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CLASP: Alcohol 2017/18 > 2: Alcoholism 3D > Flashcards

2: Alcoholism 3D Flashcards

1
Q

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

A

Palmar erythema

Dupuytren’s contracture

Caput medusae

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2
Q

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

A

Subdural haematomas - bleeding in the subdural space

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3
Q

What is Vitamin B1 also known as?

A

Thiamine

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4
Q

Give two other names for Thiamine deficiency.

A

Beriberi

Wernicke-Korsakoff syndrome

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5
Q

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

A

Ataxia (unsteadiness)

Abnormal eye movements

Impaired consciousness / memory loss

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6
Q

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

A

Confabulation

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7
Q

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

What signs of peripheral neuropathy may patients present with?

A

Thiamine is responsible for maintaining peripheral nerves

Pain

Wrist drop

Foot drop

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8
Q

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

A

Arrythmias

Congestive heart failure

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9
Q

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

A

Opening of gastroesophageal sphincter

Snoring

Suppression of cough and gag reflexes

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10
Q

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

A

Aspiration pneumonia

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11
Q

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

A

right main bronchus

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12
Q

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

A

acute inflammation (pneumonitis)

infection

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13
Q

What are the most common sites for aspiration pneumonia?

A

Right middle lobe

Right lower lobe

depends on patient position at the time

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14
Q

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

A

Neutrophils

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15
Q

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

A

negative inotropic agent

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16
Q

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

A

Heart rate increases - tachycardia

Common sensation the morning after binge drinking

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17
Q

What heart disease is associated with chronic alcoholism?

A

Dilated cardiomyopathy

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18
Q

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

A

normal

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19
Q

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

A

Arrythmias

Heart failure

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20
Q

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

A

Wet beri beri

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21
Q

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

A

Alcoholic fatty liver disease

or steatosis

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22
Q

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

A

reversible

23
Q

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

A

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

24
Q

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

A

Steatosis

25
Q

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

A

Alcoholic steatohepatitis

i.e fat accumulation AND inflammation

26
Q

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

A

acute inflammation

27
Q

What are three symptoms of alcoholic steatohepatitis?

A

Fever

Jaundice

Tenderness

28
Q

Acute inflammatory cells

Ballooning

Mallory bodies

are all seen under the microscope in alcoholic steatohepatitis. What are they?

A

Lymphocytes

Fat inclusions in hepatocytes

Damaged intermediate filaments - stain dark pink

29
Q

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

A

Cirrhosis

30
Q

Cirrhosis is (reversible / permanent) liver damage.

A

permanent

31
Q

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

A

Ito cells

32
Q

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

A

Collagen

Ito cells

33
Q

Where specifically in the liver is collagen deposited during cirrhosis?

What is left behind afterwards?

A

Space of Disse

Islands of functioning hepatocytes surrounded by bands of scar tissue

34
Q

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

A

Reduced capacity to receive blood and metabolise the chemicals in it

Toxic waste builds up

35
Q

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

A

poor

36
Q

Where is blood redirected if the liver is cirrhotic?

A

Oesophageal veins

Splenic vein

Anorectal veins

Superficial veins

37
Q

What are some signs of portal hypertension?

A

Oesophageal varices

Splenomegaly

Rectal varices

Caput medusae and spider naevi

38
Q

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

A

Hypoglycaemia

39
Q

Alcohol ___ the gastric mucosa.

A

irritates

40
Q

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

A

Rate of gastric emptying decreases

41
Q

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

A

To reduce the rate of alcohol absorption by the small bowel

42
Q

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

A

Mallory-Weiss tear

43
Q

What is Boerhaave syndrome?

A

A full-thickness tear in the oesophageal wall

44
Q

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

A
  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
45
Q

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

A

Adenocarcinoma

46
Q

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

A

Cirrhosis

47
Q

What is a varix?

A

Abnormally dilated vein

48
Q

Oesophageal varices are prone to ___ causing massive haematemesis.

A

rupture

49
Q

What are the common causes of acute pancreatitis?

A

GET SMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune

Scorpion stings

Hyperlipidaemia

ERCP

Drugs

50
Q

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

A

Fat necrosis

51
Q

What is intestinal epithelium?

A

Columnar epithelium with goblet cells

52
Q

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

A

Saponification

53
Q

What is the difference between Wernicke’s syndrome and Korsakoff’s syndrome?

A

Wernicke - Walking - ataxia, abnormal eye movements

Korsakoff - memory loss, confabulation

CLASP: Alcohol 2017/18 (8 decks)

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