Environmental Nutrition (Martin Lecture) Flashcards
Generally, what trends have we observed in diseases that are increasing?
Cardiovascular disease
Cancer
HIV/AIDs and TB

Generally, what trends have we observed in diseases that are decreasing?
Neonatal conditions
Diarrhea
Lower respiratory infections

What are some negative impacts on human health suffered from climate change?
Air pollution/heatwaves –> Cardiovascular, cerebrovascular and respiratory dzs
Floods/disruption of clean water supplies –> Gastroenteritis, cholera & foodborne/waterborne infectious dzs
Disrupted crop production –> malnutrition
Increased temps, extreme weather –> Malaria, dengue fever
Pollutant:
Ozone
Populations at risk?
Healthy children
Healthy adults
Atheletes
Outdoor workers
Asthmatics
Pollutant:
Ozone
Effects on healthy adults/chilrden?
Decreased lung function
Increased airway reactivity
Lung inflammation
Pollutant:
Ozone
Effects on Athletes, outdoor workers, asthmatics?
Decreased exercise capacity
Increased hospitalizations
Pollutant:
Sulfur Dioxide
Populations at risk?
Healthy adults
Individuals with chronic lung disease
Asthmatics
Pollutant:
Sulfur Dioxide
Effect on healthy adults?
Increased respiratory symptoms
Pollutant:
Sulfur Dioxide
Effect on Individuals with chronic lung disease?
Increased mortality
Pollutant:
Sulfur Dioxide
Effect on Asthmatics?
Increased hospitalization
Decreased lung function
Why is particulate matter (soot) so dangerous to inhale?
*THEY ENTER THE ALVEOLI –> which causes the release of inflammatory mediators
Induces pulmonary inflammation and secondary CV effects
Fine or Ultrafine particles less than 10microm in diameter are the most harmful
What is the major hallmark for carbon monoxide poisoning?
Cherry red color of the skin and mucous membranes

Describe carbon monoxide’s characteristics as a gas
Nonirritating
Colorless
Tasteless
Odorless
What are some notable situations where a person is suceptible to chronic CO poisoning?
Working in tunnels
Underground garages
Highway toll booths
What are some notable situations where a person is suceptible to acute CO poisoning?
In small, closed garage w/ running car
Mine fires
How does CO poisoning ultimatley kill?
Kills by inducing CNS depression and widespread ischemic changes
What anatomic structures are affected by CO poisoning?
Basal ganglia
Lenticular nuclei
If your patient recovers from CO poisoning, what would you expect to be lasting effects?
Memory, vision, hearing and speech impairment
With 60-70% CO saturation, a person can die in as little as…
5 min
What is unique about a CO poisoned brain vs a normal brain?
CO posioned brain has increased detail in anatomical structures

What are examples of indoor air pollution?
- Wood smoke
- Bioaerosols (pet dander, fungi, molds)
- Radon
- Formaldehyde
- Sick building syndrome
Lead
What are it’s effects on the human body?
Hematologic
Skeletal
Neurologic
GI
Renal
TOXICITIES!!!!
Where is lead frequently found by children?
Flaking lead paint and soil
Where are common places for adults to encounter lead during occupational exposure?
Battery manufacturing
Pigments
Car radiators
Tin cans
Where does lead primarily deposit in the human body?
How long does it stay there?
Bone & Developing teeth
20-30 years!
Low levels of lead in the body lead to in children?
Subtle deficits in…
- Intellect
- Behavioral problems
- Hyperactivity
- Poor organizatinoal skills in kids
- Brain damage
Low levels of lead causes what symptoms in adults?
CNS disturbances
Wrist drop
Foot drop
What is a hallmark finding in the bones to indicate lead poisoning?
“Lead lines”
What are the major things you will see on a CBC with a patient with lead posioning?
Hypochromic microcytic anemia
Basophilic stippling
Ring sideroblasts
What is “lead colic”?
Extremely severe and poorly localized abdominal pain caused by lead poisoning
What is this showing?

Lead lines
What is this showing?

Lead lines
What is this?

Ringed Sideroblast
Associated with sideroblastic anemia due to excess IRON in mitochondria

Classification of anemia
What are the lab values for:
MCV
MCH
That would allow a microcytic anemia diagnosis?
[average RBC size] MCV <80 fL
[hemoglobin amount per RBC] MCH <27 pg
Histologically speaking…
How big should a RBC be?
A RBC should be about the same size as the nucleus of a normal lymphocyte
What is this?

Microcytic/hypochromic anemia
What is this?

Basophilic stippling
What are three major metals that are enviornmental pollutants?
Mercury
Arsenic
Cadmium
What disease is related to mercury poisoining?
Minamata disease:
Cerebral palsy, deafness, blindness, mental retardation and major CNS defects in children exposed in utero
What disease is related to cadmium poisoning?
“Itai-Itai” (ouch-ouch)
Oseoporosis and osteomalacia w/ renal disease
What are visual indicators that someone has had arsenic poisoning?
Hyperpigmentation
Hyperkeratosis
“MEES lines” in the nails

What are examples of organic solvents?
Chloroform
Carbon Tetrachloride
What can prolonged exposure of chloroform and carbon tetrachloride do to the human body?
CNS depression
Coma
ASSOCIATE: Occupational exposure of rubber workers to …
Benzene and 1,3-butadiene
What is the effect of benzene/1,3-butadiene on these rubber workers?
Marrow aplasia
HUGE RISK for acute myeloid leukemia
Asbestosis leads to?
Mesothelioma ; black lung
What are furrungious bodies?
Asbestos fibers coated in iron

Vinyl chloride leads to?
Angiosarcomas in liver
What is bisphenol A?
BPA
Lines almost all food bottles and cans
*Is a potential endocrine disruptor
What is this?

Aplastic anemia

Name the disease

Mesothelioma
Name the disease

Black lung
Tobacco accounts for ___% of lung cancers
90%
How do you calculate pack years?
Pack years = average number of cigarette packs smoked/day (x) # years smoking
Describe the benefits of cessation of smoking for a smoker
Within 5 years, cessation of smoking improves mortality and decreases risk of death from cardiovascular disease
Lung cancer mortality drops by 21% w/in 5 years
Even if you quit smoking, the excess risk of smoking persists…
For 30 years
Agents in tobacco smoke have a direct irritant effect on _______________
Tracheobronchial mucosa
Tobacco smoke influences the tracheobronchial mucosa by…
Inducing inflammation
and
Increasing mucus production (bronchitis)
*Remeber, you get that nasty smokers cough b/c the smoke directly effects the ability of your respiratory cilia to “beat” debris out of the respiratory system
Cigarette smokers are at an increased risk of:
Emphysema
Bronchitis
ALL forms of cancer
COPD
MI
Atherosclerosis
Maternal smoking poses in increased risk of?
Spontaneous abortions
Preterm births
Intrauterine growth redardation
The risk of lung cancer is determined by?
The number of cigarettes smoked
Considerations when combining alcohol and smoking?
Mutiplicative increase in the risk of laryngeal cancer
Most of the alcohol in the blood is oxidized to?
By what enzyme?
Acetaldehyde
Alcohol dehydrogenase (ADH)
What are the ACUTE adverse effects of EtOH?
- Steatosis (fatty liver)
- CNS effects (depressant)
What are the CHRONIC adverse effects of EtOH?
Liver: steatosis, alcoholic hepatitis, cirrhosis, portal hypertension, hepatocellular carcinoma
Thiamine: peripheral neuropathies, Wernicke-Korsakoff syndrome
Alcoholic cardioomyopathy= dilated congestive cardiomyopathy
Malnutrition - VITAMIN B!!!
Smooth philtrum is an indication of what disease process?
Fetal alcohol syndrome

Discoloration of the skin in this image is caused by?

Adverse drug reaction to Antibiotic = Minocycline
What is a rare disorder has an increased risk in oral contraceptive use?
Hepatic adenoma
What are you at an increased risk of aquiring with acetaminophen?
Liver failure
Centrilobar necrosis
What are you at increased risk of aquiring w/ aspirin?
Acute salicylate poisoning effects the brain
Analgesic nephropathy
What are the profound risks with opiate intake?
Respiratory depression
Arrhythmia
Cardiac arrest
Pulmonary edema
What are the major risks associated with cocaine use?
Tachycardia
HTN
Peripheral vasoconstriction
Describe the differences b/w burn classifications
1st degree= superficial, only epidermis
2nd degree = partial thickness
3rd degree = full thickness, extend into the subq tissue

What is the rule of nines used to calculate?
Percentage of body surface covered in burns
What is a pugilistic stance?
Body burned beyond recognition
What is malignant hyperthermia?
“Heat-stroke-like”
Rise in core body temp and muscle contractions
In response to ANESTHETICS (RYR1 gene)
What are “second cancers”?
OTHER cancers develop in indivuduals who received radiation therapy for an initial cancer
Effects of total-body ionizing radiation
When is the brain effected?
SUPER HIGH DOSE

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