Environmental Path 2 Flashcards by alix pruzansky

what are 2 main maternal smoking risks?

1) increased risk of spontaneous abortions & preterm births
2) fetal hypoxia with Intra-uterine growth retardation

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what are the effects of smoking on respiratory system?

1) bronchitis
2) emphysema
3) lung cancer

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which 2 groups of people have a 10 fold higher incidence of lung carcinomas?

1) asbestos workers

2) uranium miners

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smoking and alcohol increases the risk of what cancer?

laryngeal

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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

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What 2 cases result in a multiplicative effect on incidence of MI?

1) HTN + hypercholesterolemia

2) smoking + oral contraception in women > 35

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What 2 types of lung cancer are associated with smoking?

small cell carcinoma,

squamous cell carcinomas

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What type of laryngeal cancer is associated with smoking?

squamous cell carcinoma

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What type of bladder cancer is associated smoking?

urothelial carcinoma

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what type of oropharyngeal cancer is associated with smoking?

squamous cell carcinoma

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what type of esophageal cancer is associated with smoking?

squamous cell carcinoma

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What type of pancreatic cancer is associated with smoking?

adenocarcinoma

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what type of kidney cancer is associated with smoking?

renal cell carcinoma

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what type of cervical cancer is associated with smoking?

squamous cell carcinoma

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what type of hematopoietic cancer is associated with smoking?

acute myeloid leukemia

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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)

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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.

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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

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Step 2 in Ethanol metabolism:

Acetaldehyde is converted to acetate by what enzyme?

ALDH (hepatic acetaldehyde DH)

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Overall breakdown of Ethanol:

Ethanol –> [ADH or CYP2E1] –> Acetaldehyde –> [ALDH] –> Acetate

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Step 1 in ethanol metabolism: What enzyme oxidizes Ethanol –> acetaldehyde?

ADH

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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

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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

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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)