Robbins Chapter 9 Flashcards
What is the single leading global cause for health loss?
Undernutrition
What 3 global complications have increased and what 2 have decreased?
Inc. = CV disease, cancer, HIV/AIDS/TB
Dec. = neonatal conditions, diarrhea/lower respiratory infections
What environmental conditions inc. risk of:
- CV, cerebrovascular, respiratory diseases
- gastroenteritis, cholera
- vector-borne infectious diseases
- heatwaves and air pollution
- flood contamination and disrupted clean water supply
- inc. temp, crop failures
What decreases CYP activity?
fasting and starvation
Ozone (Outdoor Air Pollutant)
free radicals injure respiratory tract epi/type 1 alveolar
release inflammatory mediators
- dangerous for asthma/emphysema pts
Sulfur Dioxide (Outdoor Air Pollutant)
“Witches Brew” –> combine w/ozone, particulate matter
from fossil fuel burning, copper smelting, paper mills
sulfuric acid/trioxide = burning sensation in nose/throat
Particulate Matter (Outdoor Air Pollutant)
pulmonary inflammation/secondary CV effects
particles < 10 um get into alveoli = inflammatory release
Carbon Monoxide and how it works on bodies
CNS depression (basal ganglia/lenticular nuclei); 200x greater affinity for Hb (60%-70% sat. = DEATH
rapid death = NO morphological changes
long term survival = edema, hemorrhages, neuronal changes
cherry-red skin and mucous membranes
Indoor Air Pollutants
- Wood Smoke
- Bioaerosols
- Radon
- Formaldehyde
- Sick Building Syndrome
- polycyclic hydrocarbons
- leginnaires dz, viral pneumonia
- radioactive gas = INC. LUNG CANCER RISK
- building material, poorly ventilated trailers
- black mold from damp homes
Where is Lead poisoning acquired and what changes can it cause in both KIDS and ADULTS?
KIDS: paint chips, contaminated soil
- severe brain damage (low Pb lvls)
- behavioral problems, hyperactivity, poor organizer
ADULTS: tin cans, battery maker, car radiators
- peripheral neuropathies
- foot drop and wrist drop
Lead Lines: gums and metaphyses, hypochromic microcytic anemia (MCV<80), basophilic stippling, ring sideroblasts (iron laden macrophages)
Lead Colic: severe, poorly localized abdominal pain
Mercury Poisoning and Minimata Disease
- damages CNS and kidney
- main source: contaminated FISH, mercury vapors (dental amalgams)
Minimata Disease: cerebral Palsy, blindness, CNS
Arsenic Poisoning
interfere w/cellular metabolism (GI TRACT, CNS, heart)
2-8 wks: sensorimotor neuropathy, paresthesia, numbness; MEES LINES on nails
hyperpigmentation/hyperkeratosis of palms/soles
Cadmium Poisoning and Itai-Itai
toxic to Kidneys and Lungs (batteries, soil, plants)
renal tubular damage, skeleton abnormalities
Itai-Itai: osteoporosis and osteomalacia w/renal dz
What 3 things can cause Respiratory Fibrosis? (SAC)
silica, asbestos, cobalt
What causes leukemia and liver angiosarcoma?
Leukemia = BENZENE (rubber workers)
- marrow aplasia, acute myeloid leukemia
- 30 yo with 80 yo bones
Liver Angiosarcoma = Vinyl Chloride
Where 2 cancers are Polycyclic Hydrocarbons associated with?
lung and bladder cancer (scrotal cancer in chimney sweeps)
Organochlorines and DDT
synthetic lipophilic product = no degradation
DDT –> disrupt hormonal balance (antiestrogenic and antiandrogenic activity)
What problems arise from Mineral Dust exposure?
pneumonconioses (insulation and shipyards)
asbestosis –> MESOTHELIOMA, black lung
Ferruginous Bodies: iron coating on asbestos fibers
pork chop lung = mesothelioma
Dioxin and PCB exposure
folliculits and dermatosis (CHLORACNE)
- acne, cyst formation, hyperpigmentation, hyperkeratosis behind ears and face
What does cessation of smoking within 5 years lead to?
dec. in mortality of CVD and 21% dec. in lung cancer mortality
What are Nicotine/Phenol and Formaldehyde/Nitrogen Oxides related to in smoking?
N/P –> tumor promotion
F/N –> cilia toxicity, mucosal irritation
- “smokers cough”
How does alcohol potentiate the effects of other substrates?
competitively binds to CYP2E1, delaying drug catabolism
- potentiates the depressant effects of drugs in the CNS
Alcohol and Hypertension
heavy EtOH use = liver damage, which decreases the production of HDL causing an increased likelihood of coronary artery disease
Wernicke Encephalopathy and Korsakoff Syndrome
THIAMINE DEFICIENCY
WE: reversible, hemorrhage/necrosis of mammillary bodies
KS: irreversible, short term memory disturbance and confabulation
atrophy of anterior vermis = truncal ataxia
Problems with Oral Contraceptive Use
inc. risk of cervical cancer, 3-6x risk of venous thrombosis/PE, 2x inc. risk of CAD in smokers
HEPATIC ADENOMA - rare; older prolonged OC use
Acetaminophen Toxicity
CYP2E1 causes production of NAPQ
normally can conjugate with Glutathione, but when it can’t –> protein adducts and lipid peroxidation
ultimately: HEPATOCYTE NECROSIS, LIVER FAILURE
Opiates, Meth, MDMA, Marijuana, Huffing, Bath Salts
O: profound respiratory depression, “foam cone”, infections (endocarditis right heart valve)
Meth: violent, confusion, hallucinations, paranoia
MDMA: spike other drugs to enhance CNS effects
Marijuana: inc. HR/BP, large # carcinogens in smoke
Huffing: MRI-brain damage –> severe dementia
Bath Salts: agitation, psychosis, MI, suicide
Cocaines effects on the body (2)
tachycardia, HTN, peripheral vasoconstriction –> MI!
lethal arrythmias (NOT DOSE RELATED) –> dec. blood flow to placenta = spont. abortion and fetal hypoxia
Burn Classification (1st-3rd degree)
1st = superficial, epidermis only
2nd = partial thickness, epidermis and dermis
3rd = full thickness, subQ tissue
Hyperthermia (Malignant) vs Hypothermia
Hyper: “heat-stroke” rise in core body temp w/muscle contractures –> common anesthetics (RYR1 gene)
Hypo: body temp < 90F, bradycardia –> atrial fibrillation, no consciousness
Marasmus vs Kwashiorkor
M: serum albumin lvl normal, emaciated extremities
K: hypoalbuminuria (edema), spare extremities, fatty liver
Anorexia Nervosa vs Bulimia
A: self-induced starvation, highest death of any psychiatric disorder (amenorrhea, dec. thyroid, bone)
B: binge/purge; more common and better prognosis
- pulmonary aspiration of gastric contents
BOTH: susceptible to cardiac arrhythmia due to electrolyte imbalance = HYPOKALEMIA
Acute vs Chronic Vitamin A toxicity
Acute: headache, dizziness, stupor
- Pseudotumor cerebri: unexplained cranial pressure
- eskimo eating polar bear livers
Chronic: wt loss, anorexia, bone/joint pain
Vitamin D Deficiency
- maintain adequate calcium/phosphate lvls
- prevent rickets, osteomalacia, and Hypocalcemic Tetany –> tingling around mouth and finger twitch
loss of cartilage palisades in bone
Importance of Vitamin K, B1, B3, and B6
K –> procoagulant (bleeding diasthesis)
B1 (thiamine) –> dry/wet Beriberi, Wernicke/Korsakoff
B3 (Niacin) –> NAD/NADP
- Pellagra = dementia, diarrhea, dermatitis
B6 (Pyridoxine) –> myelination of spinal cord
- dermatitis, peripheral neuropathy
BMI Ranges (3)
Normal: 18.5 - 25 kg
Overweight: 25 - 30 kg
Obese > 30 kg
Where are Leptin, PPY, and Ghrelin located and what do they bind to?
Leptin (adipose) –> POMC/CART –> NRG consumption
PYY (intestines) –> NPY/AgRP –> NRG consumption
- inhibitor
Ghrelin (stomach) –> NPY/AgRP –> Food Intake
What is Pickwickian Syndrome and what is it related to?
hypoventilation syndrome associated w/obesity
- hypersomnolence –> sleep apnea, polycythemia, right-sided heart failure (cor pulmonale)
IGF-1, Obesity, and Cancer
IGF-1 inc. during hyperinsulinemia (due to obesity)
IGF-1 = inc. cell proliferation and dec. apoptosis (perfect environment for tumor development)
obesity itself is a pro-inflammatory state = may be carcinogenic itself
Aflatoxin, Nitrosamines/Nitrosamides/High animal fat and low fiber on Cancer development
Aflatoxin - hepatocellular carcinoma
N/N - gastric carcinoma
High Animal/Low Fiber - colon cancer
total dietary fat = inc. risk of breast cancer
