2: Medical consequences of alcohol excess Flashcards
What is the weekly recommended limit of alcohol intake for men and women?
14 units
Alcohol intake should be spread evenly over ___ days or more.
three
Should pregnant women drink alcohol?
No
obviously
Patients often (overestimate / underestimate) how much they drink.
underestimate
Which lifestyle factor is mostly responsible for the increase in chronic liver disease mortality in Scotland?
Alcohol
Young people tend to suffer the ___ consequences of alcohol excess.
Older people tend to suffer the ___ consequences of alcohol excess.
(chronic / acute)
acute
chronic
Alcohol intake is also related to ___ disease.
cardiovascular
e.g MI
As of 2003, what percentage of deaths in Scotland were caused by alcohol?
5%
What is a liver disease associated with sustained excessive alcohol intake?
Alcoholic fatty liver disease
What are some long-term complications of alcoholic fatty liver disease?
Cirrhosis
Hepatocellular carcinoma
Excessive alcohol consumption causes ___ and ___ effects.
acute , chronic
What are some acute CNS effects of alcohol excess?
Poor decision making:
Accidents
Violence
What are some acute GI effects of alcohol excess?
Oesophagitis
Gastritis +/- gastric ulcers
Acute pancreatitis
What are some acute respiratory effects of alcohol excess?
Aspiration
Respiratory depression
What are some chronic cardiovascular outcomes of alcohol excess?
Hypertension
Cardiomyopathy
MI
Stroke
What are some chronic GI outcomes of alcohol excess?
Liver disease (ALCOHOLIC FATTY LIVER DISEASE!!!)
Stomach disease
Pancreatic disease
What is the presentation of Wernicke-Korsakoff’s syndrome?
Why does it occur?
Encephalopathy, lots of nervous/neuro problems
Vitamin B1 (thiamine) deficiency as a result of chronic alcoholism
Excessive alcohol use chronically causes (hypertrophy / atrophy) of the brain.
atrophy
Underage drinking has effects on the development of the brain - how do these manifest?
Poor memory
Increased activity re: reward, desire, gratification
What is foetal alcohol syndrome?
Pregnant women who drink cause damage to their foetus
What is the presentation of foetal alcohol syndrome?
Impaired growth
Mental retardation
Learning disabilities
Behavioural problems
Which enzymes play a role in alcohol metabolism?
Alcohol dehydrogenase
Aldehyde dehydrogenase
Ketone bodies from alcohol are ___ and 80% of them are broken down to carbon dioxide and water by enzymes.
toxic
Alcohol excess causes inflammation and fibrosis in the liver. What are the proper names for these two states?
Hepatitis
Cirrhosis
What is the technical name for the process in which a liver is infiltrated by fat?
What is the technical name for an inflamed fatty liver?
Steatosis
Steatohepatitis
Are steatosis and steatohepatitis reversible?
Yes
if the patient stops drinking
Is cirrhosis reversible?
No
Fibrosis is established and does not resolve. Prevention of deterioration achieved by stopping drinking but the damage is done
Any patient with cirrhosis has an increased risk of developing which cancer?
Hepatocellular carcinoma
What are the diseases found on the spectrum of alcoholic liver disease?
Alcoholic fatty liver disease (steatosis)
Alcoholic hepatitis (steatohepatitis)
Cirrhosis
What are some symptoms of alcoholic liver disease?
Malaise
Nausea
Fever
Jaundice
What are some signs of alcoholic liver disease?
Hepatomegaly
Jaundice
Sepsis
Abdominal distension
Encephalopathy
Renal dysfunction
Long INR
What are some signs of ALD that you would see on examination?
Spider naevi
Encephalopathy
Signs of portal hypertension - varices, caput medusae
Splenomegaly
What is thrombocytopenia?
Reduced number of thrombocytes (platelets) in the blood
Contributes to increased clotting time seen in liver disease
Which grading system can be used to decide on a cirrhosis patient’s prognosis?
Childs system
In alcoholic liver disease, which liver enzyme is raised?
AST
In alcoholic liver disease, ___ is higher than ___.
(ALT, AST, ALP, GGT)
AST > ALT
remember that when you drink alcohol you get wASTed
How are alcoholic hepatitis patients treated?
Supportive treatment (fluids, blood transfusion)
Which drug improves alcoholic hepatitis mortality in the short term?
Steroids e.g prednisolone
