IPHY 2420 1nd Edition Lecture 27Outline of Last Lecture Skin Cancer1. Structure of the Skin2. Basal Cell Carcinoma (Non-Melanoma)3. Squamous Cell Carcinoma (Non-Melanoma)4. Melanoma5. Risk Factors6. Signs of Melanoma (ABCDE’S) of Moles7. Who it affects? 8. Sunscreen Types9. Other Preventative StrategiesOutline of Current Lecture WOUND HEALING –Addressing nutrient needs with diet1. Who Has difficulties Healing Wounds? – Epidemiology 2. Meth Addiction: (and other drugs)3. How do you close a wound?4. Hypermetabolism5. Nutrients Needed for Wound Healing6. Contributing Conditions7. Poor Circulation8. Untreated InfectionsCurrent Lecture:1. WOUND HEALING- Addressing nutrient needs with diet (Very Complex) 1. REQUIRES ADEQUATE BLOOD FLOW FOR A SUPPLY LINE (the ability to get nutrients to the wound site)2. REQUIRES ADEQUATE BUILDING BLOCKS IN THE REPAIR PROCESS3. Needs sufficient ingestion/absorption/metabolic distribution of micro/macro nutrients4. Imbalance due to inadequate supply or excessive demand may lead to inability to heal wounds.These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.2. Who Has difficulties Healing Wounds? – Epidemiology - Protein energy-malnutrition (PEM) (inadequate supply)- Hospital Patients (inadequate supply)- Elderly/ Pressure ulcers (diabetes) (inadequate supply)- Addicts – drugs or alcohol (inadequate supply)- Burn Victim (inadequate supply)- Trauma – war, motor vehicle accidents, sports (excessive demand)3. Meth Addiction: (and other drugs) - Inadequate supply AND excessive demand work against wound healing.- Every year you use meth is 10 years aging on the body. - Teeth loss, change in facial structure- Sunken eyes, skin quality – dramatic changes- Meth makes you itch, people scratch skin off face and form wounds they cannot heal.4. How do you close a wound?1. Hemostasis –When blood floods the wound and fibrinogen converts to fibrin and the clotting cascade starts – kill bacteria off surface and close off wound from outside bacteria – happens in seconds. 2. Inflammation – Acute inflammation, white blood cells attack any infection that has occurred, and vasodilation occurs (vasodilation -widening of white blood cells) tells you that your body is addressing the wound. 3. Proliferation: Can go on for weeks, wound care may be needed. Tissue perfusion- scar formation- collagen/granulation (how your body fills in holes from inside out)4. Contraction – Wound shrinks by recruiting adjacent tissue and pulling it into the wound- the skin around the wound pulls together to heal the wound. Closing the wound with skin. Creates same tension as original skin. 5. Remolding- Can take months to years – scar is transformed to the final mature heal wound, tensile strength (tensile strength: skin around the wound and skin on wound hassame tension) approaching undamaged tissue, 3 years to completely heal. (areas of high use tend to heal more slowly)5. Hypermetabolism - The effect of stress on the body directly changes the rate that you digest/absorb and metabolize nutrients- The body starts to eat itself because it needs so much nutrients to close the wound, closing the wound can keep bacteria out of the blood stream which is the bodies #1 priority. - Protein catabolism: The body breaks down protein stores (muscles)- Nutritional Intervention: The wounded person is given large amounts of protein to encourage faster healing and avoid protein catabolism. 6. Nutrients Needed for Wound Healing- Proteins: needed for lymphocyte (white blood cells) and collagen synthesis- Fats: Omega 3 fatty acids aid in inflammatory response and enhance immune function. - Vitamin C: Free radical scavenger removes free radicles and avoids damage at cellular level, and increases defense against infection by supporting immune system- prevents scurvy! - Vitamin A: Enhances rate of collagen synthesis (mandatory for wound healing – cannot increase tensile strength without collagen) - Vitamin E: Also defeats free radicles (and elevates stress on the body so our bodies can focus on wound healing) - Vitamin K: Needed for clotting factors – Vitamin K is killed by antibiotics but if you are given antibiotics they will kill the Vitamin K – Our back up - stored vitamin K.- Zinc: Needed for cellular mitosis (we need more cells to fill in lost tissue) and Cell proliferation – no missing chunk of skin.- Iron: Makes white blood cells stronger and more powerful to defeat infection – through enhanced bactericidal activity. Also hemoglobin oxygen transports to the wound. Oxygen is so important for wound healing – increased oxygen to the wound site will cause rapid healing (oxygen chambers for trauma victims to quickly close wounds) 7. Contributing Conditions- Obesity: Infection- Diabetes: Infection, wound repair issues – People who have diabetes tend to have more wounds and more amputations. This influences the origin of the wound and wound healing- diabetics commonly have wounds farthest away fromthe heart - - This is because elevated blood sugar levels causing stress on the body:o Arteries are less pliableo Narrowing of the blood vessels - Cancer: Hyper inflammatory response/ wound repair (radiation, chemotherapy) The immune system is in high demand chronically (cancer) and acutely (wound)- Diabetic Neuropathy: Nerve damage can occur and result in loss of sensation in the limbs- cannot feel the developing blister or sore. Severity can progressquickly- complications with healing. Absence of nerves causes you to unable to feel wound. - Comorbid conditions: Things that contribute at the same time that may cause death: obesity, diabetes and wounds are 3 things contributing simultaneously to death. 8. Poor Circulation: REQUIRES ADEQUATE BLOOD FLOW FOR A SUPPLY LINE (the ability toget nutrients to the wound site)- Narrowed blood vessels leas to decrease blood flow and oxygen to a wound. - Elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue- This lowers efficiency of the white blood cells that fight infection. Without sufficient nutrients & oxygen, a wound heals more slowly. Slow rate raises higher chance of contracting an infection. - The immune cells don’t function properly due to diabetes, which raises the risk of infection. 9. Untreated Infections- Gangrene: 2 Types- Dry gangrene, slowly kills the skin and tissue.