Pawan Dhaliwal Student #: 2 The Body Systems Questions PATH 417A January 2016 WEEK 1 – CASE 1 “SCHOOL SORES”

6-year-old Stephanie O. has developed red sores around her mouth and nose. At the start of class her teacher noticed the rash and called her parents to take her home. Her parents take her to the family doctor who examines Steph. She is afebrile and does not have any swollen lymph nodes. There is no rash on her hands or feet or inside her mouth. He prescribes an antibiotic and tells her parents that she needs to stay at home for a couple of days. He swabs the rash and sends the swab to the Microbiology Laboratory. THE CASE

What are the signs and symptoms? BODY SYSTEMS QUESTION 1

 Let’s first look more closely at what is meant by a sign versus a symptom… DEFINING THE TERMS

SIGN VS. SYMPTOM SignSymptom Taken note of by…Healthcare professionalPatient Characteristics are… ObjectiveSubjective Examples High blood pressure Abnormal densities in lungs detected on x-ray Feelings of tiredness or pain Observation of skin rash Table 1: Differences between a sign and a symptom 1

 An illness characteristic can be a sign, symptom (or both) depending on the observer(s): 2 SIGN VS. SYMPTOM Sign Symptom Both sign and symptom Illness characteristic is (a): Doctor PatientDoctor and Patient

STEPHANIE’S SIGNS Red sores around mouth and nose Afebrile No swollen lymph nodes No rash on hands/feet or inside of mouth Can you define this medical sign? Click for the answer! Afebrile: absence of fever 3

STEPHANIE’S SYMPTOMS As noted before, the observer of a symptom is the patient. In this case, there are no symptoms to report as Stephanie, the patient, has not mentioned anything to her parents, or to her family doctor. Although the teacher noticed Stephanie’s rash at school, I did not include this as a symptom because Stephanie’s teacher is not the patient.

Which body system is affected, in what specific area and what is the normal physiological function of this area of the body? BODY SYSTEMS QUESTION 2

 In Stephanie’s case, the body system that is affected is the Integumentary System.  The Integumentary System is comprised of:  the skin, and  its accessory structures, including hair, nails and sweat glands. 4  In this case, the Integumentary System of the face is affected, specifically around the mouth and nose. WHICH BODY SYSTEM IS AFFECTED

 The skin has 2 layers: 5  (1) epidermis  (2) dermis  Both have a protective function  Below these 2 layers is the hypodermis, made up of fat and connective tissue. It functions as insulation and to store fat. 6 THE INTEGUMENTARY SYSTEM Figure 1: The layers of the skin

 Functions: 7  Retain body fluids  Act as barrier to protect against:  Elements – UV, wind, water  Diseases – microbes, parasites, fungi  Harmful chemicals  Eliminate waste products  Regulate body temperature  Sensory function  Vitamin D synthesis NORMAL OVERALL PHYSIOLOGICAL FUNCTIONS OF INTEGUMENTARY SYSTEM Let’s focus on this function for the next question

In what ways has the normal physiological functioning of this area of the body been disturbed by the infection? BODY SYSTEMS QUESTION 3

 The skin is able to act as a barrier against the elements and diseases because: 8 (1) cells of the epidermis, called keratinocytes, are tightly connected to one another so that bacteria can not pass between them DISTURBANCE OF NORMAL PHYSIOLOGICAL FUNCTION (2) the dermis produces anti-bacterial substances to prevent colonization by harmful microbes v Keep microbes out! Figure 3: Barrier function of skin

 In Stephanie’s case, the barrier function of the skin has been breached, possibly by a cut, scrape or other wound, and bacteria have caused an infection, resulting in red sores around her mouth and nose  In an infection, the affected skin is no longer able to serve as a protective barrier against the elements and disease 9  Bacteria are able to penetrate the protective barrier and cause an infection DISTURBANCE OF NORMAL PHYSIOLOGICAL FUNCTION Figure 4: Bacteria, allergens and chemicals may penetrate skin if barrier is breached

Are there are any secondary sites of infection and, if so, what enables the bacteria to (a) travel to; and (b) affect these areas of the body? BODY SYSTEMS QUESTION 4

 In order to know what a secondary site is, we must first know what a primary site of infection is  A primary site of infection is defined as the site where the infection is first established 10  A secondary site of infection is defined as a site other than the point of entry where an infection is established 11 PRIMARY VS. SECONDARY SITES OF INFECTION

Primary site of infection (“point of entry”) The bacteria can then travel, either on or in the body, to establish infection at a secondary site. For example, Stephanie may use her hand to scratch the sores around her mouth and nose. Larger than life bacteria This will spread the bacteria from her face to her hands.

 In Stephanie’s case, the primary site of infection is around her mouth and nose  However, there is no secondary site of infection because in the case it is noted that the doctor did not observe a rash anywhere else on Stephanie’s body:  “there is no rash on her hands or feet or inside her mouth” SECONDARY SITES OF INFECTION

Why did the doctor suggest that Stephanie stay at home for a few days? BODY SYSTEMS QUESTION 5

WHY DOES STEPHANIE HAVE TO STAY AT HOME? (1) To protect her classmates  Whatever Stephanie has may be contagious, and may easily spread to others around her  Thus, her family doctor suggests Stephanie stay at home to protect her classmates and others at her school (2) To protect herself  Infections, or any ailments, clear up faster when the body is at rest and not under stress 12  Therefore, sleep and a well- balanced nutrition at home will make Stephanie feel better sooner

THE END!

 [1] Niamh, K., & Lowe, C. (n.d.). Signs and Symptoms. Retrieved January 12, 2016, from nkPage?cmd=view nkPage?cmd=view  [2] Niamh, K., & Lowe, C. (n.d.). Signs and Symptoms. Retrieved January 12, 2016, from nkPage?cmd=view nkPage?cmd=view  [3] Merriam-Webster Medical Dictionary. (n.d.). Definition of afebrile Retrieved January 12, 2016, from webster.com/medical/afebrilehttp:// webster.com/medical/afebrile SOURCES

 [4] OpenStax College, Anatomy & Physiology Chapter 5 The Integumentary System (pages 171 – 187). OpenStax College. 25 April Retrieved January 12, 2016, from 3/AnatomyAndPhysiology-LR.pdf 3/AnatomyAndPhysiology-LR.pdf  [5] OpenStax College, Anatomy & Physiology Chapter 5 The Integumentary System (pages 172). OpenStax College. 25 April Retrieved January 12, 2016, from 3/AnatomyAndPhysiology-LR.pdf 3/AnatomyAndPhysiology-LR.pdf SOURCES

 [6] OpenStax College, Anatomy & Physiology Chapter 5 The Integumentary System (page 178). OpenStax College. 25 April Retrieved January 12, 2016, from yAndPhysiology-LR.pdf yAndPhysiology-LR.pdf  [7] OpenStax College, Anatomy & Physiology Chapter 5 The Integumentary System (pages ). OpenStax College. 25 April Retrieved January 12, 2016, from Physiology-LR.pdf Physiology-LR.pdf  [8] OpenStax College, Anatomy & Physiology Chapter 5 The Integumentary System (pages 187). OpenStax College. 25 April Retrieved January 12, 2016, from Physiology-LR.pdf Physiology-LR.pdf SOURCES

 [9] Dryden, M. S. (2010). Complicated skin and soft tissue infection. Journal of Antimicrobial Chemotherapy, 65(Supplement 3), Iii35-Iii44.  [10] Marcovitch, H. (2010). Primary site (of infection). In Black's medical dictionary. London: A. & C. Black.  [11] Marcovitch, H. (2010). Secondary site (of infection). In Black's medical dictionary. London: A. & C. Black.  [12] Opp, M. R. (2009). Sleeping to fuel the immune system: Mammalian sleep and resistance to parasites. BMC Evol Biol BMC Evolutionary Biology, 9(1), 8. SOURCES

 Figure 1: The layers of the skin Lecture 7: Integumentary System. (n.d.). Retrieved January 16, 2016, from  Figure 2: The layers of the epidermis Epidermis. (2011). Retrieved January 16, 2016, from html html FIGURES

 Figure 3: Barrier function of the skin Information for Patients: Treatments For Eczema. (2015). Retrieved January 16, 2016, from us.com/patient-information/ us.com/patient-information/  Figure 4: Bacteria, allergens and chemicals may penetrate skin if barrier is breached Understanding Eczema. (2015). Retrieved January 16, 2016, from FIGURES

 All images used in this presentation are Public Domain Images  Doctor:   Little girl:   Clipboard:   Thought bubble:   Group of bacteria:   House:  IMAGES