2: Alcoholism 3D

Question 1

Name three signs of chronic alcoholism you may see upon general examination of a patient.

Answer 1

Palmar erythema

Dupuytren’s contracture

Caput medusae

Question 2

Acutely intoxicated patients are prone to falls - what brain injury can this cause?

Answer 2

Subdural haematomas - bleeding in the subdural space

Question 3

What is Vitamin B1 also known as?

Answer 3

Thiamine

Question 4

Give two other names for Thiamine deficiency.

Answer 4

Beriberi

Wernicke-Korsakoff syndrome

Question 5

What are the three common symptoms of Wernicke-Korsakoff syndrome?

Answer 5

Ataxia (unsteadiness)

Abnormal eye movements

Impaired consciousness / memory loss

Question 6

What is the name given to behaviour in which patients make up stories to disguise their memory loss?

Answer 6

Confabulation

Question 7

Thiamine deficiency caused by alcoholism can also cause peripheral neuropathy - why?

What signs of peripheral neuropathy may patients present with?

Answer 7

Thiamine is responsible for maintaining peripheral nerves

Pain

Wrist drop

Foot drop

Question 8

In the rare cases that the vagus nerve is affected by thiamine deficiency, what may patients present with?

Answer 8

Arrythmias

Congestive heart failure

Question 9

Alcohol is a smooth muscle relaxant - what are three physiological consequences of this?

Answer 9

Opening of gastroesophageal sphincter

Snoring

Suppression of cough and gag reflexes

Question 10

Relaxation of smooth muscle combined with loss of consciousness may lead to what respiratory disease in acutely intoxicated patients?

Answer 10

Aspiration pneumonia

Question 11

Material is usually aspirated through the (left / right) main bronchus.

Answer 11

right main bronchus

Question 12

Aspiration of foreign material into the lungs leads to ___ ___ and ___.

Answer 12

acute inflammation (pneumonitis)

infection

Question 13

What are the most common sites for aspiration pneumonia?

Answer 13

Right middle lobe

Right lower lobe

depends on patient position at the time

Question 14

Which inflammatory cells will be seen under the microscope of an aspiration pneumonia biopsy?

Answer 14

Neutrophils

Question 15

Alcohol reduces the force of cardiac contraction - it is a ___ ___ agent.

Answer 15

negative inotropic agent

Question 16

What happens to compensate for the negative inotropic effect of alcohol?

Answer 16

Heart rate increases - tachycardia

Common sensation the morning after binge drinking

Question 17

What heart disease is associated with chronic alcoholism?

Answer 17

Dilated cardiomyopathy

Question 18

Dilated cardiomyopathy presents as a big, heavy heart with ___ atrial/ventricular thickness.

Answer 18

normal

Question 19

Dilated cardiac muscle is a bit crap at contracting - what does this put patients at risk of?

Answer 19

Arrythmias

Heart failure

Question 20

What is the thiamine deficiency disease associated with cardiac arrythmias and heart failure in chronic alcoholics?

Answer 20

Wet beri beri

Question 21

What is the initial liver disease seen in patients after one or two days of heavy drinking?

Answer 21

Alcoholic fatty liver disease

or steatosis

Question 22

The accumulation of intracellular fat seen in AFLD is (reversible / irreversible).

Answer 22

reversible

Question 23

Give four reasons for the accumulation of intracellular fat seen in AFLD.

Answer 23

1. More fatty acids delivered to liver

2. Alcohol converts NAD > NADH, stimulating lipid synthesis

3. Fatty acid oxidation is reduced

4. Reduced fat export by tubulins

Question 24

What is the technical name for the accumulation of fat in hepatocytes?

Answer 24

Steatosis

Question 25

What disease will be seen in a patient's liver after 3-4 weeks of heavy drinking?

Answer 25

**Alcoholic steatohepatitis** i.e fat accumulation AND inflammation

Question 26

In alcoholic steatohepatitis, the direct toxicity of alcohol triggers ___ \_\_\_.

Answer 26

**acute inflammation**

Question 27

What are three symptoms of alcoholic steatohepatitis?

Answer 27

**Fever** **Jaundice** **Tenderness**

Question 28

**Acute inflammatory cells** **Ballooning** **Mallory bodies** are all seen under the microscope in alcoholic steatohepatitis. What are they?

Answer 28

**Lymphocytes** **Fat inclusions in hepatocytes** **Damaged intermediate filaments** - stain dark pink

Question 29

What occurs in the liver after many years of heavy drinking?

Answer 29

**Cirrhosis**

Question 30

Cirrhosis is **(reversible / permanent)** liver damage.

Answer 30

**permanent**

Question 31

Which cells deposit scar tissue around hepatocytes in a cirrhotic liver?

Answer 31

**Ito cells**

Question 32

Which protein makes up the scar tissue deposited by ___ cells in a cirrhotic liver?

Answer 32

**Collagen** **Ito cells**

Question 33

Where specifically in the liver is collagen deposited during cirrhosis? What is left behind afterwards?

Answer 33

**Space of Disse** **Islands of functioning hepatocytes surrounded by bands of scar tissue**

Question 34

Why do the "islands" of functioning hepatocytes work poorly in cirrhosis?

Answer 34

**Reduced capacity to receive blood and metabolise the chemicals in it** **Toxic waste builds up**

Question 35

Blood flow through cirrhotic liver is **(good / poor).**

Answer 35

poor

Question 36

Where is blood redirected if the liver is cirrhotic?

Answer 36

**Oesophageal veins** **Splenic vein** **Anorectal veins** **Superficial veins**

Question 37

What are some **signs** of portal hypertension?

Answer 37

**Oesophageal varices** **Splenomegaly** **Rectal varices** **Caput medusae** and **spider naevi**

Question 38

Alcohol suppresses gluconeogenesis. What disease does this cause, which can be particularly dangerous in diabetics?

Answer 38

**Hypoglycaemia**

Question 39

Alcohol ___ the gastric mucosa.

Answer 39

**irritates**

Question 40

What happens to the rate of gastric emptying when the stomach is exposed to high concentrations of alcohol?

Answer 40

**Rate of gastric emptying decreases**

Question 41

Why does the rate of gastric emptying decrease when the stomach is exposed to high concentrations of alcohol?

Answer 41

**To reduce the rate of alcohol absorption by the small bowel**

Question 42

What name is given to the condition in which stress associated with vomiting causes a mucosal tear in the epithelium of the GO junction?

Answer 42

**Mallory-Weiss tear**

Question 43

What is **Boerhaave syndrome**?

Answer 43

A full-thickness tear in the oesophageal wall

Question 44

Explain the development of **Barrett's oesophagus** in a chronic alcoholic.

Answer 44

1. Alcohol relaxes smooth muscle (i.e lower oesophageal sphincter) 2. Reflux of acidic liquid (sensation of heartburn) 3. Damage to squamous epithelium 4. Repeated insults 5. Metaplasia: **stratified squamous \> columnar**

Question 45

Patients with Barrett's oesophagus have increased chances of developing which type of oesophageal cancer?

Answer 45

**Adenocarcinoma**

Question 46

Oesophageal varices are caused by portal hypertension secondary to which liver disease?

Answer 46

**Cirrhosis**

Question 47

What is a varix?

Answer 47

Abnormally dilated vein

Question 48

Oesophageal varices are prone to ___ causing massive haematemesis.

Answer 48

**rupture**

Question 49

What are the common causes of acute pancreatitis?

Answer 49

**GET SMASHED** Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion stings Hyperlipidaemia ERCP Drugs

Question 50

In pancreatitis, enzymes like **lipase** prematurely activate and digest cells in the pancreas - what is this process called?

Answer 50

**Fat necrosis**

Question 51

What is **intestinal epithelium**?

Answer 51

**Columnar epithelium with goblet cells**

Question 52

In pancreatitis, enzymes come into contact with fat and turn it into "soap". What is this process called?

Answer 52

**Saponification**

Question 53

What is the difference between **Wernicke's syndrome** and **Korsakoff's syndrome**?

Answer 53

**Wernicke** - **W**alking - ataxia, abnormal eye movements **Korsakoff** - memory loss, confabulation