Environmental Pathology Flashcards
What does environmental disease refer to?
Lesions and conditions cause by chemical and physical agents resulting from where, what and how we live
Before an autopsy what is needed?
Family consent is necessary
What is the addiction from tobacco use caused from?
Dopamine receptors in the brain
Cigarette smoking is high in ____ and ____.
Mortality and Morbidity
What is cigarette smoking associated with in excess mortality?
Chronic bronchitis and emphysema
Coronary heart disease
Bronchogenic carcinoma
If a pregnant lady smokes as little as 10 cigarettes a day what could occur?
Inc rate of spontaneous abortion
Low birth weight
Inc perinatal mortality
Inc sudden infant death syndrome SIDS
Smoking in the house around an infant can cause;
Sudden infant death syndrome
Asthma
Acute illness
Respiratory illness later in life
2nd had smoke is the equivalence of smoking ___ cigs a day.
3
What are some lung injuries related to air pollution?
Acute and chronic inflammation - direct cell injury
Emphysema-enhanced proteolysis
Asthma-allergic or irritant effect
Hypersensitivity pneumonitis - immunologic injury related to organic dusts
Pneumoconiosis-cytokines
Neoplasia -mutagenic/promoting effects
What are the main constituents of smog?
SO2 - respiratory irritant (acid rain) NO2*, NO - respiratory irritant (xs O2) CO - carboxyhemoglobin (O2) O3* - respiratory irritant Pb binds sulfhydryl groups
Oxidant pollutants
mostly produced by;
Combustion of fossil fuels
What could occur in someone who works with toxins that may be inhaled (like a miner)?
Pneumoconiosis
Characterized by cytokine mediated, progressive fibrotic scarring
What is pneumoconiosis?
“Dust in the lungs”
Non-neoplastic lung reaction to inhalation of mineral, organic or inorganic dust particulates
Includes chemical fume (vapor) induced lung disease
What are the different pathogens which can cause pneumoconiosis?
Asbestosis Silicosis Beryllium Cotton Heavy Dust
What is the simple/uncomplicated phase of coal-worker’s pneumoconiosis?
Macule composed of dust-containing macrophages in a mesh of collagen fibers
What is the complicated stage of coal-worker’s pneumoconiosis?
Nodules can coalesce
“Progressive massive fibrosis”
Centrilobular (centriacinar) emphysema
Chronic bronchitis, bronchiectasis
What causes black lung disease?
Carbon particles which are weakly fibrogenic (anthracosis)
Other coal components cause more issues - silica and trace metals
What is brown lung disease
Cotton weakly fibrogenic
Endotoxin from the gram negative bacteria within the cotton
What does silicon contamination cause?
Silicosis
What is silicosis?
A chronic, nodular, densely fibrosing pneumoconiosis
Acellular fibrous nodules in upper zones of lungs containing birefringent particles of silica and silicates
“Honeycomb” lung
What is asbestosis?
Parenchymal interstitial fibrosis
Predisposes to bronchogenic carcinoma
Causes pleural effusions, localized fibrous plaques, diffuse pleral fibrosis
Possible laryngeal cancer
What are the two types of asbestos?
Serpentine
Amphibole
Progressive massive fibrosis
What is serpentine asbestos?
Curly and flexible fibrogebic fibers
Not pathogenic
What is amphibole asbestos?
Straight, stiff and brittle
Align parallel to airway, deep impact
Spear epithelial cell and enter interstitium
Very pathogenic
What is progressive massive fibrosis asbestos?
Gross, small, firm, dark brown lungs
Honeycomb lung
Seen via light microscopy
What would be seen pathologically in pleura plaques?
Gross: gray-white to ivory white, posterolateral thorac and dome of diaphragm
Light micro: acellular basket-weave collagen
What would be seen pathologically in bronchogenic carcinoma (adeno) and malignant mesothelioma?
Gross: encasing and arising from the pleura
Si + Fe =
Ferruginous body
Adverse drug events (ADE)
Injury due to medical treatment
4% of hospitalized pts
What are some common reasons for ADEs
Lack of drug knowedlge, lack of pt info, rule violations, slip ups, memory lapses
What causes mesothelioma?
Asbestosis
What is the definition of an Adverse Drug Reactions (ADR)?
Any noxious, unintended and undesired effect of a drug which occurs at doses used in humans for prophylaxis, diagnosis or therapy
What does an ADR exclude?
Therapeutic failure Poisoning, accidental or intentional Drug abuse Non-compliance Errors in administration
How can an ADR be predicted ?
Age, dose, route of entry Ability to metabolize or excrete Underlying disease Genetic factors (CYP450) Concurrent treatment
What are the ADRs of aspirin?
Acute overdose Fatal to children - 2-4 grams Fatal adults - 10-30 grams Respiratory alkalosis, metabolic acidosis Acute papillary necrosis
What are the ADRs of acetominophen?
Adult toxic dose 7.5-10gm, normal 0.5gm
Acute: N&V, diarrhar, shock, jaundice
Severe: liver necrosis
What is the antidote for acetominophen overdose?
N-acetylcysteine within 8 hours
What is the major substance that in non-therapeutic that causes an ADR?
Ethyl alcohol
Widmark equation
C = A/ (W x r) C = conc of EtOH A = mass of alcohol ingested in grams W = body weight in grams r = widmark distribution
What can occur when alcohol in taken in excess?
Fatty change
Alcohol hepatitis
Alcoholic cirrhosis
What are some acute alcoholic changes?
Neurological Diminished coordination Peripheral vision dec Night vision dec Mood variable
When is death most likely going to occur in CO posioning?
60% Hgb saturated
What are the clinical significance of burn severity?
% of body surface involved
Depth of burn
Possible internal injuries
Post-burn therapy
What are the early consequences of burns?
Early - neurologic shock, hypovolemic shock, plasma protein loss
Late - infection and sepsis, pseudomonas and candida, DIC
What does radiation tissue injury depend on?
Dose
Linear energy transfer of radiation
Vulnerability to radiation effect
