Environmental Pathology:

physical injuries

Ma. Minda Luz M. Manuguid, M.D.

 Physical injury: mechanical force
 Mechanical force
Soft tissue injuries:
contusions, lacerations,
avulsions,
Bone injuries: fractures
Head injuries; coup &
contre-coup injuries,
concussion, contusion
Physical injury: temperature changes

Tolerable range: 31-41°C

 Hypothermia:
local freezing= Frostbite – ischemic necrosis
Systemic hypothermia= circulatory failure –
marked vasoconstriction, slowing of metabolism,
crystallization of intracellular water
Physical injury: temperature changes
 Hyperthermia:
 Heat stroke= peripheral vasodilatation, hypotension, CNS
dysfunction--- coma
 Exertional= hyperK, metabolic (lactic) acidosis,
myoglobinuria, acute renal failure, DIC, RDS
 Burns= partial & full thickness = plasma transudation,
hypovolemia, shock; sepsis: Pseudomonas aeruginosa;
Curling’s ulcers, DIC, ATN, hemoconcentration
 Smoke inhalation: ARDS, pulmonary edema, intra-alveolar
hemorrhages
burns
 Physical injuries: changes in
atmospheric pressure
 Changes in Atmospheric pressure
Blast injury: Air blast- bomb explosions;
Immersion blast- underwater
Altitude sickness: acute hypoxic injury;
chronic- anemia
Caisson disease
 Physical Injuries: Electrocution

 Electrical injury
Factors: DC less harmful than AC; duration of
exposure, amperage/voltage, path of current-
resistance of tissues, water content
Lightning: arborizing burns, organ rupture,
fractures, hemorrhages
Flashover
 Physical injury: radiation
 Ionizing Radiation- physical transfer of
energy from its site of origin to the biologic
targets, inducing ionization of its atoms:
Electromagnetic waves: x-rays, gamma rays
Particles : neutrons & charged particles- alpha,
beta, protons, mesons, deuterons
Sources of Radiation:
 background: galactic/solar cosmic rays, incl. UV,
natural terrstrial radionucleides
man-made: diagnostic & therapeutic
 Radiation

 universal symbol – radiation injuries

 Physical injury: radiation
 Quantitation of Radiation:
 R- roentgen
 r – rad- also called a “centiGray” (cGy)= energy
absorption of 100 ergs/gm of tissue (0.01 joule/kg)
 G – gray = 100 rads
 Ci - curie
 Linear energy transfer (LET)
 Relative biologic effectiveness (RBE)
 Mechanisms of Radiation injury:
 Target theory: direct damage to DNA
 Indirect action theory: radiolysis of cellular water,
production of free radicals= damage to DNA & cell
membranes
 Radiation injury
γ-rays ionizing particles
x-rays α, β, protons, etc.

IONIZATION & EXCITATION heat

Oxygen effectCHEMICAL CHANGE free radicals

BIOLOGIC CHANGE (DNA damage) DNA repair

malignant mutationsinhibition of
transformation cell division

CANCER GENETIC EFFECTS CELL DEATH

 Physical injury: Radiation
Biologic effects of Radiation
 Effects are in direct proportion to mitotic/reproductive
activity
 Various types of radiation differ in penetrability & pattern
of deposition of energy
 Oxygen effects: amplifies low LET radiation damage;
induces free radical production; fixation of radiant
injuries/lesions which would otherwise be reparable
 Cellular: swelling, nuclear & cytoplasmic chromatin
clumping, abnormal mitoses, aneuploidy, mitochondrial
distortion, ER degeneration; endothelial swelling,
thrombosis, hemorrhage
 Physical injury: Radiation
Biologic effects of Radiation
 Organ atrophy, esp. GI mucosa & hair follicles
 Lymphopenia w/in hours, granulocytopenia
w/in 1 week; Anemia; Thrombocytopenia
 Radiodermatitis: thin, atrophic skin; hyper- or
de-pigmentation
 Pulmonary interstitial fibrosis
 Sterility: Ovaries more severely affected than
Testes
 Physical injury: Radiation
Susceptibility of Tissues to Radiation injury:
 High: lymphoid, hematopoietic, spermatogonia,
ovarian follicles
 Fairly high: GI & mucosal epithelia, hair follicles,
lung; late-kidney
 Medium: GIT wall, endothelium, glandular
epitheliumof the breast & pancreas, u.bladder
epithelium, growing cartilage, bone, normal
brain
 Low: mature bone; mature cartilage; muscle;
peripheral nerves
 Radiation injury
 Brain: adult-resistant; embryonic-neuronal/glial
destruction
 Skin: erythema; edema; depigmentation;
atrophy; cancer
 Lungs: edema; ARDS; interstitial fibrosis;
 Lymph nodes: atrophy; fibrosis
 GIT: mucosal injury, ulceration, fibrosis of wall
 Gonads: destruction of germ cells
 Blood & Bone marrow: thrombocytopenia,
granulocytopenia, anemia, pancytopenia
 Acute whole body radiation
 10-50 rads: no obvious effect; minor blood
changes
 50-100 rads: vomiting & nausea for 1 day in
5-10%; fatigue; transient reduction in
lymphocytes & neutrophils
 100-200 rads: vomiting & nausea for 1 dayin
20-50%; about 50% reduction in lymphocytes
& neutrophils
 200-350 rads: vomiting & nausea in nearly
all; anorexia, diarrhea, minor hemorrhages;
about 20% die w/in 2-6 wks after exposure;
convalescence is about 3 mos.up to 75%
reduction in all circulating blood elements
 Acute whole body radiation
 350-550 rads: about 50% die w/in 1 month;
convalescence is about 6 mos.
 550-750 rads: vomiting & nausea in all w/in 4
hrs; up to 100% die; few survivors convalesce
for 6 mos
 1000 rads: vomiting & nausea in all w/in 1-2
hrs; all die w/in days
 5000 rads: almost immediate incapacitation;
all die w/in 1 week
Thank you !