PATOLOGI LINGKUNGAN DAN KERACUNAN

Dr.JB.Soebroto.Sp.PA(K)
Selasa 20 oktober 2015
Blok XIX
Jam 10.30 -12.00
*Everonmental Disease :
Penyakit akibat interaksi
Manusia

lingkungan

(Fenomena Bloom?): Keturunan Lingkungan Perilaku...

+ kejiwaan+penuaanPenyakit: Bawaan, Radang, Infeksi, Neoplasma,
Kejiwaan, Penuaan/Degeneratif, Spesial Organ
* Environmental Pathology :
Penyebab
Patogenesis PA.
*Lingkungan hidup : Keluarga, teman, masyarakat , bangsa
Patogenesis : Raga / Fisik Jiwa Roch.
Bangsa, Ibu Pertiwi saat ini baru sakit jiwa.

Pendahuluan
Lingkungan
- Luas :darat, laut, udara
- Dekat ( lingkup R.Tangga/ lingkup kerja )
jauh
- Aneka Ragam Faktor :
Fisik : Mekanik, Suhu, Tek Udara, Suara, Cahaya, Radiasi,
Getaran, Listrik
Kimia: Polutan, Asap, Rokok,Industri, Waste, Obat obatan,
Racun, insektisida, Makanan, salah makan
Biologi : Bakteri, Virus, Jamur, Parasit, Rekayasa Genetik
Historik (EDEN) Peradaban:
- Spiritual- Seks- makan(Vegetarian,ASI/PERDA)- mobilitas-kerjaKomunikasi Berkembang terus/Revolusi

Kategori Istilah
Penyakit Lingkungan berdasarkan penyebab dan ruang lingkup :
- Kultural
- Nutrisional
- Okupasional Keselamatan kerja .Patient safety??
- Global
Hazard : Potensi bahaya terjadinya kelainan / cidera
Risiko : Perkiraan seberapa besar bahaya menjadi kenyataan.
Pemajanan : Kontak faktor penyebab
Paparan
Dosis : Takaran faktor penyebab.
Hazard - Risiko
Pemajanan/paparan

Kerusakan / kelainan / penyakit.

Dosis - Daya tahan tubuh

NB: Moral Hazard BPJS? : pemerintah, Depkes, BPJS sampai kebawah
Jajaran kesehatan
Pasien masyarakat.

ENVIRONMENTAL PATHOLOGY

Organisme

Lanjutan.

mikro
makro : hewan, ular, jamur

Masuk tubuh lewat : mulut, nafas, hidung, mata, kulit (paparan, gigitan)
Penyebab lain
Blok-Blok lain
Sistema/Organ

Disengaja (tindak kekerasan, bunuh diri)

Frekuensi: Sering terjadi
Tak disengaja (kecelakaan)

Kategorial kompetensi dokter:

1. Datang
Rujuk Emergency
Rujuk
Tanda Gejala lokal (organ) II. Datang Observasi
Spesialis
Regional (sistem)
IIIa.
Datang Obati
Rujuk
Sistemik komplikasi
Spesialis
IIIB.
Datang Obati
Rujuk
Emergency
IV. Datang Obat Tuntas

Penanganan

KONSEP ENVIRONMENTAL PATHOLOGY

Lingkungan & Nutrisi
Penyebab
Masuk tubuh lewat.?
Disengaja,atau
Kecelakaan
Tanda Gejala , Perjalanan Penyakit
Penanganan
(SALING KAIT/ TERGANTUNG)
Berikut tabel-tabel Enviromental & Nutritional Patologyc (Robbins & Gotran Pathologic
Basic of Disease ) 7th Ed halaman 415-468
(Slide Akhir: 15 Tabel)

ENVIRONMENTAL PATHOLOGY
Exposure
Absorption at portals of
entry

Excretio
n

Distribution to body
Metabolis
m to more
toxic
metabolite
s

Metabolis
m to less
toxic
metabolite
s

Metabolism
to
conjugation
products

Distributi
on
Interaction with
macromolecules
( proteins, DNA, RNA,
receptors)
Toxic effects
( genetic , carcinogenic, reproductive
,immunotoxic)

Turn over
and repair

 Limbah (waste) :
-Definisi : Bahan kimia yang terbentuk
sebagai sisa suatu proses kegiatan :
manusia; industri; RS lingkungan
(khususnya perkotaan)
- Jenis Limbah : padat; cair; gas;
Infeksius(RS)
- Limbah mencemari lingkungan
Penyakit lingkungan
- Diperlukan Risk Assesment kemudian
Risk Manajemen limbah
RS

Review
Perokok : - PJK

+ Hypertensi + Hypercholesterol

Aktif - Kanker
Pasif - COPD
....Cor : - Iskemi (27%
Perda - arrest (37%)
- Arteriosklerosis(29%)

Mengapa? - Paru ( 90 %)
- Mulut (92%) - Visika urinaria (50%)
- Laring (82%) - Serviks (30%)
- Esofagus(80%) - Pankreas (30%)
- Gaster (20%)

PNEUMO KONIOSIS
Inhalasi : Debu mineral; Partikel organik & an
org ; asap ; uap kimia yang menyebabkan
kelainan/ reaksi paru berupa : Inert / Inflam;
fibrosis ; alergik ; imunologik; neoplastik
Inhalasi Debu Mineral :
- Arang Antrakosis
- Silika Silikosis
- Asbes Asbestosis
mesothelioma
- Berilium Beriliosis

PENYAKIT LINGKUNGAN
GLOBAL
1. Global Warming (Infra Merah)
Normal : Sinar matahari Bumi Memantulkan sinar
Inframerah
dibuang ke angkasa luar.
Tidak Normal :terjadi lapisan Green House Gas yang
menghalangi angkasa luar sehingga inframerah kembali
memantul ke Bumi
Green House Gas(lapisan C02, CH4, N2, CFC, H2O): terjadi
akibat Green House Efek (Efek rumah kaca) oleh aktifitas
manusia global.
Suhu bumi naik (Global Warming) yang
menggangu kesehatan dan merubah pola hidup Vektor
nyamuk, lalat dll
2. Jendela ozon (Ultra Violet)
Normal Sebelum sinar matahari sampai bumi, sinar U.V
disaring / ditahan oleh lapisan Ozon;
Lapisan Ozon dirusak (terjadi jendela) oleh Ozon Depleting
Substan : CFC (Creon); HBFC; HCFC;CCL4 ,kosmetik
sehingga sinar U.V Kontak Iritasi Kulit ManusiaPenyakit

KERACUNAN ULAR
BERBISA
- Ular berkelenjar racun bertaring (menginjeksikan racun) untuk
melumpuhkan mangsanya)
Golongan Elapidolmis : Weling, Sendok, Welang, Cabai, King Kobra
- Toksin Hematoksik (cardiovascular)
Pembengkakan, , Nyeri, ..(akibat) trombositopeni
- Neurotoksik (otak-syaraf)
Kelumpuhan kerja syaraf, korban mengantuk, pelupuk mata berat,
sesak nafas
Protein
- Sitotoksik (sel-jaringan)
Komplek
langsung (kerusakan jaringan)
- Psikologis cemas kekhawatiran +Syok korban maupun keluarga
aktifitas
Enzymmatik
lokal (sekitar tusukan taring) nyeri, perdarahan, memar, melepuh,
nekrosis
limfadenopati

PPPK : 1) Tenang, immobilisasi dengan kayu agar tidak ada pergerakan,

>< penyerapan racun ke darah limfonode
Tidak boleh: torniket
- insisi
Tak Bermanfaat pengisapan
- Kompres es
Risiko negatif - Antihistamin Contoh resiko negatif lain:
menolong
korban listrik, kebakaran,
CO2, tenggelam
-Cortico Steroid
Buang waktu
2) Di Rumah sakit : -perban katun elastis 10cm
mengganggu
aliran darah (bisa dikerjakan di lokasi)
3) Dibawa ke Rumah Sakit, dalam posisi nyaman, tenaga,
immobilisasi
4) Pertolongan Emergency >< sifat racun , life saving
5) Serum Antibisa ular polivalen
6) ATS, Penicillin Kristal 2gram , analgesik

Gejala Umum Keracunan

Makanan.

Gejala yang timbul beberapa menit sampai 2 jam setelah

makan, bisa berupa :
Peningkatan produksi air mata dan air liur
Pupil yang mengecil
Berkeringat
Muntah
Kram perut
Diare
Pusing
Linglung
Koma
Kejang (kadang kadang)

Penanganan

Cuci / bilas/lavase lambung

Perangsang muntah
Laborat !
Norit, arang
Dan seterusnya tergantung jenis bahan racun dan akibatnya
Obat Pencahar
Infuse Dextrose Nacl (kalau perlu) alat bantu pernafasan O 2
Obat Anti nyeri.
Dengan pengobatan yang tepat, biasanya akan terjadi penyembuhan
dalam waktu 24 jam, meskipun bisa terjadi kematian dalam waktu
beberapa jam.
Catatan :
Untuk Keracunan Bahan kaustik (Asam/Alkali kuat) tidak boleh
dilakukan tindakan diatas, karena telah terjadi proses seperti luka bakar
:
Oedema, Bula luka bakar
- Kerusakan / Ekskoriasi, Ulkus,
- Peforasi /
Disini kalau perlu dikerjakan Tracheotomi

LINGKUNGAN ROCHANI
MANUSIA
Fisik / raga jiwa / daya hidup roch / sukma
Roch Allah / Roch suci / Roch Kebenaran /
Roch terang.
Kalifah damai sejahtera
Roch Iblis / Roch jahat / Roch Gelap
Jiwa yang kalah dari pergulatan kemauan tubuh
/ duniawi sakit / stress R/ Roch ke Allah
Orandum es us sit, Mens Sana In Corpore Sano.
Firman Iman Kedekatan dengan Allah adalah
: sumber kekuatan yang tak terkalahkan

Lampiran lampiran
Bahan

Efek patologik

Karbon Monoksida

Terikat dengan homoglobin,

menimbulkan hipoksia

Bahan Pemutih (NAOHCI)

Iritasi lokal

Bahan Kaustik (basa atau asam)

Iritasi lokal, menimbulkan [erut

Kloroform, karbontetraklorida

Dipresi SSP, asidosis metabolik,

nekrosis tubulus.

Isopropanolol

Gastristis, Depresi SSP.

Merkuri : uap dosis tinggi

uap dosis rendah

Pneumonitis
Tremor, pelupa, gingivitis, ruam kulit,
sindrom nefrotik

Mentanol

Depresi SSP, asidosis kebutaan.

Jamur : Amanita muscarin

Amanitaphalloisdes

Sintom parasimpatik : bradikardi,

hipotensi
Simtom gastrointinal, syok, konvulasi
koma.

BBM (minyak tanah, bensin)

Depresi pernapasan, pneuminitis,

radang usus

PCB (Polychlorinated biphenyl)

Klorakne, ganguan penglihatan,

TABLE 9-2 Common Chemiscals at Hazardous Waste Sites

Acetone

DDT, DDE,DDD

Aldrine/Dieldrin

1,1 and 1,2- Diclhorethane

Arsenic

Lead

Barium

Mercury

benzene

Methylene chloride

2-Butanone

Nickel

Cadmium

Pentachlorophenol

Carbon tetrachloride

Polychlorinated biphenyls

Chrordane

Tri-and Tetrachloroethylene

Chloroform

Toluene

chromium

Vinyl Chloride

Cyanide

Zinc

Diteruskan

Toxicant

Phase I
reactions:
Hidrolis
reduction
oxidation

Primary
metaboli
te

Phase II
reaction
glucuronidati
on sulfation
methilation
conjungation

Secondary
metabolis
me

Elimination in urine, bile, or

feces

TABLE 9-3
Specific
Carcinogens
in Tobacco
TABLE
9-3Organ
Organ
Specific
Carcinogens
Smoke
in Tobacco
Smoke
Lung,Larynx
Polycyclic
aromatic
Lung,Larynx
Polycyclic
aromatic
hydrocarbons
hydrocarbons 44(Methylnitrosoamino)-1-(3-pyridyl)-1(Methylnitrosoamino)-1-(3butanone (NNK) Polonium
210
pyridyl)-1-butanone
(NNK)
Polonium
210
Esophagus
N-Nitrosonornicotine
(NNN)
Esophagus
N- Nitrosonornicotine (NNN)
Pancreas
NNK (?)
Bladder
4-Aminobiphenyl,NNK
2 - (?)
Pancreas
naphthylamine
Bladder
2Oral
cavity (Smoking) Polycyclic4-Aminobiphenyl,
aromatic hydrocarbons,
naphthylamine
NNK, NNN
Oral cavity (Smoking)
Polycyclic aromatic
Oral cavity ( snuff)
NNK,hydrocarbons,
NNN, polonium
NNK,210
NNN
Oral cavity ( snuff)

NNK, NNN, polonium 210

TABLE 9-5 Mechanisme of Disease Caused by

Ethanol Abuse
Organ System

Liver
Nervous system

Lesion

Mechanism

Farty change Acute

hepatitis Alcoholic
cirrhosis

Toxicity

Wernicke syndrome
Korsakoff syndrome
Carebellar
degeneration
Peripheral neuropathy

Thaimine deficiency
Toxicity and thiamine
deficiency
Nutritional deficiency
Thiamine deficiency.

Cardiovascular system Cardiomyopathy

Hypertesion
Gastrointestinal tract
Gastritis pancreatitis

Tpxicity Vasopresor
Toxicity
Toxicity

Skeletal
muscle
Reproductiv
e system

Fetal
Alcohol
syndrome

Rhabdomyoi
sis
Testicular
atrophy
spontaneous
abortion
Growth
retardation
Mental
retardation
Birth defects

Toxicity
?
?

Toxicity

TABLE 9-6 Common Drugs of Abuse (Farmocology)

Molecular Target

Example

Opioid narcotics

Mu Opioid receptor (agonist)

Sadative- hypnotics

GABAA Receptor (Agonist)

Heroin, Hydromorphone
(Dilaudid)
Oxycodone
(Percodan,Percocet,Oxyconti
n)
Methadone (Dolophine)
Meperidine (Demerol)
Barbiturates
Ethanol
Methaqualone (Quaalude)
Glutethimide (Doriden)
Ethchlorvynol (Placidyl)

Psychomotor stimulants

Dopamin transporter
(antagonist)
Serotonim receptor chanel
(antagonist)

Class

Cocaine
Amphetamine
3,4methylenedioxymethamphet
amine (MDMA, ecstasy)

Phencyclidine
like drugs

NMDA
glutamate
receptor
chanel
(antagonist)
Cananabiniods CBI cannabinoid
receptors
(agonists)
Necotine
Nicotine
acrtylcholine
receptor
(agonist)
Hallucinogens Serotonin 5-HT2
receptors
(agonist)

Phencyclidine
(PCP,angel
dust)
Ketamine
Marijuana
Hashish
Tabacco
Products

Lysergic acid
diethylamide
(LSD)

TABLE 9-7 Mechanism of Advers

Drug Reactions(Farmacology)
mechanism
Toxicity due to
overdose
Predicatable reaction
based on
pharmacologic
mechanism
Altered drug
metabolism related
to:
Thiopurine Smethyltransferase
deficiency
Cytochrome P-450
CYP2C9 variants.
Cytochrome P-450
CYP2D6 variants.
N-acetytransferase,
show acetylator

Example
Acetaminophen
Nonselemative,
nonsteroid antiinflammatory digs

Azathioprine
Oral anticoagulans
Some antipsychotic
drugs
Hydralazine
Choramphenicol

Adverse Effect
Liver necrosis antiinflammatory
Peptic ulcer

Bone marrow failure

Bleeding
Excessive sedation,
parkinsonism
Lupus
Aplastic anemia

TABLE 9-10 Health Effects of Outdor air Pollutants

Ozone

Healthy adults and

children
Athletes,outdoor workers
asthematics

Nitrogen dioxide

Healthy adults
Asthmatics
Children

Sulfur dioxide

Healty adults
Patients with chronic
lung disease
Asthmatics

Acid aerosols

Healty adults
Children

particulates

Children

Decreased lung fuction

Increased airway
reactivity
Lung inflammation
Decreased exercise
capacity
Increased
hoospitalizations
Increased airway
reactivity
Decreased lung fuction
Increased respiratory
infecton
Increased respiratory
symptoms
Increased mortality
Increased hospitalization
Decreased lung function
Altered mucociliary
clearance
Increased respiracory
infections
Decreased lung fuction
Increased
hospitalizations
Increased respiraory

TABLE 9-11 Human Diseases Associated with Occupational Exposures

Pollutant
Carbone
monoxida
Nitrogen dioxide

Wood Smoke

Populations at
Risk
Aduts and
children
Children

Children

Formaldehyde

Adults and
children

Radon

Adults and
children

Effects
Acute poisoning
Increased
respiratory
infections
Increased
respiratory
infections
Eye and nose
irrieation,
asthma
Lung cancer

Asbestos fibers

Maintenance and
abatement
workers

Lung cancer,
mesothelioma

Manufactured
mineral fibers

Maintenance and
constructions
workers

Skin and airway

asthma

Adults and
children

Alergic rhinitis,
Asthma

Bioaerosols

TABLE 9-12 Human Diseases Associated with Occupational

Exposures
organ
cardiovacular

effect
Heart disease

Respiratory system

Nasal cancer
Lung canzer
Cjhronic obstructive lung
disease
Hypersensitivity
Irritation
fibrosis

Nervous system

Peripheral neuropathies
Ataxic gait
Central nervous system
depression
cataracts

Urinary system

Toxity
Bladder cancer

Toxicant
Carbon monoxide,lead,
solvents,cobalt, cadmium
Isopropyl alchohol, wood
dust.
Radon, asbestos,
silica,bis (chloromethy)
lether, nickel,arsenic,
chromium,mustard gas.
Grain dust. Coal dust,
cadmium
Beryllium, isocyanates
Ammonia, sulfur oxides,
formaldehyde
Silica, asbestos, cobalt.
Solvents, acrylamide,
methyl chloride, mercury,
lead, arsenic, DDT
Chlordane, toluene,
acrylamide , mercury
Alcohols, ketones,
aldehydes, solvents
Untraviolet radiation
Mercury, lead, glycol
ethers, solvents

Reproductive
system

Male ifertility
Female
infertility
teratogenisis

Hematopoietic
system
Skin

Leukemia

Gastrointestinal
tract

liver
angiosarcomu

Foliculitis and
acneform
dermatosis
cancer

Lead, phthalate
plasticizers
Cadmium, lead.
Mercury,
polychlorinated
biphenyls
Benzene , radon,
uranium
Polychlorinated
biphenyls, dioxins,
herbicides
Ultraviolet
radiation
Vinyl chloride

TABLE 9-13 Tocix and carcinogenic Metals

Lead

Mercury

Renal toxicity
Anemia, colic
Peripheral neuropathy
Insomnia, fatigue
Cognitive dedeficits
Renal toxicity
Muscle tremor, dementia
Cerebral palsy
Mental retardation

Battery and ammunition

workers, foundry
workers, spray painting,
radiator repair
Chlorine- alkali industry

arsenic

Cancer of skin, lung, liver

Miners, smelters, oil refinery

workers, farm workers

Beryllium

Acute lung irritant

Chonic lung hypersensitivity
? lung cancer

Battery workers, smelters,

welders,soldering

Cobalt and tugsten

carbide
Cadmium

Lung fibrosis
Asthma
Renal toxicity
? prostate cancer

Tool,arkers, grinders,
diamond polishers
Battery woekers, smelters,
welders, soldering

Chromium

Cancer of lung and nasal

cavity

Pigment workers ., smelters ,

steel workers

Nickel

Cancer of lung and nasal

sinuses

Smelters, steel workers,

electroplating

TABLE 9-14 HEALTH Effeects of agricultural pesticides

category

Xexample

Effects and Associations

Insecticides

Organochlorines
DDT
Chordane
Methoxychlor
Organophosphates
Parathion
Daizinon
Malation
Carbamates
Aldicarb
Carbaryl
Botanical agents
Nicotine
Pyrethering
Retenune .

Neurrotoxicity, hepatotoxicity
Neurotoxicity : deleyed neuroohaty
Neurotoxicity ( reversible )
Parethesia; lung irritant; allergic
dermatitis

Herbicides

Aenic compounds
Dinitrophenols
Cholophennoxy herbicides
2,4-D and 2,4,5-T
TCDD
Paraquat
Ateazine
Alachlor

Hyperpigmentation ; gangrene ;
anemia; sensory neuropathy; cancer
Hypertthermia, sweathing
?Lymphoma ; sarcorma
Fototoxicity ; immunotoxicity; cancer
Acute lung injury
?cancer
?cancer

Funggicides

Captan
Maneb
benonyl

? Reprodutive toxicity

Rodenticides

Fumigants

Fluoroacetate
Warfarine
strychnine

Cardiac and
respiratory
failure
Hemorrhage
Respiratory
failure
Carbon disulfide Cardiac toxicity
Ethylene
Neurotoxicity
dibronide
Lung edema;
Phosphine
brain demage
choropicrin
Eye irritation;
lung edema;
arrhythmias

TABLE 9 21 COMPARASON of Servere Maramus-like and

Kwashiorkor-like Secondary Protein-energy Malnurtrition

Syndrom
e

Clinical
setting

Time
Course

Clinical
features

Laborato
ry
findings
Marasmu Chronic
months History
Normal
s-like
iliness
of weight or mnidly
protein
(e.g.chroni
loss
reduced
energy
c lung
muscle
serum
malnutrit disease
wasting
proteins
ion
cancer)
Absent
subcutan
eous fat
Kwashior acute
Weeks Normal
Serum
kor-like
catabolic
fat and
albumin
protein
ilines
muscle
<2.8
energy
(eg..severe
Ederma
gm/dL
malnutrit trauma,bur
Easily
ion
s, sepsis
pluckable
hair

Prognosi
s
Variable:
depends
on
underlyin
g disease

poor

TABLE 9-22 Vitamins ; Major functions and Deficiency

syndromes
Vitamin
Fat-soluble
Vitamin A

Vitamin D

Vitamin E
Vitamin K

Functions

Deficiency Syndromes

A component of visual pigment

Maintenance of specialized epithelia
Maintenance of resistance to
infection

Night blindness,
xerophthalmia, blindness
Squamous etaplasia
Vulnabili to infection,
particularly measles
Ricketin in children
Osteomalacia in adults

Facilitates intestinal absorption of

calcium and phosphorus and
nineralization of bone.
Major antioxidant ; scavenges free
radicals
Cofactor in hepatic carboxylation of
procoagulants factoers II
(prothrombin), VII,IX, and X ; and
protein C and protein S.

Wather-Soluble
As pyrophosphate, is coenzymes in
Vitamin B1
decarboxylation reaction
(thiamine)
Vitamin b2
(riboflamin)

Convereted to coenzymes flavin

monocleotide and flavin adinine
dinicleotide, cofactors for many
enzymes in intermediary
metabolism

Spinocerebellar
degeneration
Bleeding diathesis

Dry and wet beriberi,

Wernicke syndrome,
?Korsakoff syndrome
Ariboflavinosis, cheilosis,
stomatitis, glosititis,
dermatitis
corneal,vascularization.

TABLE 9-24 Functions of Trace Metals and Deficiency

Syndromes
Iron

Zinc
Lodine
Selenium
Copper

Manganese

Essential component of
hemoglobin as well as a
number of ironcontaining
mentalloezymes
Component of enzymes,
principally oxidases
Component of thyroid
hormone
Component of
glutathione peroxidase
Component of
cytochrome c oxidase,
depamin -hydroxylase,
tyrosinase, lysyl
oxidase,and unknown
enzyme involved in
cross-;inking keratin
Component of
metalloenzymes ,
including
oxidoredutases,
hydrolases, and lipases

Hypochromic microcytic
anemia

Acrodermatitis
enteoatyroidusm
Terand hypothyroidsm
Myopathy, rarely
cardiomyopathy
Muscle weakness,
neurologic defects,
hypopignentation,
abnormal collagen
cross-linking

No well-defined
deficiency syndrome

Niacin

Vitamin B6
(pyridoxine)

Viatamin B12

Vitamin C

Folata

Incorporated into
nicotinamide adenine
dinucletide (NAD) and
NAD phosphate ,
involved in a variety
of redox reactions
Derivatives serve as
coenzymes in many
intermediary
reactions
Required for normal
folate metabolism and
DNA synthesis
Maintenance of
myelinization of spinal
cord tracts
Servers in many
oxidation-reduction
(redox) reactions and
hydroxylation of
collagen.
Essential for transfer
and use of 1-carbon

Pellagra- three Ds :
dementia, dermatitis
diarrhea.

Cheilosis, glossitis,
dermatitis, peripheral
neuropathy.
Combined system
disease (megabolistic
pernicious anemia and
degeneration of
posterolateral spinal
cord tracts)
Scurvy

Megalobastic anemia,
neural tube defects

TABLE 9-26 Medical complications associated

with Obesity
Gastrointestinal

Gallstones, pancreatitis, abdominal hernia, NAFLD

(steatosis, steatohpatitis and cirrhosis) and
possibly GERD

Educrine / metabolic

Metabolic syndrome, insulin resistence, impaired

glucose telorance, type II dibetes muletus,
dyslipidemia, polycystic ovary syndrome
Hypertension, coronary aretery disease, congestive
heart failure, arrhyhamias, pulmonary
hypertension, ischemic , stroke, venous stasis,
deep vein thrombosis, pulomonary embolus.
Abnormal pulmonary function, obstructive sleep
apnea, obesity hypoventilation syndrome
Ostheorosis, gout, low back pain
Abnormal menses, infertility
Urinary stress incontinence
cataracts
Indiopathic intracranial hypertension
(pseudottumor cerebri)
Esophagus , colon, gallbladder, prostate, breast,
uterus, cervix, kidney
Atelectasis , pneumonia, deep vein thrombosis,
pulmonary embolus

Cardiovarcular

Respiratorty
Musculos keletal
Gynecologic
Genitourinary
Ophthalmologic
Neurologic
cancae
Pastoperative events