RAMOS, Cristine Joy B.BSPT - III

PATHOLOGY ASSIGNMENT

ENVIRONMENTAL DISEASES

AIR POLLUTION

1. Why do victims of CO poisoning displays a cherry-red color of the skin?

This color imparted by carboxyhemoglobin. The diagnosis of CO poisoning is based on detection of high levels of carboxyhemoglobin in the blood which has a has a characteristic cherry-red color. Hemoglobin has a greater affinity for CO than for O2. The resultant compound, carboxyhemoglobin, is incapable of carrying O2.

2. What are the consequences after suffering from CO poisoning?

If death occurs rapidly, morphologic changes may not be present; with longer survival, the brain may be slightly edematous and exhibit punctuated hemorrhages and hypoxia-induced neuronal changes. In victims who survive CO poisoning, complete recovery is possible; however, sometimes impairments of memory, vision, hearing, and speech may remain. Some persons who have suffered from carbon monoxide poisoning are later affected by psychological conditions such as depression and anxiety.

HEAVY METALS

3. Aside from the ones that are mentioned in Robbins Basic Pathology, what are the other known sources of lead?

Soil. Lead particles that settle on the soil from leaded gasoline or paint can last for years. Lead-contaminated soil is still a major problem around highways and in some urban settings. Soil close to walls of older houses may contain lead.

Water. Copper plumbing soldered with lead is a source of contamination of household drinking water.

Household dust. Household dust can contain lead from lead paint chips or from contaminated soil brought in from outside.

Pottery. Glazes found on some ceramics, china and porcelain can contain lead that may leach into food.

Toys. Lead is sometimes found in toys and other products produced abroad.

Traditional cosmetics. Kohl is a traditional cosmetic, often used as eyeliner. Testing of various samples of kohl has revealed high levels of lead.

4. What are lead lines?

Excess lead interferes with the normal remodeling of calcified cartilage and primary bone trabeculae in the epiphyses in children, causing increased bone density detected as radiodense “lead lines”. Lead lines of a different sort also may occur in the gums, where excess lead stimulates hyperpigmentation.

5. What are the effects of excessive lead exposure?BRAIN Adult: Headache, memory loss Child: Encephalopathy, mental deterioration neurologic effects in adults and children;

GINGIVA Lead line

BLOOD Anemia red cell basophilic stippling

PERIPHERAL NERVES Adult: Demyelination peripheral neuropathies

KIDNEY Chronic tubulointerstitial disease

GASTROINTESTINAL TRACT

Abdominal pain

BONES Child: Radiodense deposits in epiphyses

INDUSTRIAL EXPOSURE

6. What are pneumoconioses, its types and sources?

Inhalation of mineral dusts causes chronic, non-neoplastic lung diseases called pneumoconioses. This group of disorders includes diseases induced by organic and inorganic particulates as well as chemical fume- and vapor-induced non-neoplastic lung diseases.

The most common pneumoconioses are caused by exposures to mineral dust: coal dust (in mining of hard coal), silica (in sandblasting and stone cutting), asbestos (in mining, fabrication, and insulation ork), and beryllium (in mining and fabrication).

TOBACCO & ALCOHOL

7. NICOTINE is a tobacco component that is addictive and not carcinogenic.

8. A person who smokes 15 sticks of cigarette per day has how many pack years? (Show computation)

15 cigarettes a day for 1 year = ¾ pack year

Formula:(No. of cigarettes smoked per day/20) x no. of yrs. smoked = no. of pack years

Computation:(15/20) x 10 = 7 ½ pack years

9. What is alcoholic fatty liver disease?

It is a multiple fat droplets accumulation in the cytoplasm of hepatocytes (fatty change or hepatic steatosis). Having fat in your liver is normal, but if more than 5 to 10 percent is fat, then it’s called fatty liver disease.

10. What is liver cirrhosis?

Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from. Cirrhosis is associated with portal hypertension and an increased risk of hepatocellular carcinoma.

RADIATION

11. Differentiate ionizing from non-ionizing radiation

The energy of nonionizing radiation, such as ultraviolet (UV) and infrared light, microwaves, and sound waves, can move atoms in a molecule or cause them to vibrate but is not sufficient to displace electrons from atoms. By contrast, ionizing radiation has sufficient energy to remove tightly bound electrons. Collision of these free electrons with other atoms releases additional electrons, in a reaction cascade referred to as ionization.

Ionizing radiation is indispensable in medical practice, but this application constitutes a two-edged sword. Radiation in this form is used in the treatment of cancer, in diagnostic imaging, and as therapeutic or diagnostic radioisotopes. However, it also is mutagenic, carcinogenic, and teratogenic.

12. In 5 sentences or less, why do you think gonads, lymphatic system, hematopoietic system and the lining of the GI tract is highly sensitive to radiation?

Rapidly dividing cells are more vulnerable to injury than are quiescent cells. Therefore, tissues with a high rate of cell turnover, such as gonads, bone marrow (hematopoietic system), lymphoid tissue (lymphatic system), and the mucosa of the GI tract, are extremely vulnerable to radiation.

NUTRITIONAL

13. Differentiate primary malnutrition from secondary malnutrition

A healthy diet provides:(1) carbohydrates, fats, and proteins(2) amino acids and fatty acids(3) vitamins and minerals In primary malnutrition, one or all of these components are missing from the diet. By contrast, in secondary, or

conditional, malnutrition, the dietary intake of nutrients is adequate, and malnutrition results from nutrient malabsorption, impaired utilization or storage, excess losses, or increased requirements.

14. Differentiate marasmus from kwashiorkor

Characteristics Marasmus KwashirokorProtein compartment

depletion of somatic compartment

depletion of visceral compartment

Cause Primarily lack of calories

Lack of protein

Albumin level (reduced/increased)

increased reduced

Appearance With such losses of muscle and subcutaneous fat

the extremities are emaciated

the head appears too large for the body.

generalized or dependent edema;

skin lesions giving a “flaky paint” appearance.

Hair changes and loss of firm attachment to the scalp.

15. What is cachexia and cachectins?

A particularly severe form of secondary PEM, called cachexia or wasting syndrome, often develops in patients with advanced cancer. The wasting is all too apparent and often presages death. Although loss of appetite may partly explain it, cachexia may appear before appetite decreases. The underlying mechanisms are complex, but appear to involve “cachectins” such as proteolysis-inducing factor, which are secreted by tumor cells, and cytokines, particularly TNF, which are released as part of the host response to advanced tumors. Both types of factors directly stimulate the degradation of skeletal muscle proteins, and cytokines such as TNF also stimulate fat mobilization from lipid stores.

16. Differentiate bulimia from anorexia nervosa

Characteristics Anorexia Bulimia Mechanism state of self-

induced starvation

patient binges on food and then induces vomiting

Weight(normal/remarkableweight loss)

Remarkable weight loss

Normal

Medical complications

Amenorrheaanemialymphopenia,hypoalbuminemiacardiac arrhythmia

hypokalemia, cardiac

arrhythmias;pulmonaryaspiration of

gastric contents;

esophageal and

stomach rupture.

17. Define and identify the symptoms of the ff. diseases associated with Thiamine deficiency:

a. Beriberi (dry and wet)

Beriberi is a disease brought on by a Vitamin B-1 (thiamine) deficiency.

There are 2 types of the disease: wet and dry beriberi. Wet beriberi can effect heart function and, in the most extreme cases, heart failure. Dry beriberi damages the nerves and can lead to a loss of muscle strength and, eventually, muscle paralysis. If unchecked and untreated, beriberi will cause death.

The symptoms of beriberi vary depending on the type, wet or dry. The following are symptoms of wet beriberi: shortness of breath during physical activity, rapid heart rate, swollen lower legs and waking up short of breath.

The symptoms of dry beriberi are: decreased muscle function, particularly in the lower legs, tingling or loss of feeling in the feet and hands, pain mental confusion, difficulty speaking, vomiting, involuntary eye movement and paralysis.

b. Wernicke’s encephalopathy

Wernicke encephalopathy is characterized by foci of hemorrhage and necrosis, particularly in the mammillary bodies but also adjacent to the ventricles, especially the third and fourth ventricles. Despite the presence of necrosis, there is relative preservation of many of the neurons in these structures.

Symptoms of Wernicke encephalopathy include: confusion and loss of mental activity that can progress to coma and death, loss of muscle coordination (ataxia) that can cause leg tremor, vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping and alcohol withdrawal.

c. Korsakoff syndrome

Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke symptoms go away. Wernicke encephalopathy causes brain damage in lower parts of the brain called the thalamus and hypothalamus. Korsakoff psychosis results from permanent damage to areas of the brain involved with memory.

Symptoms of Korsakoff syndrome: inability to form new memories, loss of memory, can be severemaking up stories (confabulation), seeing or hearing things that are not really there (hallucinations)

18. What is Pellagra and what are the “three Ds”?

Pellagra is caused by deficiency of Niacin of Vitamin B3

which is characterized by “three Ds”: dementia, dermatitis, diarrhea

19. What is scurvy and its clinical manifestations?

Scurvy is caused by deficiency of vitamin C or Ascorbic acid. Occasionally, scurvy appears in patients undergoing peritoneal dialysis and hemodialysis and among food faddists.

Scurvy symptoms may begin with appetite loss, poor weight gain, diarrhea, rapid breathing, fever, irritability, tenderness and discomfort in legs, swelling over long bones, bleeding (hemorrhaging), and feelings of

paralysis. As the disease progresses, a scurvy victim may present bleeding of the gums, loosened teeth, petechial hemorrhage of the skin and mucous membranes (a tiny pinpoint red mark), bleeding in the eye, proptopsis of the eyeball (protruding eye), constochondral beading (beading of the cartilage between joints), hyperkeratosis (a skin disorder), corkscrew hair, and sicca syndrome (an automimmune disease affecting connective tissue).

20. What is rickets and osteomalacia?

Calcium is important for making the bones hard, healthy and strong, bones tend to be soft and weak because of defective absorption of calcium and defective mineralization of the bones due to Vitamin D inadequacy. This defective mineralization of the bones among children is termed as Rickets while among adults, it is termed as Osteomalacia.

INFECTIOUS DISEASES

1. Enumerate the three types of polioviruses Brunhilde – Type 1 Lansing – Type 2 Leon – Type 3

2. Enumerate and define/discuss the three types of paralytic polio

Paralytic: This is the rarest and most serious form of polio, which produces full or partial paralysis in the patient.

There are three types of paralytic polio: (1) spinal polio - affects the spine, (2) bulbar polio - affects the brainstem, and (3) bulbospinal polio - affects the spine and brainstem.

3. Shingles are very painful because it follows the DERMATOMES pattern.

4. Differentiate gram-negative from gram-positive bacteria

Characteristic Gram-negative Gram-positiveStain Red or pink crystal-violetCell wall Thin ThickOuter membrane

Present absent

Resistance to antibiotics(more/less)

More Less

5. In less than 5 sentences, describe the mechanism of Lyme disease.

Lyme disease involves multiple organ systems and in its classic form progresses through three successive stages. In stage 1, Borrelia multiply at the site of the tick bite and causing erythema chronicum migrans (bull’s eye lesion), may be accompanied by fever and lymphadenopathy but usually disappears in a few weeks’ time. In stage 2(early disseminated stage), spirochetes spread hematogenously and cause secondary annular skin lesions, lymphadenopathy, migratory joint and muscle pain, cardiac arrhythmias, and meningitis, often with cranial nerve involvement. In stage 3 (late disseminated stage), which occurs 2 or 3 years after the bite, Borrelia causes a chronic arthritis, sometimes with severe damage to large joints, and an encephalitis that ranges in severity from mild to debilitating.

6. Discuss the cause and clinical manifestations of Lyme disease.

There are three distinct phases of Lyme disease. Each phase involves different parts of the body.

Early localized disease causes skin rashes and redness.

Early disseminated disease affects the nervous system and heart. People in this stage may have palsies that cause paralysis and tremors. A rare but potentially life-threatening bacterial infection called meningitis may occur in this stage. Meningitis affects the tissue surrounding the brain and spinal cord (meninges).

Late disease involves arthritis and neurological issues. During this stage damage to nerves of sensation and movement can occur.

7. What is bull’s eye lesion?

One symptom of Lyme disease is a red rash (called erythema migrans). The rash usually starts as a small red area and then expands over several days. The rash occurs at the site of the tick bite and usually gets bigger over time. Sometimes the rash clears in the center, so that it looks like a bull's-eye.

About half the people infected with Lyme disease develop the rash within 4 weeks. The rash usually isn't painful or itchy. It fades within 4 weeks, even without treatment for Lyme disease.

8. Define and discuss the symptoms of the ff:a. Kuru

- Associated with human cannibalism- It is caused by an infectious protein found in

contaminated human brain tissue.- Symptoms of kuru include: arm and leg pain,

coordination problems that become severe, difficulty walking, headache, swallowing difficulty, tremors and muscle jerks

b. Creudzfeldt-Jakob disease- is a rapidly progressive dementing illness, with a

typical duration from first onset of subtle changes in memory and behavior to death in only 7 months.

- CJD can be transmitted from person to person iatrogenically, by surgery, organ transplantation, or blood transfusion.

- Symptoms: personality changes, anxiety, depression, memory loss, impaired thinking, blurred vision, insomnia, difficulty speaking, difficulty swallowing , sudden, jerky movements

c. Variant CJD- probably transmitted to humans through

consumption of meat from BSE-infected cattle- Early in the illness, patients usually experience

psychiatric or sensory symptoms, which most commonly take the form of depression, apathy or anxiety, and occasionally (in a third of the cases) unusual persistent and painful sensory symptoms. Neurological signs, including unsteadiness, difficulty walking and involuntary movements, develop as the illness progresses and, by the time of death, patients become completely immobile and mute.

d. Bovine spongiform encephalopathy

- better known as “mad cow disease”- Because BSE damages the brain tissue, it has a

variety of symptoms ranging from behavioural changes to coordination problems. Cows with BSE may show nervousness or aggressive behaviour, difficulty with coordination, trouble standing up, decreased milk production, and weight loss. The disease is fatal, with death usually occurring 2 weeks to 6 months after symptoms start.

9. Discuss what is Toxoplasmosis gondii, the disease it may cause, and the clinical manifestations

Toxoplasma gondii is acquired either through contact with oocyst-shedding kittens or by eating cyst-ridden, undercooked meat.

Toxoplasma gondii (household cats are the most common vector) also can cause myocarditis, particularly in immunocompromised persons.

Flu-like symptoms: About 10-20% of people infected with toxoplasmosis will develop symptoms similar to flu or glandular fever, such as: a high temperature (fever) of 38C (100.4F) or over aching muscles tiredness feeling sick sore throat swollen glandsThese symptoms are usually mild and will normally pass within a few weeks.

10. Identify the ff.a. Tinea corporis – fungal skin infection of the bodyb. Tinea capitis - fungal skin infection of the scalpc. Tinea pedis – fungal skin infection of the feet;

generally known as “athlete’s foot”d. Tinea cruris - fungal skin infection of the groin