Alcohol Flashcards
Upper limit of alcohol per week?
14 units for both men and women
How many days should this be spread over?
3 days or more
Acute effects of alcohol consumption?
• CNS
o Accidents
o Violence & aggression
• G.I.
o Oesophagitis
o Acute pancreatitis
• Resp
o Overdose
o AspirationChronic effects of alcohol
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
Foetal Alcohol Syndrome
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
Alcohol effect on cytochrome enzymes (p450)
> Acute intake = inhibits the enzymes
> Chronic intake = induces the enzymes
Does cirrhosis resolve?
No.
Once it has been established it is there to stay.
Chronic liver disease - signs
Stigmata//
> Spider naevi
Fetor (foul smell)
encephalopathy
Prolonged prothrombin time, hypoalbuminaemia
Portal hypertension
> Caput medusa
Hypersplenism
Thrombocytopoenia
What is thrombocytopoenia
Decrease in the levels of platelets in the blood.
Grading system for CIRRHOSIS?
Childs-Turcotte-Pugh
(???)
Higher score - worse prognosis
Assessing severity of chronic liver disease?
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.
Alcoholic Hepatitis -signs and symptoms
- Recent excess alcohol
- Bilirubin > 80mol/l
- Exclusion of other liver disease
- AST < 500 (AST: ALT ratio >1.5)
hepatomegaly ± fever ± leucocytosis ± hepatic bruit
Alcoholic hepatitis is related to cytokine _____?
Storm
What is used as a predictor in alcoholic hepatitis?
Maddrey’s Discriminant Function
Involves prothrombin time and serum bilirubin.
Score over 32 correlates a 45% mortality at 28 days.
What is a more accurate scoring system for predicting the outcome of alcoholic hepatitis?
Glasgow Alcoholic Hepatitis Score
Taken over a number of days. Day 1 , days 6-9.
Scores ≥9 = ↓survival rate
What drug is beneficial in the short term for severe alcoholic hepatitis?
Prednisolone
Not beneficial in medium and long term outcome
Best treatment for alcoholic hepatitis?
ABSTINENCE
Every patient we see will be on the alcohol risk spectrum
Yes.
Low risk –> Possible dependence
Are brief interventions effective?
Yes.
Can reduce total alcohol consumption and episodes of binge drinking in risky drinkers
What model/ feedback model is used in an alcohol brief intervention?
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
Alcohol Brief Intervention (stages)
- Raise the issue of alcohol
- Screening & Feedback
- Listening for readiness to change
- Select an approach
Presenting conditions of alcohol issues
Physical, (trauma, head injury, diarrhoea, pancreatitis)
Psychiatric (amnesia, anxiety, panic)
social (marriage, unsafe sex, financial problems)
Occupational (poor employment, not going to work)
Alcohol Screening in practice
- what are the 2 systems used?
- *****> 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)
1 unit =
> 1 shot of vodka
10ml/ 8g of pure alcohol
> 750ml 13.5% wine = 10 units
strength (ABV) x volume (ml) ÷ 1,000 = units
Feedback of ABI
> 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
