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G.I. > Alcohol > Flashcards

Alcohol Flashcards

1
Q

Upper limit of alcohol per week?

A

14 units for both men and women

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2
Q

How many days should this be spread over?

A

3 days or more

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3
Q

Acute effects of alcohol consumption?

A 
• CNS	
     o Accidents
     o	Violence & aggression 
• G.I.
     o	Oesophagitis
     o	Acute pancreatitis 
• Resp
     o	Overdose
     o	Aspiration
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4
Q

Chronic effects of alcohol

A

pretty much everything.

• G.I.
o Stomach
o Liver
o Pancreas

•	C.V.
     o	Hypertension
     o	Cardiomyopathy
     o	M.I.
     o	Stroke
•	C.N.S.
    o	Neuropathies
    o	Cerebellar degeneration
    o	Dementia
    o	Wernicke-Korsakoff’s syndrome 
      ♣ Thiamine deficiency

• Hematologic
o Anaemia
o Bone marrow suppression

• Musculoskeletal
o Proximal myopathy

  • Endocrine
  • Dermatologic
  • Reproductive
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5
Q

Foetal Alcohol Syndrome

A

Growth deficiency due to alcohol intake of mother

Mental retardation
Intellectual impairment
Learning disabilities
Behavioural problems

Any amount of alcohol is dangerous to the foetus

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6
Q

Alcohol effect on cytochrome enzymes (p450)

A

> Acute intake = inhibits the enzymes

> Chronic intake = induces the enzymes

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7
Q

Does cirrhosis resolve?

A

No.

Once it has been established it is there to stay.

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8
Q

Chronic liver disease - signs

A

Stigmata//

> Spider naevi
Fetor (foul smell)
encephalopathy
Prolonged prothrombin time, hypoalbuminaemia

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9
Q

Portal hypertension

A

> Caput medusa
Hypersplenism
Thrombocytopoenia

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10
Q

What is thrombocytopoenia

A

Decrease in the levels of platelets in the blood.

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11
Q

Grading system for CIRRHOSIS?

A

Childs-Turcotte-Pugh
(???)

Higher score - worse prognosis

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12
Q

Assessing severity of chronic liver disease?

A

MELD - Model for End-stage Liver Disease***

Uses serum bilirubin, creatinine and prothrombin time to give 3 month mortality.

High score = higher mortality = more urgent care required.

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13
Q

Alcoholic Hepatitis -signs and symptoms

A
  • Recent excess alcohol
  • Bilirubin > 80mol/l
  • Exclusion of other liver disease
  • AST < 500 (AST: ALT ratio >1.5)

hepatomegaly ± fever ±  leucocytosis ± hepatic bruit

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14
Q

Alcoholic hepatitis is related to cytokine _____?

A

Storm

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15
Q

What is used as a predictor in alcoholic hepatitis?

A

Maddrey’s Discriminant Function

Involves prothrombin time and serum bilirubin.

Score over 32 correlates a 45% mortality at 28 days.

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16
Q

What is a more accurate scoring system for predicting the outcome of alcoholic hepatitis?

A

Glasgow Alcoholic Hepatitis Score

Taken over a number of days. Day 1 , days 6-9.

Scores ≥9 = ↓survival rate

17
Q

What drug is beneficial in the short term for severe alcoholic hepatitis?

A

Prednisolone

Not beneficial in medium and long term outcome

18
Q

Best treatment for alcoholic hepatitis?

A

ABSTINENCE

19
Q

Every patient we see will be on the alcohol risk spectrum

A

Yes.

Low risk –> Possible dependence

20
Q

Are brief interventions effective?

A

Yes.

Can reduce total alcohol consumption and episodes of binge drinking in risky drinkers

21
Q

What model/ feedback model is used in an alcohol brief intervention?

A

FRAMES

Feedback//
- about personal risk or impairment

Responsibility//
- personal responsibility to change

Advice//

  • cut down or abstain.

Menu//

  • menu of options for changing drinking and setting a target

Empathy//

  • listenig reflectively

Self-efficacy//

interviewing style that enhances people’s belief in their ability to change

22
Q

Alcohol Brief Intervention (stages)

A
  1. Raise the issue of alcohol
  2. Screening & Feedback
  3. Listening for readiness to change
  4. Select an approach
23
Q

Presenting conditions of alcohol issues

A

Physical, (trauma, head injury, diarrhoea, pancreatitis)

Psychiatric (amnesia, anxiety, panic)

social (marriage, unsafe sex, financial problems)

Occupational (poor employment, not going to work)

24
Q

Alcohol Screening in practice

- what are the 2 systems used?

A
  • *****> AUDIT (Alcohol Use Disorders Identification Test)
  • 10 questions
  • score 0-40

and

FAST (Fast Alcohol Screening Test)

  • abbreviated version of AUDIT
  • 4 key questions (4 of the 10 in the AUDIT)
25
Q

1 unit =

A

> 1 shot of vodka
10ml/ 8g of pure alcohol

> 750ml 13.5% wine = 10 units

strength (ABV) x volume (ml) ÷ 1,000 = units

26
Q

Feedback of ABI

A

> Clearly describe their drinking level compared with recommended drinking limits.

> Explain their risks
Give clear advice

> IT IS UP TO THE PATIENT. YOU’RE JOB TO HELP THEM.

> BUILD THEIR CONFIDENCE

> Ask what they think

G.I. (20 decks)

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