Home Prevention Subcutaneous fat tissue is normal. The thickness of subcutaneous fat is normal

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Subcutaneous fat tissue is normal. The thickness of subcutaneous fat is normal

Subcutaneous fatty tissue has elasticity and tensile strength, its thickness is uneven in different parts of the body, the most significant body fat on the stomach, buttocks, and in women also on the chest. The subcutaneous fat layer in women is almost 2 times thicker than in men (m:f = 1:1.89). In men, the amount of fat is about 11% of body weight, in women - about 24%. Subcutaneous fatty tissue is richly supplied with blood and lymphatic vessels, the nerves in it form broadly looped plexuses.

Subcutaneous fat participates in the formation of the external shape of the body, skin turgor, promotes skin mobility, and participates in the formation of skin folds and furrows. It functions as a shock absorber under external mechanical influences, serves as the body's energy depot, participates in fat metabolism, and acts as a thermal insulator.

In clinical assessment development of subcutaneous fat tissue, the terms “nutrition” and “fatness” are used. Nutrition is divided into normal, increased or excessive (obesity), decreased (weight loss, emaciation) and exhaustion (cachexia). Nutrition is assessed visually, but it is judged more objectively by palpation examination of the thickness of the fat layer, body weight and its relationship with proper weight, and the percentage of fat in the body. For these purposes, special formulas and nomograms are used.

Expressiveness subcutaneous fat layer significantly depends on the type of constitution: hypersthenics are prone to increased nutrition, asthenics - to reduced. That is why, when determining the proper body weight, it is necessary to take into account the correction for the type of constitution.
At the age of 50 and over, the amount of fat increases, especially in women.

Healthy man may have different degrees of fatness, which depends on the type of constitution, hereditary predisposition, lifestyle [diet, physical activity, nature of work, habits (smoking, drinking alcohol)]. Older age, excess eating, drinking alcohol, especially beer, and a sedentary lifestyle contribute to excess fat accumulation - obesity. Poor nutrition, addiction to certain diets, fasting, exhausting physical work, psycho-emotional overload, habitual intoxication (smoking, alcohol, drugs) can lead to weight loss and exhaustion.

Obesity and weight loss observed in some diseases of the nervous and endocrine systems. Weight loss of varying degrees occurs with many somatic, infectious and oncological diseases. Excessive fat deposition and its sharp decrease can be generalized and local, limited, focal. Local changes, depending on the cause, can be symmetrical or unilateral.

The degree of development of subcutaneous fat is determined by palpation (palpation) and consists of measuring the thickness of the skin fold formed when the skin is grasped with the thumb and forefinger.

In the area of the lower third of the shoulder along the back surface;

On the anterior abdominal wall at the level of the navel along the edge of the rectus abdominis muscles;

At the level of the angles of the shoulder blades;

At the level of the costal arches;

On the front of the thigh.

With a skin fold thickness of 1-2 cm, the development of the subcutaneous fat layer is considered normal, less than 1 cm - reduced, more than 2 cm - increased.

Attention is also paid to the nature of the distribution of the subcutaneous fat layer. Normally, it is distributed evenly (the thickness of the skin fold is almost the same in different parts of the body). If the subcutaneous fat layer is unevenly distributed, it is necessary to indicate the areas of increased fat deposition.

9. Edema: varieties according to origin and mechanism of development. Characteristics of cardiac and renal edema. Methods for detecting edema.

Edema is an excessive accumulation of fluid in body tissues and serous cavities, manifested by an increase in tissue volume or a decrease in the capacity of serous cavities and a disorder in the function of edematous tissues and organs.

Swelling can be local (local) or general (widespread).

There are several degrees of edema:

1. Hidden edema: not detected by examination and palpation, but detected by weighing the patient, monitoring his diuresis and the McClure-Aldrich test.

2. Pastosity: when pressing with a finger on the inner surface of the leg, a small pit remains, which is detected mainly by touch.

3. Obvious (pronounced) swelling: the defiguration of joints and tissues is clearly visible and when pressed with a finger, a clearly visible hole remains.

4. Massive, widespread edema (anasarca): accumulation of fluid not only in the subcutaneous fatty tissue of the torso and limbs, but also in the serous cavities (hydrothorax, ascites, hydropericardium).

The main reasons for the development of edematous syndrome:

1) increase in venous (hydrostatic) pressure - hydrodynamic edema;

2) decrease in oncotic (colloid-osmotic) pressure - hypoproteinemic edema;

3) disturbance of electrolyte metabolism;

4) damage to the capillary wall;

5) impaired lymphatic drainage;

6) drug-induced edema (minerolocorticoids, sex hormones, non-steroidal anti-inflammatory drugs);

7) endocrine edema (hypothyroidism).

Edema of cardiac origin. U In a patient with heart failure, edema is always localized symmetrically. First, swelling of the feet and ankles forms, which can completely disappear after a night's rest. Swelling increases towards the end of the day. As heart failure progresses, the legs and then the thighs swell. In bedridden patients, swelling of the lumbosacral region appears. The skin over the swelling is tense, cold, and cyanotic. The swelling is dense; when pressed with a finger, a hole remains. As heart failure progresses, ascites and hydrothorox may appear. Trophic changes in the skin in the shin area are often detected in the form of increased pigmentation, depletion, cracking, and the appearance of ulcers.

degree of development, nature of distribution, thickness of subcutaneous fat folds on the abdomen, chest, back, limbs, face;

The presence of swelling and compaction;

Tissue turgor.

Some idea of the quantity and distribution of the subcutaneous fat layer can be obtained during a general examination of the child, but a final judgment about the condition of the subcutaneous fat layer is made only after palpation.

To assess the subcutaneous fat layer, a slightly deeper palpation is required than when examining the skin - with the thumb and forefinger of the right hand, not only the skin, but also the subcutaneous tissue is grasped into the fold. The thickness of the subcutaneous fat layer should be determined not in one particular area, but in different places, since in pathological cases the deposition of fat in different places turns out to be unequal. Depending on the thickness of the subcutaneous fat layer, they speak of normal, excessive and insufficient fat deposition. Attention is drawn to the uniform (over the entire body) or uneven distribution of the subcutaneous fat layer.

It is better to determine the thickness of the subcutaneous fat layer in the following sequence: first on the stomach - at the level of the navel and outside it, then on the chest - at the edge of the sternum, on the back - under the shoulder blades, on the limbs - the inner surface of the thigh and shoulder, and finally on the face - in the cheek area.

You should pay attention to the presence of edema and its prevalence (on the face, eyelids, limbs, general edema - anasarca or localized). Swelling is easy to notice upon examination if it is well expressed or localized on the face. To determine the presence of edema in the lower extremities, you need to press with the index finger of your right hand in the lower leg area above the tibia. If, when pressed, a hole is formed that disappears gradually, then this is swelling of the subcutaneous tissue; in the event that the hole disappears immediately, then they speak of mucous edema. U healthy child no hole is formed.

^ Determination of soft tissue turgor is carried out by squeezing the skin and all soft tissues on the inner surface of the thigh and shoulder with the thumb and index finger of the right hand, while a feeling of resistance or elasticity, called turgor, is perceived. If turgor is reduced in young children, then when they are squeezed, a feeling of lethargy or flabby is determined.

Edema

Edema (fluid retention) occurs primarily in the subcutaneous tissue due to its porous structure, especially where the tissue is looser. Hydrostatic and hydrodynamic factors explain the appearance of edema in low-lying areas of the body ( lower limbs). The last factor plays important role in the development of edema in heart disease accompanied by congestive heart failure. Swelling appears more often towards the end of the day, when the patient stays in bed for a long time. vertical position. At the same time, with kidney disease, small swelling most often appears primarily on the face (in the eyelid area) and usually in the morning. In this regard, the patient may be asked whether he feels heaviness and swelling of the eyelids in the morning. For the first time, the patient’s relatives may notice the appearance of such swelling.

In diseases of the heart, kidneys, liver, intestines, and endocrine glands, edema can be widespread. When venous and lymphatic drainage is impaired or allergic reactions occur, swelling is often asymmetrical. In rare cases, in older people they may appear during prolonged stay in an upright position, which (like edema in women in the hot season) is not of great clinical significance.

Patients may consult a doctor with complaints of swelling of the joints, swelling of the face and legs, rapid weight gain, and shortness of breath. With general fluid retention, edema occurs primarily, as already mentioned, in low-lying parts of the body: in the lumbosacral region, which is especially noticeable in people occupying a vertical or semi-recumbent position. This situation is typical for congestive heart failure. If the patient can lie in bed, swelling occurs primarily on the face and hands, as happens in young people with kidney disease. Fluid retention is caused by an increase in venous pressure in any area, for example, with pulmonary edema due to left ventricular failure when ascites occurs in patients with increased pressure in the system portal vein(portal hypertension).

Usually the development of edema is accompanied by an increase in body weight, but even initial edema in the legs and lower back is easily detected by palpation. It is most convenient to press the fabric onto a dense surface with two or three fingers. tibia, and after 2-3 s, in the presence of edema, pits are detected in the subcutaneous fatty tissue. Weak degree puffiness is sometimes referred to as “pastiness.” Pits on the shin form when pressure is applied only if body weight has increased by at least 10-15%. With chronic lymphoid edema, myxedema (hypothyroidism), the edema is more dense, and when pressed, a hole does not form.

Both for general and local edema important their development is influenced by factors involved in the formation of interstitial fluid at the capillary level. Interstitial fluid is formed as a result of its filtration through the capillary wall - a kind of semi-permeable membrane. Some of it returns back to the vascular bed due to the drainage of the interstitial space along lymphatic vessels. In addition to hydrostatic pressure inside the vessels, the rate of fluid filtration is influenced by the osmotic pressure of proteins in the interstitial fluid, which is important in the formation of inflammatory, allergic and lymphatic edema. Hydrostatic pressure in capillaries varies in different parts of the body. Thus, the average pressure in the pulmonary capillaries is about 10 mm Hg. Art., while in the renal capillaries it is about 75 mm Hg. Art. When the body is in an upright position, as a result of gravity, the pressure in the capillaries of the legs is higher than in the capillaries of the head, which creates the conditions for mild swelling of the legs at the end of the day in some people. The pressure in the capillaries of the legs of a person of average height in a standing position reaches 110 mmHg. Art.

Severe general swelling (anasarca) can occur with hypoproteinemia, in which oncotic pressure drops, mainly associated with the content of albumin in the plasma, and fluid is retained in the interstitial tissue without entering the vascular bed (often there is a decrease in the amount of circulating blood - oligemia, or hypovolemia).

The causes of hypoproteinemia can be a variety of conditions, united clinically by the development of edema syndrome. These include the following:

insufficient protein intake (fasting, poor nutrition);
digestive disorders (impaired secretion of enzymes by the pancreas, for example, with chronic pancreatitis, others digestive enzymes);
malabsorption of food products, especially proteins (resection of a significant part small intestine, damage to the wall of the small intestine, gluten enteropathy, etc.);
impaired albumin synthesis (liver disease);
significant loss of proteins in the urine during nephrotic syndrome;
loss of protein through the intestines (exudative enteropathies).

The decrease in intravascular blood volume associated with hypoproteinemia can cause secondary hyperaldosteronism through the renin-angiotensin system, which contributes to sodium retention and edema formation.

Heart failure causes edema due to the following reasons:

disturbance of venous pressure, which can be detected by dilation of the veins in the neck;
effect of hyperaldosteronism;
renal blood flow disorder;
increased secretion of antidiuretic hormone;
decreased oncotic pressure due to blood stagnation in the liver, decreased albumin synthesis, decreased protein intake due to anorexia, loss of protein in the urine.

Renal edema most clearly manifested in nephrotic syndrome, when, due to severe proteinuria, a significant amount of protein (primarily albumin) is lost, which leads to hypoproteinemia and hypo-oncotic fluid retention. The latter is aggravated by developing hyperaldosteronism with increased sodium reabsorption by the kidneys. The mechanism for the development of edema in acute nephritic syndrome is more complex (for example, in the midst of typical acute glomerulonephritis), when, apparently, a more significant role is played by the vascular factor (increased permeability vascular wall), in addition, sodium retention is important, leading to an increase in the volume of circulating blood, “blood edema” (hypervolemia, or plethora). As with heart failure, edema is accompanied by a decrease in diuresis (oliguria) and an increase in the patient’s body weight.

Local swelling may be due to reasons related to venous, lymphatic or allergic factors, as well as local inflammatory process. With compression of the veins from the outside, venous thrombosis, insufficiency of venous valves, varicose veins capillary pressure in the corresponding area increases, which leads to stagnation of blood and the appearance of edema. Most often, thrombosis of the leg veins develops in diseases that require prolonged bed rest, including conditions after surgery, as well as during pregnancy.

When lymph outflow is delayed, water and electrolytes are reabsorbed back into the capillaries from the interstitial tissue, but proteins filtered from the capillary into the interstitial fluid remain in the interstitium, which is accompanied by water retention. Lymphatic edema also occurs as a result of obstruction of the lymphatic ducts by filariae (tropical disease). In this case, both legs and external genitalia may be affected. The skin in the affected area becomes rough, thickened, and elephantiasis develops.

During a local inflammatory process as a result of tissue damage (infection, ischemia, exposure to certain chemicals such as uric acid), histamine, bradykinin and other factors are released, which cause vasodilation and increased capillary permeability. Inflammatory exudate contains a large amount of protein, as a result the movement mechanism is disrupted tissue fluid. Often, classic signs of inflammation are simultaneously observed, such as redness, pain, and local fever.

An increase in capillary permeability is also observed in allergic conditions, but unlike inflammation, there is no pain and no redness. With Quincke's edema - a special form of allergic edema (usually on the face and lips) - symptoms usually develop so quickly that life is threatened due to swelling of the tongue, larynx, and neck (asphyxia).

Violation of the development of subcutaneous fat tissue

When examining subcutaneous fat tissue, attention is usually paid to its increased development. In obesity, excess fat is deposited in the subcutaneous tissue fairly evenly, but to a greater extent in the abdominal area. Uneven deposition of excess fat is also possible. The most typical example is Cushing's syndrome (observed with excessive secretion of corticosteroid hormones by the adrenal cortex), Cushingoid syndrome is often observed associated with long-term treatment with corticosteroid hormones. Excess fat in these cases is deposited mainly on the neck, face, and upper torso; the face usually looks round and the neck is full (the so-called moon face).

The skin of the abdomen often stretches significantly, which is manifested by the formation of areas of atrophy and scars of a purple-bluish color, in contrast to whitish areas of skin atrophy from stretching after pregnancy or large edema.

Progressive lipodystrophy and significant loss of the subcutaneous fat layer (as well as fatty tissue of the mesenteric region) are possible, which is observed in a number of serious illnesses, after major surgical interventions, especially on gastrointestinal tract, during fasting. Local atrophy of subcutaneous fat is observed in patients

The thickness of the various layers of skin in children under three years of age is 1.5-3 times less than in adults, and only by the age of 7 does it reach the level of an adult.

The epidermal cells in children are relatively far apart from each other, and its structure is loose. The stratum corneum in newborns is thin and consists of 2-3 layers of easily listenable cells. The granular layer is poorly developed, which determines the significant transparency of the skin of newborns and its pink color. The basal layer is well developed, but in the first months of life, due to the low function of melanocytes, the skin background is lighter.

Distinctive feature the skin of children, especially newborns, is a weak connection between the epidermis and the dermis, which is primarily caused by the insufficient number and poor development of anchor fibers. In various diseases, the epidermis easily peels off from the dermis, which leads to the formation of blisters.

The surface of a newborn's skin is covered with a secretion with weak bactericidal activity, since its pH is close to neutral, but by the end of the first month of life the pH decreases significantly.

In the skin of newborns and children of the first year of life, a network of wide capillaries is well developed. Subsequently, the number of wide capillaries gradually decreases, and the number of long and narrow ones increases.

The nerve endings of the skin are not sufficiently developed at the time of birth, but are functionally sound and cause pain, tactile and temperature sensitivity.

The skin of a child in the first year of life, due to its structural features, biochemical composition and good vascularization, is soft, velvety and elastic. In general, it is thin, smooth, its surface is drier than that of adults, and is prone to peeling. The entire surface of the skin and hair is covered with a water-lipid layer, or mantle, which protects the skin from adverse factors. environment, slows down and prevents the absorption and effects of chemicals, serves as a site for the formation of provitamin D, and has antibacterial properties.

Sebaceous glands

The sebaceous glands begin to function in the prenatal period; their secretion forms a cheesy lubricant that covers the surface of the fetal skin. The lubricant protects the skin from the effects of amniotic fluid and facilitates the passage of the fetus through the birth canal.

The sebaceous glands function actively in the first year of life, then their secretion decreases, but increases again during puberty. In adolescents, they are often clogged with horny plugs, which leads to the development of acne.

Sweat glands

By the time of birth, eccrine sweat glands are not fully formed, they excretory ducts underdeveloped and covered with epithelial cells. Sweating begins at 3-4 weeks of age. During the first 3-4 months, the glands do not function fully. In young children (up to 3 years of age), sweating appears when more high temperature than in older children. As the sweat glands, the autonomic nervous system, and the thermoregulation center in the brain mature, the sweating process improves and its threshold decreases. By 5-7 years, the glands are fully formed, and adequate sweating occurs at 7-8 years.

Apocrine sweat glands begin to function only with the onset of puberty.

Primary hair is replaced by vellus hair before or shortly after birth (with the exception of eyebrows, eyelashes and scalp). The hair of full-term newborns does not have a core, and the hair follicle is not developed enough, which does not allow the formation of a boil with a purulent core. The skin, especially on the shoulders and back, is covered with vellus hair (lanugo), which is much more noticeable in premature babies.

Eyebrows and eyelashes are poorly developed, but their growth intensifies later. Hair development completes during puberty.

The nails of full-term newborns are well developed and reach the tips of the fingers. In the first days of life, nail growth is temporarily delayed and a so-called physiological feature is formed on the nail plate. At the 3rd month of life, it reaches the free edge of the nail.

SKIN RESEARCH METHOD

To assess the condition skin carry out questioning, inspection, palpation and special tests.

INQUIRY AND INSPECTION

Whenever possible, the child is examined in natural daylight. The skin is examined sequentially from top to bottom: scalp head, neck, natural folds, groin and buttock areas, palms, soles, interdigital spaces. During the examination they evaluate:

Skin color and its uniformity;

Humidity;

Cleanliness (no rashes or other pathological elements, such as peeling, scratching, hemorrhages);

State vascular system skin, in particular the localization and severity of the venous pattern;

Integrity of the skin;

Condition of skin appendages (hair and nails).

Skin rashes

Skin rashes (morphological elements) can affect various layers of the skin, as well as its appendages (sweat and sebaceous glands, hair follicles).

Primary morphological elements appear on unchanged skin. They are divided into cavitary (spot, papule, node, etc.) and cavitary with serous, hemorrhagic or purulent contents (vesicle, bladder, abscess) (Table 5-3, Fig. 5-2-5-P).

The color of the skin depends on its thickness and transparency, the amount of normal and pathological pigments it contains, the degree of development, depth and plethora skin vessels, lib content and unit volume of crop and the degree of lib oxygen saturation. Depending on race and ethnicity, a child's normal skin color may be pale pink or varying shades of yellow, red, brown, and black. Pathological changes in skin color in children include pallor, hyperemia, and nianosis. jaundice and pigmentation

The moisture content of the skin is indicated by its shine: normally the surface of the skin is moderately shiny, with high humidity the skin is very shiny and often covered with drops of sweat: excessively dry skin is matte, rough

If pathological elements are detected on the skin, it is necessary to clarify;

Time of their appearance;

connection with any factors (food, medicinal, chemical, etc.):

The existence of similar symptoms in the past, their evolution (and changes in skin color and the nature of the rash):

Morphological type (see below):

Size (in millimeters or centimeters):

Number of elements (single elements, light rash, the elements of which can be counted upon examination, abundant - multiple elements that cannot be counted):

Shape (round, oval, irregular, star-shaped, ring-shaped, etc.):

Color (for example, during inflammation, ischemia occurs);

Localization and prevalence (indicate all parts of the body that have a rash, predominantly the head, torso, flexor or extensor surfaces of the extremities, skin folds, etc.):

Skin background in the area of the rash (for example, hyperemic):

Stages and dynamics of development of rash elements: - features of secondary elements remaining after

Clean skin

fading of the rash (peeling, hyper- or gynopigmentation, crusts and etc.)

Secondary morphological elements appear as a result of the evolution of primary ones (Table 5-4).

Condition of skin appendages

When examining the hair, pay attention to the uniformity of growth, I determine! correspondence to the degree of development hairline and its distribution over the child’s body, age and gender. Evaluate appearance hair (they should be shiny with straight ends) and the condition of the scalp.

When examining nails, pay attention to the shape, color, transparency, thickness and integrity of the nail plates. Healthy nails are pink in color, have smooth surfaces and edges, and adhere tightly to the nail bed. The periungual ridge should not be hyperemphasized and painful.

PALPATION

Palpation of the skin is carried out sequentially from top to bottom, and in areas of damage - with extreme caution. Humidity, temperature and elasticity of the skin are assessed.

Humidity is determined by stroking the skin of symmetrical areas of the body, including the skin of the palms, feet, armpits and groin areas.

5.2. SUBCUTANEOUS ADIPOSE FIBER

Adipose tissue consists predominantly of white fat, found in many tissues, and a small amount of brown fat (in adults, located in the mediastinum, along the aorta and under the skin in the interscapular area). In brown fat cells there is a natural mechanism for uncoupling oxidative phosphorylation: the energy released during the hydrolysis of triglycerides and the metabolism of fatty acids is not used for the synthesis of adenosine triphosphate, but is converted into heat.

ANAT0M0-PHYSI0L0GICAL FEATURES OF SUBCUTANEOUS ADIPOSE FIBER

At the end of the prenatal period and in the first year of life, the mass of adipose tissue increases as a result of an increase in both the number and size of fat cells (by 9 months of life, the mass of one cell increases 5 times). The thickness of subcutaneous fat increases noticeably from birth to 9 months, and then gradually decreases (by the age of 5, on average, it decreases by 2 times). The smallest thickness is noted at 6-9 years.

During puberty, the thickness of the subcutaneous fat layer increases again. In teenage girls, up to 70% of fat is located in the subcutaneous tissue (which gives them roundness), while in boys only 50% is in the subcutaneous layer. total number fat

TECHNIQUE FOR STUDYING SUBSCUTANEOUS ADIPOSE FIBER

The condition of subcutaneous fat is assessed by inspection and palpation.

DEGREE OF DEVELOPMENT

The degree of development of subcutaneous fatty tissue is assessed by the thickness of the skin fold, measured in various parts of the body (Fig. 5-40):

On the stomach;

On the chest (at the edge of the sternum);

On the back (under the shoulder blades);

On the limbs.

For an approximate practical assessment, you can limit yourself to studying 1-2 folds.

Submitted by A.F. Tura, the average thickness of the fold on the abdomen is:

In newborns - 0.6 cm;

At 6 months - 1.3 cm;

At 1 year - 1.5 cm;

At 2-3 years - 0.8 cm;

At 4-9 years old - 0.7 cm;

At 10-15 years old - 0.8 cm.

Lymph nodes are oval formations of various sizes, located in groups at the confluence of large lymphatic vessels.

Axillary lymph nodes are located in the armpits and collect lymph from the skin. upper limb(except for 111. IV and V fingers and the inner surface of the hand).

Thoracic lymph nodes are located medially from the anterior axillary line under the lower edge of the great pectoral muscle, collect lymph from the skin of the chest, from the parietal pleura, partly from the lungs and from the mammary glands.

The ulnar (cubital) lymph nodes are located in the philtrum of the biceps mouse. Collect lymph from II I. IV. V fingers and inner surface of the hand.

The inguinal lymph nodes are located along the inguinal ligament, collect lymph from the skin of the lower extremities, lower parts and abdomen, buttocks, perineum, genitals and anus.

The popliteal lymph nodes are located in the popliteal fossae and collect lymph from the skin of the foot.

Research methodology

Questioning reveals:

Increased size of lymph nodes;

The appearance of pain and redness in the area of the lymph nodes;

How long ago these complaints appeared;

Possible reasons, preceding the appearance of these complaints (infections and other provoking factors);

Concomitant conditions (presence of fever, weight loss, symptoms of intoxication, etc.).

The examination reveals:

Significantly enlarged lymph nodes;

Signs of inflammation are skin hyperemia and swelling of the subcutaneous fat tissue above the lymph node.

Palpation allows you to evaluate the characteristic changes in the lymph nodes.

* Size of lymph nodes. Normally, the diameter of the lymph node is 0.3-0.5 cm (the size of a pea). There are six degrees of lymph node enlargement:

Grade I - lymph node the size of a millet grain;

SUBCUTANEOUS ADIPOSE FIBER [tela subcutanea(PNA, JNA, BNA); syn.: subcutaneous base, subcutaneous tissue, hypodermis] - loose connective tissue with fatty deposits that connects the skin to deeper tissues. It forms subcutaneous cellular spaces (see), in which there are the end sections of the sweat glands, vessels, lymph nodes, cutaneous nerves.

Embryology

P.J. to. develops from mesenchymal primordia, the so-called. primary fatty organs. They are laid by 3-2 months. embryonic development in the skin of the cheeks and soles, and by 4.5 months - in the skin of other parts of the fetal body.

Anatomy and histology

The basis of the p. consists of connective tissue fibrous cords formed by bundles of collagen fibers with an admixture of elastic fibers (see Connective tissue), originating in the reticular layer of the skin (see) and going to the superficial fascia, the edges are delimited by the pancreas. from the underlying tissues (own fascia, periosteum, tendons). Based on their thickness, fibrous cords are classified as 1st, 2nd, and 3rd order. Between the strands of the 1st order there are thinner strands of the 2nd and 3rd order. The cells, bounded by fibrous cords of various orders, are entirely filled with lobules of adipose tissue (see), forming fatty deposits (panniculus adiposus). Structure of the liner K. determines its mechanical properties - elasticity and tensile strength. In places subject to pressure (palm, sole, lower third of the buttocks), thick fibrous cords predominate, penetrating the subcutaneous tissue perpendicular to the surface of the body and forming skin retinaculum (retinacula cutis), which tightly fix the skin to the underlying tissues, limiting its mobility. In a similar way, the skin of the scalp is connected to the tendon helmet. Where the skin is mobile, fibrous cords are located obliquely or parallel to the surface of the body, forming lamellar structures.

Fat deposits in the subcutaneous tissue of the fetus up to 7 months. are insignificant, but increase rapidly towards the end of the intrauterine period. In the adult body they average approx. 80% of the total mass of P. g. (the percentage varies greatly depending on age, gender and body type). Adipose tissue is absent only under the skin of the eyelids, penis, scrotum, clitoris and labia minora. Its content in the subcutaneous base of the forehead, nose, outer ear, and lips is insignificant. On the flexor surfaces of the limbs, the content of adipose tissue is greater than on the extensor surfaces. The largest fat deposits are formed on the abdomen, buttocks, and in women also on the chest. There is a close correlation between the thickness of the pant. to. in various segments of the limbs and on the torso. The ratio of the thickness of the pant. K. in men and women averages 1: 1.89; its total weight in an adult man reaches 7.5 kg, in a woman 13 kg (14 and 24% of body weight, respectively). IN old age the total mass of adipose tissue under the skin decreases and its distribution becomes disproportionate.

In certain parts of the body in the pancreas. because muscles are located, when they contract, the skin in these places gathers into folds. The striated muscles are located in the subcutaneous tissue of the face [ facial muscles(facial muscles, T.)] and neck (subcutaneous muscle of the neck), smooth muscles - in the subcutaneous base of the external genitalia (especially in the fleshy shell of the scrotum), anus, nipple and areola of the mammary gland.

P.J. K. rich blood vessels. Arteries, penetrating into it from the underlying tissues, form a dense network at the border with the dermis. From here their branches run in fibrous cords and are divided into capillaries surrounding each fatty lobule. In P. zh. to. venous plexuses are formed, in which large saphenous veins. Lymph, vessels of the pancreas. They originate in the deep lymphatic network of the skin and go to the regional lymph nodes. The nerves form a wide-loop plexus in the deep layer of the pancreas. j. Sensitive nerve endings are represented in the subcutaneous tissue by lamellar bodies - Vater-Pacini bodies (see Nerve endings).

Physiological significance

The functions of subcutaneous fat fiber are diverse. The external shape of the body, skin turgor and mobility, and the severity of skin furrows and folds largely depend on it. P.J. K. represents the body's energy depot and actively participates in fat metabolism (see); it plays the role of a thermal insulator of the body, and brown fat, present in fetuses and newborns, is an organ of heat production (see Adipose tissue). Thanks to its elasticity, the pant. K. performs the function of a shock absorber of external mechanical influences.

Pathological anatomy

Pathological changes in the pancreas. may be associated with disorders of fat metabolism. With endogenous and exogenous forms of obesity (see) in P. because the number of fat lobules increases due to hyperplasia of lipocytes and an increase in fat in their cytoplasm (lipocyte hypertrophy). In this case, new capillaries are formed, and in the fat cells themselves they are often found destructive changes. A decrease in the amount of fat in the cytoplasm of fat cells is observed with exhaustion. In this case, the cell nuclei occupy central position, their volume often increases.

Mucoid and fibrinoid swelling connective tissue Subcutaneous fatty tissue (see Mucous dystrophy, Fibrinoid transformation) occurs in collagen diseases (see). Amyloidosis (see) is rare. Amyloid can be found in the walls of blood vessels, less often around hair follicles, sebaceous and sweat glands. Calcification (see) is possible in small areas, in the area of degenerative tissue changes. For example, with scleroderma (see), calcium salts are deposited in the form of grains, lumps or layered formations with a perifocal inflammatory reaction.

Necrosis of Subcutaneous Fat Fiber develops with local circulatory disorders, mechanical damage, injection of certain medications (for example, solutions of magnesium sulfate, calcium chloride, etc.) and chemical substances(for example, gasoline), for burns, frostbite, etc. (see Fat necrosis, Necrosis). In the fat lobules, enzymatic breakdown of neutral fat occurs with the formation of fatty acids and soaps, which irritate the surrounding tissues, causing a perifocal productive inflammatory reaction with the presence of giant multinucleated cells (see Lipogranuloma).

Arterial hyperemia of subcutaneous fat tissue often occurs when inflammatory processes in the skin and p. and is mainly local in nature. With general venous stagnation in the pancreas. a picture of edema develops. As a result of impaired lymphatic drainage in the pancreas. because sclerotic changes occur. Hemorrhages in the pancreas. to. are diffuse in nature and are accompanied by rapid absorption of blood breakdown products.

Nonspecific inflammatory processes are most often exudative in nature - serous, purulent, fibrinous. A special place is occupied by Pfeiffer-Weber-Christian syndrome (recurrent non-suppurating spontaneous panniculitis), which is characterized by focal destruction of adipose tissue with the development of an inflammatory reaction (see Panniculitis). Morphol, picture of specific inflammatory diseases P.J. to. does not differ from that in other organs and tissues (see Syphilis, Extrapulmonary tuberculosis).

Patol. processes caused in the pancreas. to. fungi, are quite diverse, which depends on the properties of fungi and the body’s reaction to them. With histol, research in P. g. to. changes characteristic of hron, inflammatory processes are detected, with features determined by the type of pathogen (see Mycoses).

Atrophy of Subcutaneous Fatty Fiber occurs in various forms of cachexia (see). P.J. It acquires an ocher-yellow color, which is associated with the concentration of lipochrome pigment; the adipose tissue is saturated with edematous fluid. Hypertrophy of the pancreas. most often occurs vicariously, for example, with atrophy of the muscles of the limbs.

Pathology

Atrophy, hypotrophy and hypertrophy of Subcutaneous Fat Fiber come down to a decrease or increase in fat deposits. They may arise due to birth defects development of pancreas to., but are often caused by many patol processes. So, atrophy of the pancreas. to. occurs with anorexia, starvation, hypovitaminosis, progressive lipoid dystrophy, severe traumatic exhaustion, purulent-resorptive fever, sepsis, malignant tumors, etc. Hypertrophy of the pancreas. is observed, as a rule, with disorders of fat metabolism due to functional changes in the pituitary gland, thyroid and gonads, with adiposogenital dystrophy, obesity, long-term hormone therapy, especially prednisolone. Excessive development of adipose tissue can be diffuse or focal (see Lipomatosis); fat deposits are especially significant in the chin area, mammary glands, abdominal wall, and buttocks. Lipomatosis with the development of dense round painful lesions in the pancreas. along the nerve trunks has a neuroendocrine nature (see Dercum's disease).

Treatment of atrophy, hypo- and hypertrophy of the pancreas. should be aimed at eliminating the cause that caused them. In some cases, to remove excess fat deposits (in particular, on the hips and abdomen), plastic surgery is performed (see), and sometimes in case of general obesity - operations with the exclusion of a significant part of the small intestine (see Obesity).

With a closed injury to the Subcutaneous Fat Fiber, hemorrhages are observed (see), which are usually manifested by a change in skin color (from lilac-red to yellow-green); sometimes hematomas are formed (see). A peculiar form of closed injury to the pancreas. K. is a traumatic detachment of the skin together with the subcutaneous base from the underlying dense tissues (fascia, aponeurosis), the edges are observed in the tangential direction of the acting force (transmission, dragging on asphalt during transport injuries, etc.). More often this happens on outer surface hips, sacrum, lower back. The hemorrhage, which is insignificant in these cases, quickly stops, and the resulting cavity is slowly filled with lymph, manifesting clinically as a fluctuating swelling, the contents of the cut move when the patient’s position changes. The diagnosis is not difficult if you remember the possibility of such an injury. With conservative treatment, lymph absorption is very slow; suppuration with extensive purulent streaks is not uncommon (see). At open damage in P. zh. to., through which the wound channel passes, along with blood clots there may be bone fragments, scraps of the victim’s clothing material and others foreign bodies(see Wounds, wounds). Toxic foreign bodies (in particular, chemical pencil graphite) and some chemicals. substances (kerosene, turpentine, etc.) that got into the pantry. to., serve as the cause of a violent deep inflammatory-necrotic process. Wound of P. with a chemical pencil, provided that the fragments remaining in it are accompanied by profuse lymphorrhea (see), the edges do not stop until they are removed.

Treatment closed injuries Subcutaneous adipose tissue with aseptic course is mainly conservative. In the presence of a large hematoma, as well as in the case of suppuration or calcification of the hematoma, it is indicated surgical treatment(puncture, incision, excision),

In case of traumatic skin detachment, repeated punctures (sometimes with an injection of antibiotics) are necessary, followed by pressure bandage; during suppuration, an incision is made with counter-apertures (see). With open, especially gunshot, wounds of L. because primary surgical treatment of wounds is necessary (see). Poisonous foreign bodies and chemical substances, caught in P. zh. to., are subject to urgent surgical removal with excision of surrounding soft tissues.

Deep (III - IV degrees) thermal burns cause necrosis of the pancreas. k. (see Burns).

The most common type of pathology of the Subcutaneous Adipose Fiber is its inflammation - panniculitis (see). Pathogens of acute nonspecific infection (staphylococcus, streptococcus, coli, Proteus, etc.) can penetrate the pancreas. through the skin (with microtraumas) or in the presence of a boil (see) or carbuncle (see) by moving from the hair bursa and sebaceous glands and cause the formation of an abscess (see) or phlegmon (see). Phlegmon often occurs with erysipelas (see), especially in its phlegmonous and gangrenous forms. Hematogenous and lymphogenous routes of infection are possible, which are observed more often in sepsis (see). Pronounced changes in the pancreas. to. are observed during hron, inflammatory processes - pyoderma (see), lipogranuloma (see), etc. Disorders of lymph circulation in the pancreas caused by inflammatory processes. to. - lymphostasis (see), lymphangiectasia (see) - play a significant role in the pathogenesis and wedge, the picture of elephantiasis (see). With certain specific processes (actinomycosis, tuberculosis) in the pancreas. because fistula tracts are formed (see Fistulas) or leaks (see).

Treatment of inflammatory processes in pancreas. complex: surgery according to indications, antibacterial therapy and other conservative measures.

Benign tumors of the Subcutaneous Adipose Fiber - lipoma and fibrolipoma (see Lipoma) - sometimes reach large sizes; they are relatively easily removed surgically. From malignant tumors P.J. because liposarcoma is rare (see). Timely treatment of it (surgery and chemotherapy) can give favorable outcome. A peculiar tumor of the pancreas. represents a hibernoma (see), benign or malignant. Often in P. zh. because metastases (including implantation) of various malignant tumors can develop.

Bibliography: Voino-Yasenetsky V. F. Essays on purulent surgery, L., 1956; Davydovsky I. V. General pathology person, s. 89, M., 1969; Kalantaevskaya K. A. Morphology and physiology of human skin, p. 19, Kyiv, 1972; Kovanov V.V. and Anikina T.I. Surgical anatomy human fascia and cellular spaces, p. 5, M., 1967; Multi-volume guide to pathological anatomy, ed. A. I. Strukova, vol. 1, p. 231, M., 1963; Multi-volume guide to surgery, ed. B.V. Petrovsky, vol. 2, M., 1964; Sorokin A.P. General patterns structures of the human supporting apparatus, p. 33, M., 1973; Strukov A.I. and Serov V.V. Pathological anatomy, With. 37, M., 1979; Struchkov V.I. Purulent surgery, M., 1967; aka, General Surgery, M., 1978; Man, Medical and biological data, trans. from English, p. 57, M., 1977. See also bibliogr, to Art. Abscess, Dercum disease, Adipose tissue, Fat metabolism, Carbuncle, Lipoma, Elephantiasis, etc.

M. A. Korendyasev; G. M. Mogilevsky (pat. an.), V. S. Speransky (an.).

The study of subcutaneous fat makes it possible to assess the degree of its severity, uniformity of distribution throughout the body, and identify the presence of edema.

To assess the severity of the subcutaneous fat layer, a slightly deeper palpation is required than when examining the skin. With the thumb and forefinger of the right hand, not only the skin, but also the subcutaneous tissue is grasped into the fold. The thickness of the subcutaneous fat layer should be determined not in one particular area, but in different places, since in pathological cases the deposition of fat in different places turns out to be unequal.

The thickness of the subcutaneous fat layer is determined in symmetrical areas in the following sequence: first on the stomach - at the level of the navel and outside it (along the outer edge of the rectus abdominis muscle), then on the chest at the edge of the sternum, on the back - under the shoulder blades, on the limbs - on the inner the surface of the shoulder and thigh and, finally, on the face - in the cheek area.

With a normal degree of severity, the thickness of the skin fold is 1.5-2 cm. If the thickness of the fold is less than 1.5 cm, the development of the subcutaneous fat layer is insufficient, and if the thickness of the fold is more than 2 cm, the development of the fat layer is excessive (obesity). With a pronounced lack of development of subcutaneous tissue (cachexia), the thickness of the skin fold is less than 0.5 cm (almost the thickness of the skin).

The distribution of the fat layer throughout the body can be uniform (mainly when overeating) and uneven, with preferential deposition of fat in certain places. Typically, uneven distribution of the subcutaneous fat layer occurs when the function of the endocrine glands is impaired.

Edema- this is the accumulation of fluid in the subcutaneous fat and tissues due to the entry of the liquid part of the blood through the wall of the capillaries. The accumulated fluid may be of inflammatory or allergic origin (exudate), or may occur due to blood stagnation due to diseases of the heart, kidneys (transudate), or metabolic disorders. According to prevalence, general, local and hidden edema are distinguished.

General swelling are characterized by distribution throughout the body (often reaching the degree of anasarca) or occur in symmetrical areas (face, lower extremities). They develop as a result of heart disease, kidney disease, and also during prolonged fasting.

Based on severity, the following types of edema are distinguished:

1) pastiness – minor swelling that is not detected upon examination, while pressure reveals a barely noticeable hole;

2) pronounced swelling , determined by eye, are characterized by swelling, tension and smoothness of the skin, as well as smoothness of the external contour of a given part of the body; when pressed, a fairly deep hole is revealed;

3) anasarca – this is massive swelling of the subcutaneous fatty tissue of the whole body with the accumulation of fluid also in the cavities (abdominal, pleural, cardiac cavity).

Local swelling arise as a result of a local disorder of blood and lymph circulation, as well as due to inflammatory or allergic lesions. They are observed in limited inflammatory processes, allergic reactions (Quincke's edema), blockage of a vein by a blood clot (phlebothrombosis), and lymphostasis.

So called hidden swelling are observed in the early stages of true edema, when 2-4 liters of fluid can accumulate in the interstitial space, outwardly imperceptibly. Clinically manifested by weight gain and decreased diuresis. Hidden edema is detected by systematic weighing, measuring daily diuresis, as well as conducting special tests to detect the “edematous readiness” of the tissue (McClure-Aldrich test).