3: Biochemistry of alcohol

Question 1

Which GI disease is alcohol a common cause of?

Answer 1

Acute and chronic pancreatitis

Question 2

What are two enzymes used as indicators for pancreatitis?

Answer 2

Amylase

Lipase

Question 3

What does GGT levels do in response to alcohol consumption?

Answer 3

Increases

Question 4

In chronic alcoholism, MCV (mean corpuscular volume) is (increased / decreased).

Answer 4

increased

Question 5

Why do triglyceride levels increase during excessive drinking?

Answer 5

Increased lipid synthesis in the liver

Question 6

What tests can be used to see if a patient is a chronic drinker?

Answer 6

Gamma GT (GGT)

MCV

Triglycerides

Question 7

What tests are done for a patient who comes to hospital in a coma?

Answer 7

Blood glucose tested (for hypoglycaemia)

Serum osmolality

Question 8

How do you calculate serum osmolality?

Answer 8

Serum osmolality roughly equals 2 x [Na+]

Question 9

How is serum osmolality used to prove a patient is in an alcoholic coma?

Answer 9

Osmolal gap = Measured osmolality - calculated osmolality

Big gap = ethanol contributing to osmolality

Question 10

What tests are carried out to pinpoint the cause of a patient’s abdominal pain?

Answer 10

Amylase

LFTs

Question 11

differential for abdominal pain:

Acute pancreatitis

Alcoholic hepatitis

Peptic ulcers +/- perforation

Portal hypertension –> Ascites +/- peritonitis

Question 12

If amylase is raised in a patient with abdominal pain, what is the likely diagnosis?

Answer 12

Pancreatitis

Question 13

ALT (alanine aminotransferase)

• found in the LIVER hepatocytes
• released in response to DAMAGE

Question 14

ALP (alkaline phosphatase)

• found in LIVER, BONE, KIDNEYS, SMALL INTESTINE
• differentiate liver and bone by testing GGT

Question 15

Gamma GT

• found in the liver, BD, GB
• too sensitive to be diagnostic but can be used to confirm liver damage when ALT is raised

Question 16

Albumin

• produced by liver
• decreases in inflammatory disease

Question 17

Prothrombin time

• clotting factors produced by the liver - gives an indication of liver function
• ALSO gives a measure of tendency to bleed

Question 18

What tests would be carried out for someone whose main complaint is vomiting?

Answer 18

U&Es

LFTs

Amylase

ABGs

Question 19

What is commonly seen on the U&Es of an alcohol user who is vomiting?

Answer 19

Low sodium

Low potassium

?High urea and creatinine, reflect reduction in glomerular function

Question 20

in gut

vomiting: loss of H+ and Cl-, gain in bicarbonate
- > metabolic alkalosis

Question 21

in duodenum:

opposite, bicarbonate lost

Question 22

in normal patients, acid-base impact limiting as fluid lost from both stomach and small intestine and cancels out

in people with pyrloric stenosis, no small intestine fluid lost –> metabolic alkalosis

Question 23

example:

metabolic alkalosis (vomiting, high bicarbonate)

respiratory acidosis to compensate (hypoventilate to raise CO2 which is acidic)

but body has limited ability to do this cuz you will die from hypoxia

so acid base abnormality is partially compensated metabolic alkalosis

Question 24

What tests should be done in a patient who presents with haematemesis?

Answer 24

U&Es

LFTs

PTR

Lactate

Question 25

urea production increases when protein consumption does i.e red meat

Question 26

urea is classically raised in haematemesis because you’re absorbing your own blood

Question 27

hyponatremia when aldosterone and adh work together because the ratio of water to sodium is greater

i.e more water reabsorbed than sodium

spironolactone - aldosterone antagonist - causes low sodium and high potassium

Question 28

ethanol is a competitive inhibitor with methanol and polyethylene glycol (antifreeze) - used to treat toxic alcohol poisoning

Question 29

38 - money slide