Enforce of pfysical, chemical and biological factors in pathogenesis of diseases

1
Enforce of pfysical, chemical and biological
factors in pathogenesis of diseases
2
Mechanical influences

• Contusion, oppression
• Tissue disruption, infraction
• Bone fractures
• Distorsion or luxation of joints
• Vessel disturbances
• Traumatic shock

3
Traumatic shock

• Ethiogenesis pain and blood loss
• Overload reactin
• Inflammatory reaction
• Vascular reaction tissue hypoxia
• Metabolic acidosis

4
Exposure to trauma

• Fat embolism
• Air embolism
• Crush syndrome
• develops after trauma followed
• by contusio and break up
• (decomposition) of sceletal muscles

5
Body core temperature

• Regulation of body core temperature
• Hypothalamic thermoregulatory centre
• Vessel reaction (vasoconstriction and
  vasodilatation)
• Creation (generation) of warmth (heat)
• Metabolism
• production under influence of
  some hormons
• catecholamines, thyroxin,
  tetraiodthyronin
• Contraction of sceletal muscles
• shivering thermogenesis

6
Acquirement and loss of warmth

• Emission - heat radation
• Conduction - contact with warm or cold substances
• Convection - dependent on air flow (ev. water
  flow)
• Evaporation
• Significantelly influenced by relative
  athmospheric humidity

7
Effect of (chilli) cold

• Global (overall) cold effect
• Sympathicus tone
• Vasoconstriction in skin
• Creation of warmth
• Voluntary muscle activity
• Muscle shivering

8
Hypothermia

• Disability of vasoconstriction and muscle tone
• to keep body core
  temperature
• Slowdown heart frequency
• Disturbance of cardiac contractility
• Consciousness disturbances
• Unconsciousness in decrease
• of body core temperature below
  32OC
• Decrease of metabolic rate
• among 34 27OC

9
Hypothermia

• Body core temperature among 34OC 27OC
• Decrease in metabolic rate
• Decrease in muscle tone
• Vasodilatation
• Death in temperature decrease to about 24O C
• Respiratory failure
• Circulatory failure less frequent

10
Other ECG changes

• Bradycardia
• Arrhythmias
• Absence of a P wave
• Wide QRS complex
• T wave inversion

11
Hypothermia danger to health

• Persones living in cold, unheated and wet areas
• (spaces), defitient nutrition
• Iatrogenic hypothermia anaesthesia inhibits
• muscle shivering
• Professional damage construction worker,
• ships company, etc.
• High altitude conditions moutaineers,
• tourists, etc.
• Rapid undercooling in cold water

12
Hypothermia - etiology (1)

• Disturbances in warm creation
• Cachexia
• Endocrine disturbances
• Liver failure
• Disturbances of thermoregulatory centre
• Hypothalamus injury
• Spinal cord injury
• Sever generalised disturbances

13
Hypothermia etiology (2)

• Sever vasculation disturbances
• Generalised atherosclerosis
• M. Bürger, collagenosis
• Cardiac diseases with hypokinetic circulation
• Aortic stenosis, bradycardia
• Others
• Drugs - benzodiazepines, hypnotics,
  anaesthetics
• Other substances - morphine, alcohol

14
Local influence of cold frostbite (cheimetlon)

• 1. degree
• arteriospasm skin goes
  pale
• 2. degree
• transient vasodilatation and
  formation
• of blisters
• 3. degree
• continued vasoconstriction
  tissue necrosis

15
Hypothermia of limbs (extremity)

• Trench (fosse) leg
• Combination of low temperature with prolonged
• water exposition
• Clinical picture
• Ischaemic stage with cold, paleness , cyanosis
• (1-3 days)
• 2. Hyperaemic stage fulminating pain,
  oedema,
• red, hot skin with blisters,
  lymphangitis,
• gangrene (10 30 days)
• Posthyperaemic stage with slow progressive
• adaptation, persisting
  paraesthaesiae,
• hyperhidrosis and intolerance
  to cold

16
Influence of increased surrouding temperature -
hyperthermia

• Hyperthermia - overheating
• Inability to quarantee heat output (expediture)
• Increase in body core temperature over 39OC
• Increase of oxygen tissue consumption
• Increase in protein, saccharide and fat
  catabolism
• Increase in pulse and breathing frequency

17
Hyperthermia heat stroke (insolation)

• Consequences
• Vasodilatation - decrease in blood pressure,
• dizzness, colaps, even transient
  loss
• of consciousness
• Sweating - depletion of water and ionts, even
• arrest of sweat production
• Significant disability of CNS - loss of
  consciuosness,
• periodic breathing, cramps

18
Hyperthermia insolation (siriasis)

• Initiated by direct sunlight on uncovered surface
  
• of head and neck
• Significantly influenced CNS function
• headache and vomiting
• Distinct disturbances of nervous functions
• Unconciousness, hyperreflexia with tonic
• clonic cramps

19
Hyperthermia

• Acute hyperthermia syncope from heat
• Subacute injury
• Instability of body core temperature
• Generalised weakness, vertigo, headache,
  tachycardia,
• excessive vasomotor
  reactions
• Muscle cramps

20
Chronic heat damage (warmth exhaustion)

• In increased loss of liquids and exhaustion -
  weight loss,
• hypotonia, insomnia, tachycardia,
  struggle
• dyspnoea
• Drop of libido, impotence
• In tropic regions more often occurrence of skin
  diseases
• Drop in function of the sweat glands
  intolerance
• to heat
• Heat caused muscle spasms

21
Local effects of high temperature - fire injuries

• 1. degree - hyperaemia with light inflammatory
  response
• 2. degree - exsudative inflammation, developement
  
• of blisters
• 3. degree - necrotic skin changes, formation of
  ulcers
• 4. degree carbonisation
• General symptoms depend on the amount of body
  surface
• damage and the degree of burns.

22
Atmospheric pressure (1)

• Low pressure
• Acute altitude illness
• The symptoms during a quick climb come as late as
  
• the second and third day
• Headache, anorexia, fatigue, vertigo, insomnia,
• dyspnoe
• Causes hypoxia, struggle, air temperature,
  previous
• viral disease, congenital
  predisposition

23
Atmospheric pressure (2)

• 2. Alpine pulmonary edema
• Life threatening situations, which can, but
  neednt be
• preceded by symptoms of acute
  alpine disease
• Dyspnoea - progressively ingravescenting, cough,
• white sputum with ocasional blood
  content
• The cause is not known - excessive hypoxic
• pulmonary vasoconstriction

24
Atmospheric pressure (3)

• Alpine brain oedema
• The most malignant form
• Symptoms strong headache, cerebellar ataxia,
• irational behaviour, hallucinations,
  oedema
• of papilla
• Persistent vasodilatation and decreasing auto-
• regulation of brain circulation

25
Atmospheric pressure (4)

• High pressure
• 1. Scuba diving narcotic effect of nitrogen,
  toxic
• hyperkapnia
• 2. Diving drowning due to lack of oxygen for
  return
• to the surface
• 3. Decompression (keson) disease the release
  
• of dissolved gas bubbles in the
  tissues when
• suddenly ascenting, air embolus

26
Sickness from the effects of ionising radiation

• Acute disease from radiation
• Genesis single, short term
  radiation
• of whole body, or in the
  inner entry
• of radionuclids into the
  organism
• in a dose bigger than 1 Gray
  (Gy)

27
Acute disease from radiation (1)

• Radiobiological effect
• depends on physio - biological
  changes
• of cell structure, can lead to cell
• apoptosis or can cause a long term
  change
• of their function
• LD50 in healthy without treatment
• 2,7- 3 Gy to the center of the
  body.
• When the dose overcomes 4 - 6 Gy,
  death
• within 60 days.

28
Acute disease from radiation (2)

• Classification of clinical manifestation
• in connection to absorbed dosage
• Up to 0,25 Gy no clinical changes, anorexia and
  nausea
• in anamnesis
• 0,25 0,75 Gy blood account changes
• 1-10 Gy typical clinical picture, domination of
  haemo
• poetic disturbances

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Classification of clinical manifestation

• 10-20 Gy bowel form
• bloody diarrhoea,
• death 10.-14. day
• 20-80 Gy toxemic form - oliguria, azotemia,
• metabolic acidosis,
• death 5. -7. day
• 80 Gy nervous form - coma,
• death within first hours
  or days

30
Stages of acute radiation disease

• Primary stage of general reaction
• 1- 5 days
• fatigue, apathy, ataxia,
  vomiting, diarrhoea
• Latent stage
• over 6 Gy not compulsory to be
  expressed,
• health status seemingly improving

31
Stage of fully developed clinical picture

• Stage of fully developed clinical picture
• weeks, months
• severe haemorrhagic diathesis
• with bleeding into mucouses, skin
  and organs,
• thrombocytopenia,
• infectious disease - pneumonia,
• exhaustion and cachexia,
• myocarditis, cardio - vascular
  failure

32
Stage of restoration to health

• Stage of recovery
• several months, up to 2 years
• persistence of fatigue syndrome
• defficiency of cardio vascular
• and neuro - endocrine system

33
Acute radiation disease - help

• First aid
• Basic first aid
• Situation analysis, radiation anamnesis
• Deactivation
• Blood and urine sample check
• Hospital care

34
Acute radiation disease - outcomes

• Permanent effects
• Aplastic anaemia
• Leukaemia
• Cataract
• Genetic malfunctions
• Breast, pulmonary and thyreoid gland carcinomas

35
Chronic radiation disease (1)

• Developement
• repeated or chronic incidence of low
  doses
• of iono radiation exceeding permitted
  dosage
• Effects
• complicated clinical syndrome from
  different
• organ and system damage
• long lasting fluctuant course
• disease signs remain clinically silent
  for a long time

36
Chronic radiation disease (2)

• Effects
• Long lasting local influence skin and nail
  injury,
• even spino - or basocellular
  carcinoma
• Uranium mine workers lung and larynx ca
• Chronic inhalation of thorium oxide
  pneumosclerosis
• Eye irradiation cataract
• Agranulocytosis, aplastic anaemia,
  panmyelophysis,
• leukaemia
• Prevention
• Protection of workers and exposure monitoring

37
Electric current and lightning damage

• Effects depend on
• Current characteristics
• Type AC 3x more dangerous than DC
• Intensity danger from 25mA
• 25 - 80mA passing through longer
  than 30s
• cardiac arrhytmia, fibrilation
• 80mA to 3A cardiac fibrilation
  after 0,3 s, over
• 3A fibrilation and vital centres
  in prolonged
• medulla irritated to eliminated,
  spasms, burns
• c) Tension
• Electric resistence of tissues and clothes
• Entrance and pathway of current through body
• Term of contact

38
Electric current damage (1)

• Resistance of current passing through tissue
• The lowest resistance along nerves and vessels,
• then muscles, skin, tendons, fat and
  bones
• The best conduction liquor and plasma
• THe biggest resistance skin and bones

39
Electric current damage (2)

• Effects
• Electrothermic (AC) big amount of heat,
  burns
• High skin resistance local skin
  destruction
• (hand, wrist, forearm and axilla
  damage)
• Low skin resistance system and organ
  damage
• (heart and brain)

40
Electric current damage (3)

• Specific effects
• Irritation of nerve endings spasms,
  breathing
• and cardiac activity arrest
• Acute kidney failure
• Tetanisation of limb muscles with generalisation
• to other muscle
• Passing through heart vessel spasms,
  muscle
• spasms with ventricular fibrilation

41
Electric current damage (4)

• Specific effects
• Passing through brain loss of consciousness,
  electro
• shock, retrograde amnesia after
  unconsciousness
• Posttraumatic stress reaction
• Polyneuropathy
• Autonomic NS dysfunction
• Long bones, vertebrae fractures
• Electric cataract

42
Lightning damage

• Lightning mechanic electric discharge
• intensity 10 20 kA,
• voltage 3 200 milion volts
• expansion of overheated air
• effect of pace voltage
• up to 30 m from impact to the
  ground
• Effects
• Asystolia, less frequent ventricular fibrilation
• Postburn syndrome and multiorgan damage
• with loss of consciousness

43
Influence of chemical substances (1)

• Xenobiotics
• Recieved in relatively low doses as
• food, water and air contamination
• Actively recieved as drugs
• Voluntary exposition to relatively toxic
  substances
• tobacco smoke, alcohol, drugs

44
Influence of chemical substances (2)

• Entry of xenobiotics into organism
• Mostly by breathing pathways, skin or
  digestive tract
• Gas substances direct lung or other organs
• influence, e.g. liver,
• CNS gas solubility significance
• Skin absorbtion lipophilic and non polar
  substances
• pass through more easily
• GIT absorbtion ability of lipophilic substances
• pass through cell membranes,
• biotransformation in liver

45
Influence of chemical substances (3)

• Xenobiotic effects mechanism
• Substance interaction with receptors
• receptor activation (morphine,
  heroin)
• or antagonistic influence
• (DDT receptor antagonist for
  testosterone)
• Interference with membranes processes

46
Influence of chemical substances (4)

• Enzyme inhibition
• reversible nebo irreversible,
• competetive or non-competetive
  molecular
• bond (CO link to hemoglobin,
• oxygen displacement)
• Influence on energetic cell metabolism
• and intracellular calcium level
• Oxygenative stress
• free radicals reaction
  (paracetamol)
• Combined mechanisms

47
Influence of chemical substances (5)

• Specific xenobiotic influences examples
• Nitrates and nitrites methaemoglobinaemia
• in newborns
• Harmful air substances sulphure dioxide,
• nitrogen oxides and dust
• Tobbacco smoke nikotine (vasoconstriction in
  CNS,
• tachycardia, blood pressure
  increase),
• nitrosamins, polyaromatic
  hydrocarbons
• (cancerogenous), carbon
  monooxide
• (high affinity to
  haemoglobin)
• Drugs

48
Unhealthy building syndrome (1)

• Originally in closed climatised industrial
  building workers, event. occurrence even without
  professional load.
• Etiology
• Fugitive organic soulvents
• aldehydes, formaldehyde,..
  soulvents from
• water soluble colours - glycol,
  ammonia,..
• General dustfall
• dust from biological remanences -
  animal fur,
• fell, mites,..
• smoke,..

49
Unhealthy building syndrome (2)

• Acute effects
• Conjunctiva, mucosaes, upper airwayes ador
• Dryness and irritation of skin
• Cephalgia, fatique, irritability, nausea
• Nasal bleeding
• Breathing difficulties
• Mass psychogenic disease
• chain incidence of dyscomfort
  induced,
• for example, by unanccountable
  smell

50
Unhealthy building syndrome (3)

• Later effects
• Radon influence from building materials on lungs
• Ionizing radiation influence from strata (lower
  beds)
• Cancerous influences (more pronounced in smokers)