Skin - structure

The skin is sometimes called the cutaneous membrane or the integument. It has 2 regions notably the epidermis and the dermis. The hypodermis is a subcutaneous tissue and is found between the dermis and any underlying structure like muscles.

Epidermis

It is the outer and thinner layer of the skin. It is made up of stratified squamous epithelium divided into several layers; the deepest layer is the stratum basale, and the most superficial layer is the stratum corneum. The deepest layer is constantly producing new cells and pushing them to the surface. The stratum corneum, on the other hand, gets keratinised to form a waterproof layer and also acts as a mechanical barrier.

Dermis

It is a thicker and denser region than the epidermis. It is composed of dense and irregular connective tissues. Its upper layer has structures called as dermal papillae that project into the epidermis to cause ridges. These form unique patterns and give the characteristic fingerprint to all individuals, though its primary function was to increase friction and give a better grip.

It is also a highly vascular region. It is here that blood increases when you blush.

Hypodermis
It is composed of loose connective tissues including adipose tissue (fat). This layer helps to give insulation to the body. Excess of adipose tissue in this layer leads to obesity. It is in this layer that subcutaneous injections are given.

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Hypokalemia - Potassium replacement calculation

DEFINITION Hypokalemia is defined as a serum potassium level of less than 3.5 mmol/L. Normal level= 3.5-5.5 mmol/L. It is encountered in >20% of patients. Patients are usually asymptomatic but severe arrhythmias and rhabdomyolysis can occur. Non-specific complaints include easy fatiguability and skeletal muscle weakness. The preferred method of replacement is via the oral route but at times this is not possible. The article below will give you an idea about how to calculate the amount of KCl to be given I.V. 1) Potassium deficit in mmol is calculated as given below: K deficit (mmol) = (K normal lower limit - K measured ) x kg body weight x 0.4 2) Daily potassium requirement is around 1 mmol/Kg body weight. 3) 13.4 mmol of potassium found in 1 g KCl . ( molecular weight KCl = 39.1 + 35.5 = 74.6) Suppose we get an asymptomatic patient of 70 Kg with a serum potassium level of 3.0 mmol/L and he is on nil by mouth but having...

Endomysium, Perimysium and epimysium - definition, histology

Each muscle fibre is closely surrounded by connective tissue. This acts as a support for the muscle fibres and unites them to each other. 1) Each muscle fibres is surrounded by delicate connective tissue that is called the endomysium . 2) Individual fasciculi are enclosed by a stronger sheath of connective tissue called the perimysium . 3) The entire muscle is surrounded by connective tissue called the epimysium . This is illustrated by the schematic diagram below. 1= perimysium, 2= endomysium, 3= fasciculus. At the junction of a muscle with a tendon, the fibres of the endomysium, the perimysium and the epimysium become continuous with the fibres of the tendon. First published on: 27 December 2016

The plantar reflex - Babinski's sign

The plantar response is an important test to identify an upper motor neuron lesion. PROCEDURE To elicit it, the muscles of the lower limbs must be relaxed. The outer edge of the sole of the foot is stimulated by firmly scratching a blunt object like a key or a stick along it from the heel towards the little toe. This is what Joseph Babinski did in the year 1896. He described the 'great toe sign' that year and then in 1903 the 'toe abduction or fan sign'. Nowadays, a final medial movement across the sole of the metatarsus is also done. i.e. we start at the heel to the little toe and finally arcing to the big toe. The final arcing movement is absent in the original Babinski plantar response test. Babinski sign refers to a combination of 'the great toe sign' and the 'fan sign'. SIGNIFICANCE The normal response is plantar flexion of the toes (down going) and they are drawn together. More precisely, there is flexion of the big toe and addu...

Differences between hyperemia and congestion

Hyperemia and congestion both indicate a local increased volume of blood in a particular tissue. Hyperemia is an active process that result from augmented blood flow due to arteriolar dilation (e.g. at sites of inflammation or in skeletal muscle during exercise). The affected tissue is redder than normal because of engorgement with oxygenated blood. Congestion, on the other hand, is a passive process resulting from impaired venous return out of a tissue. It may occur due to systemic causes like cardiac failure or a local cause like isolated venous obstruction. The tissue is cyanosed because the worsening congestion leads to accumulation of deoxygenated hemoglobin in the affected tissues.

Apgar scoring - table, mnemonic

INTRODUCTION The Apgar score was devised in 1952 by Dr Virginia Apgar (anesthesiologist) as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth. This helps to identify those requiring resuscitation and can also be used to predict survival in the neonatal period. MNEMONIC A mnemonic for learning purposes includes: A - Appearance (skin colour) P - Pulse (heart rate) G - Grimace (reflex irritability) A - Activity (muscle tone) R - Respiration Another mnemonic is also useful: How - Heart rate Ready - Respiration Is - Irritability This - Tone Child - Colour Apgar scoring is divided into 1 and 5-min scores. 1-MIN SCORE Sixty seconds after complete birth, the five parameters specified in the table above must be eval...

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