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6. HDS GI Repro > Environmental and Nutritional Disorders > Flashcards

Environmental and Nutritional Disorders Flashcards

1
Q

Toxicology Definitions

A
  • Threshold dose
    • Expressed as a range
    • Where effect first occurs
  • Threshold limit values / Permissible exposure level
    • Max exposure before harmful effect occurs
  • Ceiling effect
    • Plateau: if increases in dose, does not change level of response
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2
Q

Metabolic Metabolites

A
  • Metabolism of parent compounds
    • To more toxic metabolites (e.g. mercury)
    • To less toxic substances
    • To conjugation products
  • Exposures due to metabolites of lipophilic toxicants include:
    • ↑ Bladder CA in dye workers
    • ↑ Hepatic angiosarcoma in persons working w/ vinyl chloride
  • Remember the concept of bioaccumulation
    • Minamoto mercury poisoning
    • Fish poisoned w/ mercury, then human eats fish
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3
Q

Smoking

A
  • Know adverse effects include:
    • Cancers
    • Heart disease
    • Chronic respiratory disease
    • Atherosclerosis
    • Cerebrovascular disease
    • Low birthweight in fetus
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4
Q

Acute Alcohol Intoxication

A
  • BAC between 0.01 and 0.1 percent:
    • Feelings of wellbeing and confidence
    • Disinhibition
    • Urge to speak
    • Feelings of tranquility and relaxation
    • Mild deficits in coordination
      • Unsteady gait
      • Difficulties standing upright
    • Slightly decreased attention, memory, and judgement
    • Reddening of the skin or flushing of the face
    • Slightly ↑ HR
  • BAC between 0.15 and 0.3 percent:
    • Mood variability
    • Pronounced disinhibition
    • Slurred speech
    • Greater deficits in coordination and psychomotor skills
      • ↑ Unsteadiness of gait
      • Clumsiness
    • Increasingly impaired attention, memory, and judgement
    • Reduction in responsiveness, alertness, and reaction time
    • Confusion
    • Uncontrolled eye movements
    • Sleepiness
    • Dizziness
    • Nausea and vomiting
    • Impaired vision and sound localization
    • Memory gap
  • BAC greater than 0.3 percent:
    • Delusions and hallucinations
    • Severe difficulty speaking
    • Severe dizziness
    • Severe deficits in coordination and psychomotor skills
    • Potential hypothermia
    • Potential coma
      • Usually BAC > 0.4 percent
        • LOC
        • Lack of defensive reflexes
        • Respiratory failure
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5
Q

Chronic Alcoholism

A
  • Liver: steatosis, alcoholic hepatitis, cirrhosis
  • GI: acute gastritis, acute and chronic pancreatitis
  • CNS: atrophy of mamillary bodies
  • Reproductive: testicular atrophy
  • Heart: cardiomyopathy
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6
Q

Fetal Alcohol Syndrome

A
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7
Q

Alcohol and Cancer

A

↑ risk of oral cavity, pharyngeal, esophageal, liver cancers

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8
Q

Effects of Other Alcohols

A

Methanol toxicity: blindness

Ethylene glycol toxicity: obstruction of renal tubules by calcium oxalate crystals

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9
Q

Commonly Abused Drugs

A
  • CNS depressants
  • CNS stimulants
  • Narcotics
  • Hallucinogens
  • Combinations of drugs: e.g. alcohol and barbiturates
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10
Q

HRT and Oral Contraceptives

A
  • Exogenous estrogen: possible effects of unopposed estrogen
    • Endometrial carcinoma
    • Thromboembolism: natural less risk than synthetic
    • Cardiovascular disease
  • Oral contraceptives
    • Breast carcinoma: probably slight ↑ in women over age 45
    • Endometrial cancer: protective effect
    • Cervical cancer: ↑ risk related to duration of use and lifestyle
    • Ovarian cancer: protective effect
    • Thromboembolism: higher risk w/ older women who smoke
    • Hepatic adenoma
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11
Q

Acetominophen

A
  • Toxic doses may cause hepatic necrosis
  • Concurrent renal and myocardial damage may occur
  • Toxicity: Nausea, vomiting, diarrhea and shock, jaundice days later
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12
Q

Aspirin

A
  • Acute overdose
    • Respiratory alkalosis followed by metabolic acidosis
  • Chronic aspirin toxicity (Salicylism)
    • CNS changes
      • HA, dizziness, tinnitus, AMS, drowsiness, N/V/D
    • Acute erosive gastritis
    • Bleeding tendency: petechial hemorrhages
    • Analgesic nephropathy
      • Renal papillary necrosis
      • May be caused by combo of aspirin and phenacetin or its metabolite; also acetaminophen
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13
Q

Outdoor Air Pollution

A
  • Acute toxicity: proximal effects
  • Subacute/chronic: distal effects
    • Subclinical chronic inflammation and fibrosis
      • Ongoing toxic effects and hypersensitivity
    • Degenerative changes
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14
Q

Common Indoor Pollutants

A
  • Carbon monoxide
  • Radon
    • Emanates from earth into basements of homes
    • Inhaled into lungs where decay products emit alpha radiation
  • Asbestos: lung CA, mesothelioma
  • Fiberglass: skin and lung irritation
  • Bioaerosols: dust mites, fungi, molds
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15
Q

Industrial Exposures

A

Volatile organic compounds:

  • Aliphatic hydrocarbons: dry cleaning
    • CCl4 and chloroform: acute CNS depression, liver and kidney toxicity
  • Aromatic hydrocarbons
    • Benzene inhalation: bone marrow toxicity, aplastic anemia, acute leukemia
    • Petroleum products: CNS depression
  • Aromatic halogenated hydrocarbons
    • Soot: scrotal cancer in chimney sweeps
    • Plastics, rubber, polymers
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16
Q

Lead

A

“PLUMBISM”

Peripheral demyelinating neuropathy

Lead lines in bones/gums

Urinary excretion: damage proximal tubules, interstitial fibrosis

Mental deterioration

Brain damage in children

Intestinal Manifestations: colic, anorexia

Serum: ↑ zinc protoporphyrin

Microcytic, hypochromic, mild hemolytic anemia

“BITES”

Bone accumulation

Inhibition of heme synthesis

Toxic blood level is greater than 10 micrograms/L

Erythrocyte basophilic stippling

Surgical abdomen: lead colic

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17
Q

Cobalt/Tungsten Carbide

A

Metal workers: asthma, interstitial fibrosis

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18
Q

Cadmium

A

Acute toxicity: swelling of pneumocytes

Chronic toxicity: kidney

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19
Q

Nickel

A

Topical exposure: contact dermatitis

Inhalation: carcinogenic

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20
Q

Mercury

A

Renal toxicity, dementia

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21
Q

Chromium

A

Carcinogen in industry

22
Q

Arsenic

A

Skin, lung, liver cancers

23
Q

Occupational Exposure

Respiratory Effects

A
  • Nasal cancer
    • Isopropyl alcohol, wood dust
  • Lung cancer
    • Radon, asbestos, nickel, arsenic, chromium, mustard gas
  • COPD
    • Grain dust, coal dust, cadmium
  • Hypersensitivity
    • Beryllium
  • Irritation
    • Ammonia, sulfur oxides, formaldehyde
  • Fibrosis
    • Silica, asbestos, cobalt
24
Q

Agricultural Hazards

A
  • Insecticides
    • Many linked to neuro- and hepatotoxicity
  • Herbicides
    • Arsenic compounds: hyperpigmentation, gangrene, anemia, sensory neuropathy, cancer
  • Fungicides
    • ? Reproductive toxicity
  • Rodenticides
    • Warfarin: hemorrhage
25
Q

Natural Toxins

A
  • Mycotoxins
    • Ergot alkaloids: gangrene, convulsions, abortion
    • Aflatoxins: liver cancer
  • Animal toxins
    • Venoms
    • Cinguatoxin: parasthesias, vomiting, diarrhea
    • Tetrodotoxin (puffer fish): neurotoxin, shock
26
Q

Radiation

A
  • Factors influencing damage to tissue/cells:
    • Total dose
    • Rate at which dose is delivered
    • Rate of cell turnover
    • Capacity for cellular repair
    • Oxygen effects: free radicals
    • Radiation-induced vascular changes
      • Injury → fibrosis and loss of the lumen
  • History:
    • Areas w/ nuclear disaster, after therapeutic radiation: Papillary thyroid cancer
    • Early radiologists: ↑ aplastic anemia, brain tumors
    • Fetal exposure: Mental retardation, leukemia, malformations
27
Q

Ionizing Radiation Damage

A
  • Acute effects after exposure
    • Edema, mucosal erosion, atrophy of many tissues
  • Delayed effects after exposure
    • Fibrosis in lung, heart, GI tract, bladder, ovary, breast
    • Malignancies of bone marrow, liver, bladder, thyroid, breast, lymph nodes, brain

Know which organ systems are affected as whole-body dosage of ↑ radiation

28
Q

Radiation Effects

A
29
Q

Mechanical Trauma

A
  • Injuries are the most common cause of death in US up to age 34
    • Violence is an important factor
  • Abrasion (scrape)
  • Contusion: blunt force; damages small blood vessels, bruise
  • Laceration: irregular skin tear, overstretching w/ bridging strands of fibrous tissue or blood vessels
  • Incised wound: cut
  • Puncture wound
  • Gunshot wound: distance, direction
30
Q

Thermal Burns

A
  • Classification
    • Partial thickness
      • First degree: epidermis only
      • Second degree: epidermis and superficial dermis
    • Full thickness
      • Third degree: Into deep dermis, will need skin graft
      • Fourth degree: Into subcutaneous tissue
  • Factors for clinical significance
    • Depth of burn
    • Percentage of body surface involved (rule of 9s)
    • Possible presence of internal injuries
    • Inhalation of hot/toxic fumes
    • Promptness and efficacy of therapy is very important
    • Electrolyte management is key
    • Infection prevention/control is a critical component of therapy
31
Q

Barotrauma

A
  • High altitude sickness
  • Blast injury
  • Air/gas embolism
  • Decompression (caisson disease): bends, chokes and staggers from too rapid ascent
32
Q

Pneumoconiosis

A
  • Simple coal workers pneumoconiosis (CWP)
  • Complicated CWP: progressive massive fibrosis
  • Silicosis
  • Asbestosis
33
Q

Primary Nutritional Deficiency

A

Caused by inadequate diet

Can be due to poverty, anorexia nervosa, lack of ionized salt, chronic alcoholism (inadequate diet aspect, remember thiamine)

34
Q

Secondary Nutritional Deficiency

A

Malnutrition despite adequate nutrient supply

  • Failure of digestion or absorption: e.g. fat soluble
  • Failure of utilization: e.g. liver disease so can’t store Vitamin A
  • ↑ Requirements: pregnancy, acute, or chronic illness
  • ↑ Excretion: sweating
  • Drugs: can block uptake or use of nutrients
35
Q

Malnourishment

A

Weight is below 80% of normal

36
Q

Marasmus

A

Wasting due to too few calories

Weight below 60% of normal

  • Growth retardation
  • ↓ muscle mass due to catabolism: loss of somatic protein compartment
  • Deplete subcutaneous fat: emaciated
  • Serum albumin only slightly reduced
  • See anemia, immune deficiency, vitamin def.
  • No edema or hepatomegaly
37
Q

Kwashiorkor

A
  • Loss of visceral protein compartment
    • More severe than marasmus
  • Weight is 60-80% of normal
    • Masked by fluid retention
  • Relative sparing of subcutaneous fat and muscle mass
  • Skin lesions
  • Flaky paint sign: affects squamous epithelium resulting in alternating zones of hyperpigmentation, desquamation and hypopigmentation
  • Hair changes: flag sign
  • Also, apathy, listlessness, loss of appetite, enlarged fatty liver, immunosuppression
38
Q

Secondary Protein–Energy Malnutrition

A

Complication in patients w/ advanced cancer, AIDS (also called cachexia or wasting syndrome)

39
Q

Anorexia Nervosa

A

Severe protein energy malnutrition w/ additional endocrine system manifestations

Includes amenorrhea, skin changes, ↓ body hair, ↓ bone density, ↑ susceptibility to cardiac arrhythmia

40
Q

Fat Soluble Vitamins

A

Vitamins A, D, E, K

Patients w/ biliary tract and pancreatic dysfunction and intestinal malabsorption syndromes (e.g. cystic fibrosis) are predisposed to deficiency of fat-soluble vitamins

41
Q

Vitamin A

A
  • Vitamin A Deficiency
    • Eye changes
    • Defects in cell differentiation
      • Epithelial metaplasia
  • Vitamin A Toxicity
    • Acute
      • HA, vomiting, stupor, papilledema (pseudotumor cerebri)
    • Chronic toxicity
      • Weight loss, nausea, vomiting, dry lips, joint pain
42
Q

Vitamin D

A
  • Deficiency causes derangement of plasma levels of phosphorous and calcium, w/ resultant mineralization
    • See excess of mineralized matrix (osteoid material and cartilage)
  • Children: rickets
    • Altered endochondral bone growth
    • Prominent head deformity in infant, lumbar lordosis, bowed legs in children w/ rachitic rosary and pigeon breast deformity
  • Adults: osteomalacia
43
Q

Vitamin E

A
  • Important antioxidant
  • Deficiency
    • Spinocerebellar degeneration due to degeneration of axons in posterior columns of spinal cord
      • ↓ DTRs, ataxia, dysarthria, loss of position and vibration sense, loss of pain sense, myopathy
    • Hemolytic anemia: RBCs more susceptible to oxidative stress
44
Q

Vitamin K

A
  • Deficiency is rare due to endogenous production by gut flora
    • Seen in newborns (no gut flora, fat malabsorption, diffuse liver disease, suppression of nl intestinal flora due to use of abx)
  • Blood clotting abnormality due to deficiency of clotting factors II, VII, IX, X and proteins C and S
  • Infants: hemorrhagic disease of the newborn
    • Intracranial bleed
  • Adults: ecchymosis, gingival bleed, hematoma, hematuria, melena
45
Q

Vitamin B1

(Thiamine)

A

Deficiency seen in areas w/ polished rice diet and in chronic alcoholism

  • Dry Beriberi: demyelinating peripheral polyneuropathy
  • Wet Beriberi: w/ pulmonary edema, =/- mural thrombi secondary to hypokinetic walls
  • Wernicke Korsakoff syndrome: nystagmus, ataxia, mental confusion, disorientation, confabulation, see atrophy of mamillary bodies
46
Q

Vitamin B2

(Riboflavin)

A

Deficiency: cheilosis, glossitis, dermatitis, corneal vascularization

47
Q

Vitamin B3

(Niacin)

A

Deficiency: Pellagra

Dermatitis, diarrhea, dementia

48
Q

Vitamin B6

(Pyridoxine)

A

Deficiency: Seborrheic dermatitis, cheilosis, peripheral neuropathy, glossitis

49
Q

Vitamin C

A

Deficiency (scurvy)

  • Hemorrhages: skin, gingival mucosa, subperiosteal hematomas, intracranial hemorrhages (due to loss of collagen in vessel walls)
  • Perifollicular, hyperkeratotic papular rash which may be ringed by hemorrhages
  • Abnormal wound healing and localization of focal infections
  • In growing child: bone abnormalities
    • Can fracture due to inadequate osteoid at epiphyseal plate
50
Q

Folate

A

Deficiency: Megaloblastic anemia, neural tube defects in fetus

51
Q

Vitamin B12

(Cobalamin)

A

Deficiency: Megaloblastic anemia and degeneration of posterolateral spinal cord tracts

6. HDS GI Repro (30 decks)

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