Environmental and Nutritional Pathology
Terms
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- CYP1A1
-
Enzyme induced by plycyclic aromatic hydrocarbons in TOBACCO SMOKE
w/ activity = LUNG CNACER -
What does Glutathione-S-transferases do?
GSTM1 deficiency causes -
detoxifies xenobiotic metabolites by conjuation to glutathione (GSH)
Deficiency = risk for LUNG, BLADDER, and COLON CANCER - Cytochrome P450-Depentent Monooxygenase System
-
Phase I Reaction
located in Smooth ER of LIVER
Metabolizes BENZO[A]PYRENE (found in CIGARETTE SMOKE) to metabolite that covalently binds DNA
EPOXIDE HYDROLASE & PROSTAGLANDIN H SYNTHASE also used
^ LUNG & SKIN CANCER - Flavin-containing Monooxygenase System
-
Phase 1 Reaction
Located in Smooth ER of LIVER
Oxidizes NICOTINE - Peroxidase-dependent Cooxidation
-
Phase I Reaction
involved in Arachiodonic Acid Metabolism
Located in Smooth ER of SEMINAL VESICLES, KIDNEYS, & BLADDER
Metabolizes 2-NAPTHYLAMINE (found in SYNTHETIC DYES)
^ BLADDER CANCER - Reduction of Paraquat (herbicide) causes?
-
Depletion of cellular GLUTATHIONE (GSH)
generate excess ROS causing lung injury and pulmonary edema - Glucuronidation
-
Phase 2 Reaction
Alternative pathway for metabolism of 2-NAPHTHYLAMINE (syn dyes): oxidation by P450 then glucuronidation in liver
^ BLADDER CANCER - Biomethylation
-
Phase 2 Reaction
Hg-->DIMETHYLMERCURY
Necrosis of PCT of KIDNEY
Bioaccumulation of Hg in big fish - DIMETHYLMERCURY
-
from biomethylation of Hg2+
Necrosis of Proximal Convoluted Tubule (PCT) of KIDNEY
Bioaccumulation in big fish
Can cross BBB and Plancenta
BAD FOR PREGNANT WOMEN - Glutathione Conjugation
-
Phase 2 Reaction
VINYL CHLORIDE (in PLASTICS)
can cause vinyl chloride to bind to Macrophages after P-450 reaction -> ANGIOSARCOMA of LIVER
LIVER CANCER - 2-NAPHTHYLAMINE
-
from Synthetic Dyes
BLADDER CANCER - BENZO[A]PYRENE
-
from Cigarette Smoke
LUNG & SKIN CANCER
Enzymes:
CYP450
EPOXIDE HYDROLASE &
PROSTAGLANDIN H SYNTHASE - VINYL CHLORIDE
-
in plastics
LIVER CANCER - Hydrogen Cyanide
- Cilia toxin in Tobacco Smoke
- Smoking is a big risk for acute MI for what population?
- women age <35 on oral contraceptives
- Name 5 types of Cancer smoking causes
-
Oral Cavity
Esophagus
Lung
Pancreas
Bladder -
Tolerance to alcohol is caused by what enzyme in liver?
What other 3 factors ^ EtOH tolerance -
CYP2E1
1)^ metabolism of EtOH
2)cocaine
3)acetaminophen -
What 3 enzyme each can metboize EtOH to acetaldehyde?
Where is acetaldehyde converted to acetic acid? -
1)ADH (cytosol)
2)CYP2E1 (microsomes)
3)Catalase (peroxisomes)
mitochondria - 3 Effects of Alcohol on liver
-
1)Fatty change - acetaldehypde adducts with tubuline and impairs microtublues
causing v lipoproteins from liver
2)Hepatitis - fever, liver tenderness, jaundice - REVERSIBLE
-fat & hyaline accumulation (MALLORY BODIES) w/ PMN around necrosis; begins with central vein
3)Cirrhosis - hard, shruken liver surrounded by dense bands of collagen (IRREVERSIBLE) - Deficiency of Thiamine causes what 3 problems?
-
1) Polyneuropathy (dry beriberi)
2) Beriberi heart dz (wet beriberi)
3)Wernicke-Korsakoff - Depressive and Addictive effects of alcohol can be attricuted to?
- Fluidization of membrane phspholipids & Altered signal transduction
-
Both Wernicke & Karsakoff syndrome caused by what?
Describe effects of each -
Thiamine deficiency
Wernicke = ataxia, disturbed cognition, ophthalmoplegia, nystagmus
Karsakoff = severe memory loss, linked to confabulations - *Alcohol Effects on heart?
-
Cardiomyopathy -> dilation of heart, altered contractility
probably due to directd toxicity
HYPERTENSION (reactive) secondary to vasopressor effect of EtOH triggeered by release of catecholamines - Benefits of Alcohol to moderate drinkers?
-
Protective effect from:
1) HDL & 2) ^ platelet aggregation - Alcohol effects on GI (2)?
-
1)Gastritis - acute, direct toxicity
2)Pancreatitis - w/ chronic use - Alcohol effects on Skeletal Muscle?
- Muscle weakness, pain, brakdown of myoglobin (direct toxicity)
- Name some effects of Fetal Alcohol Syndrome
-
1) Microcephaly
2) Facial Dysmorphology
3) Malformations of Brain, CV system, GU system - Ethylene Glycol causes?
-
Acute toxicity
If survive, then acute renal failure occurs due to obstruction of kidney tubules by Ca OXALATE CRYSTALS - Do Barituates induce P450 activity?
-
Yes
Benzodiazepines do not - Cocaine actions
-
Blocks DA reuptake (euphoria, paranoia, hyperthermia)
Blocks 5-HT, EPI, NE reuptake(vasoconstriction (toxic) -> hypertension, cardiac arrhythmia, myocardial infacrct, cerebral hemorrhage, & infarct) - What is the fetus risk of cocaine?
-
Decreased blood flow to placenta (from vasoconstiction) = hypoxia
potential spontaneous abortion - Does cocain ^ or v atherosclerosis?
- acclerates
- SE of MDMA (ecstasy)
-
toxicity to 5-HT neurons in brain
imbalance in 5-HT = anxiety, depression, panic disorder - Describe cardiovascular effects of cocaine
- ^ HR, BP & coronary spasm = myocardial O2 damage & potential ischemia or infarction
- LSD, psilocybin & mescaline work by?
-
Hallucinogens
Serotonin 5-HT2 receptor agonists
CRAZY ASS ACTIONS YO! - PCP works by?
-
NMDA glutamate receptor antagonist
inebriation, disorientation, numbness, induced nystagmus - Acetaminophen OD?
- Liver necrosis/failure
- Do Oral Contraceptives cause Breast cancer?
-
No, no link found between them
also OC v endometrial & ovairan cancer - *Name 3 Uncommon/adverse effects of Oral Contraceptives (OC)
-
1)venous THROMBOSIS & pulmornary EMBOLISM - risk ^ for carriers of mutation in factor V (prothrombin)
2) Cardiovascular Dz - especially w/ smoking
3) LIVER TUMOR - SE of NSAIDs
- peptic ulcer
- Adverse effect of Thiopurine S-methltransferase defieciency with Azathioprine use
- Bone Marrow failure
- Adverse effect of CYP2C9 variants with oral anticoagulants
- Bleeding
- Adverse effect of CYP2D6 variants with some antipsychotic drugs
- Excessive sedation, Parkinsonism
- Chloramphenical's idiopathic adverse effect
- Aplastic anemia
- Adverse effect of N-acetyltransferase, slow acetylator with Hydralazine?
- LUPUS
- Asbestos
- LUNG Cancer & MESOTHELIOMA (rare malignant neoplasm of the pleura & peritoneum)
-
Aliphatic Hydrocarbons are Volatile Organic Compounds (VOC), give some examples
absorbed through what?
Effects? -
Chloroform, Carbon Tetrachloride, Perchloroethylene, & Methylene Chloride
Absorbed throug Lung, Skin, GI Tract
Effects: CNS depression and Liver/Hepatic toxicity -
**What is methylene chloride found in?
What is it metabolized to by CYP450? -
Paint removers
CO2 & CO -
Where can you be exposed to perchloroethylene?
Effects? -
Dry Cleaners
Acute: CNS depression, confusion, dizziness
Chronic: Dermatitis & potential carcinogen -
Where can you be exposed to 1,3-Butadiene?
Effects? -
Rubber Factory
^ risk of Leukemia -
Phthalate ester is used as what?
Physiologically induces? -
a Plasticizer
Induces TESTICULAR injury in rats (so does LEAD) - Biphenonol-A mimics prolifefrative effects of?
- Estrogen
-
Where is most of lead taken up in body?
Greatest affected population? -
BONES
Children - inverse correlation between blood Pb concentration and IQ, can delay puberty in females - *Name the 4 Main Toxicities of lead
-
1) High affinity for Sulfhydryl groups: inhibits important enzymes responsible for incorporation of iron into heme molecule (HYPOCHROMIC ANEMIA)
2) Competition w/ Ca Ions: problems in BONE & BRAIN developement as well as NERVE transmission
3) Inhibition of Membrane-Associated Enzymes: inhibits Na/K pumps, leading to v survival of RBC (hemolysis), RENAL DAMAGE & HYPERTENSION
4) Impaired Production of 1,25-Dihydroxyvitamin D - leads to MICROCYTIC HYPOCHROMIC ANEMIA -
Cobalt and Tungsten Carbide cause?
Occupation? -
Lung fibrosis
"TUNG LUNG fibrosis CO"
found in Toolmakes, grinders, diamond polishers -
Cadmium causes?
Occupation? -
Renal Toxicity
"Cadberry Bunny cant pee!"
Battery workers, smelters, welders, soldering -
Chromium causes?
Occupation? -
Cancer of LUNG and Nasal CAVITY
Pigment workers, smelters, steel workers -
Nickel causes?
Occupation? -
Cancer of LUNG and Nasal SINUSES
Smelters, steel workers, electroplating -
Mercury causes?
Occupation? -
Renal toxicity, Muscle tremors, Dementia, Cerebral palsy, Mental Retardation
Chlorine-alkali industry -
Beryllium causes?
Occupation? -
Acute lung irritant, Chronic lung hypersensitivity
Beryllium refining, aerospace manufacturing -
Arsenic causes?
Occupation? -
Cancer of SKIN, LUNG, LIVER
Miners, smelters, oil refinery workers, farm workers -
Insectides typically cause?
Stored where in body? -
NEUROtoxicity
Accumulates in FAT Tissue - Difference between Organophosphate Insecticides and Carbamate Insecticides?
-
Organophosphate = irreversible
Carbamate = reversible
Both cause neurotoxicity - Radioisotopes with longer or shorter 1/2 lives more dangerous?
- longer b/c continuously emit particles
- Alpha particle
-
Stronger
Less penetrance (b/c of mass)
Higher Linear energy transfer (LET)
(above realtive to Beta particle) - Beta particle
-
Weaker
Greater penetrance (b/c of mass)
Lower Linear energy transfer (LET)
(above realtive to Alpha particle) - 1 Gray = ? Rad
- 1 Gray = 100 Rad
- Rem = ?
- dosage of E needed to cause 1 rad of Xray
- What type of cells are most radiosensitive? Examples?
-
Rapidly dividing cells
Hematopoetic cells, Germ cells, GI epithelium, Squamous epithelium, Lymphocytes
Therefore,
BONE, CARTILAGE, MUSCLE & PERIPHERAL NERVES are more resistant - Cells in which stage of cell cycle most sensitive?
- G2 & Mitotic (M) stages
- What molecules increase sensitivity of tumor cells to radiation?
- Halogenated pyrimidines
- What molecules protect against radiation?
- Free Radical Scavengers & Antioxidants
- >10 Gy radiation causes?
- Overt necrosis
- 1-2 Gy radiation causes?
- Killing of proliferating cells
- <0.5 Gy radiation causes?
- No histological effect but does cause subcellular damage
- What is the exceptional cancer that cannot be induced by high radiation exposure?
- Chronic Lymphoid Leukemia (CLL)
- Delayed carcinogenic effect of ionizing radiation may be due to?
-
Induced Genetic Instability, in which mutations persist and accumulate
Very comon with Lymphomas - Name the 4 Stages of Acute Radiation Syndrome (Radiation Sickness) and describe
-
1)Subclinical: <200rem = mild nasea, vomiting, lymphocytes <1500; 100% survival
2)Hematopoietic: 200-600rem, Intermittent N/V, petechiae; lymphocytes <1000; Infections, may require bone marrow transplant
3)Gastrointestinal: 600-1000rem, N/V, diarrhea, hemorrhage and infection, lymphocytes <500; Shock and death in 10-14 days even w/ therapy
4)CNS: >1000rem, inractable N/V, com, convusions, no lymphocytes; Death in 14-36 hours - What are the clinical manifestations if exposed to radiation during preimplantation (0-9 months?
- Embryo death
- What are the clinical manifestations if exposed to radiation during Postnatal period?
- Growth and CNS retardation, eyes, teeth disrupted
- What are the clinical manifestations if exposed to radiation during Fetal period (9 weeks - birth)?
- abnormalities in CNS & reproductive system, MR, ^ childhood leukemia/brain tumors
- Radiation injury to kidneys cause?
- Hyalinizzation of glomeruli -> HTN, atrophy
- Transverse myelitis
- Necrosis, demyelination, & paraplegia caused by IRRADIATION of the spinal cord damaging the blood vessels
-
Radiation to the eyes causes?
Brain? -
CATARACTS
Demyelination of white matter from TRANSVERSE MYELINTIS - What rays does the ozone block?
-
all UVC but only part of UVA & UVB
UVB & UVA causes keratinocytes apoptosis in epidermis -> dyskeratontic, sunburn cells - How do you tan? Negative effects?
-
UVA & UVB induce MELANIN sythesis by melanocytes causing the darkeneing
UVA & UVB induce ^ MELANOCYTES, elongation & extenstion of dendritic processes, transfer of melanin to keratinocytes
both UVA & UVB deplete langerhan cells and reduce Ag presentation through epidermis - Lack of DNA repair mechanisms after sun exposure leading to potential malignancies is?
- Xeroderma Pigmentosum
- Has it been proven that power lines and wireless phone can increase teh risk of certaincancers?
- Nope!
- Difference between a Laceration and a incisions?
-
Laceration is an irregular tear in the skin produced by overstretching (ie busting head open with hammer)
KEY DIFFERENCE: lacerations will have bridging strands of fibrous tissue or blood vessels ACROSS the wound (not seen with incisions) - List the 5 problems of thermal injuries (in order of signficance)....know all
-
1)Neurogenic shock
2)Hypovolemic shock
3)Secondary infection
4)Hypermetabolic state/ Plasma protein Loss
5)Lung/Airway Damage - Sudden loss of eletrolytes, sweating
- Heat cramps
- Sudden collapse due to CV system unable to compensate for hypovolemia secondary to warter depletion; spontaneous resumptionof equilibrium shortly thereafter
- Heat exhaustion
-
Thermoregulation fails, sweating ceases, core body temp rises
common in high temps and humidity - Heat stroke
- Do you lower or elevate the room temperature during Kwashiorkor?
- keep room temperature elevated
- LOC, bradycardia, atrial fibrillation and low core temp are signs of?
- Hypothermia (core temp <90 F)
- Electrical injuries depend on what 2 factors?
-
1)tissue resistance (relative to H2O content)
2)intensity of current - Decompression (Caisson) Disease causes?
-
"Bends" = periarticular bubbles
"Chokes" = bubbles in lung vasculature
"Caisson Disease of Bone" = aseptic necrosis of femoral and humeral heads from embolic occlusion of vasculre supply to those bones - High-altitude illness causes what clinical manifestations?
- 1)Progressive mental obtundation with 2) ^ in capillary permeability -> CEREBRAL and PULMONARY EDEMA
- Describe Primary Malnutrition
- Lack one or all of adequte diet components
- Describe Secondary Malnutrition
- Nutrient supply adequate but have MALABSORPTION
-
What part of body is affected most with Marasmus?
Describe clinical setting -
SKELETAL MUSCLE from inadequate CALORIE intake
example: chronic lung disease, cancer -
What part of body is affected most with Kwashiorkor?
Describe clinical setting -
Visceral organs, esp LIVER from inadequate PROTEIN intake
example: severe trauma, burns, sepsis - Clinical/Lab features of Marasmus
-
History of weight loss
Muscle wasting
Absent subcutaneous fat
Normal Serum proteins
Hypoplastic marrow -> hypochromic microcytic anemia
(v iron); mixed macrocytic if folate deficiency also exists - Clinical/Lab features of Kwashiorkor
-
Normal fat & muscle
Edema
Easily pluckable hair
Enlarged, fatty liver
v mitotic index at GI -> loss of villi
Hypoplastic marrow -> hypochromic microcytic anemia
(v iron); mixed macrocytic if folate deficiency also exists
Serum albumin <2.8 - Give 3 examples of Secondary Malnutrition
-
1)CALCHEXIA - elderly, AIDS, and cancer patients; LOSS OF FAT & MUSCLE; increased energy expenditure W/OUT hunger; cytokine & tumor factor mediated
2)ANOREXIA NERVOSA - amenorrhea; v THYROID hormone release -> cold intolerace, bradycardia; low ESTROGEN -> v Bone density; Hypokalemia -> Cardiac arrhythmias; Anemia
3) BULIMIA NERVOSA - menstrual irregularities; electrolyte imbalances -> cardiac arrythmias; esophageal & cardiac rupture - Do people suffering from Cachexia loss fat or muscle?
- Both!
- Describe 2 hormonal disorders and their effects regarding Anorexia Nervosa
-
1) v THYROID hormone release -> cold intolerace, bradycardia
2) low ESTROGEN -> v Bone density - What are the fat-soluable vitamins?
-
A,D,E,K
Require bile & pancreatic enzymes b/c fat-soluble - If you lack Vitamin A, what are the effects?
-
1) Night blindness, Xerophthalmia (dry eyes)
Bilot spots, Corneal ulcers & Keratomalacia (destruction) of cornea
2) Squamous metaplasia (respiratory infections & renal calculi)
3) Vulnerability to infection (esp measles) - If you lack Vitamin D, what are the effects?
-
Mineralization problems -> Rickets (children), Osteomalacia (adults) leading to osteopenia (difficult to differentiate from osteoporosis)
from v intestinal absorption of Ca & P -
If you lack Vitamin E, what are the effects?
Clinical manifestations? -
1) SPINOCEREBRAL DEGERNATION
2) degeneration of axons in posterior colum of SC
3) loss of nerve cells in the DRG
Clinically:
1) absent tendon reflex
2) ataxia
3)dysarthria
4)loss of position,vibration,pain sensation - If you lack Vitamin K, what are the effects?
-
Bleeding diathesis - characterized by hematomas, hematuria, melena, ecchymoses, & bleeding from gums
also some osteopathic problems - If you lack Vitamin B1, what are the effects?
-
1) Dry beriberi - poly neuropathy -> myelin degeneration leading to dropfoot/wrist
2)Wet beriberi - Cardiovascular syndrome associated with peripheral vasodialtion, high-output cardiac failure, and flabby 4 chambered dilated heart
3)Wernicke-Korsakoff Syndrome - W = ophthalmoplegia, nystagmus, ataxia of gait, confustion; K = confabulation and inability to acquire new informaiton - Carotenoids are metabolized to what?
- active vitamine A
- What organ stores body's vitamin A? For how long?
- ITO cells of LIVER; 6 months
-
Regarding Vitamin D, the liver converts what to what?
Enzyme?? -
Vitamin D to 25(OH)D
D-25-hydroxylase -
Regarding Vitamin D, the kidney converts what to what?
Enzyme?? -
25(OH)D to 1,25(OH)2D (most active form of Vit D!)
alpha-1-hydroxylase - After normal physiolgical response, what are the body's levels of Ca & P after an episode of hypocalcemia w/ Vitamin D deficiency?
- Serum leves of Ca are normal BUT P IS LOW; hence MINERALIZATION is impaired
- Which form of Vit E exibits the most activity?
- alpha-tocopherol
- After absorption, where is Vit E stored and what is it transported by?
-
stored mostly in FAT deposits (also a little in LIVER and MUSCLE)
transported by CHYLOMICRONS - What vitamin do RBC's and Neurons really need?
- Vitamin E
- Name 3 ways the body gets Vitamin K
-
1) Exogenously
2) recycled by healthy liver
3) synthesized by bacterial flora
2 & 3 decrease dietary requirement
v bacterial flora or liver fxn will cause Vit K deficiency - What is Vitamin K needed for?
-
Act as a cofactor for clotting factors VII, IX, X, & prothrombin allowing for Ca binding
Also OSTEOCALCIN (secreted by osteoblsts) needs Vit K for Ca binding as well -> Bone calcification
VIT K GOOD FOR OSTEOPOROSIS - 3 major targets of thiamine?
-
1) peripheral nerves
2) heart
3) brain - Cheilosis, fissures at the angles of mouth (can become infected), is a sign of what?
- Riboflavin deficiency
- Glossitis, tongue becomes atrophic and magenta in color, is a sign of what?
- Riboflavin deficiency
- What ocular changes can a riboflavin deficiency cause?
- opacities and sometimes ulceration
- Dermatitis, greasy scaling skin..may extend into a butterfly distribution, sign of what?
- Riboflavin deficiency
- What vitamin is used to treat hypercholesterolemia?
- Niacin
-
3 morphilogical features of pellagra are?
pellagra is caused by what? -
1) DERMATITIS - bilaterally symmetric on exposed areas of body w/ sharply demarcated scaling and desquamation
2) DIARRHEA- atrophy of GI epithelium
3) DEMENTIA - neuronal degeneration in the brain w/ similar changes in spinal cord
Pellagra caused by NIACIN or TRYPTOPHAN deficiency - Infants fed dried milk preparations wil havea severe deficiency of what vitamin?
- Pyridoxine (Vit B6)
- Deficiency of pyridoxine (Vit B6) results in?
-
cheilosis (mouth-angle fissure), glossitis, dermatitis, peripheral neuropathy
similar to niacin & riboflavin deficiencies - Name 2 fxns of Vit C?
-
1) activated prolyl and lysyl hydroxylase, both needed for hydroxylation of procollagen (ie bone osteoid formation)
2)scavenging free radicals & acting indirecctlyby regenerating the antioxidant form of Vit E -> synergy b/w Vit E & C may reduce atherosclerosis - Deficiency of Vit C results in? (5)
-
1) Hemorrhages, purpura & ecchymoses
2) Skeletal changes b/c inadequte formation of osteoid matrix (NO DEFECT IN MINERALIZATION! (that's vitamin D!))
3) Gingial swelling and secondary bacterial periodontal infections
4) skin lesions
5) Wound healing impaired - What to vitamin deficienies result in megaloblastic anemia?
- folate and B12 (cobalamine)
- Neural tube defects caused by lack of what vitamin?
- Folate
- Deficiency of what results in microcytic anemia?
- Iron
- Keshan disease
-
Presents as a congestive cariomyopthy (NECROSIS) in children and young women
Associate with SELENIUM deficiency - *Distinctive rash on eyes, nose, mouth and distal extremities called? Caused by? Results in?
-
ACRODERMATITIS ENTEROPATHICA
ZINC deficiency
1) Growth retardation & 2) diminished reproductive capacity - Muscle weakness, neeurologic defects, hypopigmentation, abnormal collagen cross-linking
- Copper Deficiency
-
Hormone that acts as an antiobesity factor called? Actions?
Binds where? -
LEPTIN
1) v the secretion of appetite stimulant NT called NEUROPEPTIDE Y
2) ^ release of NE metabolising fatty acid
HYPOTHALAMUS - Do obese people have a high level of plasma leptin?
- Yes, but there is a problem with leptin resistance at level of transport therefore cant use
- Obesity increases the risk of a number of conditions like (6)?
-
1) Diabetes (type II)
2) Nonalcoholic steatohepatitis - fatty change in liver
3) Cardiovascular disorders
4) Cholelithiasis (gallstones)
5) Hypoventilation or Pickwickian syndrome
6) Osteoarthritis - Microcytic anemia caused by
- Fe Deficiency!!
- *pyridoxine (B6) antagonist?
- Isoniazid
- Macrocytic anemia?
-
Cobalamine (B12)
Folate
"Macro FC...the greatest team ever" - Powerful vasoconstrictor?
- Cocaine
- Severe, restrictive lung disease
- Silicosis (from silica in environment)
- Elevated levels of zinc protoporphyrin indicate?
-
Chronic LEAD poisoning
Anemia of Chronic Disease
Iron Deficiency Anemia
-all above b/c lead interferes with heme biosynthesis and inhibits the incorporation of iron into heme, as a result, zinc is used instead - Hemorragic Dermatitis
- Zinc Deficiency
- Short-term appetite acting signal? Long-term?
-
Short-term: GHRELIN (rises rapidly before every mean and falls when stomach filled)
Long-term: LEPTIN (mediated by alpha-MSH signally; ^ TRH & CRF) - Does lead poisoning lead to severe wasting?
-
No
but Marasmus does - Eating more fruits and veggies helps prevent what?
- Colong cancer
- Therapeutic doese of radiation can cause?
- Acute vascular injury - fibrosis and luminal narrowing
- Large amounts of ethanol over a short time can cause (esp w/ acetaminophen ingestion)?
-
Choronic ethanolism induces CYP450 ^ ptotential for toxic liver injury from acetaminophen
Coma & death (ACUTE alcohol problem)
CHRONIC problems: cirrhosis, wernicke dz & hematemesis - Abetalipoproteinemia occurs with? what is it?
-
Vitamin E deficiency
a rare genetic disorder that interferes with the normal absorption of fat and fat soluble vitamins from food - Fatty liver complication with consumption of?
- Tetracyclin
- Cholorpromazine ingestion may lead to?
- Cholestatic jaundice
- Quinidine theapy may lead to?
- Hemolytic anemia
- What tissue is realatively radioRESISTANT?
- Cardiac and Skeletal muscle tissue
- Inhalation of hot, toxic gases may lead to?
- Pulmonary edema
- Cerebral edema is complication likely to occur after what injury?
- Burn injury & Altitude sickness
- *Excessive ethanol ingestion ^ cancer risk where?
-
Upper aearodigestive tract including PHARYNX & ESOPHAGUS
In stomach may cause chronic gastritis but not gastric cancer - Acute renal failure results from ingestion of?
- Ethylene gycol
- What is used to treat cardiac dysrhythmias?
- Adenosine
-
Name the two deficiencies causing galactosemia? which is worse?
Can it be prevented? -
1) Galactokinase - milder (no MR)
2) Galactose-1-phophate uridyl transferase (akak GALT...more severe)
GALT defieciency can cause hepatomegaly (fatty change), jaundice cataracts, CNS problems (MR), failure to thrive
YES! early removal of GALACTOSE from diet for at least teh FIRST 2 YEARS OF lIFE - The presence of anaplasia correlates with what mutation? consequence?
-
anaplasia = underlying p53 mutation (only 5% of Wilms tumors)
Emergence of resistance to chemotherapy - *Adverse effects of Hormone Replacement Therapy?
-
1)venous THROMBOSIS & pulmornary EMBOLISM - risk ^ for carriers of mutation in factor V (prothrombin)
2) Cardiovascular Dz (MC infaction) - especially w/ smoking
3) BREAST cancer
4) Cholecystitis (GB dz) - Vitamin C ^ Iron absorption where?
- Small intestins
- Vitamin B12 (cobalamin) results in what 2 problems?
-
1)macrocytic anemia
2)degeneration of spinal cord (neuro problems)
* folate = macrocytic amemia ONLY - Nitrates
- Gastric carcinomas
- Aflatoxin
- Liver carcinomas
- During deliver, excessive bleeding causes a nutrient deficiency of what? in who?
-
IRON
in BOTH mother & baby - Cherry red lividity
- CO poinsoning
- Both marasmus and kwashikor suffer from?
-
Hypoplastic marrow -> hypochromic microcytic anemia
(v IRON)