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(Dr. Munawir) Environmental and Nutrition Pathology
(Dr. Munawir) Environmental and Nutrition Pathology
PATHOLOGY
Chemical and Physical Agents
Nutrition
dr. Al Munawir, M.Kes., Ph.D.
Laboratorium Patologi Anatomi
Fakultas Kedokteran
Universitas Jember
Environmental Pathology
Magnitude of the Problem in
US
US Government Agencies
Regulate Environmental
Hazards
Sources of Exposure
Environmental
Man-made
Intentional (Hg, Minimata, Japan)
Accidental
methyl isocyanate, Bhopal, India
radiation, Chernobyl
Mechanisms of Toxicity
Mechanisms of Toxicity
Corrosive, tissue destruction (acids, alkali)
desiccation
protein destruction
denaturation
hydrolysis
fat saponification
Inhibition of enzyme activity
cyanide: cytochrome oxidase
Cyanide Poisoning
Mechanisms of Toxicity
Alternate metabolic pathways
ethanol: NAD/NADH
Disturbances of homeostasis
steroids: immune system
aspirin: acidosis
Mutagenesis
Carcinogenesis
Clinical Findings
Symptoms-patient complaints
Signs-what you observe
Clinicopathologic correlation
related to mechanism and tissue
localization
Emphysema-enhanced proteolysis
Asthma-allergic or irritant effect
Hypersensitivity pneumonitis
immunologic injury related to organic
dusts
Pneumoconiosis-cytokines
Neoplasia
mutagenic/promoting effects
beryllium (berylliosis)
Macrophages produce cytokines
Size matters-0.5 to 5
Normal Lung
Pulmonary Fibrosis
Tobacco Smoking
400,000 deaths/yr (21% of all deaths in
US)
50 Million smokers in US
Smoke composition
carcinogens (polycyclic HC, -naphthylamine,
nitrosamines)
CO
Nicotine
12
18
4
Arsenic
Iron
Lead Lines
Basophilic Stippling
Normal Kidney
Organic Alcohols
Ethanol
1/3 of Americans characterized as
heavy drinkers
CNS depressant
legally intoxicated >100 mg/dL
Nearly 50% of fatal MVA
Normal Liver
Alcoholic Hepatitis
Mallory
Body
Alcoholic Cirrhosis
Alcoholic Cirrhosis
Bands of
Fibrosis
Regenerating
Nodules
Lung reactions
congestion
edema
hemorrhage
interstitial fibrosis
CNS reactions
respiratory depression
Systemic reactions
anaphylaxis
vasculitis
hormonal effects (HRT, OC)
Syndromes Related to
Drugs of Abuse
Pulmonary complications (edema,
septic emboli, absess, opportunistic
infections)
Granulomas (adulterants)
Infectious complications
Kidney disease
Often related to diluents, cutting
agents, and needle sharing
Industrial Exposures
Agricultural Hazards.
Organochlorine.
Organophosphate.
Carbamate.
Natural Toxins
This is the first report of garlic impaction and garlic-induced esophageal injury
Pathology Laboratory
A and C no change
B elongation, rounded cell (light microscope); apoptotic-frag
multinuclei and cells with chromatin condensation.
Pathology Laboratory
Pathology Laboratory
Exposure(20minute)
Cyclecell
Vehiclealone
(PBS)
FGE100
g/mL
FGE300
g/mL
BGE300
g/mL
Hypodiploid
21
143*
62*
21
G1
627
435*
223*
668
133
93
104
113
G2,M
234
345*
626*
214
Pathology Laboratory
Pathology Laboratory
Fig.1-1.Cytotoxicityofgarlicextracts
(freshorboiled)
Freshgarlicextracthascytotoxiceffect,notboiledgarlic
Pathology Laboratory
Physical Injuries
Mechanical force
abrasion
laceration
incision
contusion
Gunshot wounds
entry wound
exit wound
Contusion/22 hours
Incision
Stab Wound
GSW/Contact
GSW/Close
Range/Stippling
GSW/Distant and
Contact
THERMAL INJURY
Cutaneous burns.
Hyperthermia (heat cramps, heat
exhaustion, heat stroke).
Hypothermia.
Electrical Injuries
Resistence of tissue (dry or wet skin).
Intensity.
Hight-altitude illness.
Blast injury.
Air or gas embolism.
Decompression disease.
Radiation Injury
Direct (target) effect-radiation acts
directly on target molecules, such as
DNA
Indirect effect-free radical intermediary
Cell death, mutations, developmental
abnormalities
Tissues have differential radiosensitivity
Oxygen effect
Whole body radiation
Radiation Injury
Radiation Sensitivity of
Biological Tissue
Lymphocytes
Thrombocytes
Granulocytes
GI lining
Endothelial
cells
Neural tissue
Sensitivity
Cell Division
Most Sensitive Fastest
Nutritional deficiencies
Protein-Energy Malnutrition
Marasmus.
Kwashiorkor.
Nutritional deficiencies
Vitamin deficiency
Mineral deficiency
Vitamin Deficiency
Vitamin Function
A
Vision
Immune
system
Epithelium
Deficiency State
Diet, malabsorption
Night blindness,
xerophthalmia,
keratomalacia,
immune deficiency
Blood calcium Diet, malabsorption,
and phosphate inadequate sun, liver
and renal disease
Rickets,
osteomalacia
Vitamin Deficiency
Vitamin
Function
Deficiency State
E
Antioxidant Diet, malabsorption
tocopherols Free radical Neuromuscular
scavenger
deficits
K
Clotting
Malabsorption, loss
factors
of gut flora,
II, VII, IX, Coumadin therapy
X
bleeding
Vitamin Deficiency
Vitamin
Thiamine
(B1)
TPP
Function
Enzyme cofactor,
nerve
conduction
Riboflavine Enzyme co(B2)
factor
FMN, FAD
Niacin
Enzyme coNAD,
factor
NADP
Deficiency State
Diet, EtOH
Polyneuropathy,
cardiomyopathy,
Wernicke-Korsakoff
Diet, EtOH
Cheilosis, glossitis,
dermatitis (atrophy)
Diet, EtOH
Pellagra, dermitis,
diarrhaea, dementia
Vitamin Deficiency
Vitamin
Function
Deficiency State
Obesity
Atherogenesis.
Hypertension.
Diverticulosis.
Colon cancer.
Calorie restriction.
Pathology Laboratory