Alcohol Flashcards
With which cancers is alcohol intake associated?
Cancers of the oral cavity, larynx, pharynx, esophagus, liver, and lung. It may also 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, murder) death?
Alcohol is involved in roughly
- 50% of fatal car accidents
- 67% of drownings
- 67% of homicides
- 35% of suicides
- 70-80% of deaths caused by fire
What may happen if you give glucose to an alcoholic without giving thiamine first?
You may precipitate Wernicke encephalopathy.
Always give thiamine before glucose to avoid this complication.
∆ between Wernicke and Korsakoff syndromes? What causes each?
Wernicke syndrome is an acute encephalopathy characterized by ophthalmoplegia, nystagmus, ataxia, and/or confusion. It can be fatal, but is often reversible with thiamine.
Korsakoff syndrome - chronic psychosis characterized by anterograde amnesia (inability to form new memories) and confabulation (lying). Generally irreversible and is thought to be due to damage to the mamillary bodies and thalamic nuclei.
Both conditions result from thiamine deficiency.
True or false: Alcohol withdrawal can be fatal.
True
mortality rate of 1% to 5% with delirium tremens
How is alcohol withdrawal treated?
With benzodiazepines (or, in rare cases, barbiturates). The dose is tapered gradually over several days until symptoms have resolved.
What are the stages of alcohol withdrawal?
Acute withdrawal syndrome (12 - 48 hr after last drink): Tremors, sweating, hyperreflexia, and seizures (“rum fits”).
Alcoholic hallucinosis (24 - 72 hr after last drink): Auditory and visual hallucinations and illusions without autonomic signs.
Delirium tremens (2 - 7 days after last drink, possibly longer): Hallucinations and illusions, confusion, poor sleep, and autonomic lability (sweating, increased pulse and temperature). Fatality is usually associated with this stage.
These stages may overlap.
The classic example is a patient who develops delirium on postoperative day 2 but was fine before surgery. He or she could be a closet alcoholic, assuming other causes for delirium have been ruled out.
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 (white nails with a ground glass appearance and no lunula)
- Fetor hepaticus (“breath of the dead” which is a sweet, fecal smell)
- Dupuytren contractures
What are the classic laboratory findings of liver disease in alcoholics?
- Anemia (macrocytic)
- Prolonged prothrombin time
- Hyperbilirubinemia
- Hypoalbuminemia
- Thrombocytopenia
What diseases and conditions may be caused by chronic alcohol intake?
- Gastritis
- Fatty liver
- Mallory-Weiss tears
- 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 aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in alcoholic hepatitis.
at least 2:1, although both may be elevated
What is the best treatment for alcoholism?
- Alcoholics Anonymous or other peer-based support groups
- Disulfiram (aldehyde dehydrogenase enzyme inhibitor; makes people sick when they drink)
Describe the effects of alcohol on pregnancy
most common cause of preventable mental retardation in the US.
Classic presentation of a child affected by fetal alcohol syndrome:
- mental retardation
- microcephaly
- microphthalmia (one or both eyeballs are abnormally small)
- short palpebral fissures
- midfacial hypoplasia
- cardiac defects
epidemiology of alcohol abuse
Roughly 10% to 15% of the population abuses alcohol. Alcohol abuse is more common in men. The genetic component is passed most easily from father to son.
