Integumentary system:

SLIDE 2

The skin is the largest organ in the body—covering 17 to 20 square feet (1.5 to 2
square meters). It’s also extremely thin, measuring only 0.04 to 0.08 inches (1 to 2
mm) thick in most places.

More than just a covering for the body, skin is crucial for human survival.

1. This thin, self-regenerating tissue also separates the internal from the
external environment, protects the body from invasion by harmful
substances, and helps maintain homeostasis.

2. In addition, sensory nerve receptors in the skin gather information about the
outside world while its flexibility and ability to stretch permit freedom of
movement.

3. Last but not least, changes in the skin can signal diseases or disorders in
other body systems. For these reasons and more, the skin and its appendages
(hair, nails, and skin glands)—collectively known as the integumentary
system—deserve close attention

• The integumentary system includes the skin and all of its appendages (hair,
nails, and skin glands).

SLIDE 2

The average person sheds more than 1 pound (0.5 kg) of skin every year. In fact,
the outer layer of the epidermis is completely replaced every month.

It consists of two layers: epidermis and dermis.

• The epidermis is the outermost layer. It consists of stratified squamous

epithelial tissue; it also contains no blood vessels.
• The dermis is composed of connective tissue. It contains primarily collagen
fibers (which strengthen tissue), as well as elastin fibers (which add
elasticity) and reticular fibers (which bind collagen and elastin fibers
together).
• The dermis has an abundance of blood vessels plus sweat glands, sebaceous
glands, nerve endings, and hair follicles. Papillae extend upward from
dermis, where it interlocks with downward waves projecting from the
bottom of the epidermis.
• The hypodermis is made of areolar and adipose tissue; it binds skin to
underlying tissue.

SLIDE 3

• The innermost layer of the epidermis is the stratum basale (basal layer or
stratum germinativum). It consists of a layer of columnar stem cells that
continually undergo mitosis to produce new skin cells.
• The new skin cells push older cells upward. As the cells are pushed upward,
they stop dividing and produce keratin, which replaces the cytoplasm and
nucleus in each cell. In the process, the cells flatten and die.
• By the time the cells reach the outermost layer (the stratum corneum), all
that is left is their keratin. Called keratinocytes, these cells replace the dead
cells that flake away with daily wear.
• The stratum corneum consists of up to 30 layers of dead, flat, keratin-coated
cells. This makes the skin’s surface durable and resistant to abrasions. It also
forms an effective barrier, preventing water from entering the body from the
outside whereas still allowing for evaporation.

SLIDE 4 :

Scattered throughout the basal layer of the epidermis are cells called melanocytes.
These special cells produce a substance called melanin, which accumulates in the
cells of the epidermis. There are two types of melanin: a reddish pheomelanin and
a brown-black eumelanin.

A person’s skin color is determined by the amount, and type, of melanin—not the
number of melanocytes. (In fact, persons of all races have about the same number
of melanocytes. The cells in dark-skinned people produce more melanin, and the
melanin is broken down more slowly.)
• There are two types of melanin: pheomelanin (a reddish color) and
eumelanin (a brown-black color).
• Various disorders can produce abnormal changes in skin color, such as
cyanosis, jaundice, bronzing, albinism, erythema, pallor, and hematoma.

SLIDE 5 : Abnormal Changes in Skin Color

Variations in skin tone normally occur. Melanin is not evenly distributed

throughout the body: the palms and soles have less melanin than the backs of the
hands and the tops of the feet. Melanin can also concentrate in certain areas, such
as freckles and moles. A yellow pigment called carotene is also stored in skin
tissue. Eating large quantities of foods containing carotene (such as carrots) can
give the skin a yellow tint.

Slide 6 : Functions of the SKin

Appendages of the Skin

The appendages of the skin are hair, nails, and glands.

Hair
Hair occurs everywhere on the body except for a few locations: the palms and
soles, lips, nipples, and some areas of the genitals. In some locations, hair has a
protective role: The eyelashes and eyebrows keep perspiration out of the eyes; hair
in the nostrils filters out dust; and the hair on the head provides insulation against
heat and cold.

Slide 9

• The hair shaft extends above the skin’s surface.

• Each hair lies within a sheath of epidermis called a hair follicle. Hair
follicles have a rich nerve and blood supply.
• Buried in the dermis is the hair bulb or root; this is the lowest part of the hair
and is where growth occurs.
• At the base of the hair is a cluster of connective tissue and blood vessels
(called the papilla) that nourishes each hair.
• Attached to each hair follicle is a small bundle of smooth muscle called the
arrector pili muscle. Cold temperatures, or emotions such as fear, cause the
muscle to contract. When it does, the hair becomes more upright, sometimes
called “standing on end.”

Slide 10: Nails

• Nails consist of densely packed, heavily keratinized epithelial cells.

• The nail body is the visible part of the nail; the cuticle is a fold of skin
surrounding the nail body; the lunula is a crescent-shaped white area at the
base of the nail.
• The nail bed is a layer of epithelium under the nail; it normally appears pink
because of the rich blood supply in the area.
• The nail root is the proximal end of the nail (hidden underneath overlying
tissue).
• Nails grow as newly keratinized cells are added to the nail root from the nail
matrix. As the new cells are added, the nail is pushed forward.
• Various disorders can cause changes in nails, including clubbing, cyanosis,
flattened or concave nail beds, dark lines beneath nail, white nails, yellowish
nails, pale nail beds.

Slide 11: Glands

The glands associated with the skin include sweat glands, sebaceous glands, and
ceruminous glands.

Sweat Glands
These are the most numerous of the skin glands.

• There are two types of sweat glands: eccrine glands and apocrine glands.
• Eccrine glands contain a duct that leads from the secretory portion to the
skin’s surface. Eccrine glands produce sweat, which contains potassium,
ammonia, lactic acid, uric acid, and other wastes. Sweat plays a chief role in
helping the body maintain a constant core temperature and also helps the
body eliminate wastes.
• Eccrine glands are widespread throughout the body and are especially
abundant on the palms, soles, forehead, and upper torso.
• Apocrine glands contain a duct that leads to a hair follicle; these are scent
glands that respond to stress and sexual stimulation. Sweat produced by
apocrine glands does not have a strong odor unless it accumulates on the
skin; when this occurs, bacteria begins to degrade substances in the sweat,
resulting in body odor.
• Apocrine glands begin to function at puberty; they are located mainly in the
axillary and anogenital (groin) regions.
• Other glands called sebaceous glands open into a hair follicle; they secrete
an oily substance called sebum, which helps keep the skin and hair from
drying out and becoming brittle. Sebum has a mild antibacterial and
antifungal effect.
• Sebum production increases during adolescence. When excess sebum
accumulates in the gland ducts, pimples and blackheads can form.

Slide 12: Burns

Burns can be caused by fire, hot water, steam, electricity, chemicals, and sunlight.
Considering the skin’s crucial role in protecting against infection, controlling fluid
loss, and thermoregulation, it’s easy to understand the seriousness of severe or
extensive burns. In fact, following a serious burn, a patient may lose as much as
75% of his circulating fluid volume in the first few hours, placing that person at
risk for circulatory collapse and cardiac arrest. Another complication of burns is
the development of eschar—the dead tissue resulting from a burn. Besides
secreting toxins and promoting bacterial growth, eschar can restrict circulation.

Burns are classified according to depth: in other words, the number of tissue layers
affected by the burn.

Test Your Knowledge

1. What is the name of the outermost layer of the skin?

a. Dermis

b. Epidermis

c. Hypodermis

d. Papillae

2. In which skin layer are new skin cells generated?

a. Hypodermis

b. Stratum corneum

c. Stratum basale

d. Dermis

3. New skin cells produce which tough, fibrous protein?

a. Collagen
b. Elastin

c. Melanin

d. Keratin

4. What is the chief purpose of melanin in the skin?

a. Protect the nucleus of the skin cell against UV radiation

b. Strengthen the structural integrity of the skin

c. Prevent excess fluid loss

d. Aid in thermoregulation

5. The skin initiates the production of which vitamin?

a. Vitamin C

b. Vitamin K

c. Vitamin D

d. Vitamin A

6. How does the epidermis receive oxygen and nutrients?

a. It is richly supplied with blood vessels, which provide it with the oxygen and
nutrients it needs.

b. It receives oxygen and nutrients by diffusion from the dermis.

c. It receives oxygen and nutrients by diffusion from the surrounding environment.

d. It doesn’t need oxygen or nutrients because it is composed only of dead,

keratinized cells.

7. Which of the following is a function of the stratum corneum?

a. Secrete melanin

b. Generate new skin cells

c. Act as a barrier

d. Provide insulation

8. What is the function of the eccrine glands?

a. They secrete sweat, which plays a role in helping the body maintain a constant
core temperature.

b. They are scent glands that produce sweat in response to stress and sexual
stimulation.

c. They secrete an oily substance that helps keep skin and hair from drying out.

d. They secrete a waxy substance that helps keep the external ear canal from drying
out.

9. The skin helps the body conserve heat by:

a. dilating blood vessels.

b. producing sweat.

c. producing sebum.

d. constricting blood vessels.

10. Where does hair growth occur?

a. Hair follicle

b. Hair bulb

c. Hair shaft
d. Papilla

The Skeletal System :

Slide 1 :

Although most adults have 206 bones, there is some variation. Some may have an
extra rib, whereas others have extra bones in the skull. Occasionally, some bones
fail to fuse during development, also adding to the total. Of these bones, 80
comprise the upright, central supporting axis of the body, which includes the skull,
rib cage, and vertebral column. This is the axial skeleton. The other 126 bones
make up the bones of the limbs and the pelvic and shoulder area. This is the
appendicular skeleton

• The adult skeleton has 206 bones: the axial skeleton has 80 bones and the
appendicular skeleton has 126 bones.
• The surfaces of bones have surface markings (ridges, depressions, bumps,
pores, and projections); these provide routes for blood vessels and nerves,
surfaces for muscle attachment, and areas for joint formation.
•
Note: The names of bone surface markings and the names of all the bones in the
body are listed in separate tables in the textbook. Consider encouraging students
to use flashcards to learn these terms.

Slide 6 : The Skull

A complex structure, the skull is formed by 22 irregularly shaped bones. These

include eight cranial bones and 14 facial bones.

• Frontal bone (1 bone): Forms the forehead and the roof of the eye sockets
(orbits)
• Parietal bones (2 bones): Join together at the top of the head to form the top
and sides of the cranial cavity
• Occipital bone (1 bone): Forms the rear of the skull
• Temporal bones (2 bones): Form the sides of the cranium and part of the
cranial floor; also contain the structures of the inner and middle ear,
including the:
• External auditory meatus (an opening into the ear)
• Mastoid process (a prominent lump behind the ear)
• Zygomatic arch (cheekbone)
• Styloid process (an attachment point for several neck muscles)
• Sphenoid bone (1 bone): Forms a key part of the cranial floor, as well as
the floor and side walls of the orbits. With the appearance of a giant moth,
the sphenoid bone lies behind and slightly above the nose and throat. It has
an indented area called the sella turcica that houses the pituitary gland.
• Ethmoid bone (1 bone): Contributes to the walls of the orbits, the roof and
walls of the nasal cavity, and the nasal septum. It lies anterior to the
sphenoid bone; the cribriform plate (which forms part of the roof of the nasal
cavity) lies on top. Tiny perforations in the cribriform plate allow branches
of olfactory nerve to reach the brain.

Slide: Suture lines

• The bones of the skull join at immovable joints called sutures.

• The base of the skull contains a large opening (foramen magnum) through
which the spinal cord passes.
• When the brain is injured, it swells. Because the skull cannot expand to
accommodate the swelling brain, pressure inside the cranium increases. If
the swelling is severe, the pressure will force the brainstem down, through
the foramen magnum. The restricted opening of the foramen magnum will
constrict the brainstem, resulting in respiratory arrest and, usually, death.
(An exception is an infant skull, in which the suture lines haven’t yet fused.)

Slide : Foramen Magnum

The skull contains a number of holes called formina that allow for passage of
blood vessels
A large opening in the base of the skull, called the foramen magnum, allows the
spinal cord to pass through as it connects to the brainstem.
Slide : Facial Bones

The 14 bones of the face perform several functions. They support the teeth, provide
an attachment point for the muscles used in chewing and for facial expression,
form part of the nasal and orbital cavities, and also give each face its unique
characteristics.

• Zygomatic bones (2 bones): Shape the cheeks and outer edge of the orbit
• Maxillae (2 bones): Meet to form the upper jaw; every other facial bone
(except for the mandible) articulates with the maxillae; the maxillae form
part of the floor of the orbits, part of the roof of the mouth, and part of the
floor and walls of the nose
• Mandible (1 bone): Articulates with the temporal bone at the
temporomandibular joint (TMJ), making it the only facial bone that can
move; it is the largest and strongest bone of the face
• Lacrimal bones (2 bones): Paper-thin bones that form part of the side wall
of the orbit
• Nasal bones (2 rectangular bones): Form the bridge of the nose (the rest of
the nose is shaped by cartilage)
• Inferior nasal conchae (2 bones): Contribute to the nasal cavity
• Vomer (1 bone): Forms the inferior half of the nasal septum (the superior
half is formed by the perpendicular plate of the ethmoid bone)
• Palatine bones (two bones) (not shown here): Form the posterior portion of
the hard palate, part of the wall of the nasal cavity, and part of the floor of
the orbit
• Other bones associated with the skull: Auditory ossicles (malleus, incus,
stapes) and hyoid bone

Slide : Bones Associated with the Skull

Several other bones are associated with the skull but not considered a part of the
skull. These include the three bones of the middle ear. Called auditory ossicles,
these bones are named the malleus (hammer), incus (anvil), and stapes (stirrup).
(The auditory ossicles are discussed in Chapter 12, Sense Organs.)
Hyoid Bone

• The hyoid bone is the only bone that doesn’t articulate with any other bone.
• It serves as an attachment point for muscles that control the tongue,
mandible, and larynx.
Upon autopsy, pathologists look for a fractured hyoid bone as a sign of
strangulation

Slide : Paranasl Sinuses

he skull contains several cavities, which include the paranasal sinuses. The four
pairs of sinuses—which are named for the bones in which they reside—open into
the internal nose. Filled with air, they lighten the skull and act as resonators for
sound production.

The frontal, maxillary, and sphenoid sinuses have well-defined shapes. The
ethmoid sinuses are more like sinus cells, having a honeycombed shape.

• Four pairs of sinuses filled with air open into the internal nose; they lighten
the skull and act as resonators for sound production.
• Named for the bones in which they reside, the frontal, maxillary, and
ethmoid sinuses have well-defined shapes, whereas the sphenoid sinuses are
like sinus cells, having a honey-combed shape.

Slide: Infant Skull

The infant’s skull varies from that of an adult:

• Suture lines in the skull have not yet fused.
• Allows bones of skull to shift during passage through birth canal
• Allows for rapid brain growth during infancy
• Skull contains fontanels
• Areas between unfused bones covered by fibrous membranes called
fontanels
• Over time, fontanels shrink and usually close completely by age 2
Slide :

Depending on their location in the vertebral column, the structural characteristics

of vertebrae differ slightly from each other. However, all vertebrae have a number
of characteristics in common, as illustrated here.

• The vertebral column is a flexible structure consisting of 33 vertebrae; it

holds the head and torso upright, serves as an attachment point for the legs,
encases the spinal cord, and allows the body to bend forward, backward, and
sideways.
• The vertebral column consists of 5 main sections: 7 cervical vertebrae, 12
thoracic vertebrae, 5 lumbar vertebrae, the sacrum (which consists of 5 fused
vertebrae), and the coccyx (which consists of 4 fused vertebrae).
• The normal curvatures of the spine are the cervical curve, thoracic curve,
lumbar curve, and sacral curve.

Slide
• Structural characteristics of vertebrae differ slightly depending on location.
Regardless, all vertebrae have a number of characteristics in common:
• Vertebral foramen: An opening that allows for passage of the spinal
cord
• Body: The weight-bearing portion of the vertebra
• Spinous process: Projects posteriorly from the vertebra (The spinous
processes are the bumps you feel when you run your hand along the
spine.)
• Transverse processes: Extend from each side of the vertebra; both
the transverse and spinous processes serve as attachment points for
muscles and ligaments

Slide: Intervertebral Disc

• In between each vertebra is a layer of cartilage called an intervertebral disc

that is designed to support weight and absorb shock. It consists of a gel-like
core, called the nucleus pulposus, and a ring of tough fibrocartilage, called
the annulus fibrosus.
Sudden, intense pressure on the intervertebral discs (such as may occur from lifting
a heavy object) can cause the annulus of the disc to crack. When this happens, the
nucleus pulposus oozes out from the center of the disc and presses on the spinal
cord or a spinal nerve, causing pain. This is called a herniated disc

Slide: Specialty vertebrae

• The most unique of all the vertebrae are the first two cervical vertebrae (C1
and C2), called the atlas and the axis.
• The atlas (C1) has no body; it consists of a delicate ring and a large
vertebral foramen. Depressions on each side of the vertebra articulate with
bony projections from the occipital bone of the skull. When the head moves
back and forth (such as when nodding “yes”)
• , the projections rock back and forth in these depressions.
• The axis (C2) has a projection called the dens, or odontoid process. The
dens projects into the atlas and allows the head to swivel from side to side
(such as when saying “no”).

Slide: Atlas and Axis

• The transverse ligament holds the dens in place; this allows the head to
swivel from side to side.
• Bony projections from the occipital bone rock back and forth on the
depressions of the atlas, allowing the head to move back and forth.
• A hard blow to the top of the head can drive the dens through the foramen
magnum and into the brainstem, resulting in sudden death.

Slide : The thoracic cage

 consists of the thoracic vertebrae, the ribs, and the sternum; these bones
surround and protect the heart and lungs; they also provide an attachment
point for the pectoral girdle (shoulder) and upper limbs.
• Expansion and contraction of the thoracic cage cause the pressure changes in
the lungs that allow breathing to occur.
• The sternum has three regions: manubrium (the broadest portion), body
(the longest portion; it joins the manubrium at the sternal angle—also called
the angle of Louis—and provides the location of the second rib; xiphoid
process (provides an attachment point for some abdominal muscles and is an
important landmark for CPR.
• The ribs are classified as follows:
• Ribs 1 to 7 (true ribs) attach to the sternum by a strip of hyaline
cartilage called costal cartilage.
• Ribs 8, 9, and 10 attach to the cartilage of rib 7; these ribs, as well as
ribs 11 and 12, are called false ribs.
• Ribs 11 and 12 (floating ribs) do not attach to any part of the anterior
thoracic cage.
• The lower edges of the thoracic cage are called the costal margins; the two
costal margins meet at the xiphoid process, forming the costal angle.

Slide: Upper Limb

• The pectoral girdle (or shoulder girdle) supports the arm; it consists of a
clavicle (collarbone) and a scapula (shoulder blade). Key landmarks
include:
• The acromion process, which is an extension of the scapula that
articulates with the clavicle;
• The coracoid process, which provides a point of attachment for some
of the muscles of the arm; and
• The glenoid cavity, which is a shallow socket that articulates with the
head of the humerus.
• The humerus is the long bone of the arm. The enlarged end of the humerus
is called the head. Covered with articular cartilage, it articulates with the
glenoid cavity of the scapula. A depression on the posterior side of the
humerus called the olecranon fossa accommodates the olecranon process of
the ulna when the arm is extended. The olecranon process forms the bony
point of the elbow. It slides in the olecranon process when the arm is
extended.
• The radius is one of the two bones of the lower arm; it is located on the
same side as the thumb.
• The ulna is the other bone of the lower arm; it is longer than the radius.
Slide : Hand

• Eight carpal bones (two rows of four bones) form the wrist. These bones
allow the wrist to move back and forth and side to side. Each bone has a
name.
• Five metacarpal bones form the palm of the hand. The proximal end of
each bone is called the base, the shaft is called the body, and the distal end is
called the head. The knuckles that appear when you clench your fist are the
heads of the metacarpals.
• The fingers are formed by bones called phalanges. The thumb contains two
phalanges; the rest of the fingers contain three. The phalanges are identified
by the Roman numerals I through V (beginning with the thumb) and as
being proximal, middle, or distal.

Slide : Pelvic Girdle

• Each of the two large bones of the hip is called an os coxae, or innominate
bones. It may also be called a coxal bone. Together, they form the pelvic
girdle and are the foundation of the pelvis.
• Each os coxae consists of three bones fused together: the ilium (a large,
flaring section you can feel under the skin), the ischium (the lower, posterior
portion), and the pubis (the most anterior portion that joins with the other
pubis at the symphysis pubis; a disc of cartilage separates the two pubic
bones).

Posteriorly, each os coxae articulates with the sacrum at the sacroiliac joint

Slide : Os Coxae

• The combination of both os coxae and the sacrum is known as the pelvis.
• Because the marrow contained in the ilium produces blood cells, it is a
common site for bone marrow biopsies.
• Key landmarks of the os coxae:
• Iliac crest: The upper, outer edge of the ilium
• Greater sciatic notch: Point through which the sciatic nerve passes
on its path to the back of the thigh
• Acetabulum: A depression that houses the head of the femur to form
the “hip socket”
• Ischial spine: Projection into the pelvic cavity
• Ischial tuberosity: Supports your body when you are sitting
• Obturator foramen: Large hole below the acetabulum that is closed
by a ligament

Slide : Pelvis

• Combination of os coxae and the sacrum is the pelvis.

• The pelvis supports the trunk, provides an attachment point for the legs, and
protects the organs of the pelvis (lower colon, reproductive organs, urinary
bladder)
• The true pelvis extends between the pelvic brim.
• The pelvic outlet is the lower edge of the true pelvis; measured as the
distance between the two ischial bones.
• The false pelvis extends between the outer, flaring edges of the iliac bones.

Slide: Femur

• The femur is the longest and strongest bone in the body. It articulates with
the acetabulum of the pelvis to form a ball-and-socket joint.
• The head of the femur fits into the rounded contour of the acetabulum.
• The neck of the femur is a frequent site for fractures in elderly persons.
• Greater and lesser trochanter provide attachment points for hip muscles.
• The medial and lateral epicondyles are the widest points of the femur at the
knee.

Slide : Tibia and Fibula

• Of the two bones in the lower leg, the tibia is the only one that bears weight.
It articulates with the femur. The tibial tuberosity (palpable just below the
patella) serves as the attachment point for thigh muscles. Medial malleolus is
the bony knob on the inner ankle.
• The fibula helps stabilize the ankle; it does not bear any weight. The head of
the fibula articulates with the tibia. The distal end of the fibula forms the
lateral malleolus of the ankle.
• The patella (kneecap) is a triangular sesamoid bone embedded in the tendon
of the knee. It consists of cartilage at birth and ossifies between the ages of 3
and 6 years.

Slide: Foot and ankle

• The tarsal bones comprise the ankle.

• The largest tarsal bone is the calcaneus. It forms the heel and bears much of
the body’s weight.
• The second-largest tarsal bone is the talus. It articulates with three bones:
the calcaneus on its inferior surface, the tibia on its superior surface, and
another tarsal bone (called the navicular) on its anterior surface.
• The second row of tarsal bones consists of three cuneiforms and one large
cuboid bone.
• The metatarsals form the middle portion of the foot; they are numbered I
through V, beginning medially.
• The phalanges form the toes. The great toe is called the hallux.

Test Your Knowledge

1. Which bone is a facial bone?

a. Sphenoid

b. Ethmoid

c. Mastoid

d. Vomer

2. Which bones form the upper jaw?

a. Maxillae

b. Mandible

c. Zygomatic bones

d. Lacrimal bones
3. The bumps you feel when you run your hand along the spine in the back are:

a. transverse processes.

b. spinous processes.

c. intervertebral discs.

d. vertebral foramen.

4. Why are ribs 8 through 12 called false ribs?

a. These ribs are made of cartilage instead of bone.

b. These ribs do not attach to the thoracic vertebrae.

c. These ribs do not attach to the anterior thoracic cage.

d. These ribs attach to the manubrium.

5. What are the bony processes that can be felt at the wrist?

a. The styloid processes of the radius and ulna

b. The radial tuberosity

c. The carpal bones

d. The acromion process

6. Which part of the os coxae supports your body weight when sitting?

a. Obturator foramen

b. Ischial tuberosity
c. Sacroiliac joint

d. Acetabulum

7. Which bone does not support any body weight?

a. Tibia

b. Fibula

c. Medial malleolus

d. Lateral malleolus

8. The bone that forms the heel is the:

a. talus.

b. calcaneus.

c. metatarsal.

d. navicular.

9. To form the hip joint, the head of the femur rests in the:

a. ilium.

b. ischium.

c. obturator foramen.

d. acetabulum.

10. The pituitary gland rests in an indented area in which cranial bone?

a. Frontal

b. Sphenoid

c. Ethmoid

d. Temporal