Alcohol Flashcards
What are the functions of the liver?
Carbohydrate metabolism Fat metabolism Protein metabolism Storage Synthesis Produce bile Metabolism of drugs and alcohol Filtration of blood
How is alcohol processed in the liver?
Alcohol –> acetylaldehyde –> acetate –> fatty acids, CO2 and H2O
What enzymes are involved in breaking down alcohol in the liver?
ADH
ALDH
What is the issue with alcohol being broken down to acetylaldehyde?
Carcinogenic
How long does it take to process a unit of alcohol?
Healthy liver= 1 hour
What are the risk factors for liver disease?
Poor dietary status Simultaneous exposure to other drugs Genetic variations/polymorphisms Female Coexisting viruses
What are indicators of chronic alcohol use?
Elevated gamma GT Macrocytosis Low platelets Elevated ferritin Enlarged smooth edged liver on US
What are the stages of progression of liver disease?
Normal –> steatosis –> statohepatitis–> fibrosis –> cirrhosis
Wha is alcoholic hepatitis?
Fatty change in liver
Hepatic necrposis and infiltration with leucocytes
What are the signs and symptoms of alcoholic hepatitis?
Hepatomegaly Jaundice Abdo pain Fever Heoatic decompensation
What is used to determine severity of alcoholic hepatitis?
Glasgow alcoholic hepatitis score
What is the treatment of alcoholic hepatitis?
Abstinence
Steroids
Management of infection
Nutrition
What is the pathology of fibrosis and cirrhosis of the liver?
Chronic inflammation
Collagen bridging between veins and tracts
Loss of lobule structure
Activation of stellate cells
What are the complications of cirrhosis?
Variceal haemorrhage
Encephalopathy
Ascites
What is the treatment of cirrhosis?
Abstinence
What is the diagnostic criteria for alcohol dependence?
3 or more of the following for >1 month or repeatedly over 12 months
- craving/compulsions
- difficulty controlling use
- primacy
- increased tolerance
- physiological withdrawal
- persistance despite harmful consequences
What is the CAGE screening tool?
Have you ever... felt the need to Cut down? felt Annoyed by your drinking being criticised? felt Guilty about drinking? felt the need for an Eye opener?
What is the management of alcohol dependence?
Support Social work Psychiatry Inpatient care Medication
What is the withdrawal state?
Group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance
What are the signs and symptoms of alcohol withdrawal?
Tremor Weakness N&V Anxiety Seizures Confusion Agitation Death Delirium tremens
What are the features of delirium tremens?
Profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness, autonomic overactivity
When does delirium tremens occur?
48-72 hours after alcohol stopped
What causes death is delirium tremens?
CV collapse Infection Hyperthermia Seizures Self injury
What is the treatment of alcohol withdrawal?
Benzodiazepines- esp chlordiazepoxide
Prevention of Wernicke-Korsakoff syndrome- thiamine
Deterrent- disulfiram
Anti-craving- acamprosate, naltrexone, nalmefene
What are the consequnces of alcohol problems?
health (liver)
Relationships (lover)
Livelihood
Law
What physical problems can alcohol cause?
Cancer- mouth, oesophagus, stomach, liver Cerebral trophy Wernicke's encephalopathy Korsakoff's psychosis Cirrhosis
