Module 8-Environmental Pathology

Question 1

Nasal Septal Perforation is due to cocaine abuse, what is the pathogenesis for how this happens?

Answer 1

Vasoconstriction of the blood vessels —- leads to coagulative necrosis —- over time perforation

• –CNS: inhibited reuptake of dopamine
• –PNS: inhibited reuptake of catecholamines (epi and noepi) —these bind alpha one receptors

Question 2

What effect does cocaine have on the brain?

Answer 2

Coagulative necrosis and stroke (ischemic or hemorrhagic)
–hemorrhagic is due to malignant HTN which ruptures the cerebral arteries and you get projectile vomiting and headaches due to the increased ICP

Question 3

What effect does cocaine have on the eye?

Answer 3

Retinal hemorrhages and detachments and blindness all from malignant HTN
—pupil dilation (mydriasis)

Question 4

What effect does cocaine have on the aorta?

Answer 4

Dissection (From the HTN) you get an initmal tear

—vasoconstriction leads to HTN and this ruptures the intima

Question 5

What effect does cocaine have on the heart?

Answer 5

Die from arrhythmias due to ischemia to the conduction system (Sudden cardiac death, dont normally see an infarction because its too soon)

• -can get an MI
• -can also get dilated cardiomyopathy

Question 6

What effect does cocaine have on the kidney?

Answer 6

Sudden onset maligant HTN (fibronoid necrosis also called necrotizing arteriolitis)

Question 7

What is the most common cause of death from cocaine?

Answer 7

Arrhythmias

Question 8

If you inhale cocaine with TALC, what complication do you see?

Answer 8

Pulmonary fibrosis

Question 9

Review: What are the fat stains?

Answer 9

Oil red O
Sudan Black
Osmic Acid

Question 10

What morphological changes do you see in a person with alcoholic hepatitis ?

Answer 10

Macrovasicular steatosis
Mallory- Denk Bodies: sign to liver injury (also found in cirrhosis)(made up of intermediated keratin filaments — sign of liver injury)
Inflammation: neutrophil infiltration
Pericellular fibrosis

Question 11

Alcohol is a type of _____ injury?

Answer 11

Cell

Question 12

What is the pathogenesis for hepatic hepatitis due to alcohol?

Answer 12

Alcohol oxidation by alcohol dehydrogenase causes a decrease in NAD and an increase in NADH. NAD in required for fatty oxidation in the liver. Its deficiency is a main cause of fat accumulation in the liver of alcoholics. The increase in NADH/NAD ratio in alcoholics causes lactic acidosis
Metabolism of ethanol in the liver by CYP2E1 produces reactive oxygen species and causes lipid peroxidation of cell membranes.

Question 13

What are the ALT and AST levels in alcohol hepatitis?

Answer 13

AST/ALT > 2

Question 14

Carbon Monoxide Poisoning is common in whom?

Answer 14

Automobile exhaust in enclosed environment

• -incomplete combustion of furnace and water heaters
• –fires, automobiles and stove in closed spaces

Question 15

How does acute carbon monoxide poisoning present?

Answer 15

Cherry red discolorization of the skin due to carboxyhemoglobin
–CO binds to Hb tighter than O2 (200X greater affinity)

Question 16

How does chronic carbon monoxide poisoning present?

Answer 16

A family that cant afford a fireplace and using gas heaters then this is chronic
–headache
—flu like symptoms
(patients will eventually get the cherry red skin)

Question 17

What is the most common cause of death of carbon monoxide poisoning?

Answer 17

Guy trapped in a fire

—asphyxiation due to carbon monoxide poisoning

Question 18

What is the treatment for carbon monoxide poisoning?

Answer 18

• -High flow O2

- –hyperbaric chamber

Question 19

What blood work will you check for carbon monoxide poisoning?

Answer 19

Measure CO levels

–O2 levels will be normal

Question 20

What are some complications of carbon monoxide poisoning?

Answer 20

Brain: globus pallidus necrosis (only seen if the patient survives long enough)
Heart: MI due to hypoxia and coagulative necrosis

Question 21

Reye syndrome is a rare fatal childhood hepatoencephalopathy associated with what?

Answer 21

with children viral infections treated with Aspirin

• -never given aspirin to children with viral infections
• -seen with chickenpox or viral flu treated with aspirin

Question 22

What is the pathogenesis for Reyes Syndrome?

Answer 22

Aspirin metabolites — decrease Beta-oxidation by reversible inhibition of mitochondrial enzymes
Mitochondrial dysfunction in the liver — disrupts UREA cycle — increase ammonia buildup
(therefore for lab testing check blood ammonia levels and liver function test)

Question 23

Reye syndrome starts in the liver and ends in the brain, explain this

Answer 23

Brain: ammonia is toxic to the brain – cytotoxic cerebral edema
Liver: microvesicular fatty change

Question 24

What does Buddchiari mean?

Answer 24

Hepatic vein stenosis or thrombosis