Environment Pathology and Disease Bethy S Hernowo Faculty Of Medicine Universitas Padjadjaran.

Environment Pathology Environment Pathology and Diseaseand Disease

Bethy S HernowoBethy S Hernowo

Faculty Of Medicine Universitas Faculty Of Medicine Universitas PadjadjaranPadjadjaran

Environmental DiseaseEnvironmental Disease

Diseases & lesions caused by chemical or Diseases & lesions caused by chemical or ٭٭physical injuriesphysical injuries

Environmental disease : commonEnvironmental disease : common ٭٭

ILO (International Labor Organization) ILO (International Labor Organization) ٭٭estimated : 1.1 million people, work-relateestimated : 1.1 million people, work-relate

d injuries & illnesses d injuries & illnesses

Sources of ExposureSources of Exposure EnvironmentalEnvironmental

– Man-madeMan-made Intentional (Hg, Minimata, Japan)Intentional (Hg, Minimata, Japan)AccidentalAccidental

– methyl isocyanate, Bhopal, Indiamethyl isocyanate, Bhopal, India– radiation, Chernobylradiation, Chernobyl

– Natural (HNatural (H22S/CO/COS/CO/CO22, Cameroon), Cameroon)

Occupational (mining, dye, chemical)Occupational (mining, dye, chemical) Iatrogenic (drugs)Iatrogenic (drugs) Self-administered (substance abuse, Self-administered (substance abuse,

suicide)suicide)

Mechanisms of ToxicityMechanisms of Toxicity

Corrosive, tissue destruction (acids, alkali)Corrosive, tissue destruction (acids, alkali)– desiccationdesiccation– protein destructionprotein destruction

denaturationdenaturationhydrolysishydrolysis

– fat saponificationfat saponification Inhibition of enzyme activityInhibition of enzyme activity

cyanide: cytochrome oxidasecyanide: cytochrome oxidase

ABSORPTION and DISTRIBUTIONS of TOXICANTSABSORPTION and DISTRIBUTIONS of TOXICANTS

Environmental PollutionEnvironmental Pollution

Air pollutionAir pollution1.1. Outdoor Air PollutionOutdoor Air Pollution1.1. Ozone1.1. Ozone1.2. Nitrogen dioxide1.2. Nitrogen dioxide1.3. Sulfur dioxide1.3. Sulfur dioxide1.4. Carbon monoxide1.4. Carbon monoxide1.5. Lead1.5. Lead1.6 Particulates1.6 Particulates

Major Outdoor Air pollutantsMajor Outdoor Air pollutants

Air Air pollutantspollutants

Origin(s)Origin(s) ConsequencesConsequences

OzoneOzone

Nitrogen Nitrogen dioxidedioxide

Sulfur Sulfur dioxidedioxide

Interactions of oxygen with Interactions of oxygen with various pollutants such as various pollutants such as oxide of nitrogen, sulfur, & oxide of nitrogen, sulfur, & hydrocarbonshydrocarbons

Come, & woodCome, & wood

Combustion of fossil fuel such Combustion of fossil fuel such as coal, gasoline, & woodas coal, gasoline, & wood

Is highly reactive & oxidizes Is highly reactive & oxidizes polyunsaturated lipids that polyunsaturated lipids that become irritants & induce become irritants & induce release of inflammatory release of inflammatory mediators affecting all airways mediators affecting all airways down to bronchoalveolar down to bronchoalveolar junctionsjunctions

Dissolves in secretions in Dissolves in secretions in airways to form nitric & nitrous airways to form nitric & nitrous acids, which irritate & damage acids, which irritate & damage linings of airwaylinings of airway

Yields sulfuric acid, bisulfites, Yields sulfuric acid, bisulfites, and sulfites, which irritate & and sulfites, which irritate & damage linings of airways; damage linings of airways; together with nitric acid, together with nitric acid, contributes to acid raincontributes to acid rain

Carbon Carbon monoxidemonoxide

LeadLead

particulatesparticulates

Incomplete combustion of Incomplete combustion of gasoline, oil, wood, and gasoline, oil, wood, and natural gasnatural gas

Discussed in a subsequent Discussed in a subsequent sectionsection

Great variety of finely Great variety of finely divided (and therefore divided (and therefore airborne) pollutants airborne) pollutants ranging from relatively ranging from relatively innocuous plaster dust to innocuous plaster dust to highly dangerous asbestos highly dangerous asbestos dustdust

May include lead, ash, May include lead, ash, hydrocarbon residues, and hydrocarbon residues, and other industrial and other industrial and nuclear wastesnuclear wastes

Combines with Combines with hemoglobin to displace hemoglobin to displace oxyhaemogloblin & oxyhaemogloblin & thus induce systemic thus induce systemic asphyxiaasphyxia

Major contributor to Major contributor to smog & a major cause smog & a major cause of respiratory diseaseof respiratory disease

Patterns Of Lung injury Related To Air Patterns Of Lung injury Related To Air PollutionPollution

Lung responseLung response Pathogenic Mechanism(s)Pathogenic Mechanism(s)

Acute or chronic Acute or chronic inflammation (e.c. Chronic inflammation (e.c. Chronic bronchitis)bronchitis)

EmphysemaEmphysema

AsthmaAsthma

Hypersensitivity pneumoniaHypersensitivity pneumonia

PneumoconiosisPneumoconiosis

NeoplasiaNeoplasia

Direct cell injuryDirect cell injury

Enhanced proteolysisEnhanced proteolysis

Allergic or irritant effectAllergic or irritant effect

Immunologic injuryImmunologic injury

Fibrotic reactions caused by Fibrotic reactions caused by cytokines released from cytokines released from macrophages & other macrophages & other recruited leucocytesrecruited leucocytes

Mutagenic & promoting Mutagenic & promoting effects effects

Air pollutionAir pollution2.2. Indoor Air PollutionIndoor Air Pollution2.1. Tobacco smoke2.1. Tobacco smoke2.2. Carbon monoxide2.2. Carbon monoxide2.3. Nitrogen dioxide2.3. Nitrogen dioxide2.4. Wood Smoke2.4. Wood Smoke2.5. Formaldehyde2.5. Formaldehyde2.5. Radon2.5. Radon2.6. Asbestos fibers2.6. Asbestos fibers2.7. Manufactured mineral fibers2.7. Manufactured mineral fibers2.8 Bioaerosol2.8 Bioaerosol

Health Effects Of Indoor Air PollutansHealth Effects Of Indoor Air Pollutans

Toxic And carcinogenic MetalsToxic And carcinogenic Metals

Heavy Metal Toxic AgentsHeavy Metal Toxic Agents

Mercury (HgClMercury (HgCl22 , ATN; org Hg, CNS , ATN; org Hg, CNS function)function)

Lead ( inhibits heme synthesis, CNS Lead ( inhibits heme synthesis, CNS function, kidneys, GI)function, kidneys, GI)– 2-11% of children in US exceed 10 2-11% of children in US exceed 10 μg/dLμg/dL

ArsenicArsenic IronIron

Industrial ExposuresIndustrial ExposuresOrgan/SystemOrgan/System EffectEffect ToxicantToxicant

CadiovascularCadiovascular

RespiratoryRespiratory

NervousNervous

Heart diseaseHeart disease

Nasal cancerNasal cancer

Lung cancerLung cancer

COPDCOPD

HypersensitivityHypersensitivity

FibrosisFibrosis

Peripheral neuropathiesPeripheral neuropathies

Ataxic gaitAtaxic gait

Central nervous depressionCentral nervous depression

CataractsCataracts

Carbon,monoxide,lead,solvents,Carbon,monoxide,lead,solvents,

cobalt,cadmiumcobalt,cadmium

Isopropyl alcohol,wood dustIsopropyl alcohol,wood dust

Radon,asbestos,silica,bis(Chloro-Radon,asbestos,silica,bis(Chloro-methyl)ether,nickel,arsenic,methyl)ether,nickel,arsenic,

Chromium,mustard gasChromium,mustard gas

Grain dust,coal dust,cadmiumGrain dust,coal dust,cadmium

Berylium,isocyanatesBerylium,isocyanates

Silica,asbestos,cobaltSilica,asbestos,cobalt

Solvents,acrylamide,methylSolvents,acrylamide,methyl

Chloride,mercury,lead,arsenic,Chloride,mercury,lead,arsenic,

DDTDDT

Chlordane,toluen,acryllamide,Chlordane,toluen,acryllamide,

MercuryMercury

Alcohols,ketones,aldehydes,Alcohols,ketones,aldehydes,

SolventsradiationSolventsradiation

Ultraviolet Ultraviolet

URINARYURINARY

REPRODUCTIVEREPRODUCTIVE

HEMATOPOIEICHEMATOPOIEIC

SKINSKIN

GASTROINTESTINALGASTROINTESTINAL

ToxicityToxicity

Bladder cancerBladder cancer

Male infertilityMale infertility

Female infertilityFemale infertility

TeratogenesisTeratogenesis

LeukemiaLeukemia

Foloculitis and acneiformFoloculitis and acneiform

DermatosisDermatosis

CancerCancer

Liver angiosarcomaLiver angiosarcoma

Mercury,lead,glycols ethers,Mercury,lead,glycols ethers,

SolventsSolvents

Napthylamines,4-Napthylamines,4-aminobiphenyl,benzidine,aminobiphenyl,benzidine,

Rubber productsRubber products

Lead,pthalate plasticizersLead,pthalate plasticizers

Cadmium,leadCadmium,lead

Mercury,polychlorinatedMercury,polychlorinated

BiphenylsBiphenyls

Benzene,radon,uraniumBenzene,radon,uranium

Polychlorinated bipyhenyls,Polychlorinated bipyhenyls,

HerbicidesHerbicides

Ultraviolet radiationUltraviolet radiation

Vinyl chlorideVinyl chloride

PneumoconiosisPneumoconiosis

The non-neoplastic lung reaction to inhalation of The non-neoplastic lung reaction to inhalation of ٭٭mineral dustmineral dust

Agent : coal dust, silica, asbestos, berylliumAgent : coal dust, silica, asbestos, beryllium ٭٭

Coal Workers’ Pneumoconiosis (CWP)Coal Workers’ Pneumoconiosis (CWP) ٭٭

Spectrum of lung finding in coal workersSpectrum of lung finding in coal workers

1. Asymptomatic anthracosis1. Asymptomatic anthracosis

2. Simple Coal workers pneumoconiosis2. Simple Coal workers pneumoconiosis

3. Progressive massive fibrosis (PMF) 3. Progressive massive fibrosis (PMF)

Mineral Dust –Induced Lung DiseaseMineral Dust –Induced Lung Disease

Pathogenesis of Pathogenesis of PneumoconiosisPneumoconiosis

MorphologyMorphology

1. Pulmonary anthracosis1. Pulmonary anthracosisInhaled carbon pigment is engulfed by alveolar Inhaled carbon pigment is engulfed by alveolar or interstitial macrophage, then accumulate in or interstitial macrophage, then accumulate in connective tissue connective tissue linear streak & aggregates linear streak & aggregates pigment identify pulmonary lymphatic & mark pigment identify pulmonary lymphatic & mark the pulmonary lymph nodethe pulmonary lymph node

2. Simple CWP2. Simple CWPCharacterized : coal macules & coal nodule.Characterized : coal macules & coal nodule.coal macules consist : dust-laden macrophages. coal macules consist : dust-laden macrophages. The lesion scattered, but uppers lobes & upper The lesion scattered, but uppers lobes & upper zones of the lower lobes more heavily involvedzones of the lower lobes more heavily involved

MorphologyMorphology

3. Caplan syndrome3. Caplan syndrome

Coexistence of rheumatoid arthritis with Coexistence of rheumatoid arthritis with a pneumoconiosis a pneumoconiosis development development distinctive nodulardistinctive nodular develop fairly rapidly develop fairly rapidly

The nodular lesions The nodular lesions central necrosis central necrosis surrounded by palisading fibroblast, surrounded by palisading fibroblast, palsma cells, macrophages containing palsma cells, macrophages containing coal dust & collagencoal dust & collagen

The syndrome also occur in asbestosis & The syndrome also occur in asbestosis & silicosissilicosis

Clinical course CWPClinical course CWP

1.1. CWP usually benign CWP usually benign produce little produce little decrement in lung functiondecrement in lung function

2.2. Minority cases Minority cases pulmonary pulmonary dysfunction, hypertension & cor dysfunction, hypertension & cor pulmonalepulmonale

3.3. CWP CWP PMF (progressive massive PMF (progressive massive fibrosis) linked variety factors : coal fibrosis) linked variety factors : coal dust exposure level & total dust burdendust exposure level & total dust burden

4.4. PMF PMF tendency to progress even tendency to progress even absence exposureabsence exposure

SilicosisSilicosisCaused by inhalation crystalline silicaCaused by inhalation crystalline silica ٭٭ Occupations associated development Occupations associated development ٭٭

silicosis : quarry mining, sandblasting, silicosis : quarry mining, sandblasting, drilling, tunneling, & stone cuttingdrilling, tunneling, & stone cutting

Incidence : 1500 cases each year in USIncidence : 1500 cases each year in US ٭٭ : Silica : Silica ٭٭ 1. 1. CrystallineCrystalline : quartz, cristobalite, : quartz, cristobalite,

tridymite ( most toxic and fibrogenic)tridymite ( most toxic and fibrogenic)2. 2. Amorphous formsAmorphous forms (most commonly (most commonly implicated in silicosis)implicated in silicosis)

Classification SilicosisClassification Silicosis 1.1. Acute silicosis : exposure very high Acute silicosis : exposure very high

level of silica & develops quickly level of silica & develops quickly 2.2. Chronic ( nodular ) silicosis: exposure Chronic ( nodular ) silicosis: exposure

over prolonged periods over prolonged periods Characteristic fibrotic nodules of Characteristic fibrotic nodules of silicosissilicosis

3.3. Complicated ( conglomerate silicosis) Complicated ( conglomerate silicosis) result progression of chronic result progression of chronic silicosissilicosis

4.4. Other pulmonary disease : silicosis Other pulmonary disease : silicosis associated with TBCassociated with TBC

MorphologyMorphology

Gross : Characteristic nodule in early Gross : Characteristic nodule in early stage: tiny, barely palpable, discrete, stage: tiny, barely palpable, discrete, pale-to-blackened, nodules in upper pale-to-blackened, nodules in upper zones zones

Microscopically : silicotics nodule Microscopically : silicotics nodule demonstrates concentrically demonstrates concentrically arranged hyalinized collagen fibers arranged hyalinized collagen fibers surrounding an amorphous center. surrounding an amorphous center.

Microscopically: SilicosisMicroscopically: Silicosis

Clinical courseClinical course

≈ ≈ Chronic silicosis Chronic silicosis detected routine detected routine chest radiographs (asymptomatic)chest radiographs (asymptomatic)

≈ ≈ Radiographs : fine nodularity in the Radiographs : fine nodularity in the upper zones upper zones function : normal/ function : normal/ moderately affectedmoderately affected

≈ ≈ Most patients do not develop Most patients do not develop shortness of breath until late in the shortness of breath until late in the coursecourse

≈ ≈ The disease The disease slow to kill slow to kill

AsbestosisAsbestosis

» Asbestos » Asbestos family of crystalline hydrated family of crystalline hydrated silicatessilicates

» Occupotional exposure to asbestos, linked » Occupotional exposure to asbestos, linked to:to:

1.1. Parenchymal interstitial fibrosis Parenchymal interstitial fibrosis (asbestosis)(asbestosis)

2.2. Bronchogenic carcinomaBronchogenic carcinoma3.3. Pleural effusionsPleural effusions4.4. Localized fibrous plaque, rarely diffuse Localized fibrous plaque, rarely diffuse

fibrous plaquefibrous plaque5.5. Malignant pleural & peritoneal Malignant pleural & peritoneal

mesotheliomamesothelioma6.6. Laryngeal carcinomaLaryngeal carcinoma

Pathogenesis AsbestosisPathogenesis Asbestosis Dictate : concentration, size, shape & solubility of Dictate : concentration, size, shape & solubility of ٭٭

different forms asbestosdifferent forms asbestos:Two forms asbestos:Two forms asbestos ٭٭1.1. Serpentine (fiber is curly & flexible) : ChrysotileSerpentine (fiber is curly & flexible) : Chrysotile2.2. Amphibole (fiber is straight, stiff,& brittle) Amphibole (fiber is straight, stiff,& brittle) more more

pathogenicpathogenic:The greater pathogenicity amphiboles related:The greater pathogenicity amphiboles related ٭٭1. Chrysotiles 1. Chrysotiles impacted respiratory impacted respiratory removed removed

mucociliary mucociliary trapped trapped gradually leached from tissuegradually leached from tissue

2. Amphiboles 2. Amphiboles align themselves align themselvesairstream airstream deliver deliver deeper deeper penetrate epithelial cells penetrate epithelial cells reach reach interstitiuminterstitium

MorphologyMorphology

Gross: diffuse pulmonary interstitial fibrosisGross: diffuse pulmonary interstitial fibrosisMicroscopically : Characteristic Microscopically : Characteristic asbestos asbestos

bodies : golden brown, fusiform or bodies : golden brown, fusiform or beaded rods with a translucent center. beaded rods with a translucent center. They consist of asbestos fibers coated They consist of asbestos fibers coated with an iron containing proteinaceous with an iron containing proteinaceous material. material. Pleural plaque : well-circumscribes plaque Pleural plaque : well-circumscribes plaque of dense collagensof dense collagens

Asbestos Body

Clinical courseClinical course

≈ ≈ Indistinguishable from other diffuse Indistinguishable from other diffuse interstitial lung diseaseinterstitial lung disease

≈ ≈ Typically, progressively worsening Typically, progressively worsening dyspnea appears 10-20 years after dyspnea appears 10-20 years after exposureexposure

≈ ≈ The disease may static or progress The disease may static or progress to congestive heart failure, cor to congestive heart failure, cor pulmonale and death. pulmonale and death.

Tobacco SmokingTobacco Smoking

400,000 deaths/yr (21% of all deaths in US)400,000 deaths/yr (21% of all deaths in US) 50 Million smokers in US50 Million smokers in US Smoke compositionSmoke composition

– carcinogens (polycyclic HC, carcinogens (polycyclic HC, --naphthylamine, naphthylamine, nitrosamines)nitrosamines)

Irritants and toxinsIrritants and toxins– ammonia, formaldehyde, oxides of nitrogenammonia, formaldehyde, oxides of nitrogen

COCO NicotineNicotine

Relative Disease RisksRelative Disease RisksAssociated with SmokingAssociated with Smoking

MaleMale FemaleFemale

Lung Ca deathLung Ca death 22 22 12 12

Mouth CaMouth Ca 27 27 6 6

Larynx CaLarynx Ca 10 10 18 18

Esophogus CaEsophogus Ca 8 8 10 10

CAD >35 yoCAD >35 yo 3 3 2 2

Cerebro VD >35 yoCerebro VD >35 yo 4 4 5 5

COPDCOPD 10 10 10 10Ill health effects of smoking partially reversibleIll health effects of smoking partially reversible

Tobacco smokeTobacco smoke

Adverse Adverse effects of effects of smokingsmoking

Injury By Chemical AgentsInjury By Chemical Agents

Mechanisms of chemical injury:Mechanisms of chemical injury:

1.1. DoseDose

2.2. Requirement for metabolic conversionRequirement for metabolic conversion

3.3. Sites of absorption, accumulation, or Sites of absorption, accumulation, or excretionexcretion

4.4. Individual variationIndividual variation

5.5. The capacity of the chemical to induce The capacity of the chemical to induce an immune responsean immune response

6.6. Unintentional transmission of infectionsUnintentional transmission of infections

Injury by Injury by Therapeutic Therapeutic

Agents Agents (adverse Drug (adverse Drug

ReactionsReactions))

Exogenous Estrogens And Oral Exogenous Estrogens And Oral ContraceptivesContraceptives

1.1. Exogenous Estrogens ( alone & Exogenous Estrogens ( alone & usually natural estrogen)usually natural estrogen)

Adverse effects of estrogen therapy :Adverse effects of estrogen therapy :

» Endometrial carcinoma» Endometrial carcinoma

» Breat carcinoma» Breat carcinoma

» Thromboembolism» Thromboembolism

» Cardiovascular disease» Cardiovascular disease

22. . Oral contraseptivesOral contraseptives

Adverse effects of oral contraseptives Adverse effects of oral contraseptives

( contain synthetic estrogens & always with ( contain synthetic estrogens & always with progestin)progestin)

1.Breast carcinoma1.Breast carcinoma 6.Hypertension 6.Hypertension

2.Endometrial cancer 7. Hepatic 2.Endometrial cancer 7. Hepatic adenomaadenoma

3.Cervical cancer 8. Gallbladder disease3.Cervical cancer 8. Gallbladder disease

4.Ovarian cancer 9. Cadiovascular 4.Ovarian cancer 9. Cadiovascular

5.Thromboembolism disease5.Thromboembolism disease

AcetaminophenAcetaminophen

≈ ≈ When taken very large doses When taken very large doses hepatic necrosishepatic necrosis

≈ ≈ The window therapeutic dose : 0,5 grThe window therapeutic dose : 0,5 gr

≈ ≈ Toxic dose : 15-25 grToxic dose : 15-25 gr

≈ ≈ Toxicity begins : nausea, vomiting, Toxicity begins : nausea, vomiting, diarrhea, sometimes shock and diarrhea, sometimes shock and jaundicejaundice

≈ ≈ Serious overdose : liver failure, renal Serious overdose : liver failure, renal and myocardial damageand myocardial damage

Aspirin (Acetylsalicylic Acid)Aspirin (Acetylsalicylic Acid)

≈ ≈ Overdose ( 2-4 gr) : accidental Overdose ( 2-4 gr) : accidental ingestion of large number table ingestion of large number table young childrenyoung children

≈ ≈ Suicidal ( 10-30 gr) Suicidal ( 10-30 gr) adult adult≈ ≈ Effects : at first : respiratory alkalosis Effects : at first : respiratory alkalosis

metabolic acidosis metabolic acidosis deathdeath≈ ≈ Chronic : take > 3 gr daily Chronic : take > 3 gr daily

headache, dizziness, tinnitus, difficulty headache, dizziness, tinnitus, difficulty hearing, mental confusion, nausea, hearing, mental confusion, nausea, vomiting and diarrheavomiting and diarrhea

Injury by Non Injury by Non therapeutic Toxic therapeutic Toxic

AgentsAgents

1. Lead poisoning

2. Carbon monoxide

3. Alcohol and drug

abuse

Clinical And Clinical And Pathologic Features Pathologic Features Of Lead PoisoningOf Lead Poisoning

Lead LinesLead Lines

Lead causes injury by its multiple Lead causes injury by its multiple metabolic effectsmetabolic effects::

1.1. High affinity for sulfhydryl groups & High affinity for sulfhydryl groups & interferes with enzymesinterferes with enzymes

2.2. Competes with calciumCompetes with calcium

3.3. Interferes with membrane-associated Interferes with membrane-associated enzymesenzymes

4.4. Interferes with nerve transmission Interferes with nerve transmission and brainand brain

5.5. Membrane effects damage the Membrane effects damage the kidneyskidneys

MorphologyMorphology

Major target of Lead toxicity : blood, Major target of Lead toxicity : blood, CNS, GIT and kidneysCNS, GIT and kidneys

1.1. Blood changes Blood changes characteristic characteristic result lead accumulation occur fairly result lead accumulation occur fairly early. early.

2.2. Brain damage is prone to occur in Brain damage is prone to occur in childrenchildren

3.3. GIT : colic, extremely severeGIT : colic, extremely severe4.4. Kidney : proximal tubular damage Kidney : proximal tubular damage

with intranuclear lead inclusions.with intranuclear lead inclusions.

Normal KidneyNormal Kidney

Acute Tubular NecrosisAcute Tubular Necrosis

Carbon MonoxideCarbon Monoxide Nonirritating, colorless, tasteless, odorless Nonirritating, colorless, tasteless, odorless ٭٭

imperfect oxidation of carboneceous materials imperfect oxidation of carboneceous materials continues to be cause accidental & suicidal deathcontinues to be cause accidental & suicidal death

CO kills by inducing CO kills by inducing CNS depressionCNS depression ٭٭ CO act as a CO act as a systemic asphyxiantsystemic asphyxiant ٭٭

carboxyhemoglobin incapable carrying oxygencarboxyhemoglobin incapable carrying oxygen Acute PoisoningAcute Poisoning: generalized cherry-red color skin : generalized cherry-red color skin ٭٭

& mucous membrane& mucous membrane chronic poisoningchronic poisoning : evoke widespread ischemic : evoke widespread ischemic ٭٭

changes in the CNSchanges in the CNS

Classification Of Drugs Of AbuseClassification Of Drugs Of Abuse

ClassClass ExamplesExamples

Sedatives & hypnoticsSedatives & hypnotics

CNS symphatomimetics or CNS symphatomimetics or stimulantsstimulants

OpioidsOpioids

CannabinoidsCannabinoids

Hallucinogens or psychedelicsHallucinogens or psychedelics

InhalantsInhalants

Nonprescription drugsNonprescription drugs

Alcohol, barbituratesAlcohol, barbiturates

Cocaine, amphetaminesCocaine, amphetamines

Ritalin, weight loss productsRitalin, weight loss products

Heroin, morphine, methadoneHeroin, morphine, methadone

Marijuana, hashishMarijuana, hashish

Lysergic acid diethylamide Lysergic acid diethylamide (LSD),mescaline(LSD),mescaline

Aerosol sprays,glues,tolueneAerosol sprays,glues,toluene

Ingredients :Atrophine, Ingredients :Atrophine, scopolamin, antihistamine, weak scopolamin, antihistamine, weak analgesicsanalgesics

Alcohol And Drugs Of AbuseAlcohol And Drugs Of Abuse

1.1. EthanolEthanol

2.2. CocaineCocaine

3.3. HeroinHeroin

4.4. MarijuanaMarijuana

5.5. Other Illicit drugsOther Illicit drugs

Metabolism of EthanolMetabolism of Ethanol

EthanolEthanol

Adverse effects of ethanol:Adverse effects of ethanol:

1.1. Acute alcoholism Acute alcoholism effects mainly effects mainly CNS CNS induced hepatic & gastric induced hepatic & gastric changeschanges

2.2. Chronic alcoholism Chronic alcoholism morphologic morphologic alterations alterations liver & stomach liver & stomach

Normal LiverNormal Liver

Fatty Change in LiverFatty Change in Liver

Fatty Change in LiverFatty Change in Liver

CocaineCocaineManifestations of acute cocaine toxicityManifestations of acute cocaine toxicity1.1. Sympathetic nervous system stimulation Sympathetic nervous system stimulation

dilatated pupils, vasoconstrictiondilatated pupils, vasoconstriction2.2. Lethal arrhythmias & myocardial infarctionLethal arrhythmias & myocardial infarction3.3. Cerebral infarction & intracranial hemorrhageCerebral infarction & intracranial hemorrhage4.4. RhabdomyolysisRhabdomyolysis5.5. In pregnant women In pregnant women spontaneous abortion spontaneous abortionManifestations of chronic toxicityManifestations of chronic toxicity1.1. Perforation nasal septumPerforation nasal septum2.2. Decreased lung diffusing capacityDecreased lung diffusing capacity3.3. Dilated cardiomyopathyDilated cardiomyopathy

Effect of cocaine on Effect of cocaine on neurotransmittersneurotransmitters

CNS SynapseSympathetic Neuron-target Cell Interfere

HeroinHeroin≈ ≈ Effects : euphoria, hallucinations, somnolence & Effects : euphoria, hallucinations, somnolence &

sedationssedations≈ ≈ Heroin Heroin adversed physical effects, related to adversed physical effects, related to1.1. Pharmacologic action of the agentPharmacologic action of the agent2.2. Reactions to the cutting agents/contaminationsReactions to the cutting agents/contaminations3.3. Hypersensitivity reactionsHypersensitivity reactions4.4. Diseases contracted incident Diseases contracted incident use needle : use needle :

Sudden deathSudden death ٭٭Pulmonary complicationPulmonary complication ٭٭ Infectious complicationsInfectious complications ٭٭ Cutaneous lesionsCutaneous lesions ٭٭ Kidney diseaseKidney disease ٭٭

MarijuanaMarijuana

Effects:Effects:

1.1. Distorts sensory perception & impairs Distorts sensory perception & impairs motor coordinationmotor coordination

2.2. Lung Lung laryngitis, bronchitis, cough, laryngitis, bronchitis, cough, hoarseness hoarseness increased risk for increased risk for cancercancer

3.3. Increased heart rate and blood Increased heart rate and blood pressure pressure angina angina

4.4. Induce chromosomal damageInduce chromosomal damage

Other Illicit DrugsOther Illicit Drugs

The variety of drug The variety of drug try by those try by those seeking seeking new experiences new experiences

Range : various stimulants Range : various stimulants (amphetamines) to depressants (amphetamines) to depressants (benzodiazepines) to hallucinogens (benzodiazepines) to hallucinogens (ectasy)(ectasy)

Dangerous combination : alcohol & Dangerous combination : alcohol & drivingdriving

Injury By physical AgentsInjury By physical Agents Mechanical TraumaMechanical Trauma1.1. AbrasionAbrasion2.2. ContusionContusion3.3. LacerationLaceration4.4. Incised woundIncised wound5.5. Puncture woundPuncture wound◊◊ Thermal Injury Thermal Injury Thermal burnsThermal burns HyperthermiaHyperthermia HypothermiaHypothermia

Injury By physical Injury By physical AgentsAgents

Abrasion : A wound produced by scraping or rubbing

Contusion : A wound produced by a blunt object damage blood vessels & extravasation

Injury By physical AgentsInjury By physical Agents

Laceration : A tear or disruptive stretching of tissue force by blunt object

Injury By physical AgentsInjury By physical Agents

Puncture wound : caused by a long narrow instrument Penetrating when the instruments pieces the tissue & Perforating when it traverses a tissue to also create an exit wound

Thermal injuryThermal injury

Gross:Gross:Full-thickness burn are white or charred, Full-thickness burn are white or charred, dry and anesthetic, depending on the dry and anesthetic, depending on the depht, partial-thickness burns are depht, partial-thickness burns are mottled with blisters & painfulmottled with blisters & painful

◊ ◊ Microscopically:Microscopically:Devitalized tissue Devitalized tissue coagulative necrosis, coagulative necrosis, adjacent to vital tissue adjacent to vital tissue accumulates accumulates inflammatory cells & exudationinflammatory cells & exudation

HyperthermiaHyperthermia

Heat cramps Heat cramps loss of electrolytes loss of electrolytes via sweatingvia sweating

Heat exhaustion Heat exhaustion onset sudden, onset sudden, most common hyperthermic most common hyperthermic syndrome syndrome failure Cardiovascular failure Cardiovascular system to compensate for system to compensate for hypovolemiahypovolemia

Heat stroke Heat stroke high ambient high ambient temperatures & high humidity temperatures & high humidity thermoregulatory mechanism failthermoregulatory mechanism fail

HypothermiaHypothermia

Local reaction. Chilling or freezing Local reaction. Chilling or freezing of cells & tissues causes injury in of cells & tissues causes injury in two ways two ways

1.1. Direct effects Direct effects mediated by mediated by physical dislocations within cells, physical dislocations within cells, high salt consentrationhigh salt consentration

2.2. Indirect effects Indirect effects exerted by exerted by circulatory changedcirculatory changed

Electrical InjuryElectrical Injury

Electrical injuries Electrical injuries death death arise arise from low-voltage or high-power from low-voltage or high-power lines or lightinglines or lighting

Two types of injuriesTwo types of injuries

1.1. BurnsBurns

2.2. Ventricular fibrillation or cardiac & Ventricular fibrillation or cardiac & respiratory center standstillrespiratory center standstill

Injury Injury Produced Produced

By By Ionizing Ionizing

Radiation Radiation

Effects of ionizing radiation on DNA

Injury Produced Injury Produced By Ionizing By Ionizing RadiationRadiation

Overview of the major morphologic consequences of radiation injury