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, ship´s 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 needn´t 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 cancause a long term change of their function • LD50in healthy without treatment 2,7- 3 Gy to thecenter 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

29. 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 onenergetic 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)