ENVIRONMENTAL PATHOLOGY

dr.Truly Dasril, SpPA

Environmental Pathology
Abnormalities caused by physic factors
Mechanic Trauma/ Injury Abration (Scrape) Contution (Bruise) Laceration and Incision (Tearing and Cutting) Fractures Pressure trauma/injury Increased of atmosphere pressure

Decreased of atmosphere pressure

Thermal trauma/injury Local cold injury General cold injury

Local heat injury General heat injury Electric injury

Radiation injury
Disease caused by chemical factors and drugs Adverse drugs reaction Family planning pill

Disease caused by air pollutan: e.g. smoking

ABRATION (SCRAPE)
Mild type, on skin Superficial layer of skin is desquamated Easy healing, epidemal cell regeneration No keloid occur

CONTUSION (BRUISE)
Commonly caused by blunt trauma There is vascular damage and extravasation to

stromal
The hemorrhage is usually stop quickly Blue color to Hematoma

Contusion can also happened in internal organs Miocard contusion cause arythmia and acute heart failure

Contusion on brain commonly at inferior face

of frontal lobus

Brain contusion predispose to epileptic

seizure Contusion is very dangerous in haemophylia patients

LASCERATION AND INCISION (Tearing & Cu

Anatomic discontuinitas Bleeding Depend on the tissue type damaged spinal cord Severe laceration is called avulsion

eg:

FRACTURE
Rupture of bone

Defect of bone contuinity

This term is rare use for solid organ eg: fracture of liver, penis

PRESSURE INJURY
Increasing of athmosphere pressure A. Blast injury

Pressure caused by blasting

1. Enter the body by body cavities

2. Pressure on body surface

 The damage degree is depend on

1. How big is the pressure wave 2.The distance from blast source 3.Is there any transmision medium B. DIVING
There is a high pressure differentiation

Sudden decompression occured Nitrogen gas released

DECREASING OF ATMOSPHERE PRESSURE A. Hypoxia

Decreased of air plane cabin pressure
Lead to decrease partial oxygen pressure

hypoxia patient unconsious

If the pressure decreased occur gradually

e.g mountain hiking ( 4,5 km) dyspneu

B. Change of medium ear pressure

Defect of Tuba Eustachii balance pressure
severe pain

If this happened frequently (e.g. Airplane pilot)

Barotitis.

Membrane tympani rupture

C. Change of mood/emotion
The atmosphere pressure normal is : 760 mmHg (745-785)
Some studies: change of air pressure leads to change of mood suicide

THERMAL INJURY
Local cold injury
Occur gradually Trench Foot Occur suddenly Frostbite

General cold injury (hypothermia)

A. Mechanism Cold exposed to whole body

Commonly in old people

Mechanism
generalized vasocontriction (response reflex) body head conservation
If reflex response failed general skin vasodilatation decrease of Core temperature pooling of blood in peripheral plasme volume disturbance of blood circulation

Symptoms
Depends of the tempreature degrees

Dead caused by cell metabolism disturbance

The change can be found in otopsi frosstbite

C.Hypothermia can be used in therapy

Important in brain and cardiovascular surgery

Use in blood bank (4 degree Celcius)

LOCAL HEAT INJURY (Burns)

A.Evaluation of burn degrees 1.Depth of burn
first -degree burns second-degree burns third-degree burns (full thickness) 2.Width of body exposed

3.Burns location on body

4.Smoke inhalation

B. Complications
1. Hypovolemia 2. Necrosis of erythrocites 3. Necrosis epidermis & dermis 4. Infections 5. Peptic ulcer (Curlings ulcer) 6. Kelloid scar
GENERAL HEAT INJURY Happened in hot wave e.g. desert, heavy sports Heat cramps, Heat exhaustion , Heat pyrexia (heat stroke) , Malignant hyperthermia

ELECTRIC INJURY
Electric injury: - Building construction employee - Electrical work employee

The serverity of injury depend on electric wave Capacity

Electric injury
Thunder and electric wire that have thousands volt voltage Fatal

How big is the electric voltage in the body after the injury? Depends on:
The resistance of enter point Wet skin (resistance ) Dry skin (resistance )

Heavy or mild of the tissue damage depend on:

1. Electric resistance of tissue 2. Pathway of the electric wave 3. Duration of body-electric contact Effect of electric injury: 1. Tissue function disturbance : -Cardiopulmonary arrest

-Skeletal muscle stimulation bone fracture

2. Electric ions generate heat, and cause:

- Thermal heat burn on enter/exit point

- lighting marks - Flash burn bone fracturhe

- Thrombosis of blood in vascular

AIR POLLUTANT
CIGARETTE SMODE
USA : 1985 400.000
ACTIVE SMOKERS

Cigarette contains:
* Carcinogen * Cell irritant and toxic * Carbon Monoxide

* Nicotine
Those materials cause: Coronary heart disease (the most) Lung cancer

Death by smoking is very high Smoking mother, cause:

Low birth weight

Prematur birth, spontaneous abortion, fetal death Pregnancy complication caused by smoking:

Abruptio placenta, placenta praevia, congenital disease

PASSIVE SMOKERS intoxication depends on:

Number of air in the room Number of active smoker Air way /room ventilation

Duration of inhalation Babies and children from mother/father smokers: Lung cancer 1,5 %, Respiratory tract infection, physisca retardation, intelectual retardation

STOP SMOKING:
MORTALITY RATE LUNG CANCER RISK

FILTER IN CIGARETTES LUNG CANCER 30 - 50 %

ADVERSE DRUG REACTIONS

EXOGENOUS ESTROGEN Osteoporosis in menopausal woman - Endometiral carcinoma

- Breast carcinoma
- Cardiovascular disease - Venous thrombosis & emboli

+ Progestin 10 - 14 days/month

NON THERAPUETIC AGENTS

ETHYL ALCOHOL organ and tissue damage Acute Alcoholism : CNS : depresant

effect in stomach and liver

 CHRONIC ALCOHOLISM :
1. Liver : lipid degeneration, acute liver insuff ; Cirrhosis 2. CNS : Wernickes encephalopathy

3. Peripheral Nerves
4. Cardiovascular disease 5. Other organ diseases.

COPPER
Adult : Acute abdominal pain, fatique, arthralgia Children : Low dose Permanent mental retardation
Source of Cooper : Paint, battery, etc

Coper intoxication :
Blood Microcytic hypochromic Mild hemolytic anemia

Nervus System Pheripheral demyelinating G I Tract Kidney Saturnine Gout