Physiologic anatomical features of the skin, the subcutaneous fat and lymph nodes. The technique of their research. Semiotics of the skin disorders and

Physiologic anatomical features of the Physiologic anatomical features of the skin, the subcutaneous fat and lymph skin, the subcutaneous fat and lymph nodes. The technique of their research. nodes. The technique of their research. Semiotics of the skin disorders and Semiotics of the skin disorders and subcutaneous fat. Physiologic anatomical subcutaneous fat. Physiologic anatomical features of the bone and muscular features of the bone and muscular system. Methodic of investigation system. Methodic of investigation Semiotics of the bones and muscular Semiotics of the bones and muscular

disordersdisorders

MUSCLES• largest part of increment is at 4 mos.

AOG to early gestational maturity

1/6 BW - mid-pregnancy

1/4 - 1/5 BW - birth

1/3 BW - early adolescence

2/5 BW - late adulthood

• strength doubles between 12 and 16 years

SKELETAL SYSTEMSKELETAL SYSTEM

SKELETAL AGESKELETAL AGE

0-5 years: presence of ossification 0-5 years: presence of ossification centerscenters

5-14 years: calcification of cartilaginous 5-14 years: calcification of cartilaginous areasareas

14-25 years: epiphyseal fusion14-25 years: epiphyseal fusion

CHRONOLOGY OF HUMAN DENTITIONCHRONOLOGY OF HUMAN DENTITION(PRIMARY)(PRIMARY)

AGES (MOS)AGES (MOS) AGES (MOS)AGES (MOS)

MaxillaryMaxillary MandibularMandibular

Central Central incisorsincisors

6-96-9 5-85-8

Lateral incisorsLateral incisors 9-119-11 7-107-10

CuspidsCuspids 11-2211-22 17-2117-21

First molarsFirst molars 11-1711-17 12-1812-18

Second molarsSecond molars 22-3022-30 22-3022-30

CHRONOLOGY OF HUMAN DENTITIONCHRONOLOGY OF HUMAN DENTITION(PERMANENT TEETH)(PERMANENT TEETH)

AGESAGES AGESAGES


Central Central incisorsincisors

6 ½ - 7 ½ 6 ½ - 7 ½ 6 ½ - 76 ½ - 7

Lateral incisorsLateral incisors 6 ½ - 8 ½ 6 ½ - 8 ½ 6 ½ - 7 ½ 6 ½ - 7 ½

CuspidsCuspids 11-1211-12 11-1211-12

CHRONOLOGY OF HUMAN DENTITIONCHRONOLOGY OF HUMAN DENTITION(PERMANENT TEETH)(PERMANENT TEETH)

AGESAGES AGESAGES


First premolarsFirst premolars 10-1110-11 10-1110-11

Second Second premolarspremolars

11-1211-12 11-1211-12

First molarsFirst molars 6-7 ½ 6-7 ½ 5 ½ - 6 ½ 5 ½ - 6 ½

Second molarsSecond molars 12-1312-13 11 ½ - 12 ½ 11 ½ - 12 ½

Third molarsThird molars 18-2218-22 17-2417-24

Basic physiological functions Basic physiological functions of a skin.of a skin.

1.Protective. 1.Protective. 2.Bacterizidic.2.Bacterizidic. 3.Termoregulation.3.Termoregulation. 4.Respiratory. 4.Respiratory. 5.Deponation.5.Deponation. 6.Fermentation. 6.Fermentation.

7.Reception.7.Reception. 8.Excretation. 8.Excretation. 9.Resorbtion.9.Resorbtion. 10.Pigmentation.10.Pigmentation. 11.Syntesis of 11.Syntesis of

vitamins. vitamins. 12.Secretation.12.Secretation. 13.Changing.13.Changing.

The complaints:The complaints:

- Change of colour;- Change of colour; - Change of properties of a hair and nails;- Change of properties of a hair and nails; - Change of sensitivity; - Change of sensitivity; - Tenderness; - Tenderness; - Sweating; - Sweating; - Dryness; - Dryness; - Itching; - Itching; - Presence of eruptions;- Presence of eruptions;

Change of colourChange of colour




Change of properties of a Change of properties of a hairhair

Change of properties of a Change of properties of a hairhair

Change of properties of nailsChange of properties of nails



Palpation:Palpation:

- elasticity; - elasticity; - temperature; - temperature; - tenderness; - tenderness; - dryness or moistness; - dryness or moistness; - thickness of skin fold; - thickness of skin fold; - estimation of a condition of capillaries; - estimation of a condition of capillaries; - estimation eruption (above, on equal of - estimation eruption (above, on equal of

skin, proof or disappear at pressing).skin, proof or disappear at pressing).

Semiotics of skin Semiotics of skin diseases.diseases.

Primary morphological elements.Primary morphological elements. Elements with cavityElements with cavity ..

Elements without cavityElements without cavity ..Secondary morphological Secondary morphological

elements.elements.

Criterion of an estimation of a Criterion of an estimation of a rash: rash:

1. Size. 1. Size. 2. Form. 2. Form. 3. Colour. 3. Colour. 4. Consistence. 4. Consistence. 5. Quantity. 5. Quantity.

6. Character. 6. Character. 7. Localisation7. Localisation 8. Acts above a 8. Acts above a

surface of a skin or surface of a skin or not. not.

9. Is accompanied 9. Is accompanied by a pain, itching.by a pain, itching.

10. Its 10. Its development.development.

Primary morphological Primary morphological elements.elements.

• Close-up of the Close-up of the swollen wrists and swollen wrists and ankles The wide ankles The wide spread spread erythematous erythematous macular rash and macular rash and jaundice is a toxic-jaundice is a toxic-allergic reaction to allergic reaction to salicylatessalicylates

Primary morphological elements.Primary morphological elements.

Acute Acute thrombocytopenicpurpura thrombocytopenicpurpura due to aspirin-induced due to aspirin-induced platelet dysfunction platelet dysfunction (aggregation defect). The (aggregation defect). The 18-month-old boy received 18-month-old boy received a total of 150mg a total of 150mg acetylsalicylic acid. The acetylsalicylic acid. The striking picture of the striking picture of the purpuric rash covering the purpuric rash covering the face, limbs and buttocks face, limbs and buttocks was self-limiting and faded was self-limiting and faded within one week.within one week.

Primary morphological elements.Primary morphological elements.

Erythema multiforme Erythema multiforme circinata A rash of circinata A rash of widespread widespread distribution consisting distribution consisting of raised, of raised, circumscribed circumscribed erythematous areas erythematous areas with central blanching, with central blanching, associated with associated with infections or infections or connective tissue connective tissue diseases. It is self-diseases. It is self-limiting, but tends to limiting, but tends to recur.recur.

Not inflamed stain- at pressing on Not inflamed stain- at pressing on them do not disappear. Arise owing them do not disappear. Arise owing to infringement of integrity of a wall to infringement of integrity of a wall of vessels: haemophilia. of vessels: haemophilia.

Elements with cavityElements with cavity

Vesicle- during Vesicle- during herpesherpes


Vesicle- during Vesicle- during chickenpoxchickenpox


Pustule- during Pustule- during infections. infections.

Blister-during burn.Blister-during burn.

SECONDARY MORPHOLOGICAL ELEMENTS

• pigmentation • scalling: macroscalling, microscalling • crust • fissure: deep, superficial

-abrasion • ulcer• scar• lichenification • vegetation• erosion


• pigmentation • scalling:• macroscalling, • microscalling • crust • fissure: deep, superficial

abrasion • ulcer• scar• lichenification • Vegetation• erosion

http://dermnetnz.org/common/image.php?path=/dermatitis/img/at-derm5.jpg


• pigmentation • scalling:• macroscalling, • microscalling • crust • fissure: deep, superficial

abrasion • ulcer• scar• lichenification • Vegetation• erosion

The skin of the newborn The skin of the newborn

Milia White papules Milia White papules on the tip of the nose on the tip of the nose are hyperplastic are hyperplastic sebaceous glands, sebaceous glands, the effect of the effect of maternal maternal transplacental transplacental hormones. They hormones. They disappear with disappear with desquamation.desquamation.


Erythema toxicum of the Erythema toxicum of the newborn A benign, self-newborn A benign, self-limiting common limiting common phenomenon of phenomenon of erythematous, maculo-erythematous, maculo-papular or vesicular papular or vesicular character. Eosinophilia and character. Eosinophilia and the presence of eosinophils the presence of eosinophils in the vesicles indicate the in the vesicles indicate the allergic aetiology. The rash allergic aetiology. The rash becomes confluent and becomes confluent and intensified in areas subject intensified in areas subject to irritation .to irritation .


Physiological Physiological desquamation desquamation Paper-thin peeling. Paper-thin peeling. The skin beneath is The skin beneath is healthy. This healthy. This process is more process is more marked in areas of marked in areas of irritationirritation


Physiological jaundice Physiological jaundice An unconjugated An unconjugated transitory transitory hyperbilirubinaemia hyperbilirubinaemia appearing within the 2nd appearing within the 2nd and the 6th day after and the 6th day after birth due to deficient birth due to deficient enzyme glucuronyl-enzyme glucuronyl-transferase activity and transferase activity and immaturity of liver immaturity of liver function to metabolise function to metabolise bilirubin.bilirubin.


A mature newborn Delivery A mature newborn Delivery was spontaneous at 40 was spontaneous at 40 weeks'gestation. The skin is weeks'gestation. The skin is bright red and covered with bright red and covered with vernix caseosa, a foetal vernix caseosa, a foetal product of the sebaceous product of the sebaceous glands, shed cells and hair. glands, shed cells and hair. The eyes are closed; the The eyes are closed; the limbs are held in foetal limbs are held in foetal flexure position. The flexure position. The creases visible on the left creases visible on the left palm and the acrocyanosis palm and the acrocyanosis of the perioral area and of the perioral area and lower part of the lower part of the extremities are normal.extremities are normal.

Atopic dermatitis

Infants

Infants

Infants less than one year old often have widely distributed eczema. The skin is often dry, scaly and red with small scratch marks made by sharp baby nails.

The cheeks of infants are often the first place to be affected by eczema.

The napkin area is frequently spared due to the moisture retention of nappies. Just like other babies, they can develop irritant napkin dermatitis, if wet or soiled nappies are left on too long.

Toddlers and pre-schoolers

Atopic dermatitis

School-age children

Atopic dermatitis

School-age children

Older children tend to have the flexural pattern of eczema and it most often affects the elbow and knee creases. Other susceptible areas include the eyelids, earlobes, neck and scalp.

They can develop recurrent acute itchy blisters on the palms, fingers and sometimes on the feet, known as pompholyx or vesicular hand / foot dermatitis.

Many children develop a 'nummular' pattern of atopic dermatitis. This refers to small coin-like areas of eczema scattered over the body. These round patches of eczema are dry, red and itchy and may be mistaken for ringworm (a fungal infection).

Mostly the eczema improves during school years and it may completely clear up by the teens, although the barrier function of the skin is never entirely normal.

Atopic dermatitis

Adults

Adults

Adults who have atopic dermatitis may present in various different ways.

They may continue to have a diffuse pattern of eczema but the skin is often more dry and lichenified than in children.

Commonly adults have persistent localized eczema, possibly confined to the hands, eyelids, flexures, nipples or all of these areas.

Recurrent staphylococcal infections may be prominent. Atopic dermatitis is a major contributing factor to

occupational irritant contact dermatitis. This most often affects hands that are frequently exposed to water, detergents and /or solvents.

Hand dermatitis in adult atopics tends to be dry and thickened but may also be blistered.

Atopic dermatitis

Does atopic dermatitis persist forever? Atopic dermatitis affects 15-20% of children but only 1-2% of

adults. It is impossible to predict whether eczema will improve by itself or not in an individual.

Contact DermatitisContact Dermatitis

Adolescent AcneAdolescent Acne

Basic physiological functions Basic physiological functions of lymphatic nodes:of lymphatic nodes:

1)haemopoetic: 1)haemopoetic: place of maturing place of maturing Т-,B-lymph.Т-,B-lymph.

2) immunopoetic: 2) immunopoetic: production of production of immunoglobulins.immunoglobulins.

3) Exchange: 3) Exchange: participation in an participation in an exchange of fats, exchange of fats, carbohydrates, carbohydrates, vitamins A,B, C, D.vitamins A,B, C, D.

4) Function of 4) Function of redistribution of a redistribution of a liquid and cells liquid and cells elements between elements between blood and lymfa.blood and lymfa.

The course of dentition is sometimes The course of dentition is sometimes divided into four major stages:divided into four major stages:

(1) growth,(1) growth, (2) calcification, (2) calcification, (3) eruption, (3) eruption, (4) attrition. (4) attrition.

fontanellefontanelle

Frontal sutureFrontal suture

Sagittal suture Sagittal suture Posterior fontanelPosterior fontanelPosterior fontanelPosterior fontanelLambdoidal sutureLambdoidal sutureAnterior Anterior fontanelCoronal suturefontanelCoronal suture

Fig. 7.3 Location of Fig. 7.3 Location of sutures and fontanelsutures and fontanel

Examination of Examination of extremities.extremities.

Each extremity is inspected for Each extremity is inspected for symmetry of length and size; any symmetry of length and size; any deviation is referred for orthopedic deviation is referred for orthopedic evaluation. The fingers and toes are evaluation. The fingers and toes are counted to be certain of the normal counted to be certain of the normal number. This is so often taken for number. This is so often taken for granted that an extra digit (polydactyly) granted that an extra digit (polydactyly) or fusion of digits (syndactyly).or fusion of digits (syndactyly).

Fig. 7.4 Bowleg.Fig. 7.4 Bowleg.Fig. 7.5 Knock-knee.Fig. 7.5 Knock-knee.

Teeth:Teeth: delayed calcification, especially of permanent delayed calcification, especially of permanent

teeth;teeth; maleruption of teeth.maleruption of teeth. Abdomen:Abdomen: potbelly, constipation. potbelly, constipation. Rachitis tetany: seizures.Rachitis tetany: seizures. Symptoms of rickets are usually found in Symptoms of rickets are usually found in

children less than 2 years of age, some of them children less than 2 years of age, some of them in an reduced form can persist for the whole life.in an reduced form can persist for the whole life.

SCOLIOSISSCOLIOSIS

A lateral curvature of the is spine usually associated with a rotary deformity.A lateral curvature of the is spine usually associated with a rotary deformity.

A lateral curvature of the is spine usually associated with a rotary deformity.

6 Spine disorders (A – normal spine, B – kyphosis, C – lordosis, D – Scoliosis I, II, III dg.)

Clinical symptomClinical symptom

I. Dislocated or subluxated hip.I. Dislocated or subluxated hip. Limitation in hip abduction;Limitation in hip abduction; Unequal gluteal or leg folds;Unequal gluteal or leg folds; Unequal knee height (Allis or Galeazzi Unequal knee height (Allis or Galeazzi

sign);sign); Audible click on abduction (Ortolani sign) Audible click on abduction (Ortolani sign)

– if infant is under 4 weeks of age).– if infant is under 4 weeks of age).

Clinical symptomClinical symptom

I. Dislocated or subluxated hip.I. Dislocated or subluxated hip. Limitation in hip abduction;Limitation in hip abduction; Unequal gluteal or leg folds;Unequal gluteal or leg folds; Unequal knee height (Allis or Galeazzi Unequal knee height (Allis or Galeazzi

sign);sign); Audible click on abduction (Ortolani sign) Audible click on abduction (Ortolani sign)

– if infant is under 4 weeks of age).– if infant is under 4 weeks of age).

Bone disorder syndromesBone disorder syndromes

Pain syndrome (ossalgia, artalgia).Pain syndrome (ossalgia, artalgia). Syndrome of hyperplasia of bone tissue.Syndrome of hyperplasia of bone tissue. Syndrome of osteomalacia (osteoporosis).Syndrome of osteomalacia (osteoporosis). Syndrome of bone inflammation.Syndrome of bone inflammation. Syndrome of joint inflammation.Syndrome of joint inflammation. Syndrome of contracture.Syndrome of contracture. Syndrome of congenital malformation.Syndrome of congenital malformation. Syndrome of bone damage.Syndrome of bone damage.

Syndrome EdwardsSyndrome Edwards

Contracture of phalangesContracture of phalanges

ricketsrickets

Atopic dermatitisAtopic dermatitis

cephalohematomacephalohematoma

jaundicejaundice

AcrocianosisAcrocianosis

MeningococcemiaMeningococcemia

Scarlet feverScarlet fever

MumpsMumps

EritemaeEritemae

Hemmoragic vasculitisHemmoragic vasculitis

MiselsMisels

Alergo- dermatitisAlergo- dermatitis

psoriasispsoriasis

Chicken poxChicken pox

Hypotrophy of the Hypotrophy of the ІІІ ІІІ stagestage

ObesityObesity

Documents

Physiologic anatomical features of the skin, the subcutaneous fat and lymph nodes. The technique of their research. Semiotics of the skin disorders and