THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

ENVIRONMENTAL AND NUTRITIONAL DISEASES

ENVIRONMENTAL DISEASES

Refer to conditions caused by exposure to chemical or physical agents in workplace or personal environment (including diseases of nutritional origin)

Global health data reports: Undernutritionis the single leading global cause of health loss (1/3 of the disease burden in developing

countries) Coronary and CVA are the leading causes of death in developed countries

- Major risk factors include obesity, smoking and high cholesterol 5 of the top 10 causes of death in developing countries are infectious diseases

Air Pollution Metals as Pollutants Industrial and Agricultural Substances Tobacco Smoking Alcohol Therapeutic and Non-therapeutic Drugs Physical Agents

POLLUTION

Pollution is the introduction of contaminants into the natural environment that cause adverse change Air pollution has always accompanied civilizations

According to a 1983 article in journal Science, soot found on ceilings of prehistoric caves provides ample evidence of the high levels of pollution that was associated with inadequate ventilation of open fires

The Great Smog of 1952 in London killed at least 4,000 people. This prompted some of the first major modern environmental legislation, The Clean Air Act of 1956

OUTDOOR AIR POLLUTION

The lung is the major organ affected (e.g. by carbon monoxide and lead) Decreased pulmonary function Lung inflammation Increased airway reactivity Diminished mucociliary clearance Increased risk for infections

OZONE LAYER

Ozone forms the interaction of oxygen and UV radiation Critical in absorbing UV radiation

- Loss due to chlorofluorocarbon use increases risk for skin cancer Ozone in the lower atmosphere is also a major component of smog (along with nitrogen oxides and volatile

organic compounds) The ozone layer was discovered in 1913 by the French physicists Charles Fabry and Henri Buisson The ozone layer absorbs 97-99% of the Suns medium-frequency ultraviolet light(from about 200 nm to 315

nm wavelength), which otherwise would potentially damage exposed life forms near the surface Ozone in the Earths stratosphere is created by UV striking oxygen molecules containing two oxygen atoms (O2),

splitting them into individual oxygen atoms (atomic oxygen); the atomic oxygen then combines with unbroken O2 to create ozone O3

When UV light hits ozone it splits into a molecule of O2 and an atom of atomic oxygen, a continuing process called the ozone-oxygen cycle

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

The ozone layer can be depleted by free radical catalysts, including nitric oxide (NO), nitrous oxide (N2O), hydroxyl (OH), atomic chlorine (Cl) and atomic bromine (Br)

The concentrations of chlorine and bromine have increased markedly in recent years due to the release of large quantities of man-made organohalogencompunds, especially chlorofluorocarbons (CFCs) and Bromofluorocarbons

In 2009, nitrous oxide (N2O) was the largest ozone depleting substance (ODS) emitted through human activities The ozone hole is an annual thinning of the ozone layer over Antarctica, caused by stratospheric chlorine

SULFUR DIOXIDE

Produced by the combustion of coal and oil, copper smelting and paper manufacture Converted into sulfuric acid and sulfur trioxide which cause burning, dyspnea and airway hyperreactivity

SOOT

Emitted by coal, oil and diesel combustion Particles less than 10 microns being the most dangerous Toxic effects due to macrophage and neutrophil uptake with inflammatory mediator production

CARBON MONOXIDE

A colorless, odorless, tasteless, non-irritating gas produced by incomplete oxidation of carbonaceous materials (internal combustion engines, wood burning, cigarette smoking)

Toxic to humans at 35ppm Carbon monoxide (CO) consists of one carbon atom and one oxygen atom, connected by a triple bond that

consists of two covalent bonds as well as one dative covalent bond Carbon monoxide poisoning is the most common fatal air poisoning in many countries It combines with hemoglobin to produce carboxyhemogblobin which is ineffective in delivering oxygen to

tissues A level of 50% carboxyhemoglobin may result in seizure, coma and fatality Carbon monoxide also binds to other molecules such as myoglobin and mitochondrial cytochrome oxidase.

Exposures to carbon monoxide may cause significant damage to heart and central nervous system

INDOOR AIR QUALITY

Indoor air quality (IAQ) is a term which refers to the air quality within and around buildings and structures, especially as it relates to the health and comfort of building occupants

INDOOR AIR POLLUTION

A major source of indoor air pollution in developing countries is the burning of biomass (e.g. wood, charcoal, drug or crop residue) for heating and cooking

Second hand smoke Moisture induced growth of mold colonies and natural substances released into the air such as animal dander and

plant pollen Volatile organic compounds (VOC)

- Paints and lacquers, paint strippers, cleaning supplies, pesticides, building materials and furnishings, office equipment such as copiers and printers, correction fluids and carbonless copy paper, graphics and craft materials including glues and adhesives, permanent markers

EFFECT OF HOUSE PLANTS

Houseplants together with the medium in which they are grown can reduce components of indoor air pollution, particularly volatile organic compounds (VOC) such as benzene, toluene and xylene

Plants remove CO2 and release oxygen and water

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

LEAD

In air where leaded gasoline is burned Soil and house dusts contaminated with lead paint Water supplies in the setting of lead plumbing Inhalation > ingestion Lead competes with calcium ions (80-85% accumulates in bones and teeth)

LEAD POISONING

Lead poisoning (also known as plumbism, colica, pictorum, saturnism, Devon colic or painters colic) is a type of metal poisoning and a medical condition in humans and other vertebrates caused by increased levels of the heavy metal lead in the body

Lead is toxic to many organs and tissues including the heart, bones, intestines, kidneys and reproductive and nervous systems

It interferes with the development of the nervous system and is therefore particularly toxic to children, causing potentially permanent learning and behavior disorders

Symptoms include abdominal pain, confusion, headache, anemia, irritability and severe cases seizures, coma and death

The Centers for Disease Control (US) has set the standard elevated blood lead level for adults to be 10 ug/dl of the whole blood. For children the number is set much lower at 5 ug/dl of blood as of 2012

MERCURY

Through methyl mercury contaminated fish In dental amalgams In gold mining can contaminate water run-off CNS toxicity from high binding affinity for cellular thiol groups

ARSENIC

Found naturally in soil and water, used in herbicides and as wood preservative Trivalent forms are most toxic (arsenic trioxide and sodium arsenite) Ingestion leads to GIT, CVS and neurologic sequelae due to mitochondrial oxidative phosphorylation Chronic low level exposure increases risk for skin and lung cancer

CADMIUM

Generated by mining, electroplating, nickel cadmium batteries Ingestion of contaminated food is the most common route of exposure Toxicity due to alveolar macrophage necrosis causing obstructive lung diseases, renal tubular damage, skeletal

abnormalities due to calcium loss Increased risk of lung cancer due to DNA damage induced by reactive oxygen species

CIGARETTE SMOKING

Most common exogenous cause of human malignancy (90% of lung cancers) Contains some 4,000 constituents of which 60 are known carcinogens Nicotine

- Addictive alkaloid found in tobacco leaves, binds to CNS receptors releases catecholamines to increase heart rate, BP and cardiac contractility

EFFECTS OF CIGARETTE SMOKING

Tobacco is the single greatest cause of preventable death globally Heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

bronchitis) and cancer (lung cancer, cancers of the larynx and mouth, and pancreatic cancer It also causes peripheral vascular disease and hypertension Significant factor in miscarriages among pregnant smokers and it contributes to a number of other threats to the

health of the fetus such as premature births and low birth weight and increases by 1.4 to 3 times the chance for Sudden Infant Death Syndrome (SIDS)

ALCOHOL

Blood alcohol concentration of 80 mg/dl is the legal definition of drunk driving 200mg/dl drowsiness 300mg/dl stupor The metabolism of ethanol (Acetaldehyde) is responsible for most of toxic and chronic toxicities

ADVERSE EFFECTS OF ALCOHOLISM

Liver: fatty liver, alcoholic hepatitis and cirrhosis GIT: massive bleeding from acute gastritis and ulceration CNS: thiamine deficiency, peripheral neuropathies, cerebral atrophy, optic atrophy, cerebellar degeneration CVS: dilated cardiomyopathy, hypertension Pancreas: acute and chronic pancreatitis Fetal Alcohol Syndrome: growth and development defects Cancer: oral cavity, pharynx, esophagus, liver

THERAPEUTIC DRUGS

Oral Contraceptives - Thromboembolism, MI, Ovarian and Endometrial Carcinoma, Hepatic Adenoma

Steroids - In high levels in males can lead to testicular atrophy and gynecomastia - In females can cause virilization and menstrual changes

Acetaminophen - Glutathione stores are depleted

Aspirin (Acetylsalicylic Acid) - Chronic aspirin toxicity (>3g daily); headache, dizziness, tinnitus, dyspnea, drowsiness, vomiting and

diarrhea, erosive gastritis and ulcers with bleeding, renal papillary necrosis

NON-THERAPEUTIC DRUGS

Cocaine - Excess dopamine and adrenergic stimulation; tachycardia, hypertension, vascular spasm, arrhytmias - Hyperpyrexia and seizures

Heroin - Sudden death from overdose due to respiratory depression, pulmonary edema and arrhythmia - Infection from contaminated needles, tricuspid valve endocarditis - Cellulitis, abscesses, ulcerations - Renal pathology such as amyloidosis

Amphetamines - Aka speed induces dopamine release and euphoria - Long term use can lead to violent behavior, confusion, paranoia and hallucinations - MMDA aka ecstacy induces euphoria and hallucinations via enhanced CNS serotonin release

Marijuana - From the hemp plant Cannabis sativa - Major psychoactive substance is tetrahydrocannabinol - Acute use distorts sensory perception, impairs motor coordination, increase heart rate and BP

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

- Smoking marijuana: bronchitis, pharyngitis and COPD

MECHANICAL TRAUMA

Abrasion - Superficial wound by rubbing or scraping (only epidermis sloughed off)

Contusion - Blunt force trauma that injures small blood vessels causing interstitial bleeding, without disruption of

tissue (bruise) Incision

- Inflicted by a sharp instrument that cuts vessels and leaves relatively smooth edges (surgical wounds)

Laceration - Tear or stretching caused by blunt trauma, have intact bridging blood vessels and jagged irregular

edges Puncture

- Caused by a long, narrow instrument (stick or needle) or gunshot - penetrating when tissue is only pierced - perforating when the tissue is transversed causing an exit wound

DEGREES OF BURNS

Burns are divided into three categories, depending on the depth of damage to the skin First-degree burns

- Affect epidermis and skin may peel Second-degree burns

- Cause formation of blisters Third-degree burns

- Destroy the whole of the skins thickness and require special treatment

NAMES LAYERS APPEARANCE HEALING TIME COMPLICATIONS First Degree Burn

Superficial Skin Redness 2 3 days Increase risk of skin

cancer Second Degree Burn

Superficial Partial Thickness

Extends superficial into dermis

Red with clear blister 1 2 weeks Local infection

Second Degree Burn Deep Partial Thickness

Extends deep into dermis

Red with white bloody blisters

3 4 weeks Scarring, contractures and skin grafting

Third Degree Burn Extends through the entire dermis

Stiff and white/brown Prolonged Scarring, contactures and amputation

Fourth Degree Extends through the skin, tissue, muscle

and bone

Black or charred Requires excision Amputation, functional impairment, gangrene

and death

HYPERTHERMIA

Heat Cramps - Cramping of voluntary muscles from loss of electrolytes by sweating - Core body temperature maintained

Heat Exhaustion - Most common heat syndrome - From failure of CVS to compensate for hypovolemia secondary to water depletion

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

- Sudden onset with collapse Heat Stroke

- High ambient temperature, humidity and exertion - Thermoregulatory mechanisms fail, core body temperature rises > 40C - Necrosis of muscles and myocardium with arrhythmias and DIC

HYPOTHEMIA

As core temperature of 90F, individuals lose consciousness with further cooling, bradycardia and atrial fibrillation occur

Slowly falling temperatures may induce vasoconstriction and increased vascularity leading to edematous changes

Persistent low temperatures may cause ischemic injury

ELECTRICAL INJURY

Alternating current induces tetanic muscle spasm and prolongs duration of exposure by causing involuntary clutching

Dry skin is resistant; wet skin has decreased resistance The greater the tissue resistance, the greater the heat generated

RADIATION INJURIES

Radiation is energy travelling in the form of waves or high speed particles Non-ionizing radiation

- UV and infrared, microwaves and soundwaves - Longer wavelengths and lower frequencies

Ionizing radiation - X rays, gamma rays, high energy neutrons, alpha and beta particles - Short wavelengths and high frequency

MALNUTRITION

Primary Malnutrition - One or more component nutrition is missing - Poverty is a major determinant as well as ignorance

Secondary Malnutrition - Nutrient supply is sufficient but inadequate intake - Illness can dramatically increase metabolic demand - Alcoholism often leads to vitamin deficiencies

PROTEIN ENERGY MALNUTRITION

PEM is characterized by inadequate intake of protein and calories (or malabsorption) with resistant muscle fat and weight loss and generalized weakness

A BMI of

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

MARASMUS-OLD CHILD SIGN

Clinical signs of marasmus include:

Growth failure Wasting of subcutaneous fat and muscle (flabby muscles) and wrinkled buttocks Wizened monkey (old man face) Increased appetite (eats greedily) Sunken eyes Mood change (always irritable) and mild skin and hair changes

KWASHIORKOR-RED HAIRED CHILD

Clinical signs of kwashiorkor include:

Growth failure Wasted muscles Pitting type edema on lower limbs but also can be located on the childs feet, hands, eyelids, belly or it can

spread to the whole body Difficulty to begin walking Moon face due to hanging cheeks Loss of appetite Lack of interest in surroundings Skin changes Hair changes (straightening of hair and presence of different color bands of the hair indicating periods of

malnourishment and well nourishment (flag sign). Straightening of hair at the bottom and curling on the top giving an impression of a forest (forest sign) and easily pluckable hair

KWASHIORKOR (a protein deficiency) in a Haitian boy

The swelling (edema) of the belly is an osmotic effect The ability of the blood to take up water from the body cavity by osmosis is reduced because of the deficiency of

blood proteins (solutes)

COMPARISON OF THE FEATURES OF KWASHIORKOR AND MARASMUS

FEATURE KWASHIORKOR MARASMUS Growth failure Present Present

Wasting Present Present, marked Edema Present (sometimes mild) Absent

Hair changes Common Less common Mental changes Very common Uncommon

Dermatosis, flaky-paint

Common Does not occur

Appetite Poor Good Anemia Severe (sometimes) Present, less severe

Subcutaneous Fat

Reduced but present Absent

Face May be edematous Drawn in, monkey like Fatty infiltration

of liver Present Absent

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

CACHEXIA

PEM that occurs in chronically ill patients (e.g. cancer or AIDS) Tumors cause cachexia via proteolysis-inducing factor (PIF) and lipid mobilizing factor

ANOREXIA NERVOSA

Self-induced starvation Highest death rate in psychiatric disorder Amenorrhea is common due to suppression of hypothalamus-pituitary axis Decreased thyroid hormone: cold intolerance, bradycardia, constipation, dry scaly skin, hair thinning Decreased bone density Sudden death due to arrhythmias in the setting of hypokalemia

BULIMIA

Characterized by food binging followed by induced vomiting; diuretic or laxative abuse may also occur More common than anorexia, afflicting 1-2% of women and 0.1% of men Better overall prognosis Medical complications related to persistent vomiting and include electrolyte imbalance, arrhythmias,

esophageal or gastric ulcerations

VITAMIN A

Sources of Vitamin A and beta-carotene:

Vitamin A comes from animal sources such as eggs, meat and dairy products Beta-carotene, a precursor of Vitamin A, comes from green, leafy vegetables and intensely colored fruits and

vegetables

The benefits of Vitamin A:

Maintains health of specialized tissues such as the retina Aids in growth and health of skin and mucous membranes Promotes normal development of teeth, soft and skeletal tissue Adult RDA: 1000g RE Fat soluble

VITAMIN A DEFICIENCY

Affects vision especially night blindness, immunity and normal differentiation of various epithelia Xerophthalmia (dry eye); conjunctival dryness, Bitot spots and keratomalacia Keratinizing metaplasia of epithelial surfaces results in respiratory tract infections and renal problems

VITAMIN C

Citrus fruits, green peppers, strawberries, tomatoes, broccoli and sweet and white potatoes are all excellent food sources of vitamin C (ascorbic acid)

Vitamin C promotes a healthy immune system, helps wounds heal, maintains connective tissue and aids in the absorption of iron

RDA: 60 mg Water soluble

VITAMIN C DEFICIENCY

A deficiency of Vitamin C may lead to a condition called scurvy, characterized by weakness, anemia, bruising, bleeding gums and loose teeth

THIS MATERIAL FOR GENERAL PATHOLOGY WAS PREPARED BY OCCUPATIONAL THERAPY STUDENTS OF ANGELES UNIVERSITY FOUNDATION BATCH 2017

VITAMIN D

The body makes Vitamin D when it is exposed to ultraviolet (UV) rays from the sun Food sources: cheese, margarine, butter, fortified milk, healthy cereals, fatty fish Vitamin D promotes the bodys absorption of calcium, essential to development of healthy bones and teeth DRI: 5 g Fat soluble

VITAMIN D DEFICIENCY

A deficiency of Vitamin D or an inability to utilize vitamin D may lead to a condition called rickets, a weakening and softening of the bones brought on by extreme calcium loss

OBESITY

A BMI of 30kg/m2 or more is considered obese A BMI of 25-30kg/m2 or more is considered overweight But this is dependent on ones height Simply a caloric imbalance with intake greater than expenditure Regulation of neural and hormonal mechanisms controlling appetite satiety and energy balance

THE NEGATIVE EFFECTS OF OBESITY ON YOUR HEALTH AND YOUR LIFE

Cancer Joint problems Heart attacks Hernia Breathing problems High blood pressure Type 2 diabetes Increased sweating Bone problems

High cholesterol Deep vein thrombosis Arthritis Low life expectancy Fewer employment opportunities Low self-esteem Depression Limited mobility Social discrimination

MEDICAL COMPLICATIONS OF OBESITY

Pulmonary disease - Abnormal function - Obstructive sleep apnea - Hypoventilation syndrome

Nonalcoholic fatty liver disease - Steatosis - Steatohepatitis - Cirrhosis

Gallbladder disease Gynecologic abnormalities

- Abnormal menses - Infertility - Polycystic ovarian syndrome

Osteoarthritis Skin Gout Idiopathic intracranial hypertension Stroke

Cataracts Coronary heart disease Diabetes Dyslipidermia Hypertension Severe pancreatitis Cancer

- Breast - Uterus - Cervix - Colon - Esophagus - Pancreas - Kidney - Prostate

Phlebitis - Venous stasis