![Page 1: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/1.jpg)
1
Acute radiation disease(ARD)
Prof. G.S. Moroz, MDDepartment of Oncology & Radiology,
Ternopil State Medical University
![Page 2: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/2.jpg)
2
Chernobyl The Chernobyl accident happened at 1
o’clock 24 minutes a.m. on April, 26th,1986, was the biggest global
radiation catastrophe in the World One hundred million Ci radioactive
isotopes were threw out into atmosphere
![Page 3: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/3.jpg)
3
Victims Six hundred Chernobyl accident victims
exposured irradiation in large doses (γ-irradiation of whole body and β-irradiation vast surfaces of the body)
In 134 persons were diagnosed ARD, 28 of them have died in the first 4 months after exposure and 15 more during later period
![Page 4: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/4.jpg)
4
![Page 5: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/5.jpg)
5
40 40 оо
![Page 6: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/6.jpg)
6
Acute radiation disease (ARD) after Whole-Body Relatively Uniform Irradiation Manifestation of the ARD depends primarily on the
following factors: The type of irradiation (whole body or local) External or from incorporated radioactive isotopes The time factor (single, repeated, prolonged, or
chronic irradiation) The space factor (uniform or non-uniform The irradiated volume And localization of the irradiated portion
![Page 7: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/7.jpg)
7
Continued
Three periods are distinguished in the course of the ARD:
The formation period The recovery period The period of outcomes and Consequences (effects)
![Page 8: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/8.jpg)
8
Continued The formation period of the ARD can be
divided into four phases: The phase of the primary acute response The phase of apparent clinical well-being (the latent period) The phase of the height of the disease The phase of early recovery
![Page 9: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/9.jpg)
9
Continued
The ARD is also distinguished according to the severity of the damage
(determined by the absorbed dose)
![Page 10: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/10.jpg)
10
Continued
A developed complex of symptoms (syndromes) of the ARD appears at doses exceeding one Gray (1Gy)
![Page 11: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/11.jpg)
11
Continued
In the dose range of 1 – 6 Gy, three degrees of severity of the ARD are distinguished
![Page 12: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/12.jpg)
12
Continued ARD of the 1st (light) degree (1 – 2
Gy) ARD of the 2nd (moderate) degree
(2-4 Gy) ARD of the 3rd (severe) degree (4 –
6 Gy)
![Page 13: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/13.jpg)
13
Continued
At doses exceeding six Grays, the ARD is estimated as an extremely severe – the 4th Degree
![Page 14: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/14.jpg)
14
Continued
Singling out: Intestinal form Cerebral form and their transient Toxic form
![Page 15: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/15.jpg)
15
Continued
At doses of 6 – 10 Gy a transient form of the ARD develops
special treatment can ensure survival
![Page 16: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/16.jpg)
16
Continued
At doses of 10 – 20 Gy – a typical form of intestinal damage appears
A lethal outcome in 8 – 16 days
![Page 17: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/17.jpg)
17
Continued
At doses of 20 -80 Gy – toxemic injury develops (vascular form of damage)
Death – on the fourth to seventh day from meningitis
![Page 18: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/18.jpg)
18
Continued
At doses exceeding 80 Gy – a cerebral form of damage appears
Death in one to three days
![Page 19: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/19.jpg)
19
Prognostic features
The development of a state of shock with a drop in blood pressure, a brief loss of consciousness, a subfebrile temperature, and diarrhea are unfavourable features in a prognostic respect
![Page 20: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/20.jpg)
20
Phase of Primary Acute response
The primary response appears duringthe first minutes or hours and manifestitself in all cases of irradiation at doses
exceeding two Grays. This phase lasts from one to three
days
![Page 21: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/21.jpg)
21
Dyspeptic syndrome
Nausea and vomiting appear That increase after the taking of food The appetite is lost Sometimes dryness and bitterness is
felt in the mouth
![Page 22: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/22.jpg)
22
Complaints continued
Sometimes patients have a feeling of heaviness in their head, headache, general asthenia and drowsiness
![Page 23: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/23.jpg)
23
Objective signs
On portions of the skin exposed to doses of 6 – 10 Gy, transient hyperemia of the type of sunburn appears
![Page 24: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/24.jpg)
24
Objective signs continued Appear, namely, asymmetry of the
tendon reflexes, an increase in dermographia, and lability of the skin vasomotor responses
Features of nerve and reflex disturbances
![Page 25: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/25.jpg)
25
Changes indices of blood
During the first day after exposure, neutrophilic leucocytosis with a shift to the left, as well as absolute and relative lymphopenia are observed in the peripheral blood
![Page 26: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/26.jpg)
26
Biochemical changes
At doses above 4 Gy we can note: An increase in the sugar and bilirubin level Drop in the content of chlorides and Amino-aciduria (as a result of cells
destroyed) Hyperamylasemia (as a result of the salivary
glands damage)
![Page 27: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/27.jpg)
27
Phase of Apparent Clinical Well-Being The symptoms of the primary response
vanish in 2 – 4 days Patients feel better or even normal The disease enters into second phase
(the latent phase)
![Page 28: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/28.jpg)
28
The duration of the latent phase
It depends on the severity of damage It fluctuates from 14 to 32 days In very severe forms of damage (at
doses exceeding 10 Gy), this phase is absent in general
![Page 29: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/29.jpg)
29
Changes indices of blood
Analysis of the blood shows: Lymphopenia Throbocytopenia A drop in the number of neutrophils
and reticulocytes
![Page 30: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/30.jpg)
30
Changes in the bone marrow Aplasia is clearly expressed (in the very
first days) Features of regeneration appear with
second or third week The suppression of spermatogenesis and Skipping of a menstrual cycle may be
observed
![Page 31: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/31.jpg)
31
Phase of Pronounced Clinical Manifestations
In from two to four weeks the state of patients again sharply worsens:
Asthenia increases The temperature rises The erythrocyte sedimentation rate
(ESR) grows
![Page 32: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/32.jpg)
32
Hemorrhagic syndrome
Hemorrhages appear in: Skin (petechiae) Mucous membrane Gastro-intestinal tract Intracranial Cardiac intrapulmonary
![Page 33: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/33.jpg)
33
Changes indices of blood
Lymphopenia with relative lymphocytosis
All the other elements of the white blood are present in a very few cells or disappear completely
Anemia appears and begins to progress
![Page 34: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/34.jpg)
34
By the end of the phase
Regeneration is noted in The bone marrow Lymph nodes
![Page 35: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/35.jpg)
35
Continued Are observed: Hypoproteinemia Hypoalbuminemia Reduction in the amount of
chlorides in the hemopoietic system
![Page 36: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/36.jpg)
36
The third phase
Lasts from one to three weeks And then in cases with a favourable
outcome it passes over to The fourth phase - recovery
![Page 37: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/37.jpg)
37
Phase of Early Recovery
The beginning of this phase is characterized by normalization of
The temperature Improvement of state The appearance of an appetite The restoration of sleeping
![Page 38: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/38.jpg)
38
Continued The hemorrhages stop the dyspeptic phenomena disappear The mass of patients grows rapidly Gradual recovery of the blood indices
occurs
![Page 39: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/39.jpg)
39
But
In the peripheral blood appear: Reticulocytes Juvenile leucocytes (up to myeloblasts) Juvenile forms of thrombocytes Anemia increases and reaches its peak
by fifth or sixth week
![Page 40: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/40.jpg)
40
Next
The number of erythrocytes begins to grow
In two or three months reaches its initial level
![Page 41: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/41.jpg)
41
The biochemical indices
Of the blood and urine becomenormalized during this period
![Page 42: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/42.jpg)
42
The recovery phase
Lasts from 2 to 2,5 months Alopecia continues (hair growth
renews only by the fourth month) The ability of reproduction normalizes
only in four to six months
![Page 43: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/43.jpg)
43
Treatment of the ARD
Replacement of the loss in critical systems of cell renewal – the main task of pathogenic therapy
![Page 44: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/44.jpg)
44
Continued Bone marrow transplantation (as usually
is used at doses more than 10 – 12 Gy) Peripheral blood transfusion (prefer to
the cellular components of blood) The transfusion of liquids, salt
solutions, glucose, etc. compensating the loss of electrolytes and water
Antibiotics of the wide spectrum
![Page 45: 1 Acute radiation disease (ARD) Prof. G.S. Moroz, MD Department of Oncology & Radiology, Ternopil State Medical University](https://reader035.vdocuments.us/reader035/viewer/2022070605/5a4d1b417f8b9ab0599a0e72/html5/thumbnails/45.jpg)
45
Functional therapy
The measures taken in substitution therapy can also be related to the functional (symptomatic) treatment:
Supportive care (nursing, nutritional support, etc.)
Psychosocial aspects