clinical anatomy, physiology & pathology i introduction to the body · 2012-09-21 · 1....

6/6/2012 © Blue Sky School of Professional Massage and Therapeutic Bodywork 1 CAPP102-I – Class Notes – Semester 1

BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND

THERAPEUTIC BODYWORK

Clinical Anatomy, Physiology & Pathology – I

Introduction to the Body

CAPP102-I Session 1

LEARNING OBJECTIVES:

By the end of this session, the student will be expected to:

1. Define Anatomy, Physiology and Pathology.

2. Sequence and describe the six levels of body organization; list the four types of tissue.

3. Define and describe the six life processes; define anabolism and catabolism.

4. Describe homeostasis and how the endocrine & nervous systems regulate balance.

5. Describe the two homeostatic feedback systems; cite three examples of each.

6. Sequence the components of a feedback loop.

7. Define stress, health, disease, sign and symptom.

8. Classify the organization of organs in each body cavity; listing categories & subcategories.

9. Describe the name of each quadrant and region of the abdominopelvic (AP) body cavity.

10. Cite examples of organs found in each of the four AP quadrants and nine AP regions.

11. Define serous membrane; list the three types of serous membranes and the organs they cover.

12. Define retroperitoneal; cite examples of organs that are located retroperitoneal.

I. VOCABULARY: A. Anatomy – structure

B. Physiology – function

C. Pathology – dis-ease, dysfunction


II. ORGANIZATION OF THE BODY (Levels from least complex to most complex):

Chemical (atom/molecule)

Cellular (**CELL – basic structural/functional unit of body)

Tissue – work together for a particular function

4 types: EPITHELIAL, MUSCLE, CONNECTIVE, NERVOUS

Organ – specific function, recognizable shape (ex: hear, lungs, liver, etc.)

System – several related organs with a common function

Organism

III. LIFE PROCESSES:

A. Metabolism – sum of all of the chemical processes in the body

1. Catabolism – breakdown (splitting)

2. Anabolism – build up (synthesis)

3. Anabolism + Catabolism = Metabolism

B. Responsiveness – detect & respond to a change in the internal & external environment

C. Movement – motion

D. Growth – increase in number or size of cells

E. Differentiation – unspecialized to specialized

can go in many ways to a cell with a specific job

F. Reproduction – new cells (growth, repairs, replacement) or new individual

– 2 or more

– 2 or more

– 2 or more

– 2 or more

– 2 or more


IV. HOMEOSTASIS: stable conditions, staying within certain limits, balance *The body has many mechanisms to bring the body back into balance or homeostasis*

*tremendous healing power, remarkable resistance to abuse*

A. Regulation of Homeostasis:

1. Nervous System: quick response, short acting

2. Endocrine System: slower response, more sustained / longer effect via hormones.

B. Homeostasis Feedback Systems:

1. Negative feedback: e.g. body temperature, blood pressure & blood glucose

a. most body systems are negative

b. too much of the product, shuts off own synthesis

c. needs frequent monitoring or fine tuning around a set point

d. stable conditions over a long period

2. Positive feedback: e.g. blood clotting, labor contractions, immune response

a. amplification

b. for conditions that do not occur very often, protective in function

c. shut off by outside event – scab, baby born, kill off pathogen

3.Components – Feedback Loop

Stimulus

Receptor

Input

Control Center

Output

Effector

Response

C. STRESS: imbalance

Set

point

+ Amplification

− Fine tuning


V. HEALTH: based on the environment & our own behavior *the way we live life either supports or interferes with our balance & recovery*

VI. DISEASE: many years of poor health behavior that interferes with homeostasis, imbalance A. Sign: can see, objective, measurable (e.g. bleeding, swelling, diarrhea, rash)

B. Symptom: cannot see, subjective, description of client (e.g. pain, nausea, headache)

VII. BODY CAVITIES:

A. DORSAL – “back of the body”

1. CRANIAL – brain, skull

2. VERTEBRAL – spinal cord, vertebrae, spinal roots

B. VENTRAL – “front of the body”

1. THORACIC

a. PLEURAL: lungs only

b. MEDIASTINUM: space between lungs, in back of sternum & in front of

vertebrae that contains tubes (trachea, esophagus), thymus & heart

1) PERICARDIAL – heart only

------------------------------------------------DIAPHRAGM-----------------------------------------

2. ABDOMINOPELVIC

a. ABDOMINAL – superior cavity

*e.g.: stomach, spleen, liver, gallbladder, small & large intestine -draw line from iliac crest to top of pelvic bone, below the “imaginary” line is the pelvic cavity, above is abdominal-

b. PELVIC – inferior cavity

*e.g.: urinary bladder, large intestine (some), reproductive organs

c. DIVISIONS – more fully pinpoint where the organs are in the AP cavity

1) QUADRANTS: Belly button (umbilicus) where the division occurs

Right Upper Quadrant (RUQ) Left Upper Quadrant (LUQ)

Liver, gallbladder Stomach, spleen

Right Lower Quadrant (RLQ) Left Lower Quadrant (LLQ)

Appendix sigmoid colon


2) REGIONS: 9 areas

R. Hypochondriac Epigastric L. Hypochondriac Liver, gallbladder Stomach Spleen

R. Lumbar Umbilical L. Lumbar

Ascending colon small intestine descending colon

R. Inguinal/Iliac Hypogastric L. Inguinal/Iliac

Appendix, cecum urinary bladder sigmoid colon

VIII. SEROUS MEMBRANES – lines the body cavity (parietal) & covers the organ(s) within

the cavity (visceral portion) A. Pleura – lungs

B. Pericardium – heart

C. Peritoneum – abdominopelvic cavity

**Organs that are NOT FULLY COVERED in one of these serous membranes is considered

RETROPERITONEAL: (e.g.: Kidneys, pancreas, ureters & some parts of the large intestine)





Cells

CAPP102-I Session 2



1. List & describe the four components that comprise a cell.

2. List and describe the function of each organelle; compare smooth & rough ER.

3. Specify and describe the three cytoskeletal elements; cite two physiological examples.

4. Compare & contrast passive & active processes in regard to energy requirements & gradient.

5. Summarize the four types of passive processes.

6. Define primary and secondary active transport, symport & antiport.

7. Describe vesicular transport, endocytosis, phagocytosis, pinocytosis and exocytosis.

8. Compare & contrast mitosis & meiosis; describe the resulting cell from each process.

9. List the 5 cell cycle stages; identify the stage where duplication occurs.

I. COMPONENTS OF GENERALIZED ANIMAL CELL:

A. Plasma (cell) membrane – limiting barrier/skin, controls movement into/out of cell

B. Cytosol / cytoplasm – 75-90% water, surrounds all organelles & inclusions

C. Inclusions – temporary storage/secretion vesicles

D. Organelles – highly specialized cell activities:

1. Nucleus – “brain” - genetic information stored (genes, DNA, chromosomes)

2. Ribosomes – site of protein synthesis


3. Endoplasmic reticulum (ER) – “reaction platform”, make protein, lipids, detox.

a. Smooth ER – does NOT have ribosomes attached

b. Rough ER – HAS Ribosomes attached

4. Golgi Complex/ Apparatus – “Fed Ex” sort, package & deliver proteins/lipids

5. Lysosomes – “cell stomach” has digestive enzymes to break down molecules

6. Peroxisomes – “detoxifiers” digest with oxygen to rid harmful substances.

7. Mitochondria – “energy powerhouse” main generator of cell energy (ATP)

*Preservatives; BHT & BHA kill off mitochondria

8. Cytoskeleton: Structure of the cell (like bones), coordinate cell movements

a. Microtubules – “conveyor belt, RR tracks” + reinforce cell shape/structure

1) composed of tubulin, thickest

2) move substances within the cytoplasm

b. Intermediate Filaments – hold organelles in place + reinforce cell shape

c. Microfilaments – Muscle contraction + support cell shape

1) composed of actin/myosin, smallest

d. Examples: composed of different combinations of the cytoskeletal elements

1) Flagella – long whip like tail on sperm, moves entire cell

2) Cilia – little tiny hairs, move substances along cell (respiratory tract)

II. MOVEMENT OF SUBSTANCES ACROSS THE CELL MEMBRANE:

A. Passive Processes: *HIGH to LOW concentration gradient, NO ENERGY required*

1. Simple Diffusion – smallest solutes

2. Osmosis – water

3. Bulk flow/Filtration – larger particles

4. Facilitated Diffusion – channel/transporters needed – for the largest particles

B. Active Processes: *LOW to HIGH concentration gradient, ENERGY REQUIRED*

1. Active Transport:

a. Primary: Direct use of energy (ATP) – Sodium/Potassium Pump

example: Walking up a hill carrying a big box & a skateboard (using energy)


b. Secondary: Indirect use of energy – Sodium/Glucose transporter

example: Place box on the skateboard & let it roll down the hill (stored energy)

1) Symport – moving 2 substances in the SAME direction

2) Antiport – moving 2 substances in OPPOSITE directions.

2. Vesicular Transport: small packets/blisters (vesicles)

a. Endocytosis: Bring vesicle INTO the cell

1) Phagocytosis – cell eating (solids, e.g. engulfing bacteria)

Pseudopod – false foot (like frog’s tongue) goes out to engulf particle

2) Pinocytosis – cell drinking (liquid)

b. Exocytosis: Send vesicles OUT of the cell

*cell barfing/pooping

*e.g. Neurotransmitter release, removing cellular waste


III. NORMAL CELL DIVISION:

A. MITOSIS – EXACT DUPLICATION of genetic information

1. Somatic Cell Division – duplication of genes during interphase

2. Diploid - 46 chromosomes

3. Replacement & repair

B. MEIOSIS – ½ of the genetic information in each daughter cell

1. Sex Cell Division – NO duplication of genes during interphase

2. Haploid - 23 chromosomes

3. Gametes, sperm, egg.

IV. CELL CYCLE: IPMAT

A. Interphase: “resting” double all of the cell components (cytoplasm, organelles)

*Mitosis – also doubling of genetic information

*Meiosis – NO doubling of genetic information

B. Prophase

C. Metaphase

D. Anaphase

E. Telophase

Interesting “CELL” Facts: The entire cell can be viewed as a factory that contains an elaborate network of interlocking assembly lines, each of which is composed of a set of large protein machines. Even the simplest cells are bristling with high-tech machinery. On the outside, their surfaces are studded with sensors, gates, pumps and identification markers. Some bacteria even sport rotary outboard motors. Inside, cells are jam-packed with power plants, automated workshops and recycling units. Miniature monorails whisk materials from one location to another.

Focus on the Family, “Whose Comfortable Myth?” by Mark Hartwig, PhD. June 2002, p.2

XX XX

XX

XX

XX Parent Interphase

daughter

cells

XX XX

X

X Parent Interphase





Tissues

CAPP102-I Session 3



1. Compare the characteristics of epithelial tissue and connective tissue.

2. List the functions of epithelial tissue and connective tissue.

3. Define Simple, Stratified & Pseudostratified epithelial tissue.

4. Explain the function, location and identify the shape of the four types of epithelial cells.

5. Compare and contrast exocrine & endocrine glands.

6. Compare loose and dense connective tissue compositions.

7. Describe the types of loose and dense connective tissue; cite examples where each is located.

8. Specify the functions and location of the three cartilage types; list the composition of cartilage.

9. List the two liquid connective tissues and their functions.

10. Classify each muscle tissue type with its location and characteristics.

11. Identify and label the components of the neuron.

12. Define membrane; describe the function and location of the three types of membranes.

I. EPITHELIAL TISSUE: A. Characteristics:

1. Located on free surfaces (open to outside or lumen)

2. Avascular (no blood vessels), nutrition & waste removal by diffusion

3. High Mitotic Rate – rapid replacement in areas where protection is needed

4. Nerve supply throughout


B. Functions:

1. PROTECTION

2. Filtration

3. Absorption

4. Secretion

5. Excretion

6. Gas exchange

7. Sensation

C. EPITHELIAL CELLS:

1. Arrangement of Layers:

a. Simple – 1 cell layer thick

b. Stratified – many cell layers thick

c. Pseudostratified – specialized for cilia or mucus (Respiratory tract)

2. Types:

a. SQUAMOUS – flat cells

1) Simple squamous - Alveoli/capillary junction –gas exchange

2) Stratified squamous - Skin, digestive system – protection

b. CUBOIDAL – block shaped cells

secretions – sweat/digestive enzymes (glands) & absorption – intestine

1) EXOCRINE glands – release product into ducts

e.g.: sweat, oil, mucous, wax, digestive enzymes

2) ENDOCRINE glands – release hormones via the bloodstream

e.g.: adrenaline, testosterone, estrogen, etc.

c. COLUMNAR – long cells

protect, secrete, absorb & movement of substances – intestine

d. TRANSITIONAL – “cobble stone street” when empty, flat when filled

change shape – urinary bladder

pseudostratified

“Empty” “Filled”


II. CONNECTIVE TISSUE: Most common type of tissue in the body A. Characteristics:

1. VASCULAR except tendons, ligament, cartilage

2. NEVER found on a free surface

3. Rich nerve supply except cartilage

B. Functions: (think of a bra/jock strap!)

1. Bind together

2. Support

3. Insulate

4. Transport

5. Strengthen

6. Protect

7. Compartmentalize

C. Types of Connective Tissue

1. LOOSE Connective Tissue: Many cells, few fibers – loosely woven

a. Areolar – strength, elasticity & support, in subcutaneous tissue

b. Adipose – reduce heat loss, maintain body temp, protection, insulation

c. Reticular – framework of the outer capsule of organs

2. DENSE Connective Tissue: Many fibers, few cells – tightly or orderly arranged

a. Dense Regular Connective Tissue (DRCT) – 1 directional fibers

*very strong if pulled from 1 direction only

*tendon, ligament

b. Dense Irregular Connective Tissue (DICT) – fibers in many ways

*can withstand tensions from various directions

*fascia


c. Elastic Connective Tissue –

*elasticity, strength, maintain shape

*underlies the organs that change shape (bladder, lung, arteries, etc.)

3. Cartilage: can withstand more stress than dense or loose CT

a. Composition:

1) collagen/elastic fibers – strength

2) chondroitin sulfate (rubbery) – resilience (go back to normal shape)

b. Types:

1) Hyaline Cartilage: most abundant

*epiphyseal plate & joints

*allows flexibility, support, reduces friction, absorbs shock

*weakest of cartilage types

2) Fibrocartilage:

*intervertebral discs

*combines strength & rigidity

*strongest of cartilage types

3) Elastic Cartilage:

*external ear

*strength, elasticity & maintains shape

4. Bone: we will cover this in detail with the Skeletal System lecture

5. Liquid connective tissues:

a. Blood – transport oxygen & carbon dioxide

b. Lymph – transport interstitial fluid, dietary fats & pathogens


III. MUSCLE TISSUE: More in the Muscular System lecture

Type of Muscle Striations? Voluntary? Where found?

Skeletal Yes Yes* Attached to bone

Cardiac Yes No Heart*

Smooth No* No Intestinal tract

The * items in the chart above are all you will see on the quiz next week, you will need to fill in the rest.

IV. NERVOUS TISSUE: More in the Nervous System lecture during CAPP103

Neuron cell diagram:

V. MEMBRANES: flat sheet of flexible tissue that covers/lines, can be an EPI / CT combo.

A. MUCOUS: line body cavities open directly to the outside, fluid: mucus

1. digestive, respiratory, reproductive & urinary

2. lubricate, prevent drying out, traps particles, etc.

B. SEROUS: line body cavities NOT open to the outside, fluid: serous

1. Pleura - lungs

2. Pericardia - heart

3. Peritoneum – AP cavity

*reduce friction, allows organs to glide next to one another

C. SYNOVIAL: lines freely moveable joints (diarthritic), fluid: synovial

1. lubricate & nourish





INTEGUMENTARY SYSTEM: Anatomy & Physiology

CAPP102-I Session 5



1. Define the prefixes & roots describing the Integumentary system.

2. Describe the nine functions of the Integumentary system.

3. Compare the blood supply, function, location, composition of the three main layers of skin.

4. List the five layers of the epidermis; describe the characteristics of the corneum & basale.

5. Define corn, callus; describe the function of the epidermal cells.

6. Specify the function & location of the dermal ridges, Meissner & Pacinian corpuscles.

7. List the three names for the layer of skin directly below the dermis.

8. Compare the color, function, characteristics & vocabulary of the three skin pigments.

9. List the three epidermal derivatives.

10. Summarize the hair’s composition, function and associations; describe goose bumps.

11. Compare the secretion, function, characteristics, & vocabulary of the four types of glands.

12. Distinguish eccrine from apocrine sweat glands; define lactation.

13. Explain the functions, composition & growth of nails.

I. REVIEW OF MEDICAL TERMINOLOGY

Prefixes:

Epi = above/upon/on

Pachy = thick

Xantho = yellow

Xero = dry

Roots:

Aden/o = gland

Cutane/o = skin

Derm/at/o = dermis/skin

Epitheli/o = epithelium

Roots (continued):

Hidr/o = sweat

Ichthy/o = dry/scaly/fish-like

Kerat/o = epidermis

Keratin/o = keratin

Melan/o = melanin

Onych/o = nail

Pil/o = hair

Seb/o = sebum/sebaceous gland

Squam/o = scaly

Trich/o = hair


II. PHYSIOLOGY:

A. Regulation of body temperature (sweat, flow of blood)

B. Protection – physical barrier

C. Sensation (Nerve endings, touch, pressure, pain)

D. Excretion – heat loss, water loss, sweat (ions) – eliminating an unwanted product

E. Immunity – fight foreign invaders

F. Blood reservoir – 8-10% of the total blood flow

G. Synthesis of Vitamin D –helps absorb calcium from digestive tract to blood.

H. Absorption - of most substances placed on the skin

I. Secretion – (sweat, oil, ear wax) – distributing a wanted product on the skin’s surface

III. ANATOMY:

A. EPIDERMIS:

1. Characteristics:

a. Avascular (no blood)

b. #1 Function = PROTECTION

c. Composed of stratified squamous epithelium

2. Layers:

a. Stratum corneum – most superficial, 2-4 weeks from the basale to here

1) dead cells with keratin

2) continuously replaced from underneath

3) sloughed off dead cells fall off everywhere (bed, car, store, etc.)

4) CORN – focal area of thickening on foot

5) CALLUS – extra thick & hard epidermis on constantly used areas

So there is a “new you” in the bed every 2-4 weeks if you do not wash your sheets! Makes you want to vacuum out your car, doesn’t it!

The more you massage your clients, the thicker your hands will callus over (developing even more layers of stratified squamous epithelium) – in order to protect your hands from the constant use.

b. Stratum lucidum

c. Stratum granulosum


d. Stratum spinosum

e. Stratum basale/germinativum – deepest layer

1) Only “alive” layer - blood via diffusion from the dermal ridges

2) Very active in mitosis Chemical stripping of the skin or exfoliation actually strips away the upper layers of our stratified squamous epithelium. The “ruddy” or red glow after this technique is really caused by being closer to the blood supply layer, and having less protective layers left! Occasional scrubbing with Loofah is OK!

3. Epidermal Cells:

a. Keratinocytes produce Keratin

*Function: Protect skin from light, heat, microbes & some chemicals

b. Melanocytes produce Melanin: yellow to black pigment (skin color)

*Function: Absorption of UV light – shield nuclei from damage

c. Langerhans cells – immune response against microbes,

*easily damaged by UV light

These cells hang out behind the melanin shielded stratified squamous epithelial cells so they do not get damaged by the sun’s rays.

d. Merkel disks / cells – sensitive to touch, found in the germinativum

B. DERMIS:

1. Characteristics:

a. very vascular (lots of blood!)

b. Dense Irregular Connective tissue (DICT) = extensibility & elasticity

c. thicker on the palms, soles, posterior & lateral parts of the body

2. Dermal Ridges/Papillae – reflect in the epidermis as FINGERPRINTS

a. Increased surface area for diffusion to the stratum basale

b. Allows rapid replacement of sloughed off cells

Since fingerprints originate at the dermal ridges, only 2nd to 3rd degree burns tend to affect the pattern/design of the fingerprints.

3. Meissner corpuscles – nerve endings sensitive to touch

C. HYPODERMIS / SUBCUTANEOUS TISSUE / SUPERFICIAL FASCIA:

1. areolar & adipose tissue

2. very vascular

3. Pacinian corpuscles – sensory nerve endings that are sensitive to pressure


IV. SKIN COLOR – PIGMENTATION:

A. Melanin – secreted by melanocytes

1. Color: Pale yellow to black

2. Function: protect the skin from UV damage (“tanning”)

3. # melanocytes same for all races, amount of melanin produced different

4. Vocabulary:

a. Freckle, liver spot, age spots – melanin patch

b. Skin cancer = Too much exposure to UV rays

c. Albinism = no melanin produced

d. Vitiligo = lost patches of melanocytes – irregular white spots on skin/hair

When someone lays out in the sun to “tan”– they are actually challenging the protective function of melanin. Melanin’s job is to scan the genetic code sequence of the cells that are reproducing and replace any errors that may occur as a result of UV ray damage. When a person “tans” for a long period of time – often the errors occur too frequently & fast for melanin to keep up – leading to a genetic error, if the mutation is replicated over a period of time it can lead to skin cancer.

B. Carotene – secreted by carotenocytes

1. Color: yellow-orange (think carrots)

2. Function: vitamin A precursor (helps vision & skin/hair health)

3. Found in all layers of the skin

Inexpensive “fake sun” products that are used to create a “tanned” look often stimulate carotenocytes – causing you to look orange. This is exactly why they suggest trying out the chemical on some inconspicuous place. The more expensive brands seem to be more successful at stimulating melanocytes - but why would you want to place chemicals on your body in the first place? *If little melanin or carotene is present – epidermis appears clear/person has light colored skin*

C. Hemoglobin – iron compound carried by the Red Blood Cell (Erythrocyte)

1. Color: red

2. Function: transport oxygen & carbon dioxide

3. Vocabulary:

a. Cyanotic = low oxygen dissolved in blood, mouth, nails & skin appear blue

b. Jaundice = bilirubin build up in blood, whites of eyes & skin appear yellow

c. Erythema = blushing, redness of skin (exercise, heat, injury, inflammation)

4. This pigment seen best in people with light colored skin.


V. 3 EPIDERMAL DERIVATIVES / Accessory Skin Structures: (The horn & hooves division)

A. HAIR: *you lose 100 SCALP hairs per day*

1. Composition: Keratin

Melanin (hair color), if pigment is lost – grey/white hair results

2. Function: protection from injury, sun, heat loss or foreign particles entering

3. Associated with each hair is a:

a .nerve ending – sensitive to touch

b. sebaceous gland - oil

c. arrector pili smooth muscle – goose bumps – cold/fright pull hair straight up

(Goose bumps & shivering can increase the body temp DRASTICALLY)

B. GLANDS:

1. Sebaceous glands – secrete SEBUM (oil)

a. Associated with a hair or empties onto the skin surface

b. NOT found on the palms & soles

c. Function: prevent skin drying out, inhibits bacterial growth & keeps skin flexible.

d. Acne = overproduction of sebum with bacterial growth (pimples/boils)

2. Sudoriferous glands – secrete sweat

a. Secrete directly onto skin surface

b. Function: Regulate body temperature (evaporation), Eliminate wastes (urea)

Urea is a nitrogenous waste product also found in urine (so either you pee pee or you sweat pee)

c. Types:

1) ECCRINE: Most common type (think sweaty palms)

a) Found: Forehead, palms & soles + many other body areas

b) Watery secretion

2) APOCRINE:

a) Found: “smelly areas” – axilla, inguinal, breast regions

b) Pheromone secretion from:

*sexual excitement

*emotional stresses

*puberty

c) Sticky, viscous secretion – which is supposed to be ATTRACTIVE

to your mate!

(The pheromones can be truly overwhelming when enclosed in a hot, crowded bus in a third world country!) American Adolescents notice that they “smell” and need to use deodorant about this time.


Antiperspirants versus Deodorants: Antiperspirants have aluminum in them to stop sweat elimination, preventing a VITAL & NECESSARY body function. A build up of toxins at the axillary region has been strongly linked to breast cancer. Aluminum has also been linked to Alzheimer’s disease, brain tumors and demyelinating diseases. Aluminum can leech into your food when cooking acidic foods (tomatoes especially) with aluminum foil or aluminum pans. Soda that is packaged in aluminum cans is equally a problem. Aluminum is a neurotoxin and is harmful to the body in large amounts! Deodorants just “cover the smell”, but do not prevent the perspiration.

3. Ceruminous glands – secrete cerumen (ear wax)

a. Modified sudoriferous glands

b. sticky secretion

c. Function: traps foreign particles & bugs to prevent damage to ear

Ear candling can greatly help to reduce the excess build up of the cerumen - to improve hearing & enhance the ear’s protective abilities.

4. Mammary glands – secrete milk

a. Modified sudoriferous glands

b. Nipple – pigmented projection where all of the milk ducts empty

c. Areola – circular pigmented area around nipple, rough due to oil glands

d. Function: Lactation: synthesis, secretion & ejection of milk

Remember that newborn babies see only contrasting/black & white colors: the difference between the lighter skin of the breast & the darker areola and darkly pigmented nipple appears as a bulls-eye target for a nursing baby.

C. NAILS:

1. Composition: hard keratinized plates

2. Functions: Grasp/manipulate objects, protection end of the finger/toe, scratch

3. Growth: 1mm/wk – most used hand/finger grows faster, toenails grows slower

Don’t be surprised that as massage students & therapists your nail growth will be MUCH faster than 1mm/wk. You will feel like you have to CONSTANTLY clip your fingernails. Your body responds to the increased use of your hands by increasing nail growth in order to protect your fingertips!!





Integumentary System – Pathology

CAPP102-I Session 6



1. List the four signs of inflammation.

2. Label the skin condition diagram.

3. Describe and compare the causes & characteristics of the 7 CONTAGIOUS skin disorders.

4. Define tinea pedis & cruris and pediculosis capitis & pubis.

5. Summarize the causes & characteristics of the 10 Non-contagious skin disorders.

6. Define Atopic, Seborrheic, & Contact dermatitis.

7. Specify the prevalence, location & treatment of the three types of skin cancer.

8. List the results of burns; describe the appearance of first, second & third degree burns.

9. Define alopecia, petechia, pruritis, and vitiligo.

I. SIGNS OF INFLAMMATION:

RUBOR = redness

CALOR = heat

DOLAR = pain

TUMOR = swelling

II. SKIN CONDITION DIAGRAM – fill in! (next page)


Answers are in

alphabetical order.

No words will be

provided on quiz

or exam


III. OTHER PATHOLOGY OF THE INTEGUMENTARY SYSTEM:

A. Contagious Skin Disorders:

Immunosuppression (stress, not sleeping or eating right, with no exercise or no water) increases

YOUR risk of acquiring these pathological conditions

It is advisable to re-schedule any client with the following seven conditions until recovery/not actively contagious.

1. Furuncle – boil, caused by Staph. aureus bacteria – very hot & painful

2. Tinea - ringworm (dermatophytosis) – caused by fungus, much itching

Tinea pedis – athlete’s foot Tinea cruris – jock itch

3. Herpes Simplex Virus (HSV) –

a. cold sores– viral infection of mucous membranes/skin

b. infectious when lesions present.

c. Itching, pustule, ulcer, crusting.

4. Impetigo – staph /strep bacterial infection, crusted over pustules, kids

5. Scabies –

a. caused by mites that drink blood burrows in warm, moist areas

b. unrelenting itching

c. Treatment often causes more itching than condition, necessary to wash bedding,

clothes, couch, etc.

6. Lice (Pediculosis) – caused by insects that feed on blood; itching, nits (eggs) cling to hair

shaft (behind ears, neckline) & look like tiny rice grains.

Suffocating the lice with mayo is a less toxic alternative to the pesticidal shampoos.

Pediculosis capitis – head lice Pediculosis pubis – crab lice / genital lice

7. Warts (verruca vulgaris) –

a. caused by Human Papillomavirus (HPV),

b. transferred by direct contact through cut/break in skin.

c. VERY slow growth & slow to disappear.

d. Most benign neoplasms which target the keratinocytes.

e. Immunosuppression & hormone flux (puberty, pregnancy) increases risk

Homeopathic remedy: Thuja occidentalis seems to be of some help to get rid of warts. Also making a poultice out of a Kombucha mushroom can also help warts disappear.


B. Non-Contagious Skin Disorders:

1. Acne – bacterial infection of sebaceous gland. Worse: hormonal flux, stress or liver

congestion.

Helpful treatments include:

*Cleansing the liver:

1. Dandelion root (tea, tincture, or capsule) – 1-2x/day for 30-60 days

2. Milk thistle (tea, tincture, or capsule) – 1-2x/day for 30-60 days

3. OR Drinking Kombucha &/or Beet Kvass

*Cleansing the blood: Ginger & Turmeric (Compound P) or Garlic (raw is best –

internally)

*Colon cleanse / recolonization

Active Probiotic (refrigerated best) - Acidophilus/Bifidus

Abdominal or foot reflexology colon massage

Lactofermented foods (especially Kefir)

*Cleaning face/affected areas with tea tree essential oil (or soap)

*Changing the diet to more whole foods & SOAKED grains, less processed foods

*Drinking more water, getting more sleep & exercise; reducing stress!

2. Dermatitis - inflammation of the skin (immune system over-reaction)

a. Atopic dermatitis – hypersensitivity reaction: allergy, heredity, psychological

wool clothing & excessive washing/soap exposure makes condition worse

b. Seborrheic dermatitis – Dandruff–scalp, cradle cap – infants; Gray oily, dry thick

scales

c. Contact dermatitis – external irritant or allergen

As a general rule – if you cannot pronounce what is in your cosmetic product & there is NO explanation in parenthesis that explains what the ingredient is used for – you probably do NOT want to place that product on your body. The best lotions, soaps, shampoos, etc. should sound good enough to EAT! Considering that your skin absorbs your skin product directly into your bloodstream (without the gastric acid/enzyme buffers that occur in the digestive system) – you should be MORE cautious about what you put ON your body than what you place IN your body!

Often dermatitis is brought on by a chemical irritant found body/facial products. Some of these agents are:

Mineral oil – found in ALL mainstream lotions, baby oils & many other cosmetic products – is

actually a machine lubricant & a human body desiccant (dries out the skin) Hm – so the

lotion companies put in a chemical that dries out the skin, so you will………. BUY MORE

of their products (very interesting!) So the more you use a lotion with mineral oil, the drier

your skin will be. But what about baby oil you say? Well babies are REALLY quick to

replace their hydration – so the mineral oil strips away the nourishment of the skin & the

baby’s body quickly replenishes the supply (making them feel very soft). Try using one of

the fabulous alternatives found in many health food stores that use coconut, aloe vera,

calendula or avocado oil to hydrate instead.


Propylene glycol – which is actually automobile radiator coolant/fluid. Do you REALLY want

to put this onto your skin so you can directly absorb it into the bloodstream & then have your

liver detoxify it? Most deodorants (even natural ones) seem to have this chemical in them.

Petroleum jelly – formed by the oil refining process to lubricate machinery. It “hydrates”

human skin by preventing loss of moisture (think suffocation here). The skin & mucous

membranes MUST breathe – to eliminate toxins & to regulate body temperature. Use

beeswax based lip-balms instead.

Antibacterial soaps – tend to kill off the less resistant bacteria, leaving behind the Arnold

Schwarzenegger type bacteria - which can make us REALLY sick. We carry around on our

skin most of the bacteria & viruses that will infect us throughout our lives, so why select the

really VIRULENT, strongest strains to make us sick? If you are worried about bacteria – use

tea tree essential oil products to naturally cleanse the skin.

Fragrance, Red Dye #2 & 3, Yellow Dye #5, Orange Dye #8, Green Dye #3, etc – most of

these are known carcinogens & harmful to the body in large amounts (e.g. daily use of

products or intake of food with these ingredients). Choose products with natural fragrance or

essential oils for scent. Choose natural products with beet juice, spinach, carrot or turmeric

for coloring.

3. Urticaria – hives, wheals appear after contact with/ingestion of allergen/food or stress

4. Freckle – simple melanin concentrations, like nail head.

5. Mole – elevated, colored spot; harmless unless irritated.

6. Seborrheic keratosis – benign, pigmented skin tumor, waxy, “pasted on” appearance

(elderly)

7. Ecchymosis – bruising (black & blue mark)

Remember that most people do NOT look at their back & gluteal regions – so you will need to inform your clients about bruises, moles, or changes in skin that you see while giving a massage.

#1 – it reminds the client to keep track of ALL parts of their body.

#2 – it prevents the client who has had deep tissue/neuromuscular therapy from thinking that the therapeutic technique used caused the bruise.

8. Psoriasis – chronic, recurring skin inflammation; Stem cells in the basale divide every

2-4 days, instead of 28-32 days. Pile up of itchy, red or pink, with silvery scales on top;

massage enhances exfoliation & benefits the client.

9. Decubitus ulcers (bed sores) - caused by pressure/friction over bone; inadequate blood

supply: causing craters in skin; bed-ridden, elderly: greatest risk.


10. Candidiasis (Thrush) – superficial fungal infection /yeast; Caused by:

immunosuppression, improper hygiene & antibiotic use increased growth of Candida

albicans.

Treat yeast infections with:

1. NO sugar diet (no sweeteners, fruit or simple starches),

2. anti-fungal (grapefruit seed extract)

3. Probiotic (HIGH doses! of Acidophilus, Bifidus to recolonize)

4. OR: Take in more lacto-fermented foods like Sauerkraut, Chutneys, Kvass,

Kombucha, Kefir & Fil Mjolk. All of these foods contain Acidophilus & Bifidus

(as long as they do NOT have Vinegar to provide the tartness.)The Lactic acid

environment that these foods promote actually inhibits the pathogenic yeast from

multiplying. Kefir has the added benefit of killing off the yeast and re-colonizing

the inside lining of the gut with beneficial bacteria.

IV. CANCER: ABCDEs: Asymmetrical, Borders (irregular), Color (multicolored), Diameter

(large), Elevated

A. Basal cell carcinoma (BCC) – 75% of all skin cancer

*Arise from the stratum basale & rarely spread

*Can be successfully surgically removed

B. Squamous cell carcinoma (SCC) – 20%

*Arise from epidermal squamous cells & vary in their spread

*sun damaged skin – where lesions arise

*Can be successfully surgically removed

C. Malignant melanoma – 5%

*Arise from melanocytes, spread rapidly

*Leading cause of death from skin cancer

V. BURNS: disrupt homeostasis, destroy protection *infection, invasion, loss of fluid & loss of temperature regulation*

1st degree – sunburn, mild pain & redness – epidermis only is affected

2nd

degree – blisters, fluid accumulates between epidermis & dermis, redness, edema, pain

*some skin functions are lost *all of the epidermis & some dermis affected

3rd

degree – charring, destroys the epidermis, dermis & epidermal derivatives

*most skin functions lost *Tx: debridement (gently “scrub” away dead skin cells)

VI. VOCABULARY:

A. Alopecia – balding, hair loss

B. Petechia – small, pinpoint hemorrhage

C. Pruritus – severe itching

D. Vitiligo– loss of pigment (melanin) on skin/hair, white patches

Please remember that change to a healthier lifestyle takes time – decide to change

a few things at a time, not everything at once!





SKELETAL SYSTEM: Part 1

CAPP102-I Session 7



1. Define the prefixes, suffixes & roots describing the Skeletal System.

2. Describe the 6 functions of bone; define hemopoiesis.

3. List calcium amount in blood versus stored; describe the functions of calcium.

4. Compare & contrast the location and function of yellow & red bone marrow in kids and adults.

5. Specify the location & characteristics of the 5 classes of bone.

6. Label the parts of a long bone; describe each component’s function and location.

7. List & describe the functions of the three bone making cells; compare immature & mature bone.

8. Describe the function and appearance of the cell that breaks down bone.

9. Compare the functions, location, organization & characteristics of compact & spongy bone.

10. Identify & define canaliculi, lacunae, osteon, Haversian canal, & trabeculae.

11. Describe intramembranous & endochondrial ossification; specify the location where they occur.

12. Describe the important forces that stimulate bone remodeling.

I. REVIEW OF MEDICAL TERMINOLOGY:

Prefixes: Endo = within

Roots:

Ankyl/o = fusion/adhesion

Arthr/o = joint

Chondr/o = cartilage

Disc/o = Intervertebral disc

Fibr/o = fibre

Kyph/o = crooked/humped

Lamin/o = lamina

Lith/o = stone

Lord/o = bent forward

Myel/o = bone marrow

Osse/o = bone

Oste/o = bone

Scoli/o = crooked/twisted

Spondyl/o = vertebrae

Suffixes:

-blast = immature germ cell

-centesis = puncture to remove fluid

-clast = breaking

-desis = fixation

-genic = pertaining to formation

-malacia = condition of softening

-olisthesis = slipping


II. ANATOMY & PHYSIOLOGY OF THE SKELETAL SYSTEM:

A. Functions of Skeletal System:

1. Support – framework & attachment for muscles

2. Protection – from internal organ injury

3. Assist in Movement – muscles pull on bones to create movement

4. Mineral homeostasis – Calcium & Phosphorus

a. bone stores 99% of our calcium, 1% - blood (balance by Parathyroid hormone)

b. muscle contraction, neural conduction, enzymes, co-factors & blood clotting all

require Calcium to function correctly.

Consuming too much soda (infinitely high in phosphorus) actually LEECHES out the calcium stored in bone. Phosphorus needs to be bound to Calcium in order to be eliminated from the body. The phosphorus in soda pulls away the calcium from our bone in order to be excreted by the urinary or digestive systems.

5. Site of blood cell production – red bone marrow makes RBCs, WBCs, & platelets

Hemopoiesis – “make blood”

a. sites in adults: pelvis, ribs, sternum, vertebrae, skull, end of arm, thigh

b. sites in children: everywhere

c. Composition: stem cells, blood blast cells, adipocytes & macrophages

Here is where stem cell research fits into the picture. Stem cells can be stimulated to become white blood cells, red blood cells or platelets depending on what the body needs. For example, if you have an anemia & your RBCs are being broken down rapidly – the stem cells are provided the correct nutrients, substrates & conditions to make more erythrocytes – quickly! If you are fighting off a severe infection – then the stem cells will chug out more white blood cells for your infantry against the bug/microbe/virus/fungus/bacteria/ pathogen/beasty that you are fighting.

6. Energy storage – yellow bone marrow (fat / triglycerides)

a. In adults – most long bones (hopefully NONE in children)

b. With age much of red bone marrow changes to yellow.

With the age of fast & processed food – children are building up yellow bone marrow at an alarming rate. Unfortunately the switch from red to yellow bone marrow in kids means that they are less adaptable to changes. If they suddenly experience a new illness, they will have a harder time healing from the sickness because their body does not have a huge reserve of red bone marrow to make armies of new white blood cells.


B. Classification of bones:

1. LONG – greater length than width, curved for strength

Location: femur, tibia, fibula, humerus, ulna, radius, phalanges (great test question)

So why are the long bones curved? If your bones where straight up & down they would NOT be very strong, so on walking – you would break your leg bones…OUCH! The curving creates strength – like the flying buttresses on a cathedral or an arched doorway. The curve helps to evenly distribute the weight of the stress across the bone, instead of localizing it in one spot (like the ends of the bone) - it’s like walking in 4 feet of snow with boots (you sink into the drifts) versus snow shoes (you walk on top of the snow). A curved bone distributes the forces associated with movement across the bone length, in turn increasing strength & efficiency.

2. SHORT – cube shaped, equal in length & width

Location: tarsal & carpal bones

3. FLAT – thin, protective, extensive muscle attachment sites

Location: cranial bones, sternum, ribs, scapulae (another great test question)

4. IRREGULAR – complex shapes

Location: vertebrae, facial bones

5. SESAMOID – develop in tendons where friction, tension or stress occur; protect

tendons from wear & tear, can change pull direction to increase efficiency.

Location: palms, soles *vary in number, but most people have patellae*

Can you crawl on your hands & knees for an extended period of time without having your knees hurt? How do babies do it? Children are NOT BORN with a patella – normally after two years of age the patella forms in the common quadriceps TENDON (muscle to bone) inserting at the tibial tuberosity to change it to the patellar LIGAMENT (bone to bone) below the knee cap. Not having a hard kneecap to damage during the crawling & walking stages allows the child to learn these developmental milestones without the incredible pain of repeatedly bruising their sesamoid bones.


C. Structure of a long bone (you will need to be able to identify the parts on a diagram)

1. Epiphysis – End

2. Metaphysis – neck (Middle)

a. Epiphyseal plate/ Growth line – cartilage is replaced by bone (grows bone in

length)

3. Diaphysis – shaft

4. Periosteum – covers entire bone, except where hyaline cartilage is, repair/nutrition

a. Outer layer: fibrous (DICT)

b. Inner layer: osteogenic – growth of the diameter of bone

5. Medullary / Marrow cavity – where red or yellow bone marrow resides

a. Nutrient artery - carries blood / nutrients to bone tissue.

b. Endosteum – Lines the marrow cavity.

1) Has osteogenic (making bone) & osteoclast (breaking down bone) cells.

2) Helps to grow the width of bone

6. Articular / Hyaline cartilage – reduce friction, absorb shock, cushion bone from bone

There is NO periosteum underneath the layer of Articular cartilage. So when the cartilage is stripped away from excessive wear on the joint or lack of hydration – there is no periosteum to repair & protect the end of the bone. Essentially the cartilage is a small cushion pad, when the pad is gone, osteoarthritis results: bone grinds against bone – causing bone loss, inflammation & much pain. Cartilage is VERY slow to heal & gets its blood and oxygen from diffusion only. Extremely high doses of Glucosamine Sulfate (9,000-12,000mg/day) for at least 60 days (or more; until the pain subsides) seems to stimulate cartilage replacement. Efficient cartilage tissue is very well hydrated, so the formation of new cartilage in our joints requires high water intake as well.


D. Bone cells:

1. Making bone cells:

a. OSTEOGENIC CELLS – unspecialized cells, mitotic

b. OSTEOBLASTS – immature, secrete collagen, NO MITOSIS

1) Cells become trapped in matrix

2) Calcification – when mineral salts deposit into the collagen framework

c. OSTEOCYTES – mature bone cells, daily activities: nutrients in/ wastes out

Note: There are more bone cells in IMMATURE bone, than there is in MATURE bone

Remember that ALL the main work of the skeletal system happens at the level of the cell (osteocytes)

_____________________________________________________________________________________

2. Breaking down bone cell:

a. OSTEOCLASTS – Remodel, recycle bone components.

1) Needed for maintenance, growth & repair.

2) Resorption of bone due to lysosomal enzymes that destroy bone matrix.

3) Huge cells, up to 50 monocytes (WBCs) fuse together (think Pacman!)

Matrix

Calcified &

mineralized matrix


E. Bone Structure:

1. Compact / Dense:

a. Function – protect, support, resist stress

b. Location – external layer of all bones & most of the diaphysis

c. Organization – few spaces, orderly, concentric rings, Haversian canal (osteon)

d. Unique characteristic – Canaliculi – spoke on wheel, nutrient supply to

osteocytes, Lacunae – hub on wheel – where osteocytes

reside

2. Spongy / Cancellous: a. Function – Site of hemopoiesis in adults, shock absorber (protect ends)

b. Location – internal layer of short, flat, irregular bones & epiphysis – long bones

c. Organization – irregular network (spongy bone can progress to compact bone)

d. Unique characteristic – Trabeculae – thin spike/plate of bone – nourished by

blood that circulates in the marrow cavity.

Canaliculi

Osteocyte

in Lacunae

Osteon

Osteon from

side

Osteocyte Lacunae


F. Types of Ossification:

1. Intramembranous – where mesenchyme goes directly to osteogenic cells

a. Location: fontanels, flat bones of skull, mandible

The “soft spot” or fontanel on the skull of a baby is really composed of VERY tough & fibrous tissue. If the fontanel was composed of cartilage instead – it would be VERY easy to damage the delicate & highly specialized brain tissue. So intramembranous ossification (mesenchyme to bone) occurs in areas where having a “gushy” cartilagenous stage would cause more harm than good.

2. Endochondrial – where mesenchyme goes through cartilage & then to osteogenic cells

a. Location: long bones (cartilage replaced by bone at epiphyseal plate), most bones

Endochondrial ossification allows extensive growth (in length) of the long bones.

*BONES remodel according to lines of mechanical stress.

*The pull from skeletal muscles plus the pull of gravity help to keep our bones healthy.

This is exactly why WEIGHT bearing exercise is so important. If we do not USE our bones, we LOSE bone density. The forces (from exercise & movement) that act upon our bones actually increase the bone density & strength of our bones, keeping them healthy & efficient.





SKELETAL SYSTEM: Part 2

CAPP102-I Session 8



1. Describe the important areas and characteristics of interstitial & appositional bone growth.

2. Specify the functions of each different factors that effects bone metabolism/remodeling.

3. List the three bone components; describe the percentage and function of each.

4. Define rubbery and brittle bones

5. Describe fractures; define complete, open, closed, incomplete.

6. Summarize the causes, characteristics, signs/symptoms & treatment of:

a. Osteoporosis

b. Osteoarthritis

c. Osteomyelitis

d. Dislocations

e. Osgood-Schlatter Disease

f. Plantar Fasciitis

7. Describe the characteristics of osteomalacia and Paget’s disease.

8. Specify the cause of postural deviations; define kyphosis, lordosis, scoliosis.

A. BONE GROWTH: 1. Interstitial: LENGTH, epiphyseal plate

The length of time that the epiphyseal plate “stays open” (is still cartilaginous) the TALLER you potentially could be! Doctors can see the difference between cartilaginous & osseous tissue on an X-ray & will often tell children – “you are still growing”. Growth hormone influences interstitial growth & the amount of time that the growth plate “stays open”.


So if you are a child and have a pituitary gland tumor (where growth hormone is synthesized) that results in a hypersecretion of growth hormone – you become a GIANT! Think Andre the Giant. If you are an adult, with a hypersecretion of growth hormone – you develop REALLY long facial bones, digits (fingers/toes) and a large jaw. Think Abraham Lincoln. The facial bones, phalanges & jaw are the last places in the body for the growth plates to close. If you are a child and have a hyposecretion of growth hormone, meaning your epiphyseal plate “closes” early, you become a dwarf. Think the Munchkins on Wizard of Oz.

2. Appositional: WIDTH, periosteum – osteogenic cells &

endosteum – osteogenic & osteoclast cells

When you use bone more – you increase the density of the bone and the amount of calcified & mineralized matrix. A thicker bone needs an increased blood flow (larger marrow cavity) to support the main function of the osteocytes – nutrients in, wastes out. So when you decide to take up aerobics 5x per week after being a couch potato for a year – the osteogenic cells will rapidly add bone to the outside of the diaphysis (but still under the outer DICT layer of the periosteum). The marrow cavity needs to be enlarged to support a bigger bone, so the osteoclast cells in the endosteum eat away at the inner margin of the medullary cavity to increase its size. In summary – to grow a bone in width – you need to add more bone to the outside (periosteum) and break down more bone on the inside (endosteum).

What happens when you are running 100 miles a week and then you suddenly stop? Does your body need to sustain all the extra dense bones? Absolutely not! The body is very efficient & very rapidly breaks down the extra bone (osteoclasts chomp away at the outside of bone) and the marrow cavity also reduces down by increasing the inner margin of bone inside the cavity (endosteum). So you break down more bone on the outside, & make more bone on the inside.

Bone is CONSTANTLY remodeling to keep up with the new physiological stresses (or lack of them) that we require our body to do. If we break a leg – than the casted leg’s bone will decrease in bone density – because it does not have to resist as much stress. The uncasted leg increases in bone density because it is “taking up the slack” and doing more work to compensate for the broken leg.

3. Characteristics of bone growth:

a. Interstitial growth is only in one direction – LONGER (never shorter ;)

b. Appositional growth is flexible according to activity level (wider vs. less wide)

c. Bone is CONSTANTLY being remodeled, old bone replaced with new bone.

Think of a street getting a new layer of asphalt. The old asphalt is ripped up by the bulldozers, then the new layer of asphalt is laid down by the paver. In bone both processes are happening at the same time. As the osteoclasts are recycling the components of old bone & ripping out the worn out osteon, right behind this process the osteogenic cells are laying down a new osteon.

B. BONE METABOLISM / REMODELING INFLUENCES:

Factors: Function / Needed for (normal):

1. Minerals:

Calcium & Phosphorus hard matrix

Magnesium osteoblast activity


2. Vitamins:

Vitamin A osteoclast remodeling

Vitamin C bone matrix maintenance, growth, repair

Vitamin D increases absorption of calcium from small intestine

3. Hormones:

Human growth hormone (hGH) general growth of bone (secreted by pituitary gland)

Insulinlike growth factors (IGFs) bone growth (secreted by bone & liver)

Insulin bone growth (pancreas)

Thyroid hormones (TH) bone growth (thyroid gland)

Parathyroid hormones (PTH) bone reabsorption by osteoclasts, increases

calcium in blood, less in bone(parathyroid glands)

Estrogen bone growth spurt in puberty (ovaries)

Androgens bone growth spurt in puberty (testes/adrenal glands)

Please notice that all of the other hormones stimulate the osteogenic cell progression & there is only one hormone, parathyroid hormone, that stimulates bone reabsorption by the osteoclasts. (This is a great multiple choice test question!)

4. Exercise weight bearing activities = thicker, stronger bones

& reduce the bone mass loss of aging.

C. COMPOSITION OF BONE:

1. Water: 25%

2. Protein / Collagen 25% (TENSILE STRENGTH / resist stretching)

3. Mineral salts: 50% (HARDNESS) - Calcium carbonate & hydroxyapatite

*Too much protein/collagen = rubbery bones (osteomalacia/rickets)

*Too many mineral salts = brittle bones (osteoporosis)

D. PATHOLOGY:

1. Fractures

a. Complete – bone entirely broken through

1) Open – bone sticking through skin (increasing infection risk)

2) Closed – bone not through skin

b. Incomplete – bone partially broken through

2. Osteoporosis – Calcium is used faster than it can be replaced. Porous bones

a. Increase in bone resorption, lose bone mass, increase bone fractures

b. 5x more common in women

c. 60% genetic, 40% lifestyle (diet, smoking, exercise, stress)


d. Soda interferes with calcium absorption, leeched from bone to excrete phosphorus.

f. WHITE SUGAR &/or stress will pull out the calcium from bones!

g. Bio-available sources of calcium include the following:

1) Sea Veggies: wakame, nori, kombu and agar-agar

2) Dairy: milk, yogurt, cheese

3) Dark green leafy veggies: kale, collard greens, romaine lettuce and turnip greens

4) Eggshells: the following information is taken from

http://nourishedmagazine.com.au/blog/articles/how-to-make-calcium-using-egg-

shells

How to Make Calcium using Egg Shells By Bee Wilder

Eggshells present healthy, balanced calcium due to trace amounts of other minerals contained in it. Eggshell calcium is probably the best natural source of calcium, and it is easier for your body to digest and absorb. Dutch researchers have reported recently a highly positive effect of eggshell calcium (with added magnesium and vitamin D) on bone mineral density in a scientific study (double blind, placebo-controlled). Laboratory test and measures of bone density were carefully made in these studies. The eggshell supplemented group had measurable increases in bone density in their hip bones, after one year. The ideal bone-building combination of eggshell calcium and vitamin D3 was also well documented in Japanese studies. Researchers at the Japan Women’s University, Tokyo studied a combination of vitamin D3 and eggshell powder in animals with osteoporosis. Not only was the eggshell powder with vitamin D3 able to improve bone mineral density, but it did it without significantly increasing blood calcium levels. You can use any kind of egg (chicken, goose, duck), but it is best to use organic or certified organic eggs from free-range birds. If the bird does not get proper nutrients the eggshells won’t contain the nutrients we need.

g. Tx: weight bearing exercises (PREVENTION= KEY!)

The balance of too many mineral salts to not enough calcium can get so bad that the simple act of sitting down could cause a bone fracture! OUCH!

3. Osteomalacia – no mineralization of bone, no calcium or vitamin D deficiency

Soft / rubbery bones (Rickets in kids)

http://nourishedmagazine.com.au/blog/articles/author/bwilder/


4. Paget’s disease

a. Healthy bone reabsorbed much faster than normal

b. Bone replaced with jumbled connective tissue, which never hardens

c. Weakens/distorts affected bones

d. Tx: weight bearing exercise & massage!

5. Postural Deviations: often due to muscular imbalances, especially growth years.

a. Kyphosis – humpback

b. Lordosis – sway back (“big butt syndrome”) – anterior hip rotation

c. Scoliosis – S or C shaped spine.

Remember that after dealing with an imbalance for a long enough period of time the body finally gives up, accepts the imbalance as “normal” and resets homeostasis to that new position. Massage (especially during the growth years in kids) often will help prevent or “correct” the unequal muscle tensions that are pulling the vertebrae out of alignment. If you have a client with these deviations it is a GREAT time to recommend a Chiropractor to join your Allied Health Professionals Team!

6. Osteoarthritis – Hyaline / Articular cartilage is worn away or off.

a. Bones GRIND against each other

b. Bone worn down because it is not covered by periosteum

7. Osteomyelitis – Infection in a bone.

a. Causes:

1) In young children – bacteria spread to bone from other sites

2) Local trauma – compound fracture – puncture skin letting bacteria enter

b. Signs/Symptoms:

1) pain, sudden fever, chills, malaise, headaches

2) acute – need antibiotics quickly or amputations may be needed.

3) chronic – joint deformity, decreased ROM, increased dislocation.

8. Dislocations – displacement of bone from joint

a. Most commonly seen in shoulder, hip, fingers

b. Partial dislocations (subluxations) occur in the spinal facet joints.

d. Causes: trauma (life?), deformity, disease

e. signs/symptoms: pain, swelling, deformity, lack of mobility of joint.

9. Osgood-Schlatter Disease – ischemic necrosis of the tibial tuberosity.

a. Tibial tuberosity can rip off of the tibia due to the force of the quads.

b. Young athletes that overuse their quads are the most affected.

c. Signs/symptoms: significant pain & swelling below knee

d. Treatment: immobilize leg to encourage healing.


10. Plantar Fasciitis – inflamed fascia on inferior foot surface.

a. Causes:

1) excessive walking, running, jumping

2) high arch of foot

3) bone spur

4) tightly tucked bed sheets – extended plantar flexion can lead to this.

5) Statin drugs (cholesterol lowering medications like Lipitor, Mevachor, etc.)

b. Signs/symptoms:

1) pain along plantar surface (especially when placing weight on heel)

2) pain relieved when removing weight from foot

3) worse with dorsiflexion of foot and/or extension of toes.





MUSCULAR SYSTEM: Part 1

CAPP102-I Session 9



1. Define the suffixes & roots describing the Muscular System.

2. Describe the five functions of muscle tissue.

3. Summarize the five characteristics of muscle tissue.

4. Sequence the five skeletal muscle components.

5. Describe the three Connective Tissue elements that comprise the tendon.

6. Compare superficial and deep fascia.

7. Define a motor unit & the All or None principle for muscle; compare more or fewer motor units.

8. Describe & label the components that comprise the neuromuscular junction.

9. Specify the functions of the sarcolemma, T tubules, sarcoplasm, myoglobin, sER.

10. Label the sarcomere diagram; list the 3 light filaments; define H zone & A and I bands.

11. Summarize muscle contraction.

I. REVIEW OF MEDICAL TERMINOLOGY:

Roots:

Aponeur/o = aponeurosis

Cardi/o = heart

Kinesi/o = movement

Lei/o = smooth muscle

Muscul/o = muscle

My/o = muscle

Rhabd/o = striated muscle

Tax/o = ordered movement

Tendin/o = tendon

Tend/o = tendon

Ten/o = tendon

Suffixes:

-algia = condition of pain

-kymia = involuntary muscle twitching

-paresis = slight paralysis

-sclerosis = abnormal hardening

-tonia = tension/tone

-trophy = nourishment/development


II. ANATOMY & PHYSIOLOGY OF THE MUSCULAR SYSTEM:

A. Functions of Muscle Tissue:

1. Motion of body – walking, running, etc.

2. Stabilize body position – stabilize joints, standing, sitting, postural muscles

3. Regulate organ volume - sphincters help provide temporary storage in stomach, bladder

4. Movement of substances within the body - blood flow, peristalsis, urination

5. Thermogenesis – (byproduct of movement) make heat – normal body temp, shivering

After you have been studying for a while & not moving – your body may feel very cool. When our bodies are cold – we often move around (jumping jacks, rubbing arms/legs, etc.) to “warm up”. Muscle plays a SIGNIFICANT role on keeping our bodies at the correct temperature. When the body is cold:

1. Muscle helps to pump the blood from the veins back to the heart to distribute the “heat” of the body; carrying warm blood to the extremities & other areas that need the blood.

2. A by-product of muscle contraction (splitting ATP ) is the release of thermal energy: heat is a “waste” product in this reaction, just like plants release oxygen as a “waste” product of photosynthesis.

3. The arrector pili muscles which insert in the skin, pull the hair shaft vertical (creating goose bumps) to trap a layer of warm air next to the body – like putting on a layer of clothing in winter. Combining goose bumps with shivering (another muscular system responsibility) your body warms up 200%!

When the body is warm: Increased vasoconstriction (smooth muscle contraction) in the veins combined with sweat secretions at the skin’s surface, the warm blood is cooled by evaporation at the epidermis when the body needs to cool off.

B. Characteristics of Muscle Tissue:

1. Excitability / Irritability – receive & respond to stimuli

2. Conductivity – spread stimuli across muscle belly & down both ends

3. Contractility – shorten & thicken

4. Extensibility – stretch (without damage)

5. Elasticity – go back to original shape after contraction / extension


The nervous/muscle relationship in a nutshell: The nervous & the muscular systems are intertwined. The nervous system is the supervisor & the muscles are the grunt workers; muscles do EXACTLY what the nerves tell them to do! If your nervous system is “hyperactive” or irritable, the muscles receive more signals from the nervous system to contract, making muscle more excitable as well (spasms / rigidity). If the nervous system is very “hypoactive” or mellow, the muscles receive few signals, making flaccid or weak muscles. The nervous system needs to (for lack of a better term) “smack” the muscle with enough stimuli or the muscle will not contract. De-myelinating diseases, like Multiple Sclerosis, which strip away the neuron’s protective coating, prevent the nerve from adequately stimulating muscle. If muscle lacks stimulation it will ATROPHY! Or if muscle loses its ability to respond to the motor neuron, like in Myesthenia Gravis, then again the muscle atrophies because it is not stimulated. Use it or lose it!

C. Connective Tissue & Skeletal Muscle Components:

Fascia – “bandage”

Superficial Fascia – (Subcutaneous tissue/Hypodermis) – skin

Deep Fascia – DICT (hold muscles together & separates into groups)

combine EPIMYSIUM – surrounds entire muscle

at both Muscle ends to PERIMYSIUM – separates one fascicle from another

form Fascicles tendons ENDOMYSIUM – separates one muscle fiber from another

Sarcolemma – surrounds one muscle fiber (level where neuron connects)

Muscle fibers – elongated shape / muscle cells

Myofibrils

Myofilaments (protein filaments) (level where muscle contraction

starts)

overlap in patterns to Thick / Heavy filaments: Myosin

form sarcomeres Thin / Light filaments: Actin, Troponin, Tropomyosin

Elastic filaments: Titin / Elastin – anchor myosin to Z-disc

The extensive multilevel organization of muscle allows the nervous system to have the ability to moderate our responses to different stimuli. Let’s say you have 100 fascicles in your Biceps Brachii muscle. Doing an arm curl with a 1 pound weight may only need 3 fascicles worth of strength. However doing an arm curl with a 20 pound weight may need 60 fascicles contracting to complete the same motion. If your nervous system responded with the same force for each stimuli, like 60 fascicles for a 1 pound weight, then you would end up getting a lot of punches in the nose! The more fascicles that are enlisted, the stronger & faster the contraction will be. If you start to pick something up & it is heavier than you expected, then more fascicles are recruited to create a stronger force. Can’t move something at all? – perhaps you do not have enough fascicles (or leverage) to do the job!

{


D. MOTOR UNIT:

A single motor neuron + all the muscle fibers it stimulates allowing unified contraction

More motor units – fine motor control, precise movements (ie fingers, eyes) 1:20

Less motor units – gross motor control (arm, leg movement) 1:2000

E. ALL or NONE Principle - Muscle:

All of the muscle fibers in one fascicle, contract to their fullest extent or not at all.

Fascicles do NOT contract ½ way. If you want ½ of your full muscle force available to lift something, than 50 of the 100 fascicles will 100% contract.

F. NEUROMUSCULAR JUNCTION (NMJ):

Synapse between axon terminals of motor neuron & motor end plate of muscle fiber

G. Muscle fibers (CELLS) – have many specialized structures

1. Sarcolemma = plasma membrane

2. Transverse (T) tubules = conduction of the stimulus across the muscle

3. Sarcoplasm = cytoplasm

*many mitochondria for increased ATP production - contraction*

*myoglobin – red pigment like hemoglobin – O2 storage until make ATP*

4. Sarcoplasmic reticulum = sER - *calcium ion storage


You are born with all of the muscle cells that you are going to have in your lifetime. OK, OK so how does someone go from a Pee Wee Herman to an Arnold Schwarzenegger? During exercise your muscle cells get slightly torn (micro-tears). When these tears heal they help grow muscle in size, called hypertrophy. Muscle cells do not replicate or duplicate – so if they are injured – your muscle atrophies (gets smaller). Exercising excessively can actually tear the microfilaments (contraction unit) so that myosin & actin do not overlap, hence they can no longer contract.

H. SARCOMERE: basic functional unit of striated muscle (where all the work is done in muscle!)

1. Light/Thin filaments

a. ACTIN – myosin binding sites

b. Troponin – cover the myosin binding sites until activated.

c. Tropomyosin – cover the myosin binding sites until activated.

2. Heavy / Thick filaments – MYOSIN: heads form cross bridges with actin

3. Titin: anchor the Myosin filaments to the Z disc

4. Z disc: separate one sarcomere from another (zig-zagged)

5. M line: midline

6. H zone: only HEAVY (thick) filaments – MYOSIN

7. I band: only LIGHT (thin) filaments – ACTIN

8. A band: the entire length of myosin, both Heavy & Light filaments

{ alternating light & dark bands

under a microscope give skeletal

muscle STRIPED / STRIATED

appearance.


Three sarcomeres: notice how much this unit changes in size from resting to contracted.

I know that we are at the microscopic level here, and it is a bit overwhelming, so let’s break it down! If you have a small movement in one sarcomere, and a bigger contraction over 3 sarcomeres, extrapolate that movement to a chain of 100 sarcomeres (myofibril level) and you begin to see how the biceps brachii can help flex your arm from 0 to 140 degrees. When MSAK mentions the “direction of the fibers” from origin to insertion, or CST tells you to “work in the direction of the muscle fibers” - well here is where the pattern is established! Myofibrils are actually very long strands of sarcomeres in a row.


I. DO SARCOMERE DANCE! – Class participation exercise

Need at least 9 people to do the dance:

Have student #1 be a Z disc (their body) & actin myofilaments (outstretched arms/hands to one side - pretending to hold a 2 foot tall box on the top & bottom). Student #2 stands straight (M line) with their arms (myosin) 90 degrees out from their sides (forming a T shape). The third student finishes sarcomere #1 by mirroring student #1. Student #2 should have their arms/hands 1/3rd of the way bordered on top & bottom by students #1 & 3. Student #4 has their back to Student #3, but doing the pattern of student #1. Students #5-9 follow the pattern above to complete sarcomeres #2 & #3. After you have the human body sarcomeres, first point out all of the parts of the sarcomere (Z disc, actin, myosin, M line, H zone, I band & A band) on your human players, as well as where the resting muscle starting point is. Then CONTRACT or shorten the sarcomeres. Keep student #1 the same, move student #2 closer to student #1 (arms overlapping ¾ of the way) & continue to condense the sarcomeres for students #3-9. Notice where the contracted sarcomeres have ended. There should be a significant difference between starting & ending points.

Now extrapolate this information, over 100s of sarcomeres & you begin to see how we contract our muscles. Now, switch to at least 9 other students so the first “sarcomere players” can see the movement too. Remember to review the parts, the starting & ending points.

WHEW – aren’t you glad you do not have to think THAT much to contract your muscles when a bear is after you?





MUSCULAR SYSTEM: Part 2

CAPP102-I Session 10



1. Specify the sequence of events that occur during the sliding filament mechanism.

2. Describe the function of acetylcholinesterase.

3. Define muscle tone; describe the three functions of tone; define hypertonia & hypotonia.

4. Describe the process & causes of muscle fatigue.

5. Compare the types of skeletal fibers regarding fatigue, oxygen use, contraction & location.

6. Define recruitment of skeletal muscle fibers.

7. Specify the results of exercise on skeletal muscle; define hypertrophy & atrophy.

8. Summarize the characteristics, location & function of cardiac & smooth muscle tissue.

9. Describe the causes, symptoms, characteristics & treatment of:

a. Fibromyalgia

b. Muscular Dystrophy

c. Myesthenia Gravis

d. Sprains

e. Strains

f. Muscle Spasms

I. SKELETAL MUSCLE:

A. SLIDING FILAMENT MECHANISM: Muscle contraction - story style

Brain tells motor neuron to wake up muscle Motor neuron barfs out (exocytosis) Acetylcholine (ACh) from the synaptic vesicles ACh diffuses across synapse to push the muscle fiber’s doorbell. When ACh pushes the doorbell (binds receptor) the muscle gets EXCITED to have visitors.


The muscle fiber opens the door for cousin Calcium to come in (CONDUCTIVITY) Then cousin Calcium uncovers the rowing machine & the kids hop on. Kid #1: Myosin grabs the oar handles and pulls them toward him (power stroke). Kid #2: Actin slides toward the middle. (CONTRACTILITY) They continue this activity until they get tired & cousin Calcium is snoring. The kids take cousin Calcium to the SenioR (Sarcoplasmic Reticulum) home Then they go home and RELAX!

B. Chemicals & conditions that influence muscles:

1. Acetylcholinesterase –breaks down ACh at synapse, muscle relaxation. (so ACh will

STOP ringing the doorbell & the muscle fiber will NOT get excited!)

2. Acetylcholinesterase inhibitors – slow the removal of ACh, enhances muscle contraction

activity. Currently used in treating Alzheimer’s patients.

3. Botulinum toxin – stops ACh from being barfed into the synapse - causing diaphragm

paralysis & is found in improperly canned food (especially tomato-based products).

4. Curare - blocking ACh from pushing the doorbell. Natives first used Curare as a poison

in arrow darts to “detain” the animal they were going to have for supper. Now it is used

in surgery to relax skeletal muscles. Hm – how interesting!

5. Rigor Mortis – Calcium leaks out after death stimulating muscles to contract, since ATP

production has stopped, the Myosin can link with Actin but can’t unlink, hence stiffness.

__________________________________________________________________________

C. Muscle TONE: Involuntary activation of a few fascicles in order to keep muscle:

1. Functions:

a. Healthy – rotation of the few fascicles contracting.

b. Primed & Ready – for a quick reaction to outside stimulus.

c. Firmness – keep head upright & not slumped against chest.

Did you notice the word INVOLUNTARY here? This is a great test question: in our SKELETAL muscle (voluntary) we also have an INVOLUNTARY component to contraction! (Hm, three times said – perhaps you will see this on a quiz or test– hint, hint!) So let’s say at any given time at rest you have 3 out of 100 fascicles contracting. First fascicles #1-3 contract – but they start getting tired after a while & they want to relax, so fascicles #4-6 contract & so on through all of the fascicles. This rotation keeps our muscles HEALTHY, primed and ready for action & gives us some definition to our muscles – even at rest! When you see a bear, your brain does NOT want to have to pound copious messages out to muscle to get it to move. There is already a small amount of contraction happening all the time, in each muscle – so it takes less time to recruit the rest of the fascicles needed than it does to start off a contraction from scratch. Believe you me – when you see the bear – you want to RUN!


2. Hypertonia: too much tone – spastic, rigid

3. Hypotonia: too little tone – flaccid (weak), atrophy (wasting away)

D. Muscle Fatigue: inability for muscle to contract forcefully after prolonged activity.

Due to: *lower availability of calcium, ATP or O2

*build-up of lactic acid

*not enough ACh released from the motor neuron to stimulate muscle

E. Types of Skeletal Muscle Fibers:

1. SLOW TWITCH: Slow oxidative (type I) – very fatigue resistant

Needs oxygen at a slow steady rate for sustained contract.

Where found: back & neck muscles

I know that there are times when you go home from a VERY long day & feel like every muscle is slumped over – but look at the mirror your head & back are still erect due to these slow twitch fibers!

2. FAST TWITCH: Fast oxidative (type IIa) – moderate fatigue resistance

Needs oxygen at a faster rate for faster contraction

Lactic acid build up over time

Where found: leg muscles

These are the fibers that help you run a marathon, but if you do not train enough – the lactic acid (fatigue) will make your body stop 100 yards from the finish line with NO ENERGY left to move!

3. FAST TWITCH: Fast glycolytic (type IIb) – fatigue quickly

NO OXYGEN is used! (Anaerobic process)

Most powerful contraction, most rapid

Where found: arm/shoulder muscles

Think moving: you are carrying heavy boxes from the moving van, up the stairs, down the hall & into the apartment. This is your 5th trip: when you get to where the box is going to reside (until you move it to the next place? ;) do you gently place it down or do you drop it? Chances are that your arms are already fatigued by the end of this process & you drop the box because you do not have the strength left! You cannot BREATHE & get more oxygen into the tissues to help this type of fiber. The Lactic acid (byproduct of muscle energy production) needs to be broken down in the liver before these muscles will regain their strength. Fibers recruited in the order needed – Slow twitch first, then type IIa, then type IIb if a maximal contraction needed. All skeletal muscles are composed of all three types.


F. EXERCISE & Skeletal Muscle:

1. Hypertrophy: increase muscle diameter (exercise & hGH, testosterone, adrenaline)

2. Atrophy: wasting away of muscle due to lack of use or lack of nervous stimulation.

a. Denervation atrophy – skeletal muscle is replaced by fibrous connective

tissue between 6 months & 2 years of the injury.

Remember Christopher Reeve? Well, after his spinal cord injury he could not walk. But just in case his nervous system would have recovered before his death, he was hoping that all of his injured axons would re-grow so he could walk again (this regeneration truly CAN happen over time - if you believe & have patience!) he was ensuring that his MUSCLES would stay toned & active. He had regular massages & physical therapy sessions to take his muscles through their normal range of motion every day. He truly was a SUPERMAN with this kind of determination!

Just a reminder – that if you do not move every skeletal muscle through its entire range of motion, EVERY day – it will result in a limited ROM over a short amount of time. Stretch! MOVE! Exercise! Use those muscles daily, or lose them!

II. CARDIAC MUSCLE: Contraction: 75x/minute in HEART only A. Striated & involuntary

B. Intercalated discs – the cells “hold hands” so that they all contract uniformly

C. Gap junctions – allow stimuli to spread quickly

D. Autorhythmicity – intrinsic contractions (does not need ACh to stimulate)

III. SMOOTH MUSCLE: Internal organs & blood vessels A. Non-striated & involuntary

B. Visceral – autorhythmic

C. Slower, longer contraction than skeletal muscle tissue

D. Can stretch & shorten greater than other muscle types – allows contraction with stretching

(uterus, stomach, intestines, urinary bladder)


IV. PATHOLOGY:

A. Fibromyalgia - affect fibrous CT, muscle, tendon, ligaments

1. Sx: numbness, tingling, diffuse pain, headaches, irritable bowel, insomnia

2. Aggravated by stress, no sleep, dampness, bad diet, caffeine

3. Rx: opposite of above, exercise, anti-candida diets.

B. Muscular Dystrophy - genetic degeneration of skeletal muscle fibers leading to atrophy

(essentially you are destroying part of the muscle & weakening it)

C. Myesthenia Gravis –

1. Blockage of the NMJ

2. destroying ACh receptors on motor end plate (taking out doorbell!)

3. Autoimmune

4. Gradual muscle weakening (atrophy)

D. Strain –

1. Overstretching of muscle or tendon,

2. Tx: RICE (Rest, Ice, Compression, Elevation)

E. Sprain –

1. Overstretching a ligament or joint capsule

2. Tx: RICE

F. Muscle Spasm / Cramp – Involuntary contraction of skeletal muscle

1. Causes: Electrolyte imbalance (Tx: 2 Calcium: 1 Magnesium)

Ischemia – lack of oxygen

Exercise-induced – overexcitement of muscle contraction receptors

Splinting – protection from injury

2. Tx: more in CST, but massage (if not in acute stages) will help!

REVIEW, REVIEW, REVIEW – Exam #2 is next week!

clinical anatomy, physiology & pathology i introduction to the body · 2012-09-21 · 1....

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