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M3 Path Block 2 > 5 - Environmental and Nutritional Diseases > Flashcards

5 - Environmental and Nutritional Diseases Flashcards

1
Q

Worldwide, there’s been a dramatic increase in mortality due to?

A

HIV/AIDS and associated infections

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2
Q

There’s been an 11.2% decrease in deaths from?

A

Infectious diseases, maternal, neonatal, and nutritional disorders

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3
Q

There’s been a 39.2% increase in deaths from non-communicable diseases such as?

A

Cancer, CVD, and DM

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4
Q

What’s the single leading global cause of health loss?

A

Undernutrition

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5
Q

What are leading causes of death in developed countries?

A

Ischemic heart disease and cerebrovascular diseases

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6
Q

Health effects of climate change: Overview

A

Partly man-made
Culprit: increase in greenhouse gases (CO2) via burning of fossil fuels, ozone, and methane

GHG along with water vapor gives the greenhouse effect: absorbs and re-emits infrared energy radiated from Earth’s surface

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7
Q

Health effects of climate change: on human body

A

CVD, cerebrovascular and respiratory disease

Gastroenteritis, cholera, food-borne and waterborne infectious diseases

Vector-borne diseases, malaria and dengue fever

Malnutrition

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8
Q

Toxicology of Chemical and Physical agents

A

Xenobiotics: exogenous chemicals

Chemicals may be excreted in urine or feces; eliminated in expired air, or may accumulate in bone, fat, brain or other tissues

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9
Q

Xenobiotics Pathway (Slide 10)

A

Pollutants in air, water, and soil are absorbed through lungs, GIT and skin

Reaches various organs where they get metabloized via blood stream

Get either:
Detoxified into water soluble compounds

OR

Activated into toxic metabolites

Both these types produce ROS that can produce cellular damage

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10
Q

Air Pollution

A

Among pre-existing pulmonary or cardiac disease

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11
Q

Outdoor Air Pollution

A

Ozone (O3): produced by UV radiation and O2 in the stratosphere

Absorbs most dangerous UV radiation

Decreased extent and thickness of O3: CFCs in A/Cs and fridges

CFCs drift up and participate in chemical reactios that destroy ozone

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12
Q

Outdoor Air Pollution 2

A

Ground level ozone gas (N2O and volatile compounds) produce free radicals –> injures epithelial cells of respiratory tract

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13
Q

Carbon Monoxide

A

Systemic asphyxiant
Hgb has 200 fold greater affinity for CO

Accidental and suicidal death

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14
Q

Indoor Air Pollution - Bioaerosols

A

Range form microbiologic agents causing infections like: Legionnaire’s Disease, viral pneumonia, common cold

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15
Q

Indoor Air Pollution - Radon

A

Radioactive gas derived from uranium
Widely present in soils
can cause lung cancer in uranium miners

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16
Q

Metals as Environmental Pollutants: Lead

A

Readily absorbed metal that binds to sulfhydryl groups in proteins, which then

Interferes calcium metabolism and leads to

Hematologic, skeletal, neurologic, GI and renal toxicities

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17
Q

Metals as Environmental Pollutants: Mercury

A

Binds to sulfhydryl group proteins with high affinity lead to damage in CNS and kidney

Minimata Disease - Cerebral palsy, deafness, blindness, mental retardation

Forms
Metallic (elemental)
Inorganic mercury compounds (mercuric cholride)
Organic (methyl mercury)

Main sources of exposure: contaminated fish (methyl mercury)

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18
Q

Metals as Environmental Pollutants: Arsenic

A

Interfere with several aspects of cellular metabolism

Toxicities prominent in the GIT, nervous system, skin, and heart

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19
Q

Metals as Environmental Pollutants: Cadmium

A

Preferentially toxic to: KIDNEYS AND LUNGS

Involve increased production of ROS

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20
Q

Occupational Health Risks: Industrial and Agricultural Exposures

A
  1. Chloroform and CCL4 in dry cleaning agents and paint removers –> CNS depressions and coma
  2. Polycyclic hydrocarbons released during combustion of fossil fuels –> potent carcinogens
  3. Organocholorides llike DDT, lindane, aldrin, and dieldrin –> disrupt hormonal balance due to antiestrogenic and antiandrogenic activity
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21
Q

Tobacco

A

90% of lung cancers
Smoke contains more than 2000 compounds
Nicotine

Potent carcinogens is polycyclic aromatic hydrocarbons

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22
Q

Tobacco 2

A

Tobacco with alcohol multiplies risk of oral, laryngeal, esophageal, and lung cancers

Maternal smoking increases risk of abortion, premature birth and IUGR

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23
Q

Alcohol Abuse

A

After consumption, unaltered absorption in stomach and SI

Distributes in tissue and body fluids in direct proportion to blood levels

Increased NADH/NAD Ratio

Decreased NAD major cause of accumulation of fat in liver

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24
Q

Adverse effects of alcohol

A

Acute alcoholism: Mainly affects CNS; reversible changes in hepatic and gastric tissue

Chronic: Affects all organs of body; significant morbidity

25
Q

Acute effects of alcohol: Liver

A

Fat droplets in cytoplasm of hepatocytes

26
Q

Acute effects of alcohol: Stomach

A

Acute gastritis and ulceration

27
Q

Acute effects of alcohol:CNS

A

Major depressant

Sub-corticular structures, cortical motor neurons, and medullary centers

28
Q

Acute effects of alcohol: RS

A

Respiratory arrest at higher levels

29
Q

Chronic effects of alcohol: Liver

A

Fatty change initially

Alcoholic hepatitis and cirrhosis with portal hypertension with risk of hepatocellular carcinoma

30
Q

Chronic effects of alcohol: GIT

A

Massive bleeding and gastritis, ulcer, and esophageal varices (fatal)

31
Q

Chronic effects of alcohol: Nervous System

A

Thiamine deficiency causes peripheral neuropathies and Wernicke-Korsakoff syndrome; cerebral atrophy, cerebellar degeneration and optic neuropathy

32
Q

Therapeutic Drugs and Drugs of Abuse: Menopausal Hormone Therapy (MHT)

A

Increases risk of thromboembolism, endometrial, and breast cancers

33
Q

Therapeutic Drugs and Drugs of Abuse: OCPs

A

Protective effect against endometrial and ovarian cancers but increase risk of thromboembolism and hepatic adenomas

34
Q

Therapeutic Drugs and Drugs of Abuse: Acetaminophen overdose

A

Centrilobular liver necrosis, leading to liver failure

35
Q

Therapeutic Drugs and Drugs of Abuse: Aspirin

A

Gastric ulceration and bleeding

36
Q

Non-therapeutic agents (Drug Abuse)

A

Sedative-hypnotics (Barbiturates, ethanol)

Psychomotor stimulants (cocaine, methamphetamine, ecstasy)

Opioid narcotics (heroin, oxycodone)

Hallucinogens and cannbinoids (marijuana)

37
Q

Nutritional Diseases: Undernutrition

A

Protein Energy Malnutrition

Anorexia and Bulimia

Vitamin Deficiencies

38
Q

Nutritional Diseases: Over nutrition

A

Obesity

Vitamin toxicity

39
Q

Undernutrition: Protein Energy Malnutrition

A

Serious, lethal disease affecting children

Common in low income countries

Primary and secondary PEM

Kwashiorkor: Protein depletion in VISCERAL compartment

Marasmus: Protein depletion in SOMATIC compartment

40
Q

Kwashiorkor

A

Protein depletion in VISCERAL compartment

Hypoalbuminemia

Generalized edema (loss of fat masked by fluid retention)

41
Q

Kwashiorkor Symptoms (6)

A

Skin changes: ‘flaky paint dermatosis’

Hair changes: loss of color, alternating pale and dark hair

Enlarged fatty liver

Apathy, listlessness, loss of appetite

Decreased immunity

Secondary infections

42
Q

Marasmus

A

Protein depletion in SOMATIC compartment

43
Q

Marasmus Symptoms (5)

A

Loss of muscle proteins and growth retardation, which leads to

Decreased subcutaneous fat, which leads to

Decreased leptin, which leads to

Stimulation of hypothalomo-pituitary axis, which leads to

Increased cortisol and lipolysis

44
Q

Marasmus: Other Features (4)

A
  1. Growth retardation; head appears too large for body
  2. Normal serum albumin
  3. Emaciation with loss of muscle mass and fat
  4. Anemia and immune deficiencies (secondary infections)
45
Q

Undernutrition: Anatomic Changes

A

Growth failure, peripheral edema in kwashiorkor

Loss of body fat and muscle atrophy in marasmus

Liver: Enlarged and fatty (K)

Bone Marrow: hypolastic

Small bowel: mucosal atrophy

Brain: cerebral atrophy and impaired myelination of white matter

46
Q

Secondary PEM: Cachexia

A

PEM in patients with AIDS and advanced cancer

Extreme weight loss, fatigue, muscle atrophy, anemia

Mechanism:

Advanced cancer and chronic inflammatory reaction (increased secretion of cachetic agents) -> proteolysis inducing factor and lipid mobilizing factor ( increase in FA oxidation and pro inflammatory cytokines (TNF and IL-6) -> skeletal muscle breakdown through NF-kB induced activation of ubiquitin proteosome pathway

47
Q

Anorexia Nervosa and Bulimia

A

Psychological disorders

Healthy young women who developed obsession with body image

*Altered serotonin has been suggested as important neurobiology

48
Q

Anorexia: Features

A

Prominent endocrine effects

Amenorrhea: decreased GnRH and subsequent decrease in FSH and LH

Decreased thyroid hormone: cold intolerance, bradycardia, constipation, dry and scaly and hair change

Decreased bone density due to decreased estrogen

Anemia, lymphopenia, hypoalbuminemia

Increased susceptibility to cardiac arrhythmia and sudden death due to hypokalemia

49
Q

Bulimia: Features

A

Binge eating followed by induced vomiting
Electrolyte imbalance - Hypokalemia with cardiac arrythmias

Pulmonary aspiration of gastric contents

Esophageal and gastric rupture

50
Q

Vitamin Deficiencies: Endogenously synthesized vitamines

A

D from steroids

K from Biotin from intestinal microflora

Niacin from tryptophan

Vitamin deficiency can be primary or secondary to disturbances in intestinal absorption, transport, or tissue

Can be primary or secondary to disturbances in intestinal absorption, transport, or tissue storage

51
Q

Vitamin A Deficiency

A

Keratomalacia

52
Q

Vitamin D Deficiency - Childhood

A

Rickets
Epiphyses are open
Cartilage overgrowth

53
Q

Vitamin D Deficiency - Adult

A

Osteomalacia

Bone matrix is not calcified

Bone fractures occur with very little injury

Muscle weakness

Widespread bone pain, especially in the hips

54
Q

Vitamin K Deficiency: Causes

A

Fat malabsorption

Reduced gut bacterial flora

Administration of wide spectrum antibiotics

Neonatal period before gut is colonized

Liver disease with reduced recycling of vitamin K

55
Q

Vitamin K Deficiency: Effects

A

Bleeding diathesis

Routine prophylactic vitamin K therapy for all newborns

56
Q

Obesity

A

Disorder of energy regulation

BMI:
Normal: 18.5 to 25
>30 obese
25-30 overweight

57
Q

Regulation of Energy Balance (obesity) Components (3)

A
  1. Afferent signals, provided mostly by insulin, leptin, ghrelin, and peptide YY
  2. Central hypothalamic system, which integrates afferent signals and triggers the efferent signals
  3. Efferent signals, which control energy balance
58
Q

What plays a key role in energy balance?

A

Leptin: its output from adipose tissues is regulated by the abundance of fat stores

Binding to its receptors in the hypothalamus increases energy consumption by stimulating POMC/CART neurons and inhibiting NPY/AgRP neurons

59
Q

Obesity: Clinical Findings

A

Hypertension

Cancer

Cholelithiasis

Hypertriglyceridemia

Type 2 DM

Hepatomegaly

M3 Path Block 2 (10 decks)

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