Alcohol 3D

Question 1

Dupuytren’s contracture is pathognomonic of chronic alcoholism

Answer 1

False-Not all those with alcoholic cirrhosis have Dupuytren’s and the converse is true. More common causes include idiopathic fibrosis, diabetes and anti epileptic medication.

Question 2

Alcohol causes oesophagitis via direct toxicity to the oesophageal mucosa.

Answer 2

False. Alcohol is a muscle relaxant. With relaxation of the lower oesophageal sphincter there is an increase in reflux of gastric contents. Alcohol is thought to act through GABA receptors in the central nervous system. Alcohol can often relieve spasm like pain and often those with chronic back pain etc. find it relieves their pain. The muscle relaxant effect also reduces tone in the pharynx and is the cause for the severing snoring associated with sleeping off a heavy night

Question 3

Barrett’s oesophagus consists of stratified epithelium

Answer 3

False. Barrett’s oesophagus describes metaplastic change from mature squamous epithelium (which is stratified) to intestinal epithelium (columnar epithelium with goblet cells).

Question 4

Metaplasia is a reversible change from one mature type of epithelium to another.

Answer 4

True. Metaplasia occurs in response to a noxious stimulus of some sort. The epithelium changes to another form in order to better cope with stress placed on it. The epithelium is normal (“mature”) and often on removal of the stimulus the changes can regress. Although the cells are normal they are more susceptible to accumulating mutations and are therefore at more risk of dysplastic and pre-malignant change. Metaplasia could therefore be said to represent a pre-pre-malignant change.

Question 5

Oesophageal varices are only caused by alcoholic liver disease.

Answer 5

False. Any cause of portal hypertension is associated with oesophageal varices. There are rare causes that aren’t associated with liver cirrhosis but the majority are. It is important to recall that any cause of cirrhosis will result in portal hypertension etc. That essentially includes any cause of prolonged liver damage including untreated viral hepatitis and the inherited disorders such as haemachromatosis.

Question 6

All cysts have an epithelial lining.

Answer 6

ue. The pathological definition of a cyst requires that the structure be lined by epithelium. The lesions that arise in pancreatitis are lined by connective tissue and inflammatory cells and are therefore referred to as pseudocysts.

Question 7

Saponification is the name given to the conversion of fat into “soap”.

Answer 7

True. Some of you may recall an infamous scene from the movie “Fight Club” where the protagonists steal fat to make soap. A similar process occurs when enzymes are released in pancreatitis and come into contact with surrounding fat.

Question 8

Significant alcohol consumption is a risk factor for pneumonia.

Answer 8

True. Alcohol is a depressant in the nervous system and also acts to reduce muscle tone. Swallowing is often impaired and aspiration pneumonia during vomiting is not uncommon.

Question 9

Aspiration pneumonia is more common in the left lower lobe.

Answer 9

False. The left main bronchus deviates at a more acute angle to the more vertical right main bronchus. Any aspirated material is more likely to travel down the right main bronchus. This is true of any aspirated material including small objects swallowed by children.

Question 10

Aspiration pneumonitis is most commonly caused by anaerobic bacteria.

Answer 10

False. The term pneumonitis refers to inflammation without infection and is caused by sterile and acidic gastric contents reaching the lung parenchyma. That being said both pneumonia and pneumonitis commonly occur together and a clinicians should have a low threshold for prescribing broad spectrum antibiotics in the setting of aspiration.

Question 11

The cardiomyopathy most commonly associated with chronic alcoholism is a dilated cardiomyopathy.

Answer 11

True. Hypertrophic cardiomyopathies are often associated with genetic abnormalities as is arrhythmogenic ventricular dysplasia.

Question 12

Dilated cardiomyopathy is only seen in alcoholics.

Answer 12

False. Dilated cardiomyopathy is seen in association with a number of underlying conditions. These include pregnancy and chemotherapeutic drugs used to treat cancer.

Question 13

Alcohol has positive inotropic effects.

Answer 13

False. Alcohol is negatively inotropic. People often experience a mild tachycardia after significant alcohol intake in order to compensate and maintain a normal cardiac output.

Question 14

Acute fatty liver is associated with high calorie content of alcohol.

Answer 14

False. This is a tricky question. Often being overweight and drinking go hand in hand. The fatty changes in the liver seen in obesity and alcohol are essentially identical and making the distinction required clinical history taking more than anything else.

Question 15

Alcohol causes a hypoglycaemia.

Answer 15

True. Alcohol inhibits hepatic gluconeogenesis and reduces blood sugar levels. This has significant implications for insulin dependent diabetics.

Question 16

Alcoholics may suffer from symptoms resembling stroke.

Answer 16

True. Chronic thiamine deficiency can cause both sensory and motor problems in peripheral nerves and can occasionally lead to a “foot drop”.

Question 17

Korsakoff’s syndrome relates to memory loss.

Answer 17

True. Korsakoff syndrome is a term used to describe the loss of recent memories and often results in patients “confabulating” during conversation.

Question 18

Wernicke’s syndrome relates to abnormal walking.

Answer 18

True. Wernicke’s syndrome is characterized by ataxia (shaking gait) as well as nystagmus (a type of jerky eye movement) and ophthalmoplegia (loss of eye movement).

Question 19

Patient’s suffer from Wernicke’s or Korsakoff’s syndrome but rarely both.

Answer 19

False. It is common to suffer from both syndromes and the names are usually used together (Wernicke-Korsakoff syndrome). Patients may tend to have symptoms skewed one way or the other but commonly have at least some features of both.

Question 20

. The features in the accompanying image are those of cirrhosis.

Answer 20

True. This image shows islands of hepatocytes encircled by bands of scarring fibrosis. Many of the bands radiate out from portal areas which contain a vein, artery and bile duct. The hepatocytes are identified as cords of polygonal pink cells with relatively abundant cytoplasm and central round nuclei.

Question 21

The white material in the hepatocytes is fat.

Answer 21

True. Fat of any kind is lost during the processing of histological sections. Large bubble like white areas within hepatocytes therefore represent fatty inclusions.