Alcohol Flashcards
With which cancers is alcohol intake associated?
Oral cavity, larynx, pharynx, esophagus, liver, and lung. Also may be associated with gastric, colon, pancreatic, and breast cancer.
What is the most common cause of cirrhosis and esophageal varices?
Alcohol
Describe the relationship between alcohol and accidental or intentional (i.e. suicide and murder) death?
Alcohol is involved in 50% of fatal car accidents, 67% of drownings, 67% of homicides, 35% of suicides, and 70-80% of deaths caused by fire.
What may happen if you give glucose to an alcoholic without giving thiamine first?
May precipitate Wernicke encephalopathy. Always give thiamine before glucose to avoid this.
What is the difference between Wernicke and Korsakoff syndromes?
Wernicke - acute encephalopathy characterized by ophthalmoplegia, nystagmus, ataxia, and/or confusion; can be fatal but is reversible with thiamine
Korsakoff - chronic psychosis characterized by anterograde amnesia (inability to form new memories) and confabulation; generally irreversible and thought to be due to damage to mamillary bodies and thalamic nuclei
*Both conditions result from thiamine deficiency
True or false: Alcohol withdrawal can be fatal.
True. Alcohol withdrawal needs to be treated on an inpatient basis because it can result in death (mortality rate of 1-5% with delirium tremens).
How is alcohol withdrawal treated?
Benzodiazepines (or, in rare cases, barbiturates). Dose is tapered gradually over several days until symptoms have resolved.
What are the stages of alcohol withdrawal?
Acute withdrawal syndrome (12-48 hrs after last drink) Alcoholic hallucinosis (24-72 hrs after last drink) Delirium tremens (2-7 days after last drink, possibly longer)
Describe acute withdrawal syndrome
12-48 hrs after last drink: tremors, sweating, hyperreflexia, and seizures (“rum fits”)
Describe alcoholic hallucinosis
24-72 hrs after last drink: auditory and visual hallucinations and illusions without autonomic signs
Describe delirium tremens
2-7 days after last drink: hallucinations and illusions, confusion, poor sleep, autonomic lability (sweating, increased pulse and temp); fatality associated with this stage
What are the classic physical stigmata of liver disease in alcoholics?
Abdominal wall varices (caput medusae), testicular atrophy, esophageal varices, encephalopathy, hemorrhoids (internal), asterixis, jaundice, scleral icterus, ascites, edema, palmar erythema, spider angiomas, gynecomastia, Terry nails, fetor hepaticus, dupuytren contractures
What are the classic lab findings of liver disease in alcoholics?
Anemia (classically macrocytic) Prolonged prothrombin time Hyperbilirubinemia Hypoalbuminemia Thrombocytopenia
What diseases and conditions may be caused by chronic alcohol intake?
Gastritis, fatty change in the liver, Mallory-Weiss tear, hepatitis, pancreatitis (acute or chronic), cirrhosis, peripheral neuropathy (via thiamine deficiency and a direct effect), Wernicke or Korsakoff syndrome, cerebellar degeneration (ataxia, past-pointing), dilated cardiomyopathy, rhabdomyolysis (acute or chronic)
Describe the classic derangement of AST and ALT in alcoholic hepatitis
Ratio of AST to ALT is at least 2:1 although both may be elevated
What is the best treatment for alcoholism?
Alcoholic Anonymous or other peer-based support groups
What is disulfiram?
Aldehyde dehydrogenase inhibitor - makes people sick when they drink (or take metronidazole or certain cephalosporins)
Describe the effects of alcohol on pregnancy
Definite teratogen and most common cause of preventable mental retardation in the U.S. No amount of alcohol consumption can be considered safe during pregnancy.
Describe fetal alcohol syndrome
Mental retardation, microcephaly, microphthalmia, short palpebral fissues, midfacial hypoplasia, cardiac defects
Rates vary but estimated around 1 in 1000 births
Epidemiology of alcohol abuse?
10-15% of population abuses alcohol
More common in men
Genetic component is passed most easily from father to son
What kind of pneumonia should you suspect in a “skid-row” alcoholic?
Aspiration pneumonia
Look for enteric organisms (anaerobes, E. coli, streptococci, staphylococci)
What does Klebsiella spp. pneumonia sputum and culture reports looks like?
Sputum resembles currant jelly
Culture reports mention thick, mucoid capsules
True or false: Alcohol can precipitate hypoglycemia.
True. But give thiamine first, then glucose.
What are the classic electrolyte abnormalities in alcoholics?
Low magnesium
Low potassium
Low sodium
Elevated uric acid (resulting in gout)
What are the classic vitamin abnormalities in alcoholics?
Deficiencies of folate and thiamine
How are the bleeding esophageal varices treated?
ABCs, stabilized patient with IV fluids and blood if needed, correct clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K
Endoscopy -> sclerotherapy of veins with cauterization, banding, or vasopressin
Try transjugular intrahepatic portasystemic shunt (TIPS) over open surgical portacaval shunt
Most physiologic shunt type among surgical options is the splenorenal shunt
How are varices with no history of bleeding treated?
Nonselective beta-blockers (propranolol, nadolol, timolol)
