Panniculus
Dr. Preethi chekuriMD DVL
Introduction
Occurs almost universally over the body surface, between the skin and deep fascia
Absent from eyelids and male genitalia
It varies in thickness with the race, age, sex, endocrine and nutrtional status
In a normal person, fat constitutes 10% of body weight
Functions
Acts as an insulating layer
Protective cushion
Thermogenesis
Store of readily available energy
Major endocrine organ
Provides support and has cosmetic function (contours of face)
Embryology
Pre – adipocyte appears in the mesenchyme at 14th week of fetal life
Pre – adipocyte terminally differentiate into either brown adipocyte or white adipocyte
Development of brown fat begins at the 20th week of gestation, reaches maximum at birth
Brown fat
It is multilocular and metabolically very active with many mitochondria
Surrounded by a greater capillary network than white fat ( partly responsible for the brown colour), such that heat can be rapidly tranferred into the circulation
Most prominent in neck and upper thorax of fetus
Adults have supraclavicular areas of brown fat
Histology of adipocytes
Have a diameter upto 100 microns
Mature fat cell has a characteristic signet ring appearance, because the oval nucleus is displaced to a side by a single, large, intracellular, fat containing vacuole, which is surrounded by perilipin
Arranged in lobules, which are separated by interlobular septa
Each lobule consists adipocytes, stromavascular tissue being macrophages, fibroblasts, mast cells, pericytes, endothelial cells and pre-adipocytes
Blood, nerve and lymph supply
BLOOD - Fat tissue has an abundant blood supply, each lobule being supplied by a terminal arteriole running along the septa
Then breaks up to form capillaries
LYMPH - Also contains a rich lymphatic plexus
These lymph vessels penetrate deep fascia and drain into regional lymph nodes
NERVE - Innervated by noradrenergic fibres of sympathetic nervous system and para sympathetic fibres
Adipogenesis It refers to the recruitment from multipotent
stem cells in the mesenchyme and stromavascular tissue, and proliferation of pre adipocytes followed by their differentiation into mature fat cells
-Glucocorticoids -growth hormone and -insulin, stimulate cells to terminally differentiate, but after a certain size, growth occurs through hyperplasia rather than hypertrophy
Energy homeostasis
Catabolism and anabolism of fat depends on -nourishment, endocrine and nervous activity
Insulin inhibits hydrolysis and breakdown of triglycerides, conserving the energy store
Adipose tissue in vitro has a metabolic rate similar to a kidney and half that of liver
Outline of lipogeneis in an adipocyte
Fat as an organ
Apart from the subcutaneous fat, 20% of fat tissue occurs internally, in mediastinal and retroperitoneal tissues, mesentry, marrow and other individual organs including blood vessels
In view of the recent obesity epidemic, increase in the upper body and visceral fat are associated with an increase cardiovascular and metabolic risks
Fat as an endocrine organ
Adiponectin
Protein with structural similarity to collagen and C1q
Has autocrine/paracrine effects locally and endocrine effects distally
Promotes pre adipocytes to become mature fat cells with increase in size
Serum adiponectin levels are lower with weight gain and higher with weight loss
Also exerts anti inflammatory properties
Leptin
Adipokine involved in energy homeostasis
Structural homology similar to other cytokine proteinssuch as TNF alpha and IL-6
Exerts main effect via satiety centres
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