Environmental Path 2 Flashcards
what are 2 main maternal smoking risks?
1) increased risk of spontaneous abortions & preterm births
2) fetal hypoxia with Intra-uterine growth retardation
what are the effects of smoking on respiratory system?
1) bronchitis
2) emphysema
3) lung cancer
which 2 groups of people have a 10 fold higher incidence of lung carcinomas?
1) asbestos workers
2) uranium miners
smoking and alcohol increases the risk of what cancer?
laryngeal
what is the mechanism of action that links atherosclerosis to MI?
increased plt aggregation –> decreased oxygen supply to heart –> increased oxygen demand –> decreased threshold for v-fib
What 2 cases result in a multiplicative effect on incidence of MI?
1) HTN + hypercholesterolemia
2) smoking + oral contraception in women > 35
What 2 types of lung cancer are associated with smoking?
small cell carcinoma,
squamous cell carcinomas
What type of laryngeal cancer is associated with smoking?
squamous cell carcinoma
What type of bladder cancer is associated smoking?
urothelial carcinoma
what type of oropharyngeal cancer is associated with smoking?
squamous cell carcinoma
what type of esophageal cancer is associated with smoking?
squamous cell carcinoma
What type of pancreatic cancer is associated with smoking?
adenocarcinoma
what type of kidney cancer is associated with smoking?
renal cell carcinoma
what type of cervical cancer is associated with smoking?
squamous cell carcinoma
what type of hematopoietic cancer is associated with smoking?
acute myeloid leukemia
What are some non-neoplastic conditions associated with smoking?
1-GIT 2- Bones 3- Thyroid 4- Eyes 5- Menopause
1- GIT = GERD, PUD 2- Osteoporosis exacerbated by tobacco 3- Graves Disease 4- Macular degeneration and cataracts 5- earlier menopause in females (estradiol is hydroxylated to estrone in liver)
Acetaldehyde
causes acute effects of alcohol metabolism and development of oral cancer.
Efficiency of alcohol metabolism varries b/w populations – asians have low to no ALDH activity and cannot tolerate alcohol.
At high blood alcohol levels, what enzyme in addition to ADH metabolizes ethanol to acetaldehyde?
What is generated during this reaction?
CYP2E1
= MEOS (microsomal ethanol oxidizing system)
ROS, lipid peroxidation of cell membranes
Step 2 in Ethanol metabolism:
Acetaldehyde is converted to acetate by what enzyme?
ALDH (hepatic acetaldehyde DH)
Overall breakdown of Ethanol:
Ethanol –> [ADH or CYP2E1] –> Acetaldehyde –> [ALDH] –> Acetate
Step 1 in ethanol metabolism: What enzyme oxidizes Ethanol –> acetaldehyde?
ADH
Effects of ADH during oxidation of alcohol
& importance of NAD
-Causes REduction of NAD to NADH (thus depletes NAD)
NAD is required for fatty acid oxidation and in alcohols, this is depleted and is the main cause of fat accumulation in Liver
Chronic alcoholism results in what Liver pathologies? (3 main ones)
1) Chronic injury-
i) Fatty change (steatosis)
ii) alcoholic hepatitis
iii) cirrhosis
2) portal HTN
3) increased risk of hepatocellular carcinoma
Steatosis/Fatty change results in accumulation of what in hepatocytes?
triglycerides
Chronic alcoholism results in deficiency of what vitamin and what does this result in clinically?
Thiamine (b1)
peripheral neuropathy, wernicke-korsakoff (hemorrhage and necrosis of mammillary bodies) resulting in ataia, confabulation, nystagmus
What 2 diseases are a chronic alcholic at risk for in the CVS?
1) dilated congestive cardiomyopathy (alcoholic cardiomyopathy)
2) HTN
What type of anemia is an alcoholic susceptible to?
megaloblastic anemia (due to folate deficiency)
infective endocarditis from IV drug use affects which heart valves and is caused by which bacteria?
tricuspid/aortic
S. Aureus
Cocaine’s AE’s on CNS, CVS, and other
CVS:
MI, sudden death
CNS:
seizures
Other:
perforated nasal septum
What type of pulmonary injury results from heroin use?
Edema, foreign body granuloma from talc
What infection results from heroin use?
endocarditis (R- tricuspid valve, s. aureus), viral hepatitis, AIDs
what are 2 Renal problems from heroin?
amyloidosis
heroin nephropathy = focal segmental glomerulosclerosis
Abrasion
wound produced by scraping or rubbing
removal of superficial layer
contusion
produced by blunt object
damage to blood vessels and extravastion of blood into tissues
laceration
tear or disruptive stretching of tissue caused by applicaiton of force by a blunt object
intact bridging blood vessels and jagged irregular edges
incised wound
by sharp instrument
bridging blood vessels severed
puncture wound
penetrating v perforating
caused by along, narrow instrument
penetrating: when instrument pierces tissue
Perforating: when instrument traverses tissue to create exit wound
Superficial Burn
first degree
confined to epidermis
partial thickness burn
second degree
involves dermis
full thickness burn (3rd v 4th)
third degree- extends to subcutaneous tissue
fourth degree- may also involve damage to muscle tissue
Hypovolemic shock:
1) what percentage of body surface is burned?
2) mechanism?
3) most common bacteria?
1) >20%
2) rapid shift of body fluids into interstitial compartment. Excess head loss and increased need for nutritional support.
3) Pseudomonas aeruginosa (MOST!), s. aureus, candida
What internal injury can result when water-soluble gas is inhaled?
inflammation and swelling causing partial or complete airway obstruction esp. in upper airways
(chlorine, sulfur oxides, ammonia)
what internal injury can result when lipid-soluble gases are inhaled?
reach deep airways producing pneumonitis
NO, burning plastics
What is a long-term consequence of burn injury?
Hypertrophic scars
What causes a hypertrophic scar?
continuous angiogensis in wound due to excess neuropeptide released from injured nerve endings (i.e. substance P)
How does Hypothermia cause injury? (direct. v indirect)
Direct: crystallization of intra and extracellular water –> physical disruption within cells
Indirect: circulatory changes – i.e. trench food (slowly developing chill results in edema and hypoxia, gangrene)
Electrical injury produces what 2 types of injury?
1) burns (at site of entry and exit, in internal organs)
2) V-fib
what cell types are more vulnerable to ionizing radiation injury? What types of tissue are most vulnerable?
Rapidly dividing cells
Gonads
Bone marrow
Mucosa of GI
What type of vascular damage is produced from injury due to ionizing radiation?
damage to endothelial cells, occlusion/narrowing of blood vessels, impaired healing –> fibrosis and chronic ischemic atrophy!
0-1 Sv irradiation causes:
1) injury where?
2) signs & symptoms
3) time of development
4) lethality
none.
1-2 Sv irradiation causes:
1) injury where?
2) signs & symptoms
3) time of development
4) lethality
1) lymphocytes
2) lymphopenia, granulocytopenia
3) 1-7 days
4) none
2-10 Sv irradiation causes:
1) injury where?
2) signs & symptoms
3) time of development
4) lethality
1) bone marrow
2) leukopenia, hemorrhage, hair loss, vomiting
3) 2-6 weeks
4) variable
10-20 Sv irradiation causes:
1) injury where?
2) signs & symptoms
3) time of development
4) lethality
1) small bowel
2) diarrhea, fever, electrolyte imbalance, vomiting
3) 5-14 days
4) 100%
> 50 Sv irradiation causes:
1) injury where?
2) signs & symptoms
3) time of development
4) lethality
1) brain
2) ataxia, coma, convulsions, vomiting
3) 1 to 4 hours
4) 100%
what are pathological features of tissue that has had persistent exposure to radiation?
1) arterioles– endothelial swelling, collagen deposition
2) small arteries – fragramentation of IEL, fibrosis
3) bizarre fibroblasts with large hyperchromatic nuclei
what are 4 clinical conditions that result from chronic radiation?
1) interstitial fibrosis in heart and lungs, constrictive pericarditis
2) radiation dermatitis
3) cataracts
4) atrophy of testes and ovaries
what are features of radiation-induced fibrosis?
1) what tissues affected?
2) Timeframe?
3) DNA damage?
1) all tissues included in irradiation
2) after weeks or months
3) DNA mutations that can inititate carcinogenesis if repair mechanisms fail
What 2nd cancers can individuals get who received radiation therapy for childhood cancers?
AML
MDS
HL (Hodgkins Lymphoma)
