= Epithelium (epidermis) & connective tissue (dermis)
Stratified
squamous keratinising; ectodermal origin. Appendages of skin (sebaceous
& sweat glands, hair, nails) derive from it.
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Stratum
corneum |
Close-packed
layers of dead keratinocytes in lipid cement, normally softened by moisture
and grease; imbibes water š thick, soft and white. |
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Stratum
lucidum |
Present in
thick skin only |
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Stratum
granulosum |
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Stratum
spinosum |
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Stratum
basale |
Metabolically
active cells |
Melanocytes found in lowest layers, usually adjacent
to basement membrane. Produce melanin which is taken up into vacuoles by
keratinocytes.
- these are the primary determinants of
skin colour; (there are racial type differences, eg yellowed, brown)
Langerhans cells
Merkel cells in hairless skin =
pressure sensors.
Sweat Glands:
most are eccrine (deliver water to body surface \
regulate temp); apocrine
(scent) glands located in axillae, areolae of breasts & urogenital regions.
sweat glands are not found on lip
margins, glans penis, labia minora, nipples, tympanic membranes.
Especially plentiful on hands, feet, face
including forehead.
Sebaceous
Glands: confined to
hairy skin. Both sweat & sebaceous glands open into hair follicles.
except on eyelids, lips, papillae of
nipples, labia minora š straight onto skin surface.
Hair: = hard keratin, arises from hair matrix
(epidermal cells) at base of follicle, moving up a tubular sheath to form hard
keratin rods. Melanocytes in follicle impart colour. Nails form in
similar fashion.
follicles have erector pili muscles, stand hair on ends,
simultaneously secreting sebaceous contents
hair grows in cycles, (adjacent follicles out of sync), scalp
~2-3yrs then rests, brows ~1-2months.
Tension
lines: due to pattern of
fibre bundles in the dermis. Run parallel to skin creases near joints.
incisions to be made along these lines,
and certainly not across flexor creases.
Skin is variably bound to its deeper structures, and folds in places where thinner and firmly bound.
Panniculus
adiposus = subcutaneous
fat blanket, contains nerves, vessels and lymphatics to skin. Panniculus
carnosus = muscle fibres
with one attachment to bone, other to skin (platysma, dartos, palmaris brevis,
corrugator cutis ani).
A membrane of
fibrous tissue, wrapping limbs and body wall.
variable from thick (fascia lata) to thin
(over external oblique) to absent (face).
always anchored to periosteum of
bone.
attaches skin by fibrous stands to fat
above, and most muscles slide freely beneath it.
Is very
sensitive (supply same
as that for overlying skin & periosteum)
Where it lies
over non-expansile parts (prevertebral mÕs, pelvic wall) it is strong and
readily sutured, whereas over expansile parts, eg cheek, pharynx it is
indefinite.
Dense CT (bone to bone), non-elastic and not mobile unless prolonged strain (except sacroiliacs and intervertebral discs)
2nd type of ligament: eg ligamentum flavum: stretches then regains former shape.
Attach muscle to bone in a sheet / flat insertion.
Blood from: i) muscle belly artery tracking down; ii) vessels ascending from periosteum; iii) in long ligaments a supplementary artery of their own.
Lubricate tendons where they bear on adjacent structures.
Parietal layer attached firmly to surrounds, visceral layer firmly attached to tendon.
a fluid film in-between ensures smooth motion
Do not usually completely encircle, rather open at
one end for blood vessels etc, or perforated by a bundle that raises a mesotendon
Interdigitation of short tendinous muscle fibre ends; may elongate passively.
eg buccinator and superior constrictor interdigitate in the pterygomandibular raphe, allowing the mandible to open.
Cells and fibres embedded in a firm ground substance.
Hyaline c: covers articular surfaces, forms epiphyseal plates.
is avascular and slightly deformable, when damaged is replaced by fibrous tissue
Fibrocartilage: islands of cartilage & ground substance between collagen bundles
eg intervertebral discs, menisci of knee, some articulations eg clavicle-sternum
tends to calcity / ossify with age.
Elastic: large amounts of elastin in ground substance. Remains spongy
- like hyaline, nourished only by diffusion (cf fibro = regular blood supply)
Individual fibres may be parallel (more stretch eg satorius) or oblique (more power) to the line of pull.
Obliques have 3 patterns:
unipennate Ð tendon forms on one margin, fibres slope in like half a feather, eg FPL
bipennate Ð tendon centrally like a feather, eg rectus femoris
multipennate Ð like a series of bipennate muscles side by side (subscapularis) or cylindrically with the tendon centrally (tibialis anterior)
Origins are usually described superior, insertions inferior where there is more motion possible.
Prime mover: where the muscle effects a certain desired movement
Antagonist: opposite of the desired movement, relaxing in a controlled manner
Fixators: stabilise one attachment so the other end may move.
Synergists: prevent unwanted movement, eg stabilise the wrist so other muscles can move fingers.
muscles may also contract isometrically so their tension increases but length stays the same.
Skeletal muscle
supplied by somatic
nerves which contain motor, afferent & autonomic fibres. Efferent
fibres are axons of a anterior horn cells. Efferents
from g cells innervate spindles wrt proprioception, and the
spindles send sensory afferents back to cord.
Exceptions: no sensory fibres in nerves to facial
muscles, spinal part of accessory, and hypoglossal nerves.
proprioception here supplied by other
cranial nerves.
Limb nerves
do not pierce muscle but
pass in planes (cf pass through flat body wall muscles to skin).
Limb plexi š limbs, anterior divisions to flexors,
posterior divisions to extensors.
Fired in one of
3 pathways:
UMN: in contralateral motor cortex (prime mover)
Extrapyramidal System: causes synergic contraction, modifying
action of prime movers
Sensory pathways: reflex tone (eg in tendon reflexes)
Bone is dense CT with cells imbedded in calcified ground substance.
filled with marrow; nothing to do with the bone, just a convenient place to store it.
Periosteum is a thick layer of fibrous tissue in which runs blood vessels to bone
has a deeper osteogenic layer; unites to underlying bone by ïSharpeyÍs fibresÍ
very sensitive (supply from overlying skin, or nearby muscle branches if deeper)
Endosteum occurs inside bone surfaces (including canals) and is osteogenic (or in less-well vascularized areas produces hyaline cartilage)
Blood supply is mainly via periosteum (the nutrient arteries go to marrow); veins and arteries run together in VolkmannÍs canals in compact bone; lymph is scant.
intramembranous bones may have ïsecondary cartilageÍ, eg fibrocartilage at clavicle ends, which acts like an epiphysis in a long bone.
Endochondral: a hyaline c. model is first made, and gradually replaced with bone (most bones)
these have ossification centres, and continue to grow from hyaline epiphyses.
Fibrous jts: eg skull sutures, are between bones or cartilage Ð firm & allow little movement
these ossify with time (apart from the tib-fib joint).
Primary cartilaginous jts: bone and hyaline meet strongly (eg rib junctions), rarely separate.
Secondary cartilaginous: ïsymphysisÍ; hyaline laminae are united by fibrocartilage.
Synovial joints: include all limbs:
bones are covered in hyaline
surrounded by a capsule (at epiphyseal lines in fetus, but move either way in adult)
enclose a cavity
are reinforced by ligaments
are lined by synovial membrane (invests non-articulating surfaces and secretes a lubricating viscous fluid that thins with rapid movement; a mere film in normal circumstances)
are able to move
There are also intra-articular fibrocartilages (discs or menisci)
usually in jts with 2 movements: eg knee; sternoclavicular joint, wrist.
Stability: is conveyed by bony, ligamentous and muscular contributions (least to most important)
The blood supply is arranged such that nutrient arteries terminate at epiphyseal plates in children (hence infarction in osteomyelitis) but connect in adults after plates fused.
Nerves: joints and capsules are sensitive, synovium has little & articular cartilage has none
HiltonÍs Law: motor
nerve to a muscle tends to branch to the joint which the muscle moves, and
again to the skin over that joint.
Line interior surfaces that communicate with the exterior.
Have epithelium and lamina propria, and often muscularis mucosa. Lie on a submucosa.
Lining of closed
body cavities: pleural, pericardial & peritoneal.
Consists of
connective tissue with lining of flattened mesothelial cells derived from
mesoderm.
Parietal layer
has segmental sensory supply, visceral layer has none.
slide readily over each other, lubricated
by lymph.
Widely variable growth pattern: anastomosing vessels grow and regrow in fetus.
sometimes organs carry a long blood supply when migrating, others gain new supplies
Veins are bigger and double the number (slower rate), with dead space around to accommodate increased flow (eg femoral canal, carotid sheath)
often regional lymph nodes lie in this dead space.
Anastomoses: are of two types, or there are none: end-arteries (eg liver spleen, kidney)
actual anastomosis: meet end to end, eg around margin of colon, stomach.
Potential: terminal arterioles meet, can take flow only if given time (eg coronaries, brain)
Lymph: takes tissue fluid away
superficial lymph follows veins, deep lymph follows arteries
There is no set path for lymph flow: may bypass nodes, may reverse flow, and communicates with veins.