病理学-环境和营养学习课件

Environmental and Nutritional PathologyEnvironment and Disease⏹Environmental and occupational healthencompasses the diagnosis, treatment, andprevention of injuries and illnesses resultingfrom exposure to exogenous chemical orphysical agents⏹Envirornmental pathology is the field thatdeals with the diseases caused by exposureto harmful external agents and deficiencies of vital substancesIn this Chapter⏹Environmental Contamination and Occupational Exposures⏹Outdoor Air Pollution⏹Indoor Air Pollution⏹Occupational Exposures⏹Addictions and Associated Disease⏹Tobacco Use⏹Alcoholism⏹Drug Abuse⏹Iatrogenic Drug Injury⏹Sex Hormones⏹Nutritional Disorders⏹Obesity⏹MulnutritionEnvironmental Contamination and Occupational Exposures⏹Environmental Hazards⏹Outdoor air pollution⏹Indoor air pollution⏹Industral explosures⏹Argricultural hazards⏹Home used chemicals⏹Personal abuse⏹Biotoxins⏹Drugs⏹OthersHealth Effects of Outdoor Air PollutantsPollutant Populations at Risk EffectsOzone Healthy adults and children Decreased lung functionIncreased airway reactivityLung inflammationAthletes, outdoor workers Decreased exercise capacityAsthmatics Increased hospitalizations Nitrogen dioxide Healthy adults Increased airway reactivityAsthmatics Decreased lung functionChildren Increased respiratory infections Sulfur dioxide Healthy adults Increased respiratory symptomsPatients with chronic lung disease Increased mortality Increased hospitalizationHealth Effects of Outdoor Air PollutantsPollutant Populations at Risk EffectsAcid aerosols Healthy adults Altered mucociliary clearanceChildren Increased respiratory infectionsAsthmatics Decreased lung functionIncreased hospitalizations Particulates Children Increased respiratory infectionsDecreased lung functionExcess mortalityPatients with chroniclung or heart diseaseAsthmatics Increased attacksHealth Effects of Indoor Air PollutantsPollutant Populations at Risk EffectsCarbonmonoxideAdults and children Acute poisoningNitrogendioxideChildren Increased respiratory infections Wood smoke Children Increased respiratory infections Formaldehyde Adults and children Eye and nose irritation, asthmaRadon Adults and children Lung cancerAsbestos fibers Maintenance andabatement workersLung cancer, mesotheliomaManufactured mineral fibers Maintenance andconstruction workersSkin and airway irritationBioaerosols Adults and children Allergic rhinitis, asthmaOccupational Exposure⏹INDUSTRIAL EXPOSURES⏹Volatile Organic Compounds⏹Polycyclic Aromatic Hydrocarbons⏹Particles⏹Plastics, Rubber, and Polymers⏹MetalsOccupational Exposure⏹AGRICULTURAL HAZARDS⏹Insecticides⏹Herbicides⏹Fungicides⏹Rodenticides⏹FumigantsHuman Diseases Associatedwith Occupational Exposures Organ Effect ToxicantCardiovascular system Heart disease Carbon monoxide, lead, solvents, cobalt,cadmiumRespiratorysystemNasal cancer Isopropyl alcohol, wood dustLung cancer Radon, asbestos, silica,bis(chloromethyl)ether, nickel, arsenic,chromium, mustard gasChronic obstructivelung diseaseGrain dust, coal dust, cadmiumHypersensitivity Beryllium, isocyanatesIrritation Ammonia, sulfur oxides, formaldehydeFibrosis Silica, asbestos, cobaltwith Occupational Exposures Organ Effect ToxicantNervous system Peripheralneuropathies Solvents, acrylamide, methyl chloride, mercury, lead, arsenic, DDTAtaxic gait Chlordane, toluene, acrylamide, mercuryCentral nervoussystem depressionAlcohols, ketones, aldehydes, solventsCataracts Ultraviolet radiationUrinary system Toxicity Mercury, lead, glycol ethers, solventsBladder cancer Naphthylamines, 4-aminobiphenyl,benzidine, rubber productswith Occupational ExposuresOrgan Effect ToxicantReproductivesystemMale infertility Lead, phthalate plasticizersFemale infertility Cadmium, leadTeratogenesis Mercury, polychlorinated biphenyls HematopoieticsystemLeukemia Benzene, radon, uraniumSkin Folliculitis andacneiform dermatosis Polychlorinated biphenyls, dioxins, herbicidesCancer Ultraviolet radiation GastrointestinaltractLiver angiosarcoma Vinyl chlorideToxic and Carcinogenic MetalsMetal Disease OccupationLead Renal toxicity Battery and ammunition workers, foundryworkers, spray painting, radiator repair Anemia, colicPeripheral neuropathyInsomnia, fatigueCognitive deficitsMercury Renal toxicity Chlorine-alkali industryMuscle tremors,dementiaCerebral palsyMental retardationToxic and Carcinogenic MetalsMetal Disease OccupationMiners, smelters, oil refinery workers, farm workers Arsenic Cancer of skin,lung, liverBeryllium Acute lung irritant Beryllium refining, aerospace manufacturing, ceramics Chronic lunghypersensitivity? Lung cancerLung fibrosis Toolmakers, grinders, diamond polishersCobalt andtungsten carbideAsthmaCadmium Renal toxicity Battery workers, smelters, welders, soldering? Prostate cancerPigment workers, smelters, steel workers Chromium Cancer of lung andnasal cavityNickel Cancer of lung andSmelters, steel workers, electroplatingnasal sinusesAddictions and associated disease⏹PERSONAL EXPOSURES⏹Tobacco Use⏹Alcohol Abuse⏹Drug AbuseTobacco Use (Smoking)⏹Cardiovascular disease is a major complication of smoking⏹Cancer of the lung is largely a disease of cigarette smokers⏹Smokers develop non-neoplastic diseases⏹Smoking impairs female reproductive function⏹Passive smoking is defined as exposure of non-smokers to smoke produced by tobacco smokersDiseases associated with cigarette smokingOrgan-Specific Carcinogens in TobaccoSmokeOrgan CarcinogenLung, larynx Polycyclic aromatic hydrocarbons 4-(Methylnitrosoamino)-1-(3-pyridyl)-1-butanone (NNK)Polonium 210Esophagus N'-Nitrosonornicotine(NNN)Pancreas NNK (?)Bladder4-Aminobiphenyl, 2-naphthylamineOral cavity (smoking)Polycyclic aromatic hydrocarbons, NNK, NNNOral cavity (snuff)NNK, NNN, polonium 210Alcohol Abuse⏹Alcoholism is an addiction to ethanol that features dependence and withdrawal symptoms, and results in the acute an chronic toxic effects of alcohol on the body ⏹Chronic alcoholism has been defined as the regular intake of a quantity of alcohol that is enough to injure a person socially, psychologically, or physicallyAlcohol Abuse⏹Alcohol ingestion affects organs and tissues⏹Fetal alcohol syndrome results from alcohol abuse in pregnancy⏹Alcohol increases the risk of some cancers⏹The mechanisms by which alcohol injures tissues are not understoodComplications of chronic alcohol abuseAbuseOrgan System Lesion MechanismLiver Fatty change ToxicityAcute hepatitisAlcoholic cirrhosisNervous system Wernicke syndrome Thiamine deficiencyKorsakoff syndrome Toxicity and thiamine deficiencyNutritional deficiencyCerebellardegenerationPeripheral neuropathy Thiamine deficiencyCardiomyopathy ToxicityCardiovascularsystemHypertension VasopressorAbuseOrgan System Lesion MechanismGastritis Toxicity GastrointestinaltractPancreatitis Toxicity Skeletal muscle Rhabdomyolysis ToxicityTesticular atrophy? ReproductivesystemSpontaneous abortion?Growth retardation ToxicityFetal alcoholsyndromeMental retardationBirth defectsDrug AbuseDrug abuse has been defined as “the use of any substance in a manner that deviates from the accepted medical, social, or legal patterns within a given society”Drug Abuse⏹Agents are usually used to alter mood and perception⏹Derivatives of opium (heroin, morphine)⏹Depressants (barbiturates,tranquilizers,alcohol)⏹Stimulants (cicaine, amphetamines),marijuana, psychedelic drugs⏹Inhalants (amyl nitrite, organic solvents)Drug Abuse⏹Heroin is a potent diacetyl derivative of morphine⏹Illicit drugs are responsible for many pathological syndromes⏹Intravenous drug abuse has many medical complications⏹Drug addiction in pregnant women poses risks for the fetusIatrogenic drug injury⏹Iatrogenic drug injury referes to the unintended side effects of therapheutic or diagnostic drugs prescribed by physicians⏹Adverse reactions are found in 2%-5% of patients hospitalized on medical services and 2%-12% of these reactions are fatalSex Hormones⏹Oral contraceptives carry a small risk of complications⏹Postmenopausal hormone replacement therapy increases the risk of some cancersComplications of oral contraceptivesNutritional Disorders⏹Obesity is a global epidemic resulting from sedentary lifestyles, improved socioeconomic conditions, and availability of processed, high calorie foods and soft drinks in industrialized societies⏹Obesity is an increase in adipose tissue beyond the requirements of the body⏹Obesity is determined according to body mass index (BMI)⏹BMI = weight (kg) / height (m2)Body Mass Index Associated Disease RiskRisk Obesity Class BMI(kg/m2)Underweight<18.5Increased Normal18.5-24.9Normal Overweight25.0-29.9Increased Obesity I30.0-34.9High Obesity II35.0-39.9Very high Extreme Obesity III≥40.0Extremely highMechanism of obesitywith ObesityGastrointestinal Gallstones, pancreatitis, abdominal hernia,NAFLD (steatosis, steatohepatitis, andcirrhosis), and possibly GERDEndocrine/ metabolic Metabolic syndrome, insulin resistance, impaired glucose tolerance, type II diabetes mellitus, dyslipidemia, polycystic ovary syndromeCardiovascular Hypertension, coronary artery disease,congestive heart failure, arrhythmias,pulmonary hypertension, ischemic stroke,venous stasis, deep vein thrombosis,pulmonary emboluswith ObesityRespiratory Abnormal pulmonary function, obstructivesleep apnea, obesity hypoventilationsyndromeMusculoskeletal Osteoarthritis, gout, low back pain Gynecologic Abnormal menses, infertility Genitourinary Urinary stress incontinence Ophthalmologic CataractsNeurologic Idiopathic intracranial hypertension(pseudotumor cerebri)with ObesityCancer Esophagus, colon, gallbladder, prostate,breast, uterus, cervix, kidneyPostoperative events Atelectasis, pneumonia, deep vein thrombosis, pulmonary embolusMulnutrition⏹Protein-calorie malnutrition reflects starvation or specific deficiencies⏹Marasmus⏹Kwashiorkor⏹Vitamins are necessary in trace amounts for metabolic functions。