                                                                                                                                                                                1. Rubor (Redness)
                                                                                                                                                                                                                                                                                                  1. Tumor (Swelling)
                                                                                                                                                                                                                                                                                                    1. Dolor (Pain)
                                                                                                                                                                                                                                                                                                      1. Functio laesa (Loss of function)
                                                                                                                                                                                                                                                                                                        1. Due to
                                                                                                                                                                                                                                                                                                          1. Vascular changes
                                                                                                                                                                                                                                                                                                            1. Leukocyte recruitment and activation
                                                                                                                                                                                                                                                                                                      2. Itching
                                                                                                                                                                                                                                                                                                        1. Dry skin
                                                                                                                                                                                                                                                                                                            1. Leads to
                                                                                                                                                                                                                                                                                                              1. Scratch marks
                                                                                                                                                                                                                                                                                                                1. Bleeding
                                                                                                                                                                                                                                                                                                                  1. Scars
                                                                                                                                                                                                                                                                                                                    1. Infections
                                                                                                                                                                                                                                                                                                                2. Role of skin in nonspecific Immunity
                                                                                                                                                                                                                                                                                                                  1. Keratinized layer
                                                                                                                                                                                                                                                                                                                    1. Barrier for microorganisms
                                                                                                                                                                                                                                                                                                                    2. Sweat and sebaceous secretions
                                                                                                                                                                                                                                                                                                                      1. Bacteriostatic substances (Lactic acid)
                                                                                                                                                                                                                                                                                                                      2. pH (3-5)
                                                                                                                                                                                                                                                                                                                        1. Inhibits bacterial growth
                                                                                                                                                                                                                                                                                                                        2. Lipids in sebum
                                                                                                                                                                                                                                                                                                                          2. Dermcidin in sweat
                                                                                                                                                                                                                                                                                                                            1. Toxic to bacteria
                                                                                                                                                                                                                                                                                                                          3. Wound healing
                                                                                                                                                                                                                                                                                                                            1. Regeneration
                                                                                                                                                                                                                                                                                                                              1. Replacement of damaged tissue with native
                                                                                                                                                                                                                                                                                                                              2. Repair
                                                                                                                                                                                                                                                                                                                                1. Replacement of damaged tissue with fibrous scar

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